Healthcare organization management -- Requirements for patient-centred staffing

This document provides requirements for patient-centred staffing in healthcare settings. It is generic and applicable to any healthcare organization.

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Status
Published
Publication Date
07-Jun-2021
Current Stage
5060 - Close of voting Proof returned by Secretariat
Start Date
01-May-2021
Completion Date
30-Apr-2021
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INTERNATIONAL ISO
STANDARD 22956
First edition
2021-06
Healthcare organization
management — Requirements for
patient-centred staffing
Reference number
ISO 22956:2021(E)
ISO 2021
---------------------- Page: 1 ----------------------
ISO 22956:2021(E)
COPYRIGHT PROTECTED DOCUMENT
© ISO 2021

All rights reserved. Unless otherwise specified, or required in the context of its implementation, no part of this publication may

be reproduced or utilized otherwise in any form or by any means, electronic or mechanical, including photocopying, or posting

on the internet or an intranet, without prior written permission. Permission can be requested from either ISO at the address

below or ISO’s member body in the country of the requester.
ISO copyright office
CP 401 • Ch. de Blandonnet 8
CH-1214 Vernier, Geneva
Phone: +41 22 749 01 11
Email: copyright@iso.org
Website: www.iso.org
Published in Switzerland
ii © ISO 2021 – All rights reserved
---------------------- Page: 2 ----------------------
ISO 22956:2021(E)
Contents Page

Foreword ........................................................................................................................................................................................................................................iv

Introduction ..................................................................................................................................................................................................................................v

1 Scope ................................................................................................................................................................................................................................. 1

2 Normative references ...................................................................................................................................................................................... 1

3 Terms and definitions ..................................................................................................................................................................................... 1

4 Determining the scope of the healthcare organization ................................................................................................ 2

4.1 General ........................................................................................................................................................................................................... 2

4.2 Interested parties ................................................................................................................................................................................. 2

4.3 Documented information throughout the organization...................................................................................... 3

5 Leadership .................................................................................................................................................................................................................. 3

5.1 General ........................................................................................................................................................................................................... 3

5.2 Patient-focus ............................................................................................................................................................................................. 4

5.3 Traceability ................................................................................................................................................................................................ 4

6 Risks, opportunities, expectations and perceptions ....................................................................................................... 4

6.1 Addressing risks and opportunities ..................................................................................................................................... 4

6.2 Risk assessment ..................................................................................................................................................................................... 5

6.3 Gaps between expectations and perceptions — patients and staff ........................................................... 5

7 Resources ..................................................................................................................................................................................................................... 6

7.1 Environment for the operation of processes ................................................................................................................ 6

7.2 Competence and key skills ............................................................................................................................................................ 6

7.3 Organizational qualities and values ...................................................................................................................................... 7

7.4 Communication ...................................................................................................................................................................................... 7

8 Analysis and evaluation ................................................................................................................................................................................ 7

Bibliography ................................................................................................................................................................................................................................ 9

© ISO 2021 – All rights reserved iii
---------------------- Page: 3 ----------------------
ISO 22956:2021(E)
Foreword

ISO (the International Organization for Standardization) is a worldwide federation of national standards

bodies (ISO member bodies). The work of preparing International Standards is normally carried out

through ISO technical committees. Each member body interested in a subject for which a technical

committee has been established has the right to be represented on that committee. International

organizations, governmental and non-governmental, in liaison with ISO, also take part in the work.

ISO collaborates closely with the International Electrotechnical Commission (IEC) on all matters of

electrotechnical standardization.

The procedures used to develop this document and those intended for its further maintenance are

described in the ISO/IEC Directives, Part 1. In particular, the different approval criteria needed for the

different types of ISO documents should be noted. This document was drafted in accordance with the

editorial rules of the ISO/IEC Directives, Part 2 (see www .iso .org/ directives).

Attention is drawn to the possibility that some of the elements of this document may be the subject of

patent rights. ISO shall not be held responsible for identifying any or all such patent rights. Details of

any patent rights identified during the development of the document will be in the Introduction and/or

on the ISO list of patent declarations received (see www .iso .org/ patents).

Any trade name used in this document is information given for the convenience of users and does not

constitute an endorsement.

For an explanation of the voluntary nature of standards, the meaning of ISO specific terms and

expressions related to conformity assessment, as well as information about ISO's adherence to the

World Trade Organization (WTO) principles in the Technical Barriers to Trade (TBT), see www .iso .org/

iso/ foreword .html.

