A presente dissertação tem por objetivo problematizar discursos que constituem as práticas de Acreditação Hospitalar da Joint Commission International mais especificamente, aquelas enunciações voltadas para a formação/educação e empresariamento dos colaboradores. Baseada nas ideias de Michel Foucault, a pesquisa desenvolve-se na operação de conceitos/ferramentas da governamentalidade e, como constituintes desta, do governamento e da subjetivação. Como superfície de análise, foi utilizada a quinta edição do Manual de Padrões de Acreditação Hospitalar da Joint Commission International. As reflexões desenvolvidas permitem ver que os discursos da saúde, empresariais e educacionais ao articularem-se em uma grade de inteligibilidade neoliberal, operam na construção de possibilidades competitivas de formação dos colaboradores, visando a transformação do éthos hospitalar, a partir da transformação do colaborador. Portanto, há um novo éthos hospitalar formativo e homogeneizador, construído na Contemporaneidade, que impõem à Joint Commission International a escuta permanente dos clientes e, para estes, investimentos em sua formação profissional e em padronização de serviços e atendimentos. / This work aims to debate the discourses that constitute the practices of Hospital Accreditation of the Joint Commission International; more specifically, those enunciations directed to the training/education and entrepreneurship of employees. Based on Michel Foucault's ideas, the research develops operating concepts/tools of governmentality and, as constituents thereof, of the government and subjectivation. As surface to be analysed was used the fifth edition of Hospital Accreditation Standards Manual of the Joint Commission International. The developed analyses allow us to see that the discourses of health, business and education are articulated in a neoliberal intelligibility grid and operate in building competitive opportunities for employee training, aiming at the transformation of the hospital ethos from the transformation of the employee on a businessman himself. So there is a new hospital ethos, training and homogenizing, built in contemporary times, which impose to the Joint Commission International permanent listening to customers, and for them, investments in their training and standardization of services and attendances. / Esta tesis pretende problematizar los discursos que constituyen las prácticas del Hospital de acreditación de la Joint Commission International, más concretamente, esas declaraciones dirigidas a la formación / educación y el espíritu empresarial de los empleados. Sobre la base de las ideas de Michel Foucault, la investigación se desarrolla los conceptos de operaciones / herramientas gubernamentalidad y como componentes de los mismos, del governamento y subjetividad. Como análisis de superficie, se utilizó la quinta edición del Manual de Normas de acreditación de hospitales de la Joint Commission International. Las reflexiones desarrolladas nos permiten ver que los discursos de la salud, los negocios y la educación para articular en una cuadrícula inteligibilidad neoliberal, trabajamos en la construcción de oportunidades competitivas para la capacitación del personal, orientadas a la transformación de la ética del hospital, de la transformación del empleado. Así que hay un nuevo hospital éthos y la formación homogeneizador, construida en el contemporáneo, que practican la escucha permanente de la Comisión Conjunta Internacional a los clientes y, por estas inversiones en su formación y estandarización de servicios y comodidades.

