To What Extent Joint Commission International Accreditation Standards Improves Healthcare Facilities - Essay Example

According to me relevant details and review of previous literature is there in the paper. There are also independent thoughts put forth in the paper. Hence to me the paper has covered relevant details and key definitions required for the literature review for this subject. The general concept of the Saudi culture and its influence have affected healthcare issues. Saudi culture has a mixed society consisting of nomadic Bedouin tribes and sedentary inhabitants. Over 70 years ago, the majority of Saudi Arabian society nomadic Bedouins. Arabian culture influenced by Islam (1991), compares Arab countries with the United States using Hofstedes cultural matrix. Collectivism versus individualism, for example, shows that the level of individualism in the US is very high, whereas it is very low in Arab countries. This is due to the two above mentioned primary factors that influence culture (cited in Al-Dabal, 1999). Therefore, collectivism can be considered the second main factor after that of religion in influencing Saudi culture. On the other hand, one of the cultural issues influencing healthcare in Saudi Arabia is consanguineous marriages. These societies prefer consanguineous marriages for various reasons such as to strengthen family relationships or to avoid financial assets or property falling into the hands of individuals outside the family (Bittles, 2001). Regarding healthcare, according to Al- Abdulkareem and Ballal (1998), consanguineous marriages have been found to be one of the causes of certain inherited blood diseases among Saudis. In 2003, the Saudi government therefore introduced a pre-marriage test to reduce the rate of such diseases. However, a study by Alsulaiman and Hewison (2006) on attitudes to the pre-natal and pre-implantation diagnosis of Saudi parents at genetic risk showed that, out of 30 couples asked, only 50% would accept such a test. This suggests that such a procedure would still be deemed unacceptable by the majority of the population, because it is incompatible with the culture and values of Saudi society. In KSA, modern healthcare system and quality management did not exist until 1926. Up until then, health services had been provided by individuals not governmental authority. Healthcare and quality have organised through several stages to reach present day status. However, quality management started to appear in the public and private healthcare sectors, by many workers attracted to the idea of Total Quality Management (TQM). Dale (2007) argues that shifting TQM from the manufacturing industry to the health sector is difficult for a number of reasons: the managerial environment differs from other sectors, consumers in healthcare are different as they use the service as patients, the nature of failure, where few errors are able to be fixed and the complexity of the workforce in the health sector. All these reasons make the implementation of JCI accreditation standards in TQM or continuous quality improvement a challenging mission. In healthcare, there are certain challenges faced by staff, including managers and physicians, in delivering a service in an appropriate way. In most of hospitals, major opportunities have been missed to improve the quality of care; hospital deaths are avoidable, and people die partly as a result of adverse effects from medical treatment. In addition, drugs recommended are not indicated, one third of some hospital practices expose patients to risks without improving their health, and one third of abnormal laboratory tests are not followed up by clinicians. once health care organisations have successfully addressed the gross inefficiencies and cost containment, the combination of cost and quality. In that context we can expect both the visibility and cost of quality problems to rise. More and more report cards will be issued for and by stakeholder organisations. These will be more readily available because of the internet and they will be used more frequently by the public and their proxies to make decisions and choices about sources of care. These challenges vary, however, there are major concerns in resource allocation, the cost of the service, efficiency and effectiveness in healthcare (Kanji and Moura, 2003). Therefore, the direction has been to move forward to adopt JCI as a solution to delivering services in terms of high-level performance and to ensure that all patients have equal access to these services. This chapter describes the method used to carry out the present study. The secondary research aims to examine existing literature on hospital accreditation start is with Healthcare system in KSA before implementing the concept of JCI. It aims to identify the factors that block or enhance the implementation of the quality concept in healthcare organizations from a Western perspective. 2.2.1 Healthcare System and Ministry Of Health (MOH) in the KSA Total Quality Management program of health care sectors in KSA started in Markkah Region under Prince Abdul Majeed, then it became nation wide in Saudi Arabia called Central Board for Health care Institutions (CBAHI). According to Ministry of Health (2011), in 1970, the first of the government’s five-year plans to promote development in a variety of areas, including healthcare, was instituted. In healthcare, the plan only meant establishing the necessary infrastructure of hospitals, clinics, pharmacies, laboratories, and research facilities, but hiring expatriate staff to work in the facilities and encouraging Saudis to pursue careers in the healthcare field.  