Part III
National Health Care Skill Standards

This section presents the NHCSSP Standards. The Standards are intended as a template or model for users to apply as is or tailor to meet their specific needs. As previously described, these Standards are targeted broadly for health care workers primarily at the entry and technical levels. As such, they "fill the gap" between generic employability standards, such as SCANS and occupation-specific standards in the health care industry.

NHCSSP Core and Cluster Standards

In their current form, the NHCSSP Standards represent content standards, indicating the knowledge and skills that are expected of health care workers. They are not performance standards, which would specify a level of achievement. However, in the implementation stage of the project, several pilot sites did experiment with assessment tools (e.g., projects, process recordings, role playing, and scenarios) to begin addressing the issue of performance level. The results or lessons learned from the pilot studies can be used as a starting point for establishing performance standards.

Each NHCSSP Standard follows a specific format. The standard statement consists of three parts: (1) a brief title describing the skill area or topic covered by the standard, (2) a description of the knowledge and the skill embodied in the standard, and (3) specific applications, i.e., points, to clarify what is meant by the standards statement. The points are only examples; they are not intended to be an exhaustive listing, but rather to illustrate the standard in a tangible way.

Figure 6 illustrates the organization of the NHCSSP Standards, showing the connections among the various sets. This illustration is followed by a complete listing of the actual standards, beginning with the Health Care Core.

Figure 6
NHCSSP Standards

Proposed Standards

Health Care Core Standards

The industry core is a set of broad standards that serve as a foundation for occupations and functions across the health services. These standards specify the knowledge and skills that the vast majority of health care workers should have.

Academic Foundation
Health care workers will know the academic subject matter required for proficiency within their area. They will use this knowledge as needed in their role.

The following may be included:

  • Read and write, including charts, reports, and manuals
  • Perform mathematical operations, including computations, weights, and measures
  • Use health care terminology
  • Apply knowledge of life sciences, such as biology, chemistry, physics, and human growth and development
  • Be aware of the history of health care

    Communication
    Health care workers will know the various methods of giving and obtaining information. They will communicate effectively, both orally and in writing.

    The following may be included:

  • Assess others' ability to understand
  • Adapt communication to individual needs, including paraphrasing or translating
  • Ask for clarification when needed
  • Be sensitive to multicultural and multilingual needs
  • Use facility-specific guidelines and methods of sending and receiving information
  • Access and use electronically-produced information

    Systems
    Health care workers will understand how their role fits into their department, their organization, and the overall health care environment. They will identify how key systems affect services they perform and quality of care.

    The following may be included:

  • Be aware of the range of services offered to clients
  • Be aware of how reimbursement affects care delivery
  • Prevent unnecessary waste and duplication
  • Participate in quality improvement activities
  • Use facility resources, such as other staff, manuals, and training opportunities

    Employability Skills
    Health care workers will understand how employability skills enhance their employment opportunities and job satisfaction. They will demonstrate key employability skills and will maintain and upgrade skills, as needed.

    The following may be included:

  • Exhibit personal skills, such as attendance, time management, and individual responsibility
  • Maintain professional conduct and appearance
  • Use analytical skills to solve problems and make decisions
  • Adapt to changing situations
  • Upgrade technology skills
  • Understand various career options and the preparation required for them

    Legal Responsibilities
    Health care workers will understand their legal responsibilities, limitations, and the implications of their actions within the health care delivery setting. They will perform their duties according to regulations, policies, laws, and legislated rights of clients.

    The following may be included:

  • Be aware of malpractice and liability issues
  • Maintain client confidentiality
  • Operate within scope of practice
  • Comply with legal requirements for documentation

    Ethics
    Health care workers will understand accepted ethical practices with respect to cultural, social, and ethnic differences within the health care environment. They will perform their duties within established ethical guidelines, supporting sensitive and quality health care delivery.

    The following may be included:

  • Respect client rights and self-determination
  • Promote justice and equal treatment of all persons
  • Recognize the importance of client need over other considerations
  • Exhibit loyalty to fellow workers and the organization
  • Report any activity that adversely affects the health, safety, or welfare of clients or fellow workers
  • Comply with pertinent regulatory guidelines, including OSHA standards
  • Respect interdisciplinary differences among team members

    Safety Practices
    Health care workers will understand the existing and potential hazards to clients, coworkers, and self. They will prevent injury or illness through safe work practices and follow health and safety policies and procedures.

    The following may be included:

  • Use Universal Precautions to control the spread of infection
  • Apply principles of body mechanics, such as proper lifting techniques
  • Prevent fire and electrical hazards
  • Use instruments and equipment as directed
  • Manage hazardous materials
  • Follow emergency procedures and protocols
  • Comply with pertinent regulatory guidelines, including OSHA standards

    Teamwork
    Health care workers will understand the role and responsibilities of individual members as part of the health care team, including their ability to promote the delivery of quality health care. They will interact effectively and sensitively with all members of the health care team.

