Role-Based Training Approaches to JCI Standards: One Size Does Not Fit All

The highly complex and dynamic environment of healthcare delivery in the global context has as its main priority the attainment and upholding of high standards of patient safety and quality care. In this context, Joint Commission International (JCI) accreditation comes in as an indicator of a healthcare organization’s dedication to quality improvement and patient safety. However, the process of acquiring JCI accreditation and upholding its standards requires an intricate staff training.

The trap that most organizations fall victim to is the use of a blanket approach to JCI training by providing generic information to a mixed workforce. This approach to learning is ineffective and may result in shallow learning, poor knowledge retention, and eventually, non-compliance because the roles of staff or department in healthcare organizations differ. The daily work of a nurse and their interaction with JCI standards is vastly different from that of a physician, an administrative staff member, or a support services professional. For this reason, the training that will help to provide these varied positions with the required knowledge and skills should also be varied, customized or role-based.

To help healthcare organizations go through or understand the phase of JCI training standards and compliance, this article will explore role-based training approaches to JCI standards,  the essentiality of role-based training methods, and how JCI’s tailored learning approach can make a phenomenal difference to the retention of knowledge, department-specific compliance and the establishment of a strong culture of accountability throughout the whole organization.

The Imperative for Tailored JCI Training

Although generic training programs may appear efficient due to giving out general attitude to an issue, they do not always achieve the goals set by the trainer in a specialized setting such as healthcare. Such training causes disengagement with people failing to relate the abstract standards to their concrete duties since the training is not direct or specific for a particular role. Most times, the information is forgotten very soon, leading to lack of knowledge retention.

As an example, the requirements of infection prevention of a surgical team are much more complex and challenging in comparison with those of an administrative clerk. Although the two roles serve a similar purpose of controlling the overall infection, the protocols and actions they perform are different. Generic training does not have the prospect to properly train these departments on their unique compliance requirements and leaves serious gaps that may be disastrous to patient safety and JCI accreditation.

On the other hand, effective JCI training revolves around customizable learning goals. Training programs may be structured in a way that they provide specific, actionable knowledge by carefully selecting the JCI standards applicable to each job role and each department.

Deconstructing JCI Standards for Diverse Roles

JCI standards have a wide range of areas that are meant to keep patients safe and maintain a high level of care in any healthcare organization. They are, among others, International Patient Safety Goals (IPSGs), access to care and continuity of care (ACC), patient and family rights (PFR), assessment of patients (AOP), care of patients (COP), anesthesia and surgical care (ASC), medication management and use (MMU), quality improvement and patient safety (QPS), prevention and control of infections (PCI), governance, leadership, and direction (GLD), facility management and safety (FMS), staff qualifications and education (SQE), and information management (IM). All of these standards although universal to the organization apply differently to the day-to-day activities and duties of different staff members.

As an example, although the standard of “Prevention and Control of Infections” (PCI) applies to all individuals, the implementation of the standard by a nurse includes the direct patient care processes, such as hand hygiene, sterile technique, and isolation precautions. The role of a physician may be the proper prescription of antibiotics and diagnostic tests. Some administrative personnel may be used in the monitoring of infection rates, appropriate record keeping and support services personnel are essential in environmental cleanup and waste disposal. It is important to learn these role differences in order to come up with effective role-based training.

Tailoring Training for Key Healthcare Roles

In order to gain full JCI compliance, training should be accurately tailored to the needs and duties of each of the major roles of work in a healthcare facility.

Nurses: The First Line of Defense of Patient Care

Nurses are the frontline workers who have the first-hand contact with patients, and they apply numerous clinical guidelines. They should be given very practical training, and one that is based on the direct applicability of JCI standards.

Specific JCI Standards:

• International Patient Safety Goals (IPSGs): Patient identification, efficient communication, drug safety, and healthcare-related infection prevention in particular.
• Medication Management and Use (MMU): Safe administration, documentation and reconciliation of medications.
• Assessment of Patients (AOP) & Care of Patients (COP): Global patient assessment, care planning, pain management and discharge planning.
• Prevention and Control of Infections (PCI): Hand hygiene, sterile technique, isolation precautions and personal protective equipment (PPE) use.
• Clinical Documentation: Proper, timely, and complete charting which portrays the condition and the care of the patient.

Training Methods:

• Simulations and Role-Playing: Developing realistic scenarios (e.g. medication errors, patient falls, difficult patient identification) where the nurses may practice the implementation of the JCI protocols in a secure environment.
• Case Studies: The evaluation of actual or fictional patient cases to find JCI compliance problems and good practices.
• Practical Workshops: Practical experiences in sterile dressing changes, inserting IV, proper PPE donning/doffing, and calibration of equipment according to the standards of JCI.
• Bedside Mentoring: Experienced nurses or JCI champions giving on-the-job, in-real time direction and feedback on JCI-compliant practices as they are completed with patients.

Physicians: Clinical Leaders and Decision-Makers

As clinical leaders, physicians are involved in diagnosis, treatment planning and management of the patient holistically. They should be trained to focus on the clinical implications of JCI standards and how they are relevant in ensuring ethical and evidence-based practice.

Specific JCI Standards:

• Assessment of Patients (AOP) & Care of Patients (COP): Correct patient assessment, ordering of diagnostics, planning treatment, and interdisciplinary cooperation.
• Anesthesia and Surgical Care (ASC): Pre-operative measurement, use of surgical safety checklist, and post-operative management.
• Medication Management and Use (MMU): The safe practice of prescribing, medication reconciliation, and reporting of adverse drug events.
• Patient and Family Rights (PFR): Informed consent, patient autonomy and ethical dilemmas.
• Quality Improvement and Patient Safety (QPS): Involvement in the quality work, reporting of incidents, and root cause analysis.
• Clinical Pathways and Protocols: Compliance with evidence-based guidelines for ordinary conditions.