The Ministry of Health is responsible for the supervision of healthcare and hospitals in both the public and private sectors. The system offers universal healthcare coverage. The healthcare system has two tiers. One is a network of primary healthcare centres and clinics that provide preventive, prenatal, emergency, and basic services, as well as mobile clinics for remote rural areas. The second tier is represented by the hospitals and specialized treatment facilities located in urban areas. In 1970, there were 9,039 beds; by 2009, there were 220,400 beds included Governmental hospital had 173,800 beds and Privet hospital had 46,600 beds (Ministry of Health Statistical Yearbook, 2009). The Ministry of Health operates 62% of the hospitals and 53% of the clinics and centres; the remaining facilities are operated by government agencies, including the Ministry of Defence, the National Guard, the Ministry of the Interior, and several other ministries, as well as by private entities. MOH Mission and Vision The mission of the Ministry of Health is to provide comprehensive and integrative therapeutic, rehabilitative, and supportive health care, in line with the Islamic principles and the ethics of health practice. MOH carries out its mission in a way that satisfies the needs of the patients, their families and the community by upgrading health awareness and attaining justice in providing health services, whether in quality or quantity, throughout different parts of the Kingdom. MOH takes care of the status of its employees, provide training, rehabilitates, and reward them for ensuring the best health care provision. The vision of the Ministry of Health is to realise health in its comprehensive concept at all individual, family and community levels, maintaining health in both quantity and quality, and help the elderly and those of special needs by enabling them to accommodate with their health situations in coordination with different health care providers at both private and public sectors. MOH Vision for 2020: Attain the best possible quality of health care provision for the people of KSA at the levels of equality, efficiency, and ability to afford the financial burden. MOH carries out its mission in a way that satisfies the needs of the citizen by providing them with the best quality of special and general health services that covers all the population.  Create one basic structure for formulating health policies, including health insurance services. Adopt a general national health strategy that concentrates on the main burdens of diseases, including transmissible diseases, nutrition, smoking, AIDS, accidents, and injuries. The system must have an adequate and fair methodology for estimating risks and advantages. Diversify the sources of revenues for effectively financing the system, whether general revenues, insurance premiums, and equal division of allotted costs and taxes . In the next section, it is explicated that, International Medical Centre (IMC) is a unique organization. 2.2.2 International Medical Centre (IMC) in KSA The 300 bed, state of the art IMC is a multidisciplinary hospital that is committed to delivering a service like no other. One that would captivate it’s visitors and staff, engulfing them in its new approach to medicine and building a new culture that will take patience to grow but will soon be transmitted to future generations as the Islamic standards in healthcare. To ensure our commitment to accuracy, IMC works hand in hand with the highly acclaimed JCI to uphold superior international standards. IMC is a multi specialty hospital that features six Centres of Excellence that houses sub specialties that are delivered by US and Canadian Board Certified Physicians in addition to many other specialties. The centres are Children’s Health, Women’s Health, Pain and Headache Management, Diabetes, Musculoskeletal, Plastic Surgery, Dermatology, etc. The IMC’s development was done through the JCI’s supervision that wielded within IMC’s conception, construction and design as well as overseeing medical procedures and facilities. The IMC logo is considered to be a tree, which has been made up of five crescents. It symbolizes the body, mind and soul. It will be cared for in order to achieve optimum health, but the lower crescents; which start from the trunk and roots, symbolize international standards and holy ethics, which are essential for the survival of the tree . The Cleveland Clinic Foundation reviewed the IMC plans for an affiliation and agreed to being the first American institute to become partners with a Saudi Arabian based hospital. The CCF is also an equity holder, owning stock in the IMC project and will work in partnership with IMC on several joint initiatives including e-health, teleconferencing, second opinions and continuing education programs. Joint Commission International (JCI) reviewed the IMC architectural plans and confirms compliance with USA construction standards for healthcare facilities. The IMC signed a multi stage contract with JCI to aid in organizational design and operations planning to assure a level of care quality comparable to that found in the USA, leading ultimately to international accreditation. The leaders of the IMC medical team in Boston negotiated affiliations with leading medical institutions in the USA for long term strategic alliance and exchange of services. 