Beyond JCAHO: using competency models to improve healthcare organizations. Part I

In 1996 the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) required hospitals to assess, prove, track, and improve the competence of all employees. Part 1 of this two-part series discusses competencies, their assessment, and the implications of meeting and going beyond JCAHO's requirements. Part 2, which will appear in the next issue of Hospital Topics, provides specific guidelines for the development of a competence assessment system and its practical application.     

Beyond JCAHO: using competency models to change healthcare organizations. Part 2: Developing competence assessment systems

In 1996, JCAHO required hospitals to assess, prove, track, and improve the competence of all employees. This article is the second part of a review of the concept of competency assessment and the implications of meeting and exceeding the JCAHO standards. Part 1 (in the previous issue of Hospital Topics) provided the theory of competence assessment, the current situation in JCAHO surveys, and an overview of the problems inherent in competency assessment. This part puts competence assessment in the context of quality improvement and provides the details of developing competence assessment systems.     

The JCAHO's agenda for expansion

The Joint Commission on Accreditation of Healthcare Organizations is poised at a key point in its history. Decisions that will be made this year by the JCAHO, hospitals, purchasers and the government will determine what role the JCAHO will play under a reformed national healthcare system. This is the second installment of a two-part status report on the JCAHO. The first part appeared March 14.     

Critical alarms and patient safety. ECRI's guide to developing effective alarm strategies and responding to JCAHO's alarm-safety goal

Alarm-safety issues are nothing new in healthcare. ECRI, for example, has emphasized the importance of alarm safety for many years. Yet patients continue to be injured or killed because of ineffective alarm coverage, inappropriate alarm use, and failure to hear alarms. And countless "near miss" incidents occur that are never reported. In July of this year, the U.S. Joint Commission on Accreditation of Healthcare Organizations (JCAHO) intensified the focus on this topic in U.S. hospitals by making alarm safety one of its National Patient Safety Goals for 2003. Hospitals addressing JCAHO's recommendations for meeting this goal need to know what to do and what not to do. This special Guidance Article provides advice on just what JCAHO expects, how U.S. hospitals should respond to its initiative, and how much in the way of time and resources will be required. In addition, we detail our broad-based recommendations on improving alarm safety, which cover issues that are common to healthcare institutions around the world.     

JCAHO hits a wall with plan on indicators. Hospitals balk at costly and inefficient program to measure clinical outcomes

The Joint Commission on Accreditation of Healthcare Organizations is poised at a key point in its history. Decisions that will be made this year by the JCAHO, hospitals, purchasers and the government will determine what role the JCAHO will play under a reformed national healthcare system. This cover story is the first installment of a two-part status report on the JCAHO. The first part examines the development of the JCAHO's clinical indicator monitoring system and its acceptance by hospitals and others, and the ability of the system to improve patient care The second part, to be published in an upcoming issue of Modern Healthcare, will focus on the JCAHO's efforts to position itself for reform.     

Special report. Complying with the 1995 JCAHO security and safety standards: Part I

Leading consultants agree that complying with 1995 inspections by the Joint Commission on Accreditation of Healthcare Organizations will amount to the difference between an oral and a written exam: inspectors are expected to place more emphasis on quizzing all kinds of hospital employees about safety and security issues, and less on reviewing security paperwork and documents. The consensus is that hospitals that have been in compliance shouldn't have any worries about meeting the new standards, although there is some disagreement about the extent to which they will have to adapt. Initiated to set standards for patient care, JCAHO has been placing increasing emphasis lately on safety and security. The latest refinements are reflected in its 1995 Comprehensive Accreditation Manual. Terminology has been changed, security and safety standards added, and the responsibility for security has been spread throughout the organization rather than placed just on the shoulders of the security and safety departments. In Part I of this report, we'll present the viewpoints of consultants who have been heavily involved in assisting hospitals to successfully comply with the latest standards, as well as the experiences of one security director. Next month, in Part II, we'll present the latest viewpoints of JCAHO, plus the experiences of other security directors from around the country in meeting the current JCAHO challenge.     

