ISO/DIS 22956

Healthcare organization management— Guidelines for patient centered staffing

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DRAFT INTERNATIONAL STANDARD
ISO/DIS 22956
ISO/TC 304 Secretariat: ANSI
Voting begins on: Voting terminates on:
2019-11-13 2020-02-05
Healthcare organization managemen — Guidelines for
patient centered staffing
ICS: 11.020.01
THIS DOCUMENT IS A DRAFT CIRCULATED
FOR COMMENT AND APPROVAL. IT IS
THEREFORE SUBJECT TO CHANGE AND MAY
NOT BE REFERRED TO AS AN INTERNATIONAL
STANDARD UNTIL PUBLISHED AS SUCH.
IN ADDITION TO THEIR EVALUATION AS
BEING ACCEPTABLE FOR INDUSTRIAL,
This document is circulated as received from the committee secretariat.
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STANDARDS MAY ON OCCASION HAVE TO
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WHICH REFERENCE MAY BE MADE IN
Reference number
NATIONAL REGULATIONS.
ISO/DIS 22956:2019(E)
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 SUPPORTING DOCUMENTATION. ISO 2019
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ISO/DIS 22956:2019(E)
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© ISO 2019

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ISO/DIS 22956:2019(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...................................................................................... 2

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

[2]

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

Annex A (informative) ........................................................................................................................................................................................................ 8

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

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ISO/DIS 22956:2019(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.
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ISO/DIS 22956:2019(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, we play a critical role in providing care, coordinating care, preventing adverse events, and

optimizing patient outcomes.

Adopting a healthcare guideline for Patient-Centered Staffing is a strategic decision for healthcare

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

a robust set of considerations which should support sustainable development initiatives within a

managed framework. Patient-Centered Staffing has emerged as a globally important area within health

services.

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

this Patient-Centered Staffing Guideline. Organizations should monitor patients’ perceptions and

views about their experiences, and whether their needs and expectations have been met; and should

determine the methods for obtaining, monitoring and reviewing this information including:

a) service-specific or general patient surveys
b) patient focus group and quality circles
c) written expressions or comments and concerns

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

development, deployment and execution of patient-centred staffing guidelines. Interested parties may

have valuable inputs and feedback to improve the effectiveness of the guidelines, and a cooperative

relationship can improve satisfactions among interested parties. Likewise, healthcare organizations

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

staffing guidelines, including e.g., the processes and procedures that are important to those parties.

0.2 Patient-Centered Staffing principles for healthcare

This guideline is based on healthcare management principles described in organization management/

leadership healthcare literature and incorporates knowledge about effective quality management.

Patient-Centered Staffing in healthcare considers:
a) workforce planning
b) evaluating staffing methodologies
c) internal and/or external resource allocation and management
d) forecasting and planning across the service

e) improving patient care, and facilitating opportunities to enhance patient satisfaction

f) providing services that meet patient needs

g) meeting the range of applicable: statutory, regulatory and guideline requirements

h) addressing risks and opportunities
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ISO/DIS 22956:2019(E)
i) enabling capacity planning in emergency situations [in extremis]

Patient-Centered Staffing considers the requirements to match healthcare services personnel expertise

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

required to deliver holistic care, and the needs of the patient. Those needs are recognized as: age,

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

Broadly speaking, the principles for Patient-Centered Staffing are based on the following:

a) patient centered
b) considerations of patient safety
c) risk management
d) providing a seamless experience for patients
e) the practice environment

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

telemedicine and home hospitalization
g) quality of healthcare
h) organizational culture, leadership and people engagement
i) the deployment of a systematic process-based approach
j) evidence-based decision making
k) technology and Innovation
l) governance
m) the patient and service context
The benefits to an organization in implementing this guideline are:

a) providing methods for reviewing and allocating resources for effective staffing

b) effectively meeting patients’ needs
c) reviewing skill mix and workload fluctuations

d) 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 the 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. Specifically, structure indicators include the supply, skill level,

education, and certification levels of staff; process indicators measure methods of patient assessment

and interventions; and 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 deployment of this guideline include:

a) enhanced patient experience
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ISO/DIS 22956:2019(E)
b) improved compliance with statutory, regulatory and professional requirements
c) increased transparency and increased accountability
d) greater ability for evidence-based decision making
e) reduced risk of reputational damage
f) increased flexibility

g) improved staffing outcomes (attrition; recruitment; loyalty and retention of talent, existing

vacancies; staffing gaps; salaries; skill mix requirements etc.)
h) the management of the range of clinical and other service risks
i) meets the statutory, regulatory and legal requirements
j) ability to benchmark across organizations

k) meets requirements and public health data such as World Health Organization, etc.

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

e) improved outcomes (falls, hospital acquired infection rates; public health data: medical and

medication errors; patient mortality; hospital re-admissions; lengths of stay, etc.)

The guideline offers an opportunity for organizations to better understand and manage the complex

interrelated processes within healthcare; it should also contribute to the better understanding of the

healthcare organization’s effectiveness.
Incident feedback mechanisms and serious incident reporti
...