2.2.3 Healthcare Accreditations and Standards Accreditation is a process in which an entity, separate and distinct from the health care organization, usually nongovernmental, assesses the health care organization to determine if it meets a set of requirements designed to improve the safety and quality of care. Accreditation standards are usually regarded as optimal and achievable. Accreditation provides a visible commitment by an organization to improve the safety and quality of patient care, to ensure a safe care environment, and to continually work to reduce risks to patients and staff. Accreditation has gained worldwide attention as an effective quality evaluation and management tool. The accreditation standards process is designed to create a culture of safety and quality within an organization that strives to continually improve patient care processes and results. Accredited organizations must now focus attention on a series of specific actions to prevent medical mistakes, according to the Joint Commission on Accreditation of Healthcare Organizations. These actions will help to avoid confusion in identifying patients, miscommunication among caregivers, wrong site surgery, and unsafe use of infusion pumps, medication errors, and problems with equipment alarm systems. 2.2.4 Joint Commission on Accreditation of Healthcare Organizations (JCAHO) JCAHO sets standards for healthcare organizations and issues accreditation to organizations that meet those standards. An independent, not for profit organization, the Joint Commission accredits and certifies more than 18,000 health care organizations and programs in the United States. Joint Commission accreditation and certification is recognized nationwide as a symbol of quality that reflects an organization’s commitment to meeting certain performance standards. Today, more than 18,000 health care providers use Joint Commission standards to guide how they administer care and continuously improve performance. The Joint Commission is also the only accrediting organization with the capability and experience to evaluate health care organizations across the continuum of care. 2.2.5 Joint Commission International (JCI) It has been working with health care organizations, ministries of health, and global organizations in over 80 countries since 1994. Its focus is on improving the safety of patient care through the provision of accreditation and certification services as well as through advisory and educational services aimed at helping organizations implement practical and sustainable solutions. In 2000, the International Medical Centre in KSA signed an agreement with the Joint Commission International making it the first hospital in the region to involve the JCI in a project from its inception. The JCI is a world renowned authority on healthcare which is responsible for accrediting organizations illustrating high standards of medical care. The JCI’s supervision was used throughout the process of IMC’s creation, from construction and design in addition to overseeing medical procedures and facilities. JCIs mission is to improve the quality of health care in the international community. For more than 75 years, The Joint Commission and its predecessor organization have been dedicated to improving the quality and safety of health care services. JCI accreditation is a variety of initiatives designed to respond to a growing demand around the world for standards based evaluation in health care. The purpose is to offer the international community standards based, objective processes for evaluating health care organizations. The goal of the program is to motivate demonstration of continuous, sustained improvement in health care organizations by applying international agreement standards, International Patient Safety Goals, and indicator measurement support. JCI has developed standards and accreditation programs for: Clinical Laboratories, The Care Continuum (home care, assisted living, long term care, and hospital care), Medical Transport Organizations, and Ambulatory Care. It also offers certification of programs that provide Disease or Condition Specific Care such as programs for stroke care or cardiac care. JCI accreditation programs are based on an international framework of standards adaptable to local needs. 2.2.6 Benefits of JCI accreditation and certification • Provides education on good practices to improve clinical and business processes. • Improves risk management and results in risk reduction. • Strengthens community confidence in the quality and safety of care, treatment and services. • On site evaluations are conducted by highly trained clinicians and advocates for patient safety. • Standards are developed by health care experts from around the world. • Accreditation and certification decisions are made by an international committee of health care experts. • Advisory councils made up of health care leaders from Europe, the Middle East, and Asia Pacific provide guidance on key patient safety and quality issues. 2.2.7 Improvements and effectiveness JCI focus is to improve the “safety of patient care through the provision of accreditation and certification services as well as through advisory and educational services aimed at helping organizations implement practical and sustainable solutions.” (JCI) The standards used by the JCI were developed by international health care experts in order to set up consistent attainable expectations for health care organisations. The JCI accreditation and certification allows the National Guard Health Affairs (NGHA) in KSA access to a variety of resources such as an international system for measuring the quality of services to patients across the board. It also provides benchmarks for norms of quality management in patient health care, strategies to reduce patient risks, best health care practices, and quality control goals to increase the realization of the NGHA services. By achieving the JCI accreditation, the NGHA assures that its facilities are meeting the needs of its patients by focusing on patient safety, improved infection control, safe medical facilities, pharmaceutical