A presente dissertação tem por objetivo problematizar discursos que constituem as práticas de Acreditação Hospitalar da Joint Commission International mais especificamente, aquelas enunciações voltadas para a formação/educação e empresariamento dos colaboradores. Baseada nas ideias de Michel Foucault, a pesquisa desenvolve-se na operação de conceitos/ferramentas da governamentalidade e, como constituintes desta, do governamento e da subjetivação. Como superfície de análise, foi utilizada a quinta edição do Manual de Padrões de Acreditação Hospitalar da Joint Commission International. As reflexões desenvolvidas permitem ver que os discursos da saúde, empresariais e educacionais ao articularem-se em uma grade de inteligibilidade neoliberal, operam na construção de possibilidades competitivas de formação dos colaboradores, visando a transformação do éthos hospitalar, a partir da transformação do colaborador. Portanto, há um novo éthos hospitalar formativo e homogeneizador, construído na Contemporaneidade, que impõem à Joint Commission International a escuta permanente dos clientes e, para estes, investimentos em sua formação profissional e em padronização de serviços e atendimentos. / This work aims to debate the discourses that constitute the practices of Hospital Accreditation of the Joint Commission International; more specifically, those enunciations directed to the training/education and entrepreneurship of employees. Based on Michel Foucault's ideas, the research develops operating concepts/tools of governmentality and, as constituents thereof, of the government and subjectivation. As surface to be analysed was used the fifth edition of Hospital Accreditation Standards Manual of the Joint Commission International. The developed analyses allow us to see that the discourses of health, business and education are articulated in a neoliberal intelligibility grid and operate in building competitive opportunities for employee training, aiming at the transformation of the hospital ethos from the transformation of the employee on a businessman himself. So there is a new hospital ethos, training and homogenizing, built in contemporary times, which impose to the Joint Commission International permanent listening to customers, and for them, investments in their training and standardization of services and attendances. / Esta tesis pretende problematizar los discursos que constituyen las prácticas del Hospital de acreditación de la Joint Commission International, más concretamente, esas declaraciones dirigidas a la formación / educación y el espíritu empresarial de los empleados. Sobre la base de las ideas de Michel Foucault, la investigación se desarrolla los conceptos de operaciones / herramientas gubernamentalidad y como componentes de los mismos, del governamento y subjetividad. Como análisis de superficie, se utilizó la quinta edición del Manual de Normas de acreditación de hospitales de la Joint Commission International. Las reflexiones desarrolladas nos permiten ver que los discursos de la salud, los negocios y la educación para articular en una cuadrícula inteligibilidad neoliberal, trabajamos en la construcción de oportunidades competitivas para la capacitación del personal, orientadas a la transformación de la ética del hospital, de la transformación del empleado. Así que hay un nuevo hospital éthos y la formación homogeneizador, construida en el contemporáneo, que practican la escucha permanente de la Comisión Conjunta Internacional a los clientes y, por estas inversiones en su formación y estandarización de servicios y comodidades.

A presente dissertação tem por objetivo problematizar discursos que constituem as práticas de Acreditação Hospitalar da Joint Commission International mais especificamente, aquelas enunciações voltadas para a formação/educação e empresariamento dos colaboradores. Baseada nas ideias de Michel Foucault, a pesquisa desenvolve-se na operação de conceitos/ferramentas da governamentalidade e, como constituintes desta, do governamento e da subjetivação. Como superfície de análise, foi utilizada a quinta edição do Manual de Padrões de Acreditação Hospitalar da Joint Commission International. As reflexões desenvolvidas permitem ver que os discursos da saúde, empresariais e educacionais ao articularem-se em uma grade de inteligibilidade neoliberal, operam na construção de possibilidades competitivas de formação dos colaboradores, visando a transformação do éthos hospitalar, a partir da transformação do colaborador. Portanto, há um novo éthos hospitalar formativo e homogeneizador, construído na Contemporaneidade, que impõem à Joint Commission International a escuta permanente dos clientes e, para estes, investimentos em sua formação profissional e em padronização de serviços e atendimentos. / This work aims to debate the discourses that constitute the practices of Hospital Accreditation of the Joint Commission International; more specifically, those enunciations directed to the training/education and entrepreneurship of employees. Based on Michel Foucault's ideas, the research develops operating concepts/tools of governmentality and, as constituents thereof, of the government and subjectivation. As surface to be analysed was used the fifth edition of Hospital Accreditation Standards Manual of the Joint Commission International. The developed analyses allow us to see that the discourses of health, business and education are articulated in a neoliberal intelligibility grid and operate in building competitive opportunities for employee training, aiming at the transformation of the hospital ethos from the transformation of the employee on a businessman himself. So there is a new hospital ethos, training and homogenizing, built in contemporary times, which impose to the Joint Commission International permanent listening to customers, and for them, investments in their training and standardization of services and attendances. / Esta tesis pretende problematizar los discursos que constituyen las prácticas del Hospital de acreditación de la Joint Commission International, más concretamente, esas declaraciones dirigidas a la formación / educación y el espíritu empresarial de los empleados. Sobre la base de las ideas de Michel Foucault, la investigación se desarrolla los conceptos de operaciones / herramientas gubernamentalidad y como componentes de los mismos, del governamento y subjetividad. Como análisis de superficie, se utilizó la quinta edición del Manual de Normas de acreditación de hospitales de la Joint Commission International. Las reflexiones desarrolladas nos permiten ver que los discursos de la salud, los negocios y la educación para articular en una cuadrícula inteligibilidad neoliberal, trabajamos en la construcción de oportunidades competitivas para la capacitación del personal, orientadas a la transformación de la ética del hospital, de la transformación del empleado. Así que hay un nuevo hospital éthos y la formación homogeneizador, construida en el contemporáneo, que practican la escucha permanente de la Comisión Conjunta Internacional a los clientes y, por estas inversiones en su formación y estandarización de servicios y comodidades.