Maintaining life-support and non-life-support equipment. What do JCAHO's new requirements mean?

As part of its new "Shared Visions--New Pathways" initiative, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) now requires accredited healthcare facilities to demonstrate that life-support equipment receives a high priority in their equipment-maintenance programs. JCAHO has also revised its overall accreditation scoring system. Some of our member hospitals have asked ECRI for advice on how to deal with these changes. JCAHO's intent, as we understand it, is not to impose burdensome new requirements on hospitals, but simply to ensure that life-support equipment receives the necessary equipment-maintenance priority. We believe that any facility that has been meeting JCAHO's requirements up to now won't need to significantly change its equipment-management program, though it will need to revise its documentation procedures. In this article, we describe the changes to JCAHO's requirements and outline the steps that hospitals need to take to meet the requirements--as well as the steps they don't need to take.     

The role of accreditation in quality oversight and improvement under healthcare reform

Quality measurement and management are key components of the administration's healthcare reform proposal, and translating outcomes information into "report cards" for healthcare consumers and purchasers will create a "final common pathway to public accountability," according to Dennis S. O'Leary, MD, and Paul M. Schyve, MD, senior spokesmen for the Joint Commission on Accreditation for Healthcare Organizations. While the nature of the accreditation process as it currently exists may well change, the authors insist that the measurement and monitoring process that is ultimately adopted must include both performance standards and outcomes measures.     

Risk management or political micromanagement?

A major healthcare issue of the 1990s is whether providers will create effective risk management programs to cope with government reform mandates or whether an increasingly costly and complex regulatory structure will force them to make changes. Compliance with the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) standards on patient care will become increasingly important to healthcare risk management in the 1990s. The JCAHO standards create a benchmark from which government entities set their present standards and assemble agendas for the future. Another healthcare risk management factor is compliance with the National Practitioner Data Bank. The data bank is intended to protect healthcare consumers from providers who have demonstrated a tendency to commit malpractice. However, the data bank could cause problems for healthcare providers: Inaccurate or misleading data could unfairly haunt them. Healthcare risk managers should be familiar with the prohibitions on patient dumping found in the Consolidated Omnibus Budget Reconciliation Act of 1985. The amendments of the Omnibus Budget Reconciliation Act of 1989 (OBRA '89) do not create strict liability, nor do they impose traditional tort standards that could guide courts in cases that will inevitably result from new rules, creating a "litigation time bomb." And OBRA '90 significantly revises the law. Other risk management issues include the manner in which facilities handle and dispose of medical waste and the manner in which they resolve disputes.     

Integrating Healthcare Standards and Performance Measurement

Over the past 50 years the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) has relied primarily on an assessment of standards compliance to make judgments about the capability of a healthcare organization to provide good quality care. Over the last decade, the focus has shifted from paying exclusive attention to capabilities and routine processes of care, to an assessment of the actual results of care by monitoring and measuring clinical outcomes. This transition requires exploration and understanding of the complex interrelationships between healthcare standards and performance measures.Adding performance measurement to a standards-based assessment means that the JCAHO can implement a more continuous accreditation process. Continuous accreditation allows an organization to regularly evaluate and improve its processes to maintain performance that constantly meets or exceeds expectations. Establishing a valid, complementary relationship between healthcare standards and performance measures is a complex and challenging undertaking, and fertile ground for extensive research. Success will result in a more complete, thorough and continuous assessment of the care provided by healthcare organizations.     

Competency-Based Leadership Selection Case Study: Peterborough Regional Health Centre

In response to the healthcare industry's growing emphasis on accountability and leadership competencies, the Peterborough Regional Health Centre (PRHC) has adopted a Human Resource Strategy that uses a competency-based model to guide the full range of Human Resource activities for its leaders. This article outlines the model that has allowed for the strategic placement of Directors and Managers into positions in the corporation with an effective, measurable and core business oriented approach to the delivery of healthcare.     

