The Effect of Implementing International Accreditation Standards on the Performance of Health Services at King Khalid National Guard Hospital in Jeddah, Saudi Arabia

Background/Objectives: Recently there is a great demand for quality in healthcare services which has risen due to various market forces such as medical tourism, insurance, corporate growth and competition. As a result of these demands, the expectations of the consumer for best in quality has also risen, which has indeed lead to the introduction of national and international accreditation bodies to act as a quality assurance mechanism, thus enhancing customers access to better healthcare services. Methods/Statistical Analysis: The study is to analyze the impact of Implementing International Accreditation Standards (JCI) on the performance of health services at King Khalid National Guard Hospital in Jeddah as well as providing suggestions to enhance positive trends and overcome negative trends in the application of international accreditation standards in hospitals in Saudi Arabia. The investigation encompassed (128) of physicians and administrators at King Khalid National Guard Hospital in Jeddah, with 15% of the population. Findings: Our research methodology depends on using survey tool which was distributed to them and the study reached to the fact that there is a high level of implementation of JCI, high efficiency in the organization, leadership and management, management of support services, and implementation of personnel management standards at King Khalid National Guard Hospital as well as high level of efficiency in the performance of health services in King Hospital Khalid. Also, we concluded that there is a statistically significant relationship between the implementation of the standards of the institution and the leadership and management, the implementation of standards of management of support services and the implementation of standards of personnel management and performance of health services at King Khalid National Guard Hospital in Jeddah. Mechanism for the quality of service, work on the continuous assessment in compliance with international standards for the quality of health service, regarded as the King Khalid National Guard Hospital as a model for the rest of the hospitals in the Kingdom over the application of international standards in quality. Improvements/Applications: We concluded that accreditation is a transparent system of control over the accredited hospital which assures that the hospital will constantly fulfill the accreditation criteria. The on-site survey of the hospital and staff by the experienced accreditation assessment team encourages them to establish educational and performance improvement goals. The best part is that it gives the opportunity to the patients to give a feedback on the services they availed during their stay in the hospital and also to complain if they were dissatisfied.


Introduction
The theories of management change with the change of objectives. Every few years, new philosophies and theories solve organizational problems, until change becomes the only constant affecting the philosophy of management. It tries to be more interested in teamwork, relying on leadership rather than management techniques. As global competition, technological and informational acceleration increase, the path to enterprise success is to raise performance and achieve high-quality products at reasonable costs.
With the complexity of the health care system and increasing demand from health service providers, there is a need to pay attention to the quality of services provided by the health sector, so that health care institutions strive to provide quality services that are satisfactory to patients and reviewers. The talk of change puts organizational leaders collectively as responsible for the process of change. The top executive leadership creates values, objectives and systems and leads the quest for quality and achievement of good performance goals 1 .
In 2 points out that providing good health services to patients from the hospital's point of view may mean nothing if patients and reviewers themselves do not realize this fact, so patient satisfaction can be achieved only when hospital departments and doctors respond to patients' expectations and desires. It is necessary to identify the sources of patient complaints from these services and to evaluate the quality of these patients. As for the importance and quality of services provided, many hospitals have adopted what is known as customer services or patient services, which focused mainly on handling patients' complaints, solving their problems and communicating their views to the patients. Decisions on the one hand, as well as the adoption of performance efficiency standards in health services on the other. These hospitals have been racing to implement these standards, including the JCI certification for performance efficiency in Health institutions.
The importance of this article is related to the success or failure of the health and service institutions in the world today is related to the level of service efficiency and the satisfaction of the auditors, the improvement of the services provided and the achievement of the high quality of the services. The importance of the study is that it seeks to guide the hospital departments to improve efficiency through the adoption of international standards; The importance of the study can be summarized as follows: • A strategy is proposed in health organizations to improve the efficiency of health services and to improve the level of those services in accordance with international standards. • Contribute to raising the awareness of the administrations of health organizations the importance of the certificate of international reliability in particular, which contributes to the level of change and development required. • Attempt to study the attitudes of workers towards the level of health service provided in hospitals in the Kingdom, compared to international standards, to show these differences in a precise field. • Studies that examine the subject of the certificate of international reliability in particular in health organizations in the Kingdom of Saudi Arabia is rare, according to the researcher, so this study has enriched the academic aspect in the Kingdom, and constitutes a platform for further studies and research that will raise the level of The efficiency of health services in accordance with international standards.
So, the main target of this article is to:-• Study and analyze the impact of the implementation of the eight international accreditation standards on the performance of health services at King Khalid National Guard Hospital in Jeddah. • Provide suggestions to promote positive trends and overcome negative trends in the application of international accreditation standards in hospitals in Saudi Arabia.

