The Joint Commission as a Machine and an Organism - Essay Example

?The Joint Commission as a Machine and an Organism Quality control is something that most products and services need in order to sustain its good standing with their consumers/ customers. With health services, the most prestigious organization that provides health institutions with the most desired nod of approval is the Joint Commission. Just what is the Joint Commission? It is an accreditation and certification agency that is an independent and not-for profit organization overseeing the quality of more than 15,000 health care organizations and programs in the United States (Joint Commission Website, 2011). It has an international division, the Joint Commission International (JCI), which works with health care organizations in over 80 countries worldwide since 1994 (Joint Commission Resources Inc., 2009). These include hospitals, ambulatory care facilities, clinical laboratories, care continuum services, medical transport organizations, and primary care services, as well as certification for disease or condition specific care (Joint Commission Website, 2011). Being accredited and certified by the Joint Commission is recognized as a symbol of the highest quality that reflects on a health care organization’s commitment to meeting the most discriminating performance standards. The Joint Commission’s mission is to “continuously improve the safety and quality of care provided to the public through the provision of health care accreditation and related services that support performance improvement in health care organizations” (Joint Commission website, 2011). The Joint Commission provides the premium standards that health care institutions must comply with to ensure that patients are provided the utmost quality of care they deserve. Upon successfully passing the accreditation requirements, the health care organization earns the symbol of quality that reflects the organization’s commitment to excellence – the Joint Commission’s Gold Seal of Approval. To maintain it, the organization should undergo on-site surveys conducted by a Joint Commission survey team at least every three years. The Joint Commission works with other equally prestigious agencies in pursuit of the latest medical trends. The World Health Organization (WHO) Collaborating Centre is a joint endeavour of the WHO, the Joint Commission and JCI. It has been established to seek patient safety solutions (Joint Commission Resources, Inc., 2009). Metaphorical Analysis of Joint Commission Morgan (1997a) has conceptualized a way to analyse organizations with metaphors. This concept is aligned with the theories of Lakoff & Johnson (1980) as they explain: In all aspects of life ... we define our reality in terms of metaphors and then proceed to act on the basis of the metaphors. We draw inferences, set goals, make commitments, and execute plans, all on the basis of how we in part structure our experience, consciously and unconsciously, by means of metaphor (p. 158). The metaphors Morgan has chosen are machines, organisms, brains, cultures, political systems, psychic prisons, flux and transformation and instruments of domination. According to him, multiple perspectives are produced when organizations are analysed using more than one metaphor since a single metaphor will not be able to provide a holistic picture of the organization. For this essay, the writer has selected machines and organisms to analyse the organization of the Joint Commission. The functions of the organization are very much likened to a machine’s in terms of “input- output” of performance and the standards used to measure its efficiency. The organism is also chosen to analyse the Joint Commission, being an organization dedicated to the respect and preservation of life. Morgan has used the metaphor of machines to describe organizations that are designed to achieve specific purposes using a standardized method. The metaphor of organisms is used by Morgan to describe organizations as living organisms that strive to adapt and survive in an environment that constantly changes. Machine As a machine, the Joint Commission is responsible in keeping its parts well-oiled to ensure its mobility and functional operation at its optimal level. Regular maintenance will guarantee that its mission will be carried out as follows: Continually enhancing the value of its accreditation and certification programs Developing, utilizing and maintaining valid and reliable performance measures. Ensuring that the accreditation process is publicly accountable Making patient safety an imperative in all accredited organizations. Addressing pressing public policy issues that impact the quality and safety of health care. (Joint Commission website, 2011) Specifically, the Joint Commission checks if the organization’s level of performance is at par with theirs. Key functional areas such as patient rights, patient treatment and infection control are surveyed. On top of provision of safe, high quality care, the Joint Commission also looks into the organization’s actual performance. Usually, the patients’ satisfaction in the service they were provided speaks for itself. The Joint Commission develops its standards by consulting with health care experts, providers, measurement experts, purchasers, and consumers. These people may be the collaborators that ensure that the whole industry is secure for automation. Guidelines and standards set by the Joint Commission serve as the manual of the machine. When standards are met, it is given a seal of approval, like releasing the machine from quality control. Accreditation and certification by the Joint Commission improves risk management and risk reduction in health care service-providers. The Joint commission also provides education on good practices to improve the organization’s