ISO 22956:2021

INTERNATIONAL ISO
STANDARD 22956
First edition
2021-06
Healthcare organization
management — Requirements for
patient-centred staffing
Reference number
©
ISO 2021
© ISO 2021
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ii © ISO 2021 – All rights reserved

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
Foreword
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This document was prepared by Technical Committee ISO/TC 304, Healthcare organization management.
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iv © ISO 2021 – All rights reserved

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;
— 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

— 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
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