Introduction
The organisation chosen for analysis is a regional healthcare giant known as Al Ain Hospital. It has existed since 1979 and treats approximately 300, 000 patients annually. Furthermore, the institution’s emergency section handles about 350 cases daily. It has a bed capacity of 412 and employs 1, 500 staff members, of whom 202 are doctors. The company uses JCI (Joint Commission International) quality management, which is a form of total quality management (TQM) that applies to healthcare organisations around the world. JCI is a healthcare organisation that audits healthcare firms on approval in order to ensure that they adhere to rigorous quality standards. This accreditation has caused the company to continually seek improvement and high standards in patient care.
Key areas of the Joint Commission international quality system at Al Ain Hospital
The hospital largely emphasises three areas of improvement: patient safety, process and quality improvement. Through JCI, Al Ain seeks to enact process improvement in a series of areas. The company develops processes that focus on patients and seeks to increase interdisciplinary communication. It also monitors compliance to risk management activities and continually improves documentation of patient care, safety or quality improvement. In the area of patient safety, the company strives to create a safety culture among its staff members. It also has a holistic approach to medical care by incorporating family members, staff, patients and visitors in provision of services. Furthermore, the company strives to include transparency in reporting of suggestions or complaints by workers and customers. In the realm of quality improvement, Al Ain Hospital uses JCI standards to establish its quality management system. It also seeks to improve its monitoring systems in order to assess patient safety and quality changes. The company regularly analyses data in order to support quality enhancement. Al Ain Hospital has installed a surveillance system that ensures infection control through the analysis and assessment of data (Al Ain Hospital, 2012).
The company explains that the JCI quality system has boosted its reputation because the method is recognised internationally. It takes completion of 300 standards and implementation of 1,200 items in order to gain accreditation. Stakeholders respect the organisation for its world class standards, its clinical expertise as well as its commitment to safety. The establishment now has a better corporate image than before and has gained the trust of members of society.
Furthermore, it has encountered greater patient safety by reduction of medical errors. Some cost reduction has been recorded as well as increased patient satisfaction. Workers in the organisation know about the importance of quality improvement and most of them have made a commitment to the practice. They are also highly satisfied by their jobs owing to the training and additional competence stemming from JCI. These learning opportunities have contributed towards a sense of fulfilment amongst them. Since JCI focuses on tangible leadership practices, the company has benefited from the existence of quality leaders in its midst. Additionally, comparisons with other organisations, including 6 healthcare organisations in the UAE using JCI, allow the company to determine whether it is operating competitively. The company now knows its place in the healthcare industry.
Why Al Ain Hospital implemented JCI quality management
JCI quality standards are founded on the principles of total quality improvement (TQM). The key philosophy of JCI is continuous improvement. In fact, the JCI organisation used TQM to create its standards. Al Ain Hospital administrators were already familiar with total quality management as a tool for quality improvement. Therefore, it made sense for the organisation to adopt a system that used the same principles but was tailor-made for the hospital environment. The principles espoused by JCI resonated with Al Ain Hospital because it emphasised the importance of continually improving patient care quality, providing a safe hospital environment and risk reduction. These were all goals that could be effectively implemented by a healthcare organisation like Al Ain Hospital. The company also wanted to commit to JCI because it needed to take ownership over its problems. The UAE government has high expectations of quality from healthcare providers and those who do not take responsibility will have to pay severely through fines or closures. As a result, Al Ain felt that it was imperative to be proactive about its quality control. The company may suffer greatly if the government took legal action against it owing to poor quality management (Arasli and Ahmadeva, 2004).
It was essential to adopt a quality improvement program that was internationally recognised but could accommodate the cultural background of its implementers. JCI was ideal for the organisation because the standard accounts for firms’ geographical, legal and cultural backgrounds. The hospital was attracted to this standard because approximately 300 hospitals around the world already have JCI accreditation. Some of them operate in South America, Africa, Europe and even the Middle East. This vast penetration of the program in different parts of the world proved that Al Ain Hospital would be making a reasonable investment if it selected it.