business operations. Aside from that, it provides professional advice and counsel to the administration and staff of the organizations thereby enhancing staff recruitment and development. Select insurers and other third parties recognize only institutions accredited by the Joint Commission, and such accreditation may fulfill regulatory requirements in select states. It is no wonder that any thriving health care institution goes after a Joint Commission accreditation and certification to be able to reach a privileged status. Machines may breakdown for one reason or another. The Joint Commission likewise encounters some glitches or malfunctions. One common problem encountered by accredited healthcare institutions is dealing with patients who have low health literacy. Since one of the Joint Commission’s accreditation standards emphasize the fundamental right and need for patients to receive information about their care in a way that they can understand, it becomes a challenge for health care professionals if patients have difficulty understanding, or worse, refuse to understand procedures needed to be done to them for the welfare of their own health. Murphy-Knoll (2007) argue that health literacy issues that are left unaddressed undermines healthcare organizations’ capacity to adhere to accreditation standards and safety goals set by the Joint Commission to protect the safety and well-being of patients. “The safety of patients cannot be assured without mitigating the negative effects of low health literacy and ineffective communications on patient care” (Murphy-Knoll, 2007, p.206). Addressing health literacy issues must be shared by healthcare service providers, healthcare policymakers, purchasers and payers, regulatory bodies and consumers themselves. In consultation with these experts, the commission has aimed at improving communications by identifying the “need to develop organizational cultures that place high priority on culturally competent and safe environments in which clear communications are intrinsic to all care processes and interactions.” (Murphy-Knoll, 2007, p. 206). For this specific problem, to improve health literacy and patient safety, three broad strategies were recommended by the Joint Commission. One is to “make effective communications an organizational priority to protect the safety of patients.” (Murphy-Knoll, 2007, p. 206). This calls for intensive training of staff to assist patients in the best possible way they can using clear communication. A commitment to uncovering how communication issues ensue to affect patient safety, healthcare disparities and access to care must be strengthened. The second strategy is to “address patients’ communication needs across the continuum of care” (Murphy-Knoll, p. 207) from the time a patient checks in the healthcare institution until he is sent home. This means that the healthcare professionals ensure that the patients’ understanding of all procedures related to their health must be clearly delivered, using plain language to describe his/her condition and providing him/her with self-management instructions that meet his/her learning and language needs. “Handoff” communication between the healthcare professionals and workers must be standardized along with effective communication skills to ensure patient safety. The last strategy is to “pursue policy changes that promote improved provider-patient communications such as referring patients with low literacy to adult learning centers and even assisting them with enrollment procedures.” (Murphy-Knoll, 2007, p. 207). Being patient-centered means respecting the culture they come from, and healthcare professionals must likewise strive to learn the different culture and even common language expressions of their international patients for better communication with them. Communication breakdowns are not limited to patient encounters. Even between the healthcare professionals and workers within the same institution , a lot of miscommunication takes place. Transferring information about a patient has inherent gaps that may be vulnerable to misinterpretation that may spell devastating effects. That is why Adamski (2007) recommend that information shared during the handoff is dependent on the situation and persons involved. One example is during the change of shift of nurses, detailed information is provided such as the patient’s condition, changes in orders and the plan of care, activities of daily living, results of any testing, psychosocial issues, and other information. All these communication processes need patience and a mature outlook in order to ensure smooth and accurate information transfer. Organism As an organization that keeps its constituents alive by supplying it with the challenges and opportunities for growth and development, the Joint Commission is metaphorically an organism. In another book of Morgan, Imaginization (1997 b), he suggests that individuals specify a particular object to further dissect a metaphor. In the case of the Joint Commission as an organism, it is best described as a spider web. From the foregoing, it can be assumed that the Joint Commission wields much power and influence in the health care industry. It is the center of a web that spins far and wide to include deserving health care institutions in its intricate design. The web it weaves includes varied organizations and individuals that may network with each other in the name of quality health care. These networks are connected by the silky threads provided by the controlling spinner, the Joint Commission. The web spun by the Joint Commission attracts a multitude of deserving health care organizations, but this is not to say these are immune from organizational problems. Being the master web weaver that it is, the Joint Commission exerts efforts to straighten out knots in