Systematic Presentation of Data

Findings

Secondary Sources

This dissertation is based on both primary and secondary sources which describe the impacts of Joint Commission International (JCI) Accreditation on the work of healthcare facilities. First of all, literature review indicates that adoption of JCI standards can provide the following benefits:

1. improved risk management such as infection control;
2. better communication among members of the personnel,
3. better medication management and subsequent cost reduction;
4. better protection of patients’ rights (Joint Commission 2010b; Braun, Koss, & Loeb, 1999, p 283).

The most important thing is that JCI standards emphasize the importance of continuous improvement of employees’ skills and competencies. JCI accreditation is not a single-time event; more likely, it should be regarded as regular efforts to enhance performance of a healthcare organization.

To some extent, academic sources demonstrate that implementation of JCI contributes to better performance of medical organizations. One should take into consideration that JCI standards are consistent with the principles of Total Quality Management (TQM). This framework emphasizes such principles as:

1. customer focus or patient-focus,
2. employee empowerment,
3. continuous process improvement (Al-Dabal, 1999, p 14).

Existing academic literature suggests that these principles are quite applicable to the needs of healthcare institutions. Nevertheless, it should be noted the degree of implementation depends on culture, political system and those norms which regulate the relationships among employees.

However, literature review has also pointed out several limitations of JCI accreditation, in particular, the cost of accreditation which may not be affordable for healthcare organizations. Another drawback that has been identified is that JCI standards do not cover all aspects of healthcare (Jost, 1994, p 18). Furthermore, this validity of JCI accreditation is often criticized; namely, the inspection of JCI accredited hospitals revealed that many of these hospitals had many problems related to patient care and medication (Kowalczyk, 2007, p 1).

Therefore, at this point one can say that literature review does not give a univocal answer about the effectiveness of JCI accreditation. Therefore, the adoption of JCI standards is expected to yield both qualitative and quantitative benefits, such as better workplace practices and reduction of costs incurred by medical institutions.

The government of Saudi Arabia actively promotes the adoption of JCI standards among healthcare organizations in this country. At this point, there are 33 accredited institutions: 31 hospitals, one ambulatory care organization and one clinical laboratory (JCI, 2011, unpaged). These institutions are located in 13 cities of the country; the leading positions are occupied by such cities as Jeddah—nine accredited institutions, Riyadh – seven accredited hospitals, and Damman – six accredited organizations (JCI, 2011, unpaged). Some of these organizations have reported the effects of JCI accreditation. For example, Dr, Soliman Fakeeh Hospital was accredited by Joint Commission International; the representatives of this institution claim that the new model brought the following improvements:

1. increased patient and staff satisfaction;
2. better compliance with governmental standards.

Additional, this medical institution pays close attention to such measurements as medication errors and safety procedures. This longitudinal chart indicates that after adoption of JCI standards, the number of workplace incidents dramatically decreased. Moreover, this statistical information is quite consistent with the initial hypothesis, advanced at the very beginning, in particular, the positive relations between JCI accreditation and patient safety.

The main advantage of JCI implementation is that this model attaches great important to continuous assessment of quality and the use of different measurement tools. The adoption of these standards helped the hospital to uncover some problems, such as lack of safety precautions. The main requirement set by JCI is continuous reporting of incidents and defects and many Saudi Arabian hospitals like Dr, Soliman Fakeeh Hospital benefited from it (Walton, Al-Omar, & Al-Maturi 2010, p 38). Based on these reports, the administration of a medical institution can better implement new policies and standards. Scholars argue that there are three factors which affect patient safety:

1. management support;
2. adequate reporting systems; and
3. resource adequacy (Walton, Al-Omar, & Al-Maturi 2010, p 38).

TQM approach addresses each of these factors. These quantitative and qualitative data shows that those Saudi Arabian Hospitals, which have implemented JCI standards were able to improve their performance especially in the long-term.

The Case of International Medical Center

At this point it is necessary to discuss the experiences of a medical institution that has already adopted JCI standards and embraced the principles of total quality management. One of them is International Medical Center. This is multi-disciplinary which hosts three hundred beds. This healthcare organization comprises the following departments “Children’s Health, Women’s Health, Pain and Headache Management, Diabetes, Musculoskeletal, and Plastic Surgery and Dermatology.” (International Medical Center, 2011, unpaged). This medical institution received JCI status ten years ago and since that time its organizational structure underwent significant changes.

