Association Between Joint Commission International Patient-Centered Standards and Self-Reported Nursing Performance...

Yemen's prolonged conflict has severely strained the healthcare infrastructure, creating resource shortages and staffing deficits that compromise nursing practice and patient safety. The Joint Commission International (JCI) provides globally recognized patient-centered standards for quality improvement; however, their implementation and association with self-reported nursing performance remain underexplored in fragile, resource-constrained settings such as Yemen.

This cross-sectional study was conducted between August and October 2024 at six hospitals in Sana'a, Yemen. A simple random sample of 526 nurses from emergency, inpatient, intensive care, and neonatal units completed a validated 66-item questionnaire assessing six JCI domains-international patient safety goals (IPSGs), access to care and continuity (ACC), patient-centered care (PCC), assessment of patients (AOP), care of patients (COP), and medication management and use (MMU)-and self-reported nursing performance. Analyses included confirmatory factor analysis (CFA) with multigroup measurement invariance testing across hospital types, multiple regression (variance inflation factor [VIF] = 3.07-5.69; Durbin-Watson = 1.84), relative weights analysis to address multicollinearity, the marker-variable technique to assess common method bias (CMB), and extensive sensitivity analyses.

JCI implementation was moderately high, with the highest mean score