    The following may be included:

  • Practice team membership skills, such as cooperation, leadership, and anticipation of the needs of coworkers
  • Respect cultural and religious differences of team members
  • Interact with others consistent with the health care team structure and lines of authority
  • Manage conflict within the workplace through consideration of others' points of view
  • Respect interdisciplinary differences among team members

    • Therapeutic/ Diagnostic Core Standards

    The Therapeutic/Diagnostic Core Standards are a set of standards that apply to both therapeutic and diagnostic occupations and functions. The standards focus, for the most part, on direct client care.

    Health Maintenance Practices
    Therapeutic and diagnostic workers will understand the fundamentals of wellness and the prevention of disease processes. They will encourage the practice of preventive health behaviors among their clients.

    The following may be included:

  • Be knowledgeable of available preventive health screenings and examinations
  • Be aware of alternative health practices, such as massage therapy and herbal remedies
  • Explain preventive health practices, such as good nutrition and stress management
  • Encourage clients to manage and reduce health risk factors
  • Show knowledge of illness prevention

    Client Interaction
    Therapeutic and diagnostic workers will understand how to explain planned procedures and goals to clients. They will use various strategies to respond to clients' questions and concerns.

    The following may be included:

  • Determine clients' ability to understand
  • Respond to clients' feelings
  • Use language appropriate to the situation
  • Use facility guidelines for giving health care information
  • Respect clients' cultural differences

    Intrateam Communication
    Therapeutic and diagnostic workers will understand how to communicate client information within a team. They will convey this information to appropriate team members in a timely manner.

    The following may be included:

  • Provide complete client information to team, including formal and informal observations
  • Observe and report unsafe environmental conditions
  • Recognize unusual occurrences in treatment progress
  • Document and report information about changes in conditions that might introduce risk to clients or staff

    Monitoring Client Status
    Therapeutic and diagnostic workers will understand the process for monitoring client health status. They will assess health status according to respective professional standards and report results to the treatment team.

    The following may be included:

  • Observe client during administered care and procedures
  • Measure and report client vital signs or other indicators of health status
  • Record client health status according to facility protocol
  • Assist in determining the need for follow-up or alternative care

    Client Movement
    Therapeutic and diagnostic workers will understand the principles of body mechanics for positioning, transferring, and transporting clients. They will perform these activities efficiently and without injury to clients or self.

    The following may be included:

  • Position client to ensure comfort
  • Recognize center of gravity and base of support in order to use proper lifting techniques
  • Use appropriate transport or transfer equipment
  • Reassure clients and inform them of what to expect during activity

    • Therapeutic Cluster Standards

    These standards apply to occupations or functions primarily involved in changing the health status of the client over time. The standards specify the knowledge and skills that the worker in the therapeutic cluster should have.

    Data Collection
    Therapeutic workers will understand the facility protocol and guidelines for collecting data. They will participate in identifying client health care needs, strengths and problems, and report results.

    The following may be included:

  • Observe client, instrumentation, and environment
  • Follow facility policies and procedures
  • Record and report information

    Treatment Planning
    Therapeutic workers will understand the general purpose and components of the treatment plan. They will assist in planning procedures according to facility protocol.

    The following may be included:

  • Help involve client in planning
  • Participate in problem identification and recognize possible interventions
  • Identify resources needed to implement the plan, such as supplies and equipment

    Implementing Procedures
    Therapeutic workers will understand the procedures within their scope of practice and how these procedures relate to the goals and objectives of the treatment plan. They will complete procedures accurately and in a timely fashion, supporting the treatment team.

    The following may be included:

  • Organize own work and assignments
  • Document actions
  • Use equipment and instruments according to manufacturer guidelines
  • Monitor and evaluate own work to ensure continuous improvement

    Client Status Evaluation
    Therapeutic workers will know the clients' needs, strengths, and problems. They will assist in the evaluation of client status in order to determine if treatment goals are being reached.

    The following may be included:

  • Provide feedback to treatment team
  • Use appropriate evaluation tools and instruments
  • Make suggestions to modify or change treatment plan

    • Diagnostic Cluster Standards

    These standards apply to occupations or functions primarily involved in creating a picture of the health status of the client at a single point in time. The standards specify the knowledge and skills that the worker in the diagnostic cluster should have.

    Planning
    Diagnostic workers will understand the components and implications of requests for procedures. They will read the request for services and plan when and how to implement the services.

    The following may be included:

  • Identify purpose and intent of request
  • Report any inconsistency or error in the request to appropriate personnel
  • Involve appropriate persons in planning
  • Match resources to needs

    Preparation
    Diagnostic workers will know the steps of procedural set-ups. They will prepare the supplies, equipment, and client for procedures, according to facility protocol.