The Devils Lake defection of 2005 demands a re-evaluation of the venerable Boundary Waters Treaty (BWT) between Canada and the United States. Why was the long-successful water agreement unable to solve this relatively minor dispute? More importantly, given irregularities between theoretical assertions and institutional history, what theory of international relations best explains a cooperative agreement that spans a near-century? Due to the complexities of shared river systems, any theory that seeks to explain international cooperation must adequately encompass three separate sources of state motivation. First, it must explain the technical, basin-position-driven realities that affect state attitudes towards negotiations. Second, it must explain the longer-term strategic factors that can inspire states to accept immediate losses for subsequent gains. Finally, it must acknowledge domestic sources of influence and understand how these forces constrain the state vis-à-vis others. This paper argues that liberalism, as defined by Andrew Moravcsik, is the best theoretical candidate. This is proven by comparing interpretations of the BWT history through realist, neoliberal, constructivist, and liberal lenses. After identifying and examining each theory's strengths and weaknesses, liberalism emerges as the most holistic view and should be favoured as a primary explanatory theory. Liberalism's theoretical underpinnings – interest group politics – best handles the technical, strategic, and domestic influences that affect Canada-US water relations. Whether examining what prompted efforts to initiate a water-sharing agreement, explaining the agreement's final structure, determining the impetus for continued cooperation, or identifying the incentives to finally break from treaty obligations, liberalism provides the most satisfying solutions. Though derived from the Canada-US border relationship, liberalism's superiority is not limited to the North American watershed. Because the factors examined are common to all shared international river systems and the paper's results are scalable, this suggests that liberalism will continue to be the appropriate primary IR theory to employ when examining state decision-making regarding water-sharing agreements.

The Devils Lake defection of 2005 demands a re-evaluation of the venerable Boundary Waters Treaty (BWT) between Canada and the United States. Why was the long-successful water agreement unable to solve this relatively minor dispute? More importantly, given irregularities between theoretical assertions and institutional history, what theory of international relations best explains a cooperative agreement that spans a near-century? Due to the complexities of shared river systems, any theory that seeks to explain international cooperation must adequately encompass three separate sources of state motivation. First, it must explain the technical, basin-position-driven realities that affect state attitudes towards negotiations. Second, it must explain the longer-term strategic factors that can inspire states to accept immediate losses for subsequent gains. Finally, it must acknowledge domestic sources of influence and understand how these forces constrain the state vis-à-vis others. This paper argues that liberalism, as defined by Andrew Moravcsik, is the best theoretical candidate. This is proven by comparing interpretations of the BWT history through realist, neoliberal, constructivist, and liberal lenses. After identifying and examining each theory's strengths and weaknesses, liberalism emerges as the most holistic view and should be favoured as a primary explanatory theory. Liberalism's theoretical underpinnings – interest group politics – best handles the technical, strategic, and domestic influences that affect Canada-US water relations. Whether examining what prompted efforts to initiate a water-sharing agreement, explaining the agreement's final structure, determining the impetus for continued cooperation, or identifying the incentives to finally break from treaty obligations, liberalism provides the most satisfying solutions. Though derived from the Canada-US border relationship, liberalism's superiority is not limited to the North American watershed. Because the factors examined are common to all shared international river systems and the paper's results are scalable, this suggests that liberalism will continue to be the appropriate primary IR theory to employ when examining state decision-making regarding water-sharing agreements.