safety and compliance with the accreditation standards. The process of JCI has set many of the fundamental principles that guide health care organizations today. Many of these principles are routine but were revolutionary in their times. Some examples of these fundamental principles introduced by the Joint Commission demonstrate the point: Medical Records: First required in 1917, many considered the medical record unnecessary. Today the medical record is inarguably the central point of information gathering for treatment decisions, research, patient monitoring, outcomes measurement and even billing. Patient Safety: Focuses attention of health care organization on identifying medical errors, analyzing their root causes, and building safety into organization systems. The Joint Commissions approach to patient safety, has in specific instances reduced the frequency of medical errors and sentinel events. 2.2.8 Evaluation of The evaluation consists of full range of functions and systems including: Prevention of patient care hand over errors, prevention of wrong site/wrong procedure/wrong person surgical errors, prevention of continuity of medication errors, prevention of high concentration drug errors, and promotion of effective hand hygiene practices. 2.2.9 Limitations and Weakness The JCI is a private, “mechanism designed to assure that accredited health care facilities meet certain basic standards”, as well as determine whether a facility is eligible to receive Medicare/Medicaid reimbursement (Shi & Singh, 2008, p. 320). This non governmental status, essentially conducting regulatory work, has not always been agreed upon with health care organizations and has been challenged in court. For example, “Until 1984, psychiatric hospitals for persons under the age of twenty one could provided Medicaid financed care only if they were JCI accredited. Other critics have pointed out that through the use of the JC, the government “has endorsed too narrow and monolithic a vision of health care” (Jost, 1994, p. 43), and would be better served through a government regulatory body or increased competition. A second concern is that, the JC Inc. Web site lists the available consultative services (prices not listed), as well as seminars ($650 per person) and other references to prepare for surveys (Joint Commission Inc., 2008). Although these fears may be imagined, the possible perception of a conflict exists, especially when the fate of an institutes access to Medicare reimbursement is at stake. The final concern deals with the actual cost of accreditation. In addition to the actual expenses involved in preparing a facility for a survey, which will vary by the size, location, and scope of the institution, the average cost in 2008, for an accreditation survey is approximately $41,000 (Joint Commission International, 2008). The characteristics of the hospital, such as size, determine the size of the survey team, which will increase the overall survey cost because the institution (Joint Commission International, 2008). This financial aspect of the survey places an additional burden on health care institutions and demonstrates further weakness in the JC accreditation process. 2.2.10 Criticisms There has been criticism in the past from within the USA of the way the Joint Commission operates. The Commissions practice had generally been to notify hospitals in advance of the timing of inspections. An article in the "Washington Post noted that about 99% of inspected hospitals are accredited, and serious problems in the delivery of care are sometimes overlooked or missed. Similar concerns have been expressed by the "BostonGlobe, stating that "The Joint Commission, whose governing board has long been dominated by representatives of the industries it inspects, has been the target of criticism about the validity of its evaluations". The Joint Commission has over time responded to these criticisms, and in the USA, all hospital surveys since (January, 2006)have been unannounced, as the scheduled evaluations of the past used to allow institutions to prepare for them and there was no guarantee that adequate standards were being maintained between surveys. However, when it comes to the international dimension, surveys undertaken by JCI still take place at a time known in advance by the hospitals being surveyed, and often after considerable preparation by those hospitals. 2.2.11 JCI Accretions and standards for Hospitals Section I: Patient-Cantered Standards Primary care centre should define the type of services, which has to be implemented to the community and patients. In addition, these services could be provided from birth to death of the patients which needs to connect to their health care needs. It is recommended that Healthcare organisation must clarify specific services to be provided and interface between the care they provide and other services of healthcare system. On the other hand, how to effectively provide healthcare services to support patient care and patient rights, ensure the perfect assessment of the patients needs, and also it will be through care and patient education. In all these activities, the patient will be the goal of every aspect of the healthcare organisation (Joint Commission International, 2010). Standards which have been implemented in IMC: International Patient Safety Goals On 1st Jan 2011 in all organizations, IPSG accredited by JCI as required for implementation. Its goals are identify patients correctly, improve effective communication, improve the safety of high alert medications, ensure correct site, correct procedure, correct patient surgery, reduce the risk of health care associated infections, and reduce the risk of patient harm resulting