Joint Commission International helped IMC provide training to the employees and design organizational processes within the hospital, so that it could meet the quality standards established in the United States. Later IMC entered into contract with many American medical institutions and this partnership enabled them to adopt the best practices used by healthcare organizations, for instance, teleconferencing, continuous education program, and more effective utilization of technologies, for example electronic health records (IMC 2011, unpaged).

Overall, the example of these institutions demonstrates that adoption of JCI standards and TQM principles are associated with the following benefits:

1. Reduced number of non-compliance cases;
2. Better partnerships with foreign healthcare organizations;
3. Increased staff and patient satisfaction;
4. Better time-management;
5. Improved use of information technologies.
6. Increasing emphasis on the training of the personnel.
7. Well-developed skills of medical workers.

It should be noted the management of this medical institution emphasizes the importance of orientation programs for the new employees, regular training, and staff empowerment (IMC 2011, unpaged). The innovations that were implemented by the management of International Center are largely based on the principles of total quality management, especially, if one is speaking about regular training offered to the staff and orientation programs.

Thus, over a period of 10 years International Medical Center managed to improve its performance in a very dramatic way. These innovations have allowed them to make organization more oriented toward the needs of patients. In this case, one has to speak about the improved time management and less bureaucratic relations in the workplace.

Primary sources

Several medical workers have been interviewed about the effects of JCI accreditation. The questions were related to the following issues:

1. the rationale for JCI accreditation;
2. the benefits of applying JCI standards, and
3. changes brought by this strategy.

Six healthcare professionals were interviewed in the course of this research. Each of them has worked in those Saudi hospitals that have already implemented JCI standards and they agreed to tell us how TQM approach had affected these organizations. These are the questions that the respondent had to answer:

1. The objectives for adopting JCI accreditation standards
2. The importance of JCI accreditation for the maintenance of healthcare facilities:
3. The impact of JCI standards on the quality culture in a healthcare organizations
4. The effects of JCI accreditation on leadership, teamwork, and beliefs about quality in Saudi hospitals?
5. The indicators show that Saudi hospitals have implemented JCI accreditation standards.
6. The evolution of JCI standards in the future

This table summarizes the key responses of the interviewees.

This table is based on the responses given by those medical workers who have already encountered with JCI accreditation. This people were asked to describe their perceptions of this innovation. Overall, this interview has enabled to gain better understanding of this process and these professionals have given us deep insights into the work of hospitals which implemented TQM approach.

References

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Bowling, A. (1997) Measuring health – a review of quality of life measurement scales, 2nd edn. Buckingham: Open University Press.

Braun B. Koss R. & Loeb J. 1999. Integrating Performance Measure Data into the Joint Commission Accreditation Process. Eval Health Prof. 22 (3), p 283-97.

Dale, B. (1994) Managing quality. 2nd ed. Hertfordshire: Prentice Hall.

Dr. Soliman Fakeeh Hospital. 2008. “Hope for the Future: Corporate Responsibility Report”. Web.

Dr. Soliman Fakeeh Hospital. 2011. Corporate responsibility report. Web.

Joint Commission (2010b) Home: Topic Details: Facts About Joint Commission International. Web.

Jost, T. S. 1994. Medicare and the Joint Commission on Accreditation of Health Care Organizations: A healthy relationship? Law & Contemporary Problems, 57(4), 15-45.

Joint Commission International. 2011 “Regional Focus: Kingdom of Saudi Arabia”. Web.

Hudelson, P., Cléopas, A., Kolly, V., Chopard, P., & Perneger, T. (2008). What is quality and how is it achieved? Practitioners’ views versus quality models. Quality and Safety in Health Care, 17 p.31-36.

International Medical Center (2011) Home: Overview of IMC. Web.

Kanji, K. and Moura, P. 2003 ‘Sustaining health care excellence through performance measurement’ J total quality management. Vol. 14, No. 3, pp. 269-289.

Kowalczyk. L. 2007. “Surprise check faults MGH quality of care”. The Boston Boston Globe. Web.

Pasternak, D. 2009 Hospital Accreditation A Framework for the Systematic Improvement of Patient Care. Web.

Walston, S. Al-Omar B, Al-Mutari F, (2010) “Factors affecting the climate of hospital patient safety: A study of hospitals in Saudi Arabia”, International Journal of Health Care Quality Assurance, Vol. 23 Iss: 1, pp.35 – 50.