The JCI standard requires companies to analyse their resources and ensure that they are adequate enough to meet the firm’s mission. This means that leadership excellence is a vital part of the quality management system. Al Ain Hospital realised that this strong inclination towards leadership was indicative of the accreditor’s commitment to strategic issues; this was a desirable element. The latter principle stems from Total Quality Management systems that emphasise the importance of involving customers, workers, suppliers and leaders in quality improvement. Al Ain Hospital also liked the fact that the quality program would facilitate proper use of resources, which would not have been possible if the hospital ignored leadership issues. Many healthcare providers fail to perform efficiently not because they lack resources, but because their leaders are not committed to the proper use of the resources. They do not integrate or coordinate activities promptly, and this may lead to problems. Al Ain wanted to prevent the occurrence of such a situation, and thus opted to take on the program.
Good quality improvement systems are the ones that are founded on scientific principles, and JCI is not an exception. Al Ain Hospital was impressed by its strong dependence on data. Patient safety and quality enhancement must be conducted after collecting data on the same. Therefore, hospitals base any changes made on measurable and statistical outcomes. In Total Quality Management, firms must understand common challenges through statistical methods. However, it should be noted that in JCI, data collection largely centres on patient safety and quality improvement as using the same strategy for all aspects of the organisation would constrain resources. Al Ain wanted a system that had mechanisms for budget control in order to facilitate organisational savings.
Cross functionality is always an important attribute in quality management programs. JCI emphasises the need for multidisciplinary work among implementers. Since Al Ain Hospital had several departments that worked alongside one another, it needed a quality improvement system that acknowledged and incorporated these various units in its recommendations. JCI considers the various elements of clinical processes and ascertains that the interrelationship between different units is strengthened. The latter principle also mirrors TQM as cross functional, multidisciplinary work is a critical element of total quality management (Donahue & Can Ostenberg, 2000).
JCI accreditation would ensure that Al Ain Hospital benefits in six key areas of service provision: quality, cost, training, reliability, administration, and efficiency. JCI works towards these gaols even though some of them have not been fully realised in the organisation today. These were all aspects that Al Ain Hospital wanted to improve when taking on the quality improvement system.
Additionally, JCI’s commitment to patient safety was quite relevant to the hospital because safety is a highly sensitive area. Al Ain Hospital needed to ensure that the safety of its patients was given top priority as it could have dire consequences if it was downplayed. JCI focuses on risk reduction amongst staff members as well as patients. Clinical practice is such that it presents ongoing risks among these stakeholders. Facilities and equipments in medical institutions are often hazardous. If handled inadequately, they may lead to injuries, accidents or other similar conditions. Therefore, Al Ain was impressed by the promise inherent in the JCI standard when considering the option. The institution decided to take it on because it would get to reorganise its managerial processes, clinical processes, data collection, data analysis and change implementation. Furthermore, the changes initiated by JCI were supposed to be sustainable; consequently, these were ideas that resonated with the company. In line with the above point of emphasis is infection control. Al Ain opted for this program owing to its ability to implement a thorough surveillance, control and preventive program in infection control.
Challenges and accomplishments during the process of implementation
Leadership commitment has the capacity to either destroy quality improvement programs or strengthen them. Fortunately for Al Ain Hospital, the company’s administrators were firmly committed to JCI implementation. They were the initiators of the program, so they kept the rest of the workforce motivated to complete the accreditation process. Top managers ensured that employees fully understood how the JCI standards would assist them in achieving their vision and mission. Additionally, they worked hand in hand with JCI professionals to communicate how continuous improvement would be achieved. Most leaders in the organisation did not just stop at the development of a quality management program; they were involved throughout the monitoring, implementation and planning components of the process.
While leadership commitment was not a problem during the implementation process, organisational culture proved to be an impediment in this endeavour. The hospital had many formal structures that had the effect of impeding quality improvement. Al Ain Hospital was functionally arranged and this complicated the infiltration of some of the changes at the onset of the program. Decision making was centralised in the institution, and this explains why organisational culture was a critical factor to the success of the venture. Emirati culture teaches respect for authority; these perceptions were evident in the hospital during the JCI implementation process. Most individuals were concerned about job security and their ability to maintain their positions after completion of the quality measures. They felt that the demands of the quality improvement program were affecting their ability to concentrate on their jobs. Additionally, a vast number of them were afraid of being responsible for errors, so they refrained from giving their suggestions about what needed to be done. It took a lot of time and effort to challenge this way of thinking, and the company is still working on these fears to date.