from fall. Access to Care and Continuity of Care A health care organization should consider the care it provides as part of an integrated system of services, health care practitioners and professionals, and levels of care, which make up a continuum of care. The goal is to correctly match the patient’s health care needs with the services available, to coordinate the services provided to the patient in the organization, and then to plan for discharge and follow up. The result is improved patient care outcomes and more efficient use of available resources. Patient and Family Rights To promote patient rights in a health care organization, one starts by defining those rights, then educating patients and staff about those rights. Patients are informed of their rights and how to act on them. Staffs are taught to understand and to respect patients’ beliefs and values and to provide considerate and respectful care that protect patients’ dignity. Assessment of Patients An effective patient-assessment process results in decisions about the patient’s immediate and continuing treatment needs for emergency, elective, or planned care, even when the patient’s condition changes. Patient assessment is an ongoing, dynamic process that takes place in many inpatient and outpatient settings and departments and clinics. Care of Patients Providing the most appropriate care in a setting that supports and responds to each patient’s unique needs requires a high level of planning and coordination. Anesthesia and Surgical Care The use of anesthesia, sedation, and surgical interventions are common and complex processes in a health care organization. They require complete and comprehensive patient care planning, continued patient monitoring, and criteria determined transfer for continuing care, rehabilitation, and eventual transfer and discharge. Medication Management and Use Medication management is an important component of diseases that encompasses the system and processes an organization uses to provide pharmacotherapy to its patients Patient and Family Education Patient and family education helps patients better participate in their care and make informed care decisions. Education includes the knowledge needed during the care process and the knowledge needed after the patient is discharged to another care site or home. Section II: Health Care Organization Management Standards Primary care centre effort to be effective which will be through obtaining a clear management structure with visible coordination of the healthcare process, which has included the delivery of services using teams. Successful Teamwork could be when they have the information they need from an organisation and a whole patients record, which can be in a safe environment with minimized risks for both staff and patients. Staff should have the qualification and talent to supply the healthcare expectations and opportunities to improve as professionals. These conditions create primary care centres where healthcare is optimized with staff support and safety (Joint Commission International, 2010). These are standards which have been implemented in IMC: Quality Improvement and Patient Safety Integral to overall improvement in quality is the ongoing reduction in risks to patients and staff. Such risks may be found in clinical processes as well as in the physical environment. Prevention and Control of Infections The goal of an organization’s infection prevention and control program is to identify and to reduce the risks of acquiring and transmitting infections among patients, staff, health care professionals, contract workers, volunteers, students, and visitors. Governance, Leadership, and Direction In particular, these leaders must identify the organization’s mission and make sure that the resources needed to fulfill this mission are available. Facility Management and Safety Health care organizations work to provide safe, functional, and supportive facilities for patients, families, staff, and visitors. To reach this goal, the physical facility, medical and other equipment, and people must be effectively managed. In particular, management must strive to reduce and control hazards and risks; prevent accidents and injuries, and maintain safe conditions. Staff Qualifications and Education A health care organization needs an appropriate variety of skilled, qualified people to fulfill its mission and to meet patient needs. The organization’s leader’s work together to identify the number and types of staff needed based on the recommendations from department and service directors. Management of Communication and Information Providing patient care is a complex endeavor that is highly dependent on the communication of information. This communication is to and with the community, patients and their families, and other health professionals. Failures in communication are one of the most common root causes of patient safety incidents. Consequently, IMC has implemented all these 14 standards. That IMC rules as TQM department, which has involved in all these accreditation standards. They ensure these standards are implemented by inspecting all areas through the quality and environmental rounds. This inspection consists of two sessions per year, and each session covers the whole hospital. TQM round includes only TQM members. Environmental rounds include a representative from hospitality, infection control, TQM, safety, facility, biomedical, laboratory and pharmacy departments. Each department inspects the areas related to its department. The round findings will then be sent to TQM representatives to ensure that these findings will be forwarded to the head of the inspected area to make plan action for these findings. Read More