Literature Review
Quality has become a modern era and a fundamental issue for many organizations in all sectors, as a result of changing performance standards in these organizations, which no longer limit themselves to the mere provision of the service or the product but rather to provide the quality that meets the client's demands. The concept of quality management, which is the ideal model for the achievement of the overall quality and the latest administrative concepts aimed at the development of Ada Organizations through the creation of a comprehensive organizational development and construction of a deep culture of quality 3 . This shift in attention to quality has made the concept of quality management a focus of the interest of many researchers and specialists in the field of modern management, which led to a multiplicity of views around them depending on their backgrounds and theories. With the rapid and rapid progress in the various areas of communication, the increasing pace of technological progress for all productive sectors, and the entry of Vol 12 (25) | July 2019 | www.indjst.org globalization concepts and agreements to all service organizations and industry, the conditions surrounding the production environment are complex and rapidly changing; organizations that use traditional production, marketing and supply strategies can no longer compete , As the core of the new production equation has become the client and service recipient of all industry and service organizations alike, and these organizations have had to reassess their strategies with regard to their engagement with many of the Japanese experience in production was an example of the ability of organizations and countries alike to demonstrate sustainability and even progress to the top of global competition through the creation and application of TQM 4 . It is defined as "a tool for total quality. It is equipped with the means to identify which processors are advantageous to the enterprise and thus are a fundamental element of the overall quality strategy 5 .
A study entitled "Achieving Total Quality Management Using Criteria for Accreditation at Queen Rania Al Abdullah Children's Hospital in Jordan" was designed to demonstrate the ways to achieve TQM by using the accreditation criteria at the Queen Rania Al Abdullah Children's Hospital in Royal Medical Services Hospitals. International standards of reliability in total quality management, the study was based on a questionnaire distributed to a sample of 830 recipients and providers of health services. It found that there were differences for the sample of service providers who believed that the criteria for the rights of patients and their families were more than and the application of accreditation standards to achieve the hospital's access to the TQM level. The study also concluded the importance of following up the application of the accreditation criteria as an independent variable that affects the achievement of TQM 6 -8 .
The study of Sanjak aimed at verifying the level of implementation of the seven criteria of the Malcolm Baldrig Award (Leadership Standard, Strategic Planning Standard, Market Focus and Customers). The Information and Analysis Standard, the Human Resources Concentration Standard, the Operations Management Standard, and the Business Results Standard (JCI). The aim was to identify the differences in the level of application of these standards to GA The mention mentioned. In order to achieve these objectives, a questionnaire was designed and distributed to a sample of 71 members of the departments and heads of departments in Jordanian hospitals that obtained the JCI. 40 questionnaires were retrieved, i.e. 56% the study found the following results: 1-There was no statistical evidence (at the level of α = 0.05) on the existence of an acceptable level of implementation of the criteria of the Malcolm Prize gradually combined in the Jordanian hospitals that have the International Accreditation International (JCI). The statistical evidence is at the same level as the mean the level of application of the standards of analysis and information, human resources, processes and strategic planning, has negatively impacted the level of application of standards in these hospitals. (α = on the existence of differences in the level of application of hospitals inspected for the criteria of the combined award. Although the statistical evidence (at the same level of significance) on the existence of differences between the hospitals investigated in the standards of focus on markets and customers, information and analysis, information and operations, The Manual is available Loyalty to the existence of differences in the application of standards of leadership, strategic planning, human resources and business results 9 .
The study of Anuratpanich 10 aimed to explore the development of leadership skills and the conditions of sections in the practical application of international standards. The survey questionnaire was created with information from literature review and discussion with some pharmacist's managers. The targeted sample was JCI for private hospitals. Data was collected in 2013, and the study reached the most important results that the most commonly used development methods are vocational training, formal training, knowledge is "professional focus knowledge" and "leadership knowledge and management focus", the necessary skills related to the subject of knowledge with " "And" Acceptance of Diversity ". The results also showed that international standards are present at 28.6% in private hospitals, and (33.3%) in government hospitals. In the light of the results, the study recommended working on the sustainability of international standards in the Department of Pharmacy in the future, leadership skills development process should be established in the context of the hospital pharmacy with a structured approach and should be supported by the Hospital Association of Pharmacy Association 11 .
The impact of the importance of the reliability standards in health organizations on change and development, which leads to the construction of a new measure of the policy of development and change in health organizations that takes into consideration the modernity In the quality of health care services, and relied on theoretical literature and interviews with senior managers, focus groups with staff directly involved in the accreditation process, analysis of self-assessment reports, accreditation reports and related documentation. The study concluded that the results of the study have led to a positive impact of international accreditation in health organizations to develop health care and economic benefit and to improve the quality of health service for the sauce to the general objectives of the organization. In light of the results, the study recommended that to maximize the benefits of the accreditation process, from each stage of the accreditation process over time 12 .

