Medical facilities are forced into a position of working together for the sake of the patient. Nursing homes, doctor’s offices, rehabilitation centers, hospitals, and hospice centers all must communicate with each other in order to provide the best care possible. Due to advances in technology, these individual entities can communicate easier with each other than ever before. Email communications, video/telephone communications make acquiring important information less time consuming and exceptionally easy for anyone involved. These new technologies also make it easier for supervisors and subordinates to communicate information to each other, even when they happen to be in different locations. “When two individuals coordinate their actions within a predefined hierarchy—such as when supervisors communicate with subordinates—their interactions are an observable manifestation of organization-in-action. ” (Bidel, Messersmith & Kelley, 2012). One of the most important aspects of attempting a staff buy-in to any change in policy or procedure is to make the staff feel as though they had a hand in deciding how to implement the new policy or procedure changes. Staff members like to feel that their voice and opinion matters in the decision making process where they work. Staff members feel this way because any policy changes or procedural changes are changes that will directly affect their everyday work habits and life. It is important for a facility to do everything they can to follow all regulatory statutes that are required of the business, but it is more important to have a staff that is willing to do all they can to help your business reduce any potential risks that could arise. Training the staff accordingly to follow the proper procedural directives in accordance with state/federal regulations will ensure that the facility is reducing as much of their risk as possible. It is also important to schedule points during the year for additional training for changes that are occasionally made to regulations within the accreditation process. If a medical facility does not stay on top of changing regulations they can find themselves in a bad position both legally and financially. Medical facilities can be put in position to lose their license to practice, be fined into closure, and depending on the level of the violation staff members could be risking jail time for not following regulations precisely. There is nothing more important in a medical facility than patient safety and being compliant of regulations and following regulations contributes to patient safety. Long-Term Acute Care Hospitals are health care organizations that provide post-acute care and services to patients who are discharged from acute care hospitals, but need a longer stay to get well. Patients admitted to LTACH’s are not well enough to be discharged home or to an Assisted Living Facility, where caregivers provide assistance for gainful living. Upon discharged from LTACH’s some patients in need of extensive rehabilitation were referred to Acute Care Rehabilitation Facilities for further care before the patient is discharged home. Terminally ill patients in need of palliative services, upon permission were discharged from Long-Term Acute Care Hospitals and were admitted to hospices for further end-of-life care (Jones, 2012). Each health care organization and assisted living facility are accredited and regulated by the Centers of Medicare and Medicaid Service. They are also subjected to Joint Commission accreditation and standards to obtain and maintain accredited authority through the Center of Medicare and Medicaid Services, which operates under the jurisdiction of the Department of Health and Human Services. Healthcare organizations operating under state regulators may differ in Joint Commission standards (CMS, 2012). The Center of Medicare and Medicaid Services (CMS) and the Joint Commission establishes grounds and conditions for participation, and interprets guidelines for compliance. It is noted that Joint Commission’s hospital accreditation program were subjected to Centers for Medicare and Medicaid Services (CMS) requirements for organizations seeking accrediting authority. The Joint Commission (JC) also provides CMS with surveys and reports for healthcare organizations requiring and requesting accreditation and seeking to participate in, and receive payment from Medicare and Medicaid programs. Healthcare organization must become certified and comply with the Conditions of Participation (COP) or federal standards (CMS, 2012). Certifications were based on surveys conducted by state agencies on the behalf of the Center of Medicare and Medicaid Services (CMS). On the other hand, Joint Commission (JC) as a national accrediting organization can evaluate, and classify healthcare organizations as possessing standards that meet the criteria of federal Condition of Participation; therefore CMS may grant that particular accredited healthcare organization “deemed status,” which are not subjected to surveys conducted by Medicare. Deemed status options are available for hospices, home health agencies, assisted living facilities, hospitals, and other health care service providers (CMS, 2012). Risk and quality management compliments each other and are two important components in organizational structuring, maintenance, and securing the sustainability of health care organizations. They are among the most highly regulated sectors of commerce, especially because administrative liabilities and criminal sanctions could be imposed against health care organizations. Compliances to regulations and the developing risk and quality management systems, contributes to the each of these organization’s entire performance-management system. Effective management improves the healthcare provider’s ability to provide quality care. It promotes better patient, reduces errors, and reduces the likelihood of unexpected events (Lee, 2011). The overall performance management systems improve quality services, ensure better resource planning for effective utilization and ensure that the organization is in compliance with governing regulations that could affect licensing. Effective management also provides assurance to stakeholders that the healthcare organization is meeting expectations, which includes integrating risk and quality management systems that produce the right outcomes for continuance quality improvement and secure the organizations ability to serve public by providing quality care (Phoenix, 2011). Risk and quality management programs utilizes a performance management system to identify risk ,waste, identify federal standard, regulation, setting goals, requirements for accreditation, assigning accountability, monitoring performance and making adjustments as necessary. Evaluating progress, providing feedback and communicate results are among the many activities that comprise a performance management system. As you conduct your research, remember the broad efinition of a performance-management system: a comprehensive system used by an organization to ensure that the organization achieves its goals and improves its performance. A performance-management system is the overarching system that encompasses both risk management and quality management. Determine how compliance with the regulations and development of risk- and quality-management systems for each type of organization contribute to the organization’s overall performance-management system.