    The following may be included:

  • Identify and gather supplies and equipment necessary for procedure
  • Routinely maintain and calibrate equipment
  • Explain procedures and give related information to client

    Procedure
    Diagnostic workers will understand the logic and sequence of the procedure, including alternative methods. They will perform procedures to create precise and accurate products.

    The following may be included:

  • Use appropriate supplies and equipment
  • Monitor quality of sample or specimen
  • Interpret results of procedure to assure a quality product
  • Produce proper documentation

    Evaluation
    Diagnostic workers will understand the principles of quality assurance. They will continuously evaluate the procedure and its product.

    The following may be included:

  • Analyze product for diagnostic quality and take appropriate action
  • Recognize abnormal results and take action consistent with level of training
  • Customize, adjust, or modify procedures, as needed and within established guidelines

    Reporting
    Diagnostic workers will understand the need for precise, accurate, and timely reporting. They will produce and report results using appropriate communication channels.

    The following may be included:

  • Use written, oral, keyboarding, and electronic communication skills to produce reports
  • Deliver reports to all appropriate parties
  • Confirm that all necessary information is received by the parties involved

    • Information Services Cluster Standards

    These standards apply to occupations or functions that document client care. The standards specify the knowledge and skills that workers in the information services cluster should have.

    Analysis
    Information service workers will know the quantitative and qualitative requirements for client information. They will analyze that information for various purposes.

    The following may be included:

  • Verify client information
  • Use computer programs to process information
  • Prepare various reports
  • Know requirements of external agencies, such as insurance companies, courts, and regulatory bodies

    Abstracting and Coding
    Information service workers will know how to read and interpret a medical record, using knowledge of medical terminology. They will extract required information from the medical record.

    The following may be included:

  • Locate information in the record for various purposes, such as filing, coding, or information processing
  • Recognize standardized coding systems and uniform data definitions
  • Convert narrative information into a statistical database
  • Use automated systems
  • Maintain specialty registries

    Information Systems
    Information service workers will understand the sources, routes, and flow of information within the health care environment. They will contribute to the design and implementation of new or revised systems or processes within their scope of work.

    The following may be included:

  • Verify that system information is accurate and complete
  • Analyze systems functions to improve efficiency
  • Educate and orient staff to use of systems
  • Ensure data security and confidentiality by controlling access and release of information

    Documentation
    Information service workers will understand the content and multiple uses of health information. They will document appropriate information.

    The following may be included:

  • Obtain and record client information using appropriate terminology
  • Transcribe health information
  • Use available technology to document information
  • Categorize and prioritize health information requests
  • Follow legal guidelines for documentation in responding to requests for information
  • Create, route, and mail correspondence regarding the medical record
  • Perform admission, discharge, and transfer functions

    Operations
    Information service workers will understand the operations used to enter, retrieve, and maintain information. They will use health information equipment and materials safely and efficiently in daily operations.

    The following may be included:

  • Select and use automated systems
  • Maintain equipment and supplies
  • Perform general troubleshooting
  • Use and maintain filing, storage, and retrieval systems

    • Environmental Services Cluster Standards

    These standards apply to occupations or functions involving direct or indirect client care that create a therapeutic environment for providing that care. The standards specify the knowledge and skills that workers in the environmental services cluster should have.

    Environmental Operations
    Environmental service workers will understand the responsibilities of their assigned role. They will perform their tasks safely, following established internal and external guidelines.

    The following may be included:

  • Assist in the selection of materials, supplies, and equipment necessary to provide services
  • Follow manufacturer warnings and instructions, asking for clarification if needed
  • Use materials, supplies, and equipment safely
  • Monitor, observe, and report unsafe practices
  • Continuously evaluate results and procedures

    Aseptic Procedures
    Environmental service workers will know the work practices that maintain a clean and healthy environment. They will follow recommended practices to reduce or eliminate pathogenic organisms.

    The following may be included:

  • Practice Universal Precautions
  • Practice prescribed techniques to prevent nosocomial infections
  • Prevent the spread of pathogens by cleaning, disinfecting, or sterilizing surfaces, instruments, and equipment
  • Maintain a sanitary food service environment and practice proper food handling procedures
  • Conform to OSHA standards/guidelines

    Resource Management
    Environmental service workers will understand the principles and techniques of resource management. They will ensure the careful use of available resources to make timely decisions.

    The following may be included:

  • Contain costs and reduce waste
  • Provide quality service
  • Practice time management
  • Identify and solve potential problems and anticipate client needs
  • Know and use inventory appropriately
  • Practice recycling and waste management

    Aesthetics
    Environmental service workers will understand the importance of maintaining an environment that is aesthetically appealing. They will uphold facility standards for service, maintenance, and upkeep.

    The following may be included:

  • Maintain facility in good repair
  • Recognize therapeutic and functional aspects of color, decor, and furnishings
  • Ensure the quality of food for staff and clients, including presentation, taste, and service
  • Maintain an organized work environment, free from clutter
  • Promote facility accessibility through a variety of methods, such as proper signage and offering directions
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