Thesis (Ph. D.)--McMaster University, 2001. / Includes bibliographical references (leaves 234-244). Also available via World Wide Web.

The Devils Lake defection of 2005 demands a re-evaluation of the venerable Boundary Waters Treaty (BWT) between Canada and the United States. Why was the long-successful water agreement unable to solve this relatively minor dispute? More importantly, given irregularities between theoretical assertions and institutional history, what theory of international relations best explains a cooperative agreement that spans a near-century? Due to the complexities of shared river systems, any theory that seeks to explain international cooperation must adequately encompass three separate sources of state motivation. First, it must explain the technical, basin-position-driven realities that affect state attitudes towards negotiations. Second, it must explain the longer-term strategic factors that can inspire states to accept immediate losses for subsequent gains. Finally, it must acknowledge domestic sources of influence and understand how these forces constrain the state vis-à-vis others. This paper argues that liberalism, as defined by Andrew Moravcsik, is the best theoretical candidate. This is proven by comparing interpretations of the BWT history through realist, neoliberal, constructivist, and liberal lenses. After identifying and examining each theory's strengths and weaknesses, liberalism emerges as the most holistic view and should be favoured as a primary explanatory theory. Liberalism's theoretical underpinnings – interest group politics – best handles the technical, strategic, and domestic influences that affect Canada-US water relations. Whether examining what prompted efforts to initiate a water-sharing agreement, explaining the agreement's final structure, determining the impetus for continued cooperation, or identifying the incentives to finally break from treaty obligations, liberalism provides the most satisfying solutions. Though derived from the Canada-US border relationship, liberalism's superiority is not limited to the North American watershed. Because the factors examined are common to all shared international river systems and the paper's results are scalable, this suggests that liberalism will continue to be the appropriate primary IR theory to employ when examining state decision-making regarding water-sharing agreements. / Arts, Faculty of / Political Science, Department of / Graduate

The International Joint Commission was instituted under the Boundary Waters Treaty of 1909; it held its constitutive meeting in 1912. The prime purpose of this organization is to prevent or settle Canadian -U.S. boundary waters - and certain other - disputes. The functions and powers the Commission was given under the 1909 Treaty are divided into four categories: administrative, quasi-judicial, arbitral, and investigative and advisory. The administrative functions were restricted to a then controversial group of boundary waters in the prairies. In its quasi-judicial capacity, which accounted for the majority of its work in the first half of its existence, the Commission is empowered to grant or withhold permission for certain planned endeavours - public or private - that would affect boundary waters. Thus far, the services of the Commission in its arbitral capacity have not been called upon. In recent years most of the Commission's work has resulted from matters referred to it by the two federal Governments for investigation and advisory opinion. In its most comprehensive endeavour yet the Commission, at the request of the two Governments in 1964, investigated and reported upon pollution in the lower Great Lakes and the international section of the St. Lawrence River. The Commission's final findings and recommendations, published in December, 1970, provided the basis for the Great Lakes Water Quality Agreement, entered into by Canada and the United States sixteen months later. The Agreement is a comprehensive and detailed pollution abatement programme, based upon laid down water quality objectives. It gives the Commission certain, primarily surveillance powers wiith regard to Great Lakes pollution without, however, changing the fundamental structure of its functions and powers. Though the clean-up of the Great Lakes is taking considerably longer than expected the two signatory countries can, according to the wording of the Agreement, hardly be held liable for breach of treaty. A comparison with several international