Al Ain Hospital had a few challenges and accomplishments in human resources. The company was aware of the importance of training and heavily investing in this aspect of the project. Conversely, it did not pay attention to the issue of incentive compensation. Therefore, employees could not see how participation in the quality improvement program would lead to an improvement in their personal wellbeing. This disconnect may have undermined the overall potential of the program. Nonetheless, developmental issues were addressed because the company instated a developmental culture. Employees’ contributions were appreciated by providing them with opportunities for advancement. On the other hand, the company did not reorient its recruitment efforts to match this quality improvement program. Vacancies were filled on the basis of competences as well as certain unknown conditions that depended on allegiance. These divergent approaches to recruitment may have affected the outcome of JCI in the organisation.
One of the difficulties the organisation encountered was the creation of a strong team throughout the company. It needed to foster a strong sense of commitment from the workers. This implies that they needed to consider the program as an essential part of their operation. Total quality management often requires participation from all components of the organisation. Therefore, when Al Ain Hospital started the program, some members of staff thought that it was a simply a matter to be handled by the quality control team. It took a lot of education and convincing to inform everyone that it was an initiative that would affect all of them. In order to create this spirit of team work, the organisation decided to empower its staff at all levels; nurses and physicians were continually asked for their feedback concerning different occurrences. Many of them gave their recommendations and were pleasantly surprised when the administration implemented them. This won their support and commitment to the program.
JCI accreditation does not occur in a cost-free environment. The concerned organisation needed to invest a lot of money throughout the process. It needed to pay for employee training, consultation fees and many other expenses that arose in the program. Furthermore, the company had to forego a lot of revenue that would have been earned if employees’ attention was fully focused on patients rather than quality improvement. Even maintenance of the program to date still involves investment of finances. Therefore, the company needed to think about the long term benefits of the program during accreditation in order to justify is budgetary commitment. It also needed to alter the mindset of its financial stakeholders in order to fight off resistance. Now the company no longer fights this resistance because individuals have seen the benefits of accreditation.
How a quality award can bring detailed feedback for additional quality improvement at Ain Hospital
A quality award for the hospital would bring additional feedback on process variations. Sometimes processes in the hospital may encounter variations because staff members do not gave adequate information to measure them. Awards such as DFSS would assist in creation of new processes if the previous ones are deemed unnecessary. Alternatively, the company could benefit from eliminating inefficiencies in service provision. In this regard, a quality award like value stream mapping would assist the organisation in identifying significant data and managing multifaceted problems. Issues of misaligned incentives are also affecting the company. It would greatly benefit from realignment of these processes using a different award system. In this regard, the quality award would tie management systems to organisational objectives, and this would ensure that the improvement system has performance as well as strategic planning elements. While issues of culture are difficult to determine for public organisations, it is true that Al Ain has such challenges in quality improvement. The company can use succession planning programs that would establish strong feedback structures. The company was also confronted by cultural silos in quality improvement. To deal with this challenge, the hospital could benefit from change management awards that would provide insights on how to make decisions effectively or how to ensure commitment from all members of the team.
Conclusion
Al Ain Hospital’s adoption of a total quality management system known as JCI was not a seamless process. The organisation had to deal with challenges that revolved around finance, team work, organisational culture and human resource. However, the company tackled a number of those challenges and now reaps the rewards of JCI accreditation. It boasts of better job satisfaction, commitment to continuous improvement, and safety of its patients. The case study illustrates that leadership commitment are vital components in the success of TQM strategies.
References
Al Ain Hospital (2012). Hospital accreditation. Web.
Arasli, H. and Ahmadeva, L. (2004). No More Tears! A local TQM formula for health promotion. International Journal of Health Care Quality Assurance, 17(3), 135-145.
Donahue, K. & Can Ostenberg, P. (2000). Joint Commission International accreditation: relationship to four models of evaluation. International Journal of Quality in Health Care, l2 (3), 243-246.