its web by helping out its accredited members in need. It stops and gives meticulous attention to it and carefully unravels problematic threads so it can continue spinning its web in peace. An important tool in spinning strong threads in the healthcare organizational network is communication. Richmond & McCroskey (2005) defines organizational communication as “the process by which individuals stimulate meaning in the minds of other individuals by means of verbal or nonverbal messages in the context of a formal organization.” The Joint Commission, being the central figure in the healthcare web must be consistent in communicating to each accredited organization its philosophy of providing the best quality health care and treatment through collaborative efforts of professionals from different disciplines. Each healthcare worker should be able to feel that he is part of a great team that sets high goals and successfully attains them. The Joint Commission has its ways of monitoring such organizational efficiency. It should know because the strength of each uniting silk strand of its web would depend on it. Failure of one organization to maintain and uphold the standards set forth by the Joint Commission may mean the beginnings of the web’s destruction due to a weak link. Being under the ambit of a more powerful accrediting organization may result in ego clashes among the leaders of the different healthcare institutions seeking the Joint Commission’s seal of approval. Such clashes may be compared to natural elements that may blow the web to test its strength and durability. A recent controversy involves the revised Joint Commission standard MS.1.20 which appears to have addressed the concerns of the American Hospital Association and the Federation of American Hospitals. Both groups had aggressively criticized previous drafts of the revision and had accused the Joint Commission of overstepping its bounds and stripping hospital boards of their authority. (Robeznieks, 2007, n.p.) Such a reaction from healthcare institutional leaders is normal, considering the Joint Commission checks out each of the following when they survey their member institutions: the structure of the organized medical staff, processes for granting and suspending hospital privileges to independent physicians, the process for selecting and removing medical staff executive committee members, the processes for terminating medical staff membership or clinical privileges, and an appeal process on corrective actions. (Robeznieks, 2007, n.p.) However, representatives from the Joint Commission argue that the new standard only focuses on the issues that deal with quality and safety, and stresses that it involves collaboration with the medical staff of each institution. It just threatens the medical staff that they would lose control on a lot of issues of self-government. These are some quirks that need to be straightened out to avoid further misunderstandings and to ease troubled spirits. As the weaver of a highly respected and indispensable web of a healthcare network, the Joint Commission is in a position of great responsibility. It needs to ensure that each string in its web (an association, organization or institution, or even an individual involved in the health care industry) possesses unquestionable integrity to be part of an intricate system that serves to uphold and maintain the highest standards of healthcare. Coming up with a such a tight and strong masterpiece of a web, guarantees trust and reliability in the quality of health services in America and the world over. Analysis of the Metaphors Used Likening the Joint Commission to a machine or an organism may initially seem nonsensical. However, for people to gain a better understanding of its intricate functions as an organization, using metaphors that they have greater familiarity with makes the analysis of the organization clearer to them. As a machine, the organization’s functions, standard measures of quality and performance and maintenance of the high quality of the healthcare organizations it supervises are appropriately checked before they can claim a seal of approval. This metaphor is appropriate in this aspect. However, to illustrate the relationships and networks established in order to make the organization grow, the metaphor that is most suitable is the organism. It can be ironic to analyse the organization with two opposing metaphors – machine and organism: much like cold, unfeeling and objective efficiency and warm, personalized relationships. It merges the professional with the personal which encapsulates the nature of the healthcare business. References Adamski, P. (2007)”Implement a handoff communications approach”, Nursing Management, January, 2007. Joint Commission Resources Inc. (2009) About Joint Commission International, Retrieved on May 12, 2011 from http://www.jointcommissioninternational.org/about-jci/ Joint Commission Website (2011) Retrieved on May 15, 2011 from http://www.jointcommission.org/ Lakoff, G. & Johnson, M. (1980) Metaphors we Live By, University of Chicago Press Lawley, J. (2001) Metaphors of Organization Part 1, Effective Consulting, Vol. 1, No. 4, Retrieved on May 10, 2011 from http://www.cleanlanguage.co.uk/Metaphors-of-Orgs-1.html Morgan, G. (1997a) Images of Organizations. Sage Publications Morgan, G. (1997b), Imaginization, Sage Publications Murphy-Knoll, L., (2007) “Low Health Literacy Puts Patients at Risk: The Joint Commission Proposes Solutions to National Problem”, Journal of Nursing Care Quality, Vol. 22, No. 3, pp. 205-209 Richmond, V.P. & McCroskey, J.C. (2005) Organizational communication for survival: making work,work. Retrieved May 16, 2011 from http://www.ilstu.edu/~llipper/com329/mccroskey_chapter.pdf Robeznieks, A. (2007)”Setting a new standard”, Modern Healthcare, Vol. 37, Issue 28 Read More