commissions concerned with water resources reveals that the performance record of the International Joint Commission is decidedly superior to that of the others. This can be attributed to certain extrinsic advantages which it has over its counterparts, such as the number of countries involved, their political, cultural and economic proximity, and the geographically balanced location of the boundary waters, as well as to the way in which it has conducted its business, thus building up a respectable reputation over the years. Nevertheless, the Commission can ill afford to rest on its laurels. There remains considerable room for improvement in its operations. Moreover, major decisions concerning its future structure as well as a reassessment of its future role will have to be made in the near future. The final part of this thesis examines 1. whether the size of the Commission itself should be increased or whether the present six Commissioners should, instead, all serve on a full-time basis; the!latter is preferred; 2. whether the Commission should, or should not move towards becoming an international Great Lakes environmental administrative authority; basically, it should not; 3. the extent to which the public can participate in the work of the Commission. / Law, Peter A. Allard School of / Graduate

The purpose of this thesis was to explore the literature regarding physicians’ prescriptions of opioid analgesics before and after The Joint Commission Pain Standards for 2001. Opioids are a last resort treatment for chronic pain due to their high potential for tolerance, dependency, and misuse. The establishment of The Joint Commission Pain Standards for 2001 was the culmination of several movements to address the underassessment and undertreatment of pain. The Joint Commission Pain Standards for 2001 focused on improving pain assessment, management, and treatment through a systematic approach. The Joint Commission (TJC), formerly the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), is the largest accrediting body for healthcare organizations in the United States and affects thousands of medical care facilities and physicians. Although many physicians were hesitant to prescribe opioids due to addiction concerns, opioid prescriptions rose due to pressures to meet the TJC’s accreditation requirements and maintain patient satisfaction. Pain management seemed to improve for a short period before adverse reactions and unintended consequences emerged. Confusing language within the TJC Pain Standards for 2001 and its supplemental materials and misleading information from researchers and pharmaceutical companies led to unnecessary pain measurement, problematic pain treatment algorithms, and excessive opioid analgesic use. As patient safety concerns emerged, the TJC continuously amended the TJC Pain Standards for 2001. They were revised in 2017 as the opioid epidemic became a national public health emergency. The TJC has since called for better evaluation of research validity, more vigilant examination for conflicts of interest, and more detailed instructions on interpreting and implementing future standards. The medical community, pharmaceutical industry, government, and the public need to coordinate future strategies to combat the opioid epidemic.

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No. of bitstreams: 1 FRANCIELLE_BENETT_FALAVIGNA_DIS.pdf: 4248800 bytes, checksum: 0e099a12a5fff54b63e5804575c11948 (MD5) Previous issue date: 2018-12-04 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior - CAPES / Our research objective is to accredited hospital organizations, aiming to analyze the organizational discourses of hospitals with international accreditation by the Joint Commission International (JCI) that emerge in the digital environment, especially in their sites / portals; discussing the possible occurrence [or not] of some discursive intention relationship that would legitimize Joint Commission International (JCI) accreditation; and to investigate how these organizations (re) construct themselves discursively from the interaction mediated by the computer. In order to meet these objectives, we used the communication conceptions of Fran?a (2006) and Wolton (2010), to understand the interaction levels of Primo (2011, 2013) and the interaction dimensions proposed by Oliveira (2016), elements of the philosophy of language of Bakhtin (2011, 2014) and to the theoretical-methodological approach of Charaudeau (2007; 2008). Scroferneker, Amorim and Oliveira (2016), subsidized our understanding of organizational and organizational communication and Fairhurts and Putnan (2010), on the conception that organizations constitute as discursive constructions. Santaella (2006, 2007, 2010), Lima (2008), among others, supported our discussions / reflections on digital environment / communication, media / social networks and mediated interactions. We selected the Hospital of Clinics of Porto Alegre (HCPA), accredited in 2017 and considered as a Reference University Hospital, as a case study. Considering the dimensions suggested by Oliveira (2016) and the interaction levels of Primo (2011), we identified an informational posture by the HCPA when interactions analyzed on Facebook and Twitter platforms. Likewise, we note that the Hospital legitimizes and (re) affirms in its site / portal the speech seeking to approximate its values to the requests of the accreditation organization. / Nuestro objeto de investigaci?n son las organizaciones hospitalarias acreditadas, teniendo como objetivos analizar los discursos organizacionales de hospitales con acreditaci?n internacional por la Joint Commission International (JCI) que emergen en el ambiente digital, especialmente en sus sitios / portales; discutir la posible ocurrencia [o no] de alguna relaci?n de intenci?n discursiva que legitime la acreditaci?n de la Joint Commission International (JCI); e investigar sobre c?mo estas organizaciones se re-construyen discursivamente a partir de la interacci?n mediada por el ordenador. Para atender a estos objetivos recurrimos a las concepciones de comunicaci?n de Fran?a (2006) y Wolton (2010), al entendimiento de los niveles interacci?n de Primo (2011, 2013) ya las dimensiones de interacci?n propuestas por Oliveira (2016), elementos de la filosof?a del lenguaje de Bakhtin (2011, 2014) y al enfoque te?rico-metodol?gico de Charaudeau (2007; 2008). (2006), sobre la concepci?n de que las organizaciones se constituyen como construcciones discursivas. Santaella (2006, 2007, 2010), Lima (2008), entre otros autores, a su vez, apoyaron nuestras discusiones / reflexiones sobre ambiente / comunicaci?n digital, medios / redes sociales e interacciones medi?ticas. En cuanto a las dimensiones sugeridas por Oliveira (2016) y los niveles de interacci?n de Primo (2011), identificamos una postura informacional, por parte del HCPA, cuando las interacciones analizadas en las plataformas de Facebook y Twitter. Igualmente, observamos que el Hospital legitima y (re) afirma en su sitio / portal el discurso buscando aproximar sus valores a las solicitudes de la organizaci?n acreditadora. / O nosso objeto de pesquisa s?o as organiza??es hospitalares acreditadas, tendo como objetivos analisar os discursos organizacionais de hospitais com acredita??o internacional pela Joint Commission International (JCI) que emergem na ambi?ncia digital, especialmente nos seus sites/portais; discutir a poss?vel ocorr?ncia [ou n?o] de alguma rela??o de inten??o discursiva que legitime a acredita??o da Joint Commission International (JCI); e, investigar sobre como essas organiza??es se (re)constroem discursivamente a partir da intera??o mediada pelo computador. Para atender a esses objetivos recorremos ?s concep??es de comunica??o de Fran?a (2006) e Wolton (2010), ao entendimento dos n?veis intera??o de Primo (2011, 2013) e ?s dimens?es de intera??o propostas por Oliveira (2016), elementos da filosofia da linguagem de Bakhtin (2011, 2014) e ? abordagem te?rico-metodol?gica de Charaudeau (2007; 2008). Scroferneker, Amorim e Oliveira (2016), subsidiaram o nosso entendimento sobre organiza??es e comunica??o organizacional e Fairhurts e Putnan (2010), sobre a concep??o de que as organiza??es se constituem como constru??es discursivas. Santaella (2006, 2007, 2010), Lima (2008), dentre outros autores, por sua vez, apoiaram nossas discuss?es/reflex?es sobre ambi?ncia/comunica??o digital, m?dias/redes sociais e intera??es midiatizadas. Selecionamos o Hospital de Cl?nicas de Porto Alegre (HCPA), acreditado em 2017 e considerado como um Hospital Universit?rio de refer?ncia, como estudo de caso. Considerando as dimens?es sugeridas por Oliveira (2016) e os n?veis de intera??o de Primo (2011), identificamos uma postura informacional, por parte do HCPA, quando das intera??es analisadas nas plataformas do Facebook e do Twitter. Igualmente, observamos que o Hospital legitima e (re)afirma em seu site/portal o discurso buscando aproximar os seus valores ?s solicita??es da organiza??o acreditadora.