Training Methods:

• Grand Rounds and Clinical Conferences: Incorporating JCI standards into the discussion of complex cases by noting the best practices and areas of improvement.
• Peer-to-Peer Learning Sessions: Doctors discussing their experiences and difficulties with JCI compliance in their specialities.
• Evidence-Based Practice Discussions: The review of the existing literature and the implementation of the JCI principles in clinical decision-making.
• Workshops: Working on particular JCI needs such as documentation of informed consent, appropriate handoffs, or communication of important test results.
• Online Modules including Clinical Vignettes: This involves the presentation of brief clinical scenarios, which need the JCI standards to be applied to resolve a scenario.

Administrative Staff: The Backbone of Operations

Although the administrative personnel are not directly engaged in the care of the patients, they are an important part of the clinical envhironment, control information, and allow the facility to operate efficiently. They are trained on the systemic and procedural JCI compliance.

Specific JCI Standards:

• Information Management (IM): Accuracy of data, confidentiality of data, record keeping and privacy of the patients (HIPAA compliance).
• Patient and Family Rights (PFR): Registration of the patient, dealing with complaints, and availing information.
• Access to Care and Continuity of Care (ACC): Meeting of appointments, flow of patients and referrals.
• Governance, Leadership and Direction (GLD): Comprehending policies in an organization, quality indicators, and reporting arrangements.
• Staff Qualifications and Education (SQE): Credentialing, privileging and retaining staff records.
• Facility Management and Safety (FMS): Reporting on maintenance problems, learning about emergency codes, and the management of visitors.

Training Methods:

• Policy and Procedure Review Workshops: In-depth and comprehensive sessions on the relevant JCI-aligned policies, to be sure of their actual implementation.
• Software Training: Practical training in electronic health records (EHR) systems, patient management software, and incident reporting platforms, with a focus on JCI data requirements.
• Mock Audits and Drills: Attending mock-surveys, to learn the procedural flow of auditing and what areas could be improved in documentation and process.
• Cross-Departmental Training: Knowledge of the effects of their job on the clinical departments and the overall safety of the patients.
• Interactive E-learning Modules: Topics such as patient privacy, data security and communication protocols will be covered.

Support Services: Ensuring a Safe and Functional Environment

Environmental services, dietary, maintenance and security are all support services staff essential to ensure that the patients and staff remain in a safe, clean, and functional environment. They should be trained in a very practical manner with emphasis on their role towards JCI standards.

Specific JCI Standards:

• Prevention and control of infections (PCI): Environmental cleaning procedures, waste management and linen handling.
• Facility Management and Safety (FMS): Repair of equipment, fire safety, emergency planning, hazardous material safety and security measures.
• Staff Qualifications and Education (SQE): Knowledge of the job specifications and acting in accordance with the training needs.
• International Patient Safety Goals (IPSGs): Providing input to support a safe environment to avoid falls and other events.

Training Methods:

• Practical Demonstrations: On-the-job training on how to clean, waste separation, usage of equipment, and usage of emergency equipment.
• Safety Drills: Active involvement in fire drills, disaster preparedness drills and security simulations.
• Checklist-Based Training: Providing visual checklists to be used during daily tasks to guarantee the compliance of the procedures with the JCI requirements.
• Toolbox Talks: Frequent training on a particular safety or hygiene procedure that they readily apply in their day-to-day work.
• Visual Aids: Posters, infographics, and videos will be used in demonstrating proper cleaning, waste management, and equipment handling procedures.

Designing Effective Role-Based JCI Training Programs

Implementation of JCI training based on a role needs a systematic and strategic approach to be implemented successfully such as:

• Needs Assessment: A needs assessment should always be the first step that determines particular knowledge gaps and compliance issues within each role and department. This is possible by use of surveys, interviews, observations, and the examination of previous audit results or incident reports. It is important to know the areas of weakness to design appropriate content.
• Content Development: Create tailored training modules according to needs assessment. Learning objectives of each module must be well defined and measurable, thus being directly connected with the JCI standards applicable to the target audience. Learning materials must be interesting by applying some real life examples and situations. Use visual aids, short videos and quizzes as learning tools.
• Delivery Methods: The blended learning model should be used, where different methods of delivery should be included to allow addressing the needs of different learning styles and operational limitations.
• Face-to-face Workshops: To practice, have a discussion with the group of people, and to learn complicated issues that need to be addressed face-to-face.
• Simulations and Drills: To practice and to reinforce skills.
• Mentorship Programs: Matching old employees with new staff to guide them continually.
• Evaluation: Provide effective evaluation strategies to determine knowledge retention and application of skills. This is not a mere multiple-choice quiz but a practical demonstration, analysis of cases and direct observation of practices.
• Continuous Improvement: JCI standards and healthcare practices do not remain still. The training programs should be dynamic and should be updated regularly to reflect the changes in standards, organization policies and best practices.

Conclusion: A Unified Approach Through Diverse Paths

The saying that “one size does not fit all” is very deep when it comes to JCI-related training in health institutions. A complex network of obligations and different processes requires highly tailored approach.

With careful consideration of the content and delivery of JCI role-based training to suit the individual needs of nurses, physicians, administrative and support services, healthcare organizations can reap numerous benefits.

It is a strategic necessity to move beyond generic training so that organizations can achieve JCI accreditation and more importantly, to achieve and maintain excellence in patient safety and quality care.