New JCAHO report assesses hospitals' standards compliance

The JCAHO recently released a report detailing hospitals' compliance with accreditation standards. What's behind the varying levels of compliance? The JCAHO is finding a mixed picture: generally partial compliance, with small and rural hospitals struggling to keep up with mandated standards.     

Healthcare managers' roles,competencies, and outputs in organizational performance improvement

Healthcare CEOs recognize that managers are under increasing pressure to work smarter and more efficiently with fewer available resources. Jobs in the healthcare industry are in a constant state of change, requiring a workforce that is not only prepared to adjust quickly to the changing environment but to simultaneously maintain or improve overall organizational performance. Traditionally, trainers were viewed as the people with the primary responsibility for improving organizational performance. Today some CEOs believe healthcare managers should own that responsibility, and other CEOs believe the responsibility should be shared among healthcare managers and trainers. This shift in how accountability is viewed poses at least two important questions. Are managers aware of the various roles they need to enact to achieve successful organizational performance improvement? Do managers possess the competencies associated with those roles? The seven most contemporary trainer roles, now referred to as workplace learning and performance roles, are examined in this article to help managers increase their knowledge of the roles, competencies, and outputs expected of them. Based on findings of a study conducted to examine CEO's perceptions of managers' roles in the performance improvement process, this article provides theoretical backgrounds, includes verbatim study comments, and offers practical recommendations or tips for managers.     

In search of coherence: a view from the Accreditation Council for Graduate Medical Education

The Conjoint Committee on Continuing Medical Education has developed a position paper, a set of recommendations, and next steps in the reform of continuing medical education (CME). The Accreditation Council for Graduate Medical Education (ACGME) sets standards for and accredits residency programs in graduate medical education and is not directly involved with CME. This article offers a perspective about the Conjoint Committee's recommendations from the executive director of the ACGME. It is a personal rather than an organizational perspective. Each of the 7 recommendations of the Conjoint Committee offers some opportunity for the ACGME and identifies issues that confront medical educators and accreditors at earlier stages of the formation of physicians. The Conjoint Committee's report also exposes the painful reality that organized medicine is almost hopelessly fragmented at a time when it is important to work together. Earlier efforts to produce a more coherent system of professional oversight have failed, but several emerging realities now may make possible what was not before. These include a common language for the competencies needed to practice medicine, common metrics of competence, technologic advances in learning portfolios, conceptual advances about the use of data on physician competence, and an inexorable focus on improvement of patient care. The possibility of patient-centered rather than profession-centered oversight is emerging. The most profound consequence of the Conjoint Committee's work may be a new organizational model, based on readily available data, that enhances trust. If so, a radical transformation of the accreditation of medical education will follow.     

The Joint Commission has provided a tool to change your work force: are you paying attention?

Most health care managers wonder how to change employee "attitudes" so that their staff will be more accountable for patient satisfaction, cost reduction, and quality of care. Employees were trained to function in an industry where the power players were the physician and the administrator and now it is exceedingly difficult to get them to switch their attention to the patient and the payer in a market-driven economy. For hospital managers, the answer may be right at their fingertips: The Joint Commission on Accreditation of Healthcare Organizations' standards demanding that employee competence be objectively measured, proven, tracked & trended, improved, and age specific. A comprehensive competence assessment system can save the health care manager enormous work in measuring fewer things, focusing performance assessment on the 20 percent of things that are true problems, and helping to specifically define certain competencies such as customer focus and cost consciousness so that coaching, training, and giving performance feedback is easier. Developing a comprehensive competence assessment system is a powerful tool to change the culture of organizations. Consequently, it is important that managers be aware of those possibilities before they embark on developing "competencies" or before their organizations get too carried away on redesigning systems to satisfy standards.     