This document was prepared by Technical Committee ISO/TC 304, Healthcare organization management.

Any feedback or questions on this document should be directed to the user’s national standards body. A

complete listing of these bodies can be found at www .iso .org/ members .html.
iv © ISO 2021 – All rights reserved
---------------------- Page: 4 ----------------------
ISO 22956:2021(E)
Introduction
0.1 General

Healthcare personnel work in highly complex environments characterized by multiple competing

challenges, including interdependent processes, a growing population of older, more acutely ill

hospitalized patients, the need to stay current with rapid advances in medical knowledge and

technology, and a multigenerational and multi-cultural workforce. The ever-changing demands of the

new healthcare delivery models exacerbate the complexity by orders of magnitude.

Healthcare personnel work across all sectors and settings and are integral to the delivery of a range

of health services. They monitor and respond to changes in patients’ health status, develop care plans,

deliver interventions and educate patients about self-care. As key players on the front lines of healthcare

delivery, they play a critical role in providing care, coordinating care, preventing adverse events and

optimizing patient outcomes.

Adopting a healthcare standard for patient-centred staffing is a strategic decision for healthcare

organizations; it can assist health services in improving overall performance. This document provides

a robust set of requirements which support sustainable development initiatives within a managed

framework. Patient-centred staffing has emerged as a globally important area within health services.

Patient satisfaction is an important underpinning concept associated with the implementation of this

document. Organizations monitor patients’ perceptions and views about their experiences, and whether

their needs and expectations have been met. They determine the methods for obtaining, monitoring

and reviewing this information, including:
— service-specific or general patient surveys;
— patient focus group and quality circles;
— written expressions or comments and concerns.

Healthcare organizations are encouraged to cooperate with interested parties (see 4.2) in the

development, deployment and execution of patient-centred staffing standards. Interested parties can

have valuable input and feedback to improve the effectiveness of these standards, and a cooperative

relationship can improve satisfaction among interested parties. Likewise, healthcare organizations are

encouraged to share with interested parties relevant information regarding patient-centred staffing

standards, for example the processes and procedures that are important to these parties.

0.2 Patient-centred staffing principles for healthcare

This document is based on healthcare management principles described in organization management

or leadership healthcare literature and incorporates knowledge about effective quality management.

Patient-centred staffing in healthcare considers:
— workforce planning;
— evaluating staffing methodologies;
— internal and external resource allocation and management;
— forecasting and planning across the service;

— improving patient care and facilitating opportunities to enhance patient satisfaction;

— providing services that meet patient needs;

— meeting the range of applicable statutory, regulatory and guideline requirements;

— addressing risks and opportunities;
© ISO 2021 – All rights reserved v
---------------------- Page: 5 ----------------------
ISO 22956:2021(E)
— enabling capacity planning in emergency situations.

Patient-centred staffing considers the requirements to match healthcare service personnel expertise

with the needs of the patient. This expertise should include a full range of professional experience

required to deliver holistic care and meet the needs of the patient. Those needs relate to age, family,

home environment and personal circumstances, culture and kind of illness – acute or chronic.

Broadly speaking, the principles for patient-centred staffing are based on the following:

— considerations of patient safety;
— risk management;
— providing a seamless experience for patients;
— the practice environment;

— management of continuity in healthcare: in-patient (hospitalized) and out-patient (ambulatory)

telemedicine and home hospitalization;
— quality of healthcare;
— organizational culture, leadership and people engagement;
— the deployment of a systematic process-based approach;
— evidence-based decision making;
— technology and innovation;
— governance;
— the patient and service context.
The benefits to an organization of implementing this document are:

— providing methods for reviewing and allocating resources for effective staffing;

— effectively meeting patients’ needs;
— reviewing skill mix and workload fluctuations;

— managing patent flow and matching service provision with any wider service requirements.

0.3 Benefits of a standardized approach

Understanding the influences that contribute to or detract from an optimal work environment for

healthcare professionals is essential for health systems seeking to better manage patient needs, reduce

harm and improve value across the care continuum. This can be achieved through in-depth analysis of

the relationships between the structure, process and outcomes measures that directly relate to patient

care.

Healthcare personnel structure, process and outcome indicators are those elements of patient care

that are directly affected by their care. Structure indicators include the supply, skill level, education

and certification levels of staff. Process indicators measure methods of patient assessment and

interventions. Outcome indicators reflect both patient clinical and experience outcomes, such as

pressure ulcers and falls, and staff outcomes such as job satisfaction or turnover.