The Research Problem and Applied Methodology
It is argued that most of the health care organizations in our country seek to develop and change and get out of the state of administrative stalemate and the remnants of the past, and keep pace with the global development, especially in light of the great development in technology and communications and the intensity of competitiveness and the opening of markets. It is noted that many of these organizations have taken corrective decisions in aspects, but these decisions no longer meet the requirements of development and change required by the stage and it is necessary to adopt a comprehensive management model or model capable of success of administrative development programs, in addition to employing modern technology in these institutions, (JCI) is an essential prerequisite for performance development and requires local and international competition. It believes that quality must be achieved in the performance of services, the requirements of the citizen and the resident, the sponsor of renewal, the importance of information and continuous improvement in the performance of operations. International reliability the most comprehensive and innovative management practices are the most visible and best applied in hospitals as a flexible approach that enables management to respond to various environmental forces and indicators, which calls for its application in the health sector. The problem of the article lies in the following questions: • What is the level of efficiency of health care services in King Khalid National Guard Hospital in Jeddah in terms of (qualifications of staff, training, patient relations) • What is the degree of compatibility of health care services at King Khalid National Guard Hospital in Jeddah with JCI standards? • What are the attitudes of staff at King Khalid National Guard Hospital in Jeddah towards the implementation of JCI standards?
The research methodology that author used it in this article is the descriptive approach is based on identifying the characteristics of the phenomenon and describing its nature and the quality of the relationship between its variables, causes and trends, which achieves the current research goals and objectives. The researcher used the descriptive approach which is considered a broad and flexible umbrella that includes a number of secondary methods and methods such as social surveys and developmental and field studies. , Where the analytical descriptive method reviewed the most important literature related to the subject of the study with some analysis and comparisons whenever possible, and test the validity of hypotheses and answer their questions in order to identify the impact of the application of standards International accreditation (JCI) on the performance of health services at King Khalid National Guard in Jeddah, by relying on the questionnaire will be designed according to scientific steps recognized.
The first two sources of data will be based on a review of the sources of the study and the International Accreditation Standards (JCI), as well as reviewing the studies that dealt with both the international accreditation standards and the efficiency of health care services at the local and Arab foreign levels.
The researcher will collect data from the field by applying the study criteria to a sample of the study community that is representative of the original community, which includes two parts. First, general information about the respondent includes his / her scientific qualification, experience, section, Measure the study variables. Methods of statistical analysis: In order to reach accurate and unified indicators that serve the objectives of the study and test hypotheses, the researcher adopted the following statistical methods: The percentage, frequency, arithmetical mean and standard deviation were used to measure the dispersion of the responses to the mean values of the mean, as well as to show the views of the study sample in their variables and to determine the importance of the paragraphs in the questionnaire.

Numerical Results
This section deals with the results of the statistical analysis that was carried out using the statistical packages program (SPSS). The descriptive analysis and the hypothesis testing were included as follows: The aim of this study was to identify the views of the study sample members regarding the impact of applying the JCI on the performance of the health services at King Khalid National Guard Hospital in Jeddah. To achieve this goal, a questionnaire was developed to survey the views of the study sample. The sample of the study was retrieved. After the audit, 4 questionnaires were neglected because the answers were not completed. Consequently, 114 questionnaires were applied. Statistical analysis was conducted at the statistical significance level (α 0.05 0.05). Table 1 indicates a medium degree of institution, leadership and management with an average of 3.9928 (3.9928) indicating a high level of institution, leadership and management. The table indicates that the value of the square of Kai is a positive value and statistical function at the level of significance (0.05) for all the paragraphs of the axis, indicating a consensus on the axis. Table 2 indicates a high degree of importance for the axis of the standards of the management of supporting services, where the mean of the related paragraphs (3.99), which indicates the average efficiency in the axis of standards of management of supporting, services. Also, the indicates a statistical significance at the level of (0.05) for the value of the square of Kay in all indicating that the sample members of the study are consistent on the result.

Conclusion and Recommendations
The rapid technological and scientific development in the world, accompanied by changes in the economic situation led to the emergence of institutions to raise the level of services in the health sector. With the development of quality concepts and increased interest in health, a new era of quality has emerged in health care and in subsequent years. Quality control and standards, which have become all aspects of health services, are the criteria that qualify hospitals to gain competitive advantage in the ranks of international hospitals in the level of health care provided to patients, and because of the importance of hospitals in the Kingdom, Fiat to international reliability to win the prestigious position, which drives hospitals in the Kingdom to the occupation of the forefront of health services in the Arab region and the growing demand for them, making the adoption of international standards required to keep pace with the development of health services in order to maintain its leadership position and raise the status and reputation, The JCI is a branch of the Joint Commission for Accrediting Health Institutions in America (CICC), established to provide accreditation services outside the United States, Divided into three parts: a patient segment, an institution-focused part, a performance segment. We finally concluded that:- In the light of the findings, the study reached the following recommendations:-• Work to monitor adherence to international standards of quality of health service because of their impact on the efficiency of health service. 4 All the services available in the hospital from television broadcasting to cafeteria services ---etc. are in accordance with the wishes of patients. The hospital management conducts studies on the quality of performance to work with its recommendations and analyzes to improve the quality of the services it provides. The information is handled and analyzed in scientific ways and with high accuracy to ensure its quality. 4.14 0.818 53.584 0.000 The overall mean of the axis 3.99 0.837 • Work on continuous assessment of adherence to international standards for quality of health service. • The need to work as King Khalid National Guard Hospital as a model for the rest of the hospitals in the Kingdom in the extent of applying international standards in quality. • Conduct further studies on the impact of the implementation of the International Accreditation Standards (JCI) on the performance of health services in hospitals in the Kingdom. • Work on the dissemination of the results of the study on hospitals because of their significant impact on raising the level of performance, and uplift.