Building an understanding of the competencies needed for health administration practice

Rapid change in the healthcare environment has pressured healthcare organizations, health management professional associations, and educational institutions to begin examining more carefully what it means to be a fully competent healthcare executive. As a result, interest in healthcare management core competencies has increased. Most competency development initiatives seek to build consensus and typically result in the generation of five or six broad competency domains--but consensus around what? Most competency initiatives are based on literature reviews and consensus-building efforts. Typically, such efforts in healthcare management have involved defining general competency domains and attempting to specify representative behavioral exemplars that demonstrate mastery of the general competency domain. This study describes an approach that used a purposeful sample of ACHE affiliates who represent different geographic regions and health industry segments to construct a framework composed of critical healthcare issue clusters. A panel of healthcare executives then specified five sets of entry-level behavioral competencies that would be required to address the clusters of critical issues. Although the behavioral competencies identified by the executives in this study are anchored to a framework, their empirical association with performance has not been tested. Before implementing broad curriculum redesign, the effect of these competencies on performance should be established. Additionally, competencies should be examined in the context of potential moderating influences such as specific educational program focus, educational delivery format, and type and preparation of students entering healthcare management education programs. Competency, competencies, competency models, and competency-based training are all Humpty Dumpty words meaning only what the definer wants them to mean. The problem comes not from malice [or] stupidity... but instead from some basic procedural and philosophical differences among those racing to define the concept and to set the model for the way the rest of us will use competencies (Zemke 1982).     

三甲医院急诊科护士核心能力影响因素研究

目的研究西安市三级甲等医院急诊科护士核心能力状况及影响因素,为改善护理服务质量提供参考。方法采用中国注册护士核心能力量表,选取西安市三级甲等综合性医院331名急诊科护士进行问卷调查。结果急诊科护士核心能力总分170.39±25.07,其中经过百分比转化后专业发展能力维度得分最高,评判性思维／科研能力维度得分最低。结论西安市三级甲等医院急诊科专科护士核心能力处于中等水平,行政职务、工作年限、用工性质为其主要影响因素。     

Quality Oversight: Why Are Rural Hospitals Less Likely to be JCAHO Accredited?

There is a large rural-urban disparity in the proportion of hospitals that are accredited by the Joint Commission on the Accreditation of Health Care Organizations (JCAHO). Several factors can influence whether a hospital participates in the accreditation process. A few of those factors include the hospital's size, case mix and ownership. However, even after controlling for many of these factors, hospitals in the most rural locations are less likely to be accredited by the JCAHO than urban hospitals. A survey was conducted to explore why rural hospitals are not participating in the accreditation process. Survey results show that the largest factor contributing to rural hospital deterrence to seeking accreditation is cost. Without accreditation by the JCAHO and compliance with their movement into performance measurement, quality monitoring of rural hospitals will fall further behind that of urban hospitals. Policy initiatives that make accreditation more financially feasible should be considered.     

谈医院核心竞争力

未来医疗服务市场的竞争将是核心竞争力的竞争。面对国内外医疗市场一体化，我国医院今后的战略选择只能是大力培育核心竞争力。作者在对医院核心竞争力概念进行界定的基础上，分析了医院核心竞争力的特点及构成要素，提出了医院核心竞争力的构建措施。     

Home care in Canada

This is an overview of the home care sector's evolution in Canada, including current models and delivery structures, funding, eligibility criteria, and services provided. Cost escalations of the traditional healthcare system and a reduction in federal funding has driven health reform in Canada. This has been accompanied by a major but sporadic expansion of the home care sector across the country. For the home care sector to develop in a more rational, cost-effective and client-focused manner, the development of common standards, a common database and programme evaluation will be required. This will also be necessary for political, planning, and administrative officials to understand and justify the reallocation of resources from institutional to community health sectors. Addressing issues such as the impact of health reform, the role of the private sector, realignment of system incentives, and developing effective partnerships with hospitals is critical if home care is to be recognized as an essential, cost-effective component in Canada's healthcare system.