Benefits to the organization emerging from the implementation of this document include:

— enhanced patient experience;
— improved compliance with statutory, regulatory and professional requirements;
vi © ISO 2021 – All rights reserved
---------------------- Page: 6 ----------------------
ISO 22956:2021(E)
— increased transparency and increased accountability;
— greater opportunity for evidence-based decision making;
— reduced risk of reputational damage;
— increased flexibility;

— improved staffing outcomes (e.g. attrition, recruitment, loyalty and retention of talent, existing

vacancies, staffing gaps, salaries, skill mix requirements);
— management of a range of clinical and other service risks;
— ability to benchmark across organizations;

— meets requirements and public health data, such as those of the World Health Organization (WHO).

Staff benefits include:
— reductions in fatigue, burnout and sickness rates;
— better staff retention and lowered attrition;
— improved job satisfaction.
Patient benefits include:
— greater visibility of staff at all levels;
— more effective meeting of needs;
— improvements in staff competences;
— better quality of service;

— improved outcomes (e.g. falls, healthcare-associated infection rates, public health data: medical and

medication errors, patient mortality, hospital readmissions, lengths of stay).

This document offers an opportunity for organizations to better understand and manage the complex

interrelated processes within healthcare. It will also contribute to a better understanding of healthcare

organizations’ effectiveness.

Incident feedback mechanisms and serious incident reporting data may be analysed to identify trends

and highlight potential sources of prevention. Falls with or without fracture rates in hospital can

provide an area for improvement if these are above national rates, or alternatively can offer other

organizations an opportunity to learn and develop their services.

The following patient safety goals suggest that it is important to address specific areas of concern in

patient safety:
— identify patients correctly;
— improve effective communication;

— ensure high-alert medications (using drugs which can cause significant harm or if maladministered

cause devastating consequences for patients) are given according to guidan
...

FINAL
INTERNATIONAL ISO/FDIS
DRAFT
STANDARD 22956
ISO/TC 304
Healthcare organization
Secretariat: ANSI
management — Requirements for
Voting begins on:
2021­03­05 patient-centred staffing
Voting terminates on:
2021­04­30
RECIPIENTS OF THIS DRAFT ARE INVITED TO
SUBMIT, WITH THEIR COMMENTS, NOTIFICATION
OF ANY RELEVANT PATENT RIGHTS OF WHICH
THEY ARE AWARE AND TO PROVIDE SUPPOR TING
DOCUMENTATION.
IN ADDITION TO THEIR EVALUATION AS
Reference number
BEING ACCEPTABLE FOR INDUSTRIAL, TECHNO­
ISO/FDIS 22956:2021(E)
LOGICAL, COMMERCIAL AND USER PURPOSES,
DRAFT INTERNATIONAL STANDARDS MAY ON
OCCASION HAVE TO BE CONSIDERED IN THE
LIGHT OF THEIR POTENTIAL TO BECOME STAN­
DARDS TO WHICH REFERENCE MAY BE MADE IN
NATIONAL REGULATIONS. ISO 2021
---------------------- Page: 1 ----------------------
ISO/FDIS 22956:2021(E)
COPYRIGHT PROTECTED DOCUMENT
© ISO 2021

All rights reserved. Unless otherwise specified, or required in the context of its implementation, no part of this publication may

be reproduced or utilized otherwise in any form or by any means, electronic or mechanical, including photocopying, or posting

on the internet or an intranet, without prior written permission. Permission can be requested from either ISO at the address

below or ISO’s member body in the country of the requester.
ISO copyright office
CP 401 • Ch. de Blandonnet 8
CH­1214 Vernier, Geneva
Phone: +41 22 749 01 11
Email: copyright@iso.org
Website: www.iso.org
Published in Switzerland
ii © ISO 2021 – All rights reserved
---------------------- Page: 2 ----------------------
ISO/FDIS 22956:2021(E)
Contents Page

Foreword ........................................................................................................................................................................................................................................iv

Introduction ..................................................................................................................................................................................................................................v

1 Scope ................................................................................................................................................................................................................................. 1

2 Normative references ...................................................................................................................................................................................... 1

3 Terms and definitions ..................................................................................................................................................................................... 1

4 Determining the scope of the healthcare organization ................................................................................................ 2

4.1 General ........................................................................................................................................................................................................... 2

4.2 Interested parties ................................................................................................................................................................................. 2

4.3 Documented information throughout the organization...................................................................................... 3

5 Leadership .................................................................................................................................................................................................................. 3

5.1 General ........................................................................................................................................................................................................... 3

5.2 Patient­focus ............................................................................................................................................................................................. 4

5.3 Traceability ................................................................................................................................................................................................ 4

6 Risks, opportunities, expectations and perceptions ....................................................................................................... 4

6.1 Addressing risks and opportunities ..................................................................................................................................... 4

6.2 Risk assessment ..................................................................................................................................................................................... 5

6.3 Gaps between expectations and perceptions — patients and staff ........................................................... 5

7 Resources ..................................................................................................................................................................................................................... 6

7.1 Environment for the operation of processes ................................................................................................................ 6

7.2 Competence and key skills ............................................................................................................................................................ 6

7.3 Organizational qualities and values ...................................................................................................................................... 6

7.4 Communication ...................................................................................................................................................................................... 7

8 Analysis and evaluation ................................................................................................................................................................................ 7

Bibliography ................................................................................................................................................................................................................................ 8

© ISO 2021 – All rights reserved iii
---------------------- Page: 3 ----------------------
ISO/FDIS 22956:2021(E)
Foreword

ISO (the International Organization for Standardization) is a worldwide federation of national standards

bodies (ISO member bodies). The work of preparing International Standards is normally carried out

through ISO technical committees. Each member body interested in a subject for which a technical

committee has been established has the right to be represented on that committee. International

organizations, governmental and non­governmental, in liaison with ISO, also take part in the work.

ISO collaborates closely with the International Electrotechnical Commission (IEC) on all matters of

electrotechnical standardization.

The procedures used to develop this document and those intended for its further maintenance are

described in the ISO/IEC Directives, Part 1. In particular, the different approval criteria needed for the

different types of ISO documents should be noted. This document was drafted in accordance with the

editorial rules of the ISO/IEC Directives, Part 2 (see www .iso .org/ directives).

Attention is drawn to the possibility that some of the elements of this document may be the subject of

patent rights. ISO shall not be held responsible for identifying any or all such patent rights. Details of

any patent rights identified during the development of the document will be in the Introduction and/or

on the ISO list of patent declarations received (see www .iso .org/ patents).

Any trade name used in this document is information given for the convenience of users and does not

constitute an endorsement.

For an explanation of the voluntary nature of standards, the meaning of ISO specific terms and

expressions related to conformity assessment, as well as information about ISO's adherence to the

World Trade Organization (WTO) principles in the Technical Barriers to Trade (TBT), see www .iso .org/

iso/ foreword .html.

This document was prepared by Technical Committee ISO/TC 304, Healthcare organization management.

Any feedback or questions on this document should be directed to the user’s national standards body. A

complete listing of these bodies can be found at www .iso .org/ members .html.
iv © ISO 2021 – All rights reserved
---------------------- Page: 4 ----------------------
ISO/FDIS 22956:2021(E)
Introduction
0.1 General

Healthcare personnel work in highly complex environments characterized by multiple competing

challenges, including interdependent processes, a growing population of older, more acutely ill

hospitalized patients, the need to stay current with rapid advances in medical knowledge and

technology, and a multigenerational and multi-cultural workforce. The ever-changing demands of the

new healthcare delivery models exacerbate the complexity by orders of magnitude.

Healthcare personnel work across all sectors and settings and are integral to the delivery of a range

of health services. They monitor and respond to changes in patients’ health status, develop care plans,

deliver interventions and educate patients about self-care. As key players on the front lines of healthcare

delivery, they play a critical role in providing care, coordinating care, preventing adverse events and

optimizing patient outcomes.

Adopting a healthcare standard for patient-centred staffing is a strategic decision for healthcare

organizations; it can assist health services in improving overall performance. This document provides

a robust set of requirements which support sustainable development initiatives within a managed

framework. Patient-centred staffing has emerged as a globally important area within health services.

Patient satisfaction is an important underpinning concept associated with the implementation of this

document. Organizations monitor patients’ perceptions and views about their experiences, and whether

their needs and expectations have been met. They determine the methods for obtaining, monitoring

and reviewing this information, including:
— service-specific or general patient surveys;
— patient focus group and quality circles;
— written expressions or comments and concerns.

Healthcare organizations are encouraged to cooperate with interested parties (see 4.2) in the

development, deployment and execution of patient-centred staffing standards. Interested parties can

have valuable input and feedback to improve the effectiveness of these standards, and a cooperative

relationship can improve satisfaction among interested parties. Likewise, healthcare organizations are

encouraged to share with interested parties relevant information regarding patient-centred staffing

standards, for example the processes and procedures that are important to these parties.

0.2 Patient-centred staffing principles for healthcare

This document is based on healthcare management principles described in organization management

or leadership healthcare literature and incorporates knowledge about effective quality management.

Patient-centred staffing in healthcare considers:
— workforce planning;
— evaluating staffing methodologies;
— internal and external resource allocation and management;
— forecasting and planning across the service;

— improving patient care and facilitating opportunities to enhance patient satisfaction;

— providing services that meet patient needs;

— meeting the range of applicable statutory, regulatory and guideline requirements;

— addressing risks and opportunities;
© ISO 2021 – All rights reserved v
---------------------- Page: 5 ----------------------
ISO/FDIS 22956:2021(E)
— enabling capacity planning in emergency situations.

Patient-centred staffing considers the requirements to match healthcare service personnel expertise

with the needs of the patient. This expertise should include a full range of professional experience

required to deliver holistic care and meet the needs of the patient. Those needs relate to age, family,

home environment and personal circumstances, culture and kind of illness – acute or chronic.

Broadly speaking, the principles for patient-centred staffing are based on the following:

— considerations of patient safety;
— risk management;
— providing a seamless experience for patients;
— the practice environment;

— management of continuity in healthcare: in-patient (hospitalized) and out-patient (ambulatory)

telemedicine and home hospitalization;
— quality of healthcare;
— organizational culture, leadership and people engagement;
— the deployment of a systematic process-based approach;
— evidence-based decision making;
— technology and innovation;
— governance;
— the patient and service context.
The benefits to an organization of implementing this document are:

— providing methods for reviewing and allocating resources for effective staffing;

— effectively meeting patients’ needs;
— reviewing skill mix and workload fluctuations;

— managing patent flow and matching service provision with any wider service requirements.

0.3 Benefits of a standardized approach

Understanding the influences that contribute to or detract from an optimal work environment for

healthcare professionals is essential for health systems seeking to better manage patient needs, reduce

harm and improve value across the care continuum. This can be achieved through in-depth analysis of the

relationships between the structure, process and outcomes measures that directly relate to patient care.

Healthcare personnel structure, process and outcome indicators are those elements of patient care

that are directly affected by their care. Structure indicators include the supply, skill level, education

and certification levels of staff. Process indicators measure methods of patient assessment and

interventions. Outcome indicators reflect both patient clinical and experience outcomes, such as

pressure ulcers and falls, and staff outcomes such as job satisfaction or turnover.

Benefits to the organization emerging from the implementation of this document include:

— enhanced patient experience;
— improved compliance with statutory, regulatory and professional requirements;
— increased transparency and increased accountability;
vi © ISO 2021 – All rights reserved
---------------------- Page: 6 ----------------------
ISO/FDIS 22956:2021(E)
— greater opportunity for evidence-based decision making;
— reduced risk of reputational damage;
— increased flexibility;

— improved staffing outcomes (e.g. attrition, recruitment, loyalty and retention of talent, existing

vacancies, staffing gaps, salaries, skill mix requirements);
— management of a range of clinical and other service risks;
— ability to benchmark across organizations;

— meets requirements and public health data, such as those of the World Health Organization (WHO).

Staff benefits include:
— reductions in fatigue, burnout and sickness rates;
— better staff retention and lowered attrition;
— improved job satisfaction.
Patient benefits include:
— greater visibility of staff at all levels;
— more effective meeting of needs;
— improvements in staff competences;
— better quality of service;

— improved outcomes (e.g. falls, healthcare-associated infection rates, public health data: medical and

medication errors, patient mortality, hospital readmissions, lengths of stay).

This document offers an opportunity for organizations to better understand and manage the complex

interrelated processes within healthcare. It will also contribute to a better understanding of healthcare

organizations’ effectiveness.

Incident feedback mechanisms and serious incident reporting data may be analysed to identify trends

and highlight potential sources of prevention. Falls with or without fracture rates in hospital can

provide an area for improvement if these are above national rates, or alternatively can offer other

organizations an opportunity to learn and develop their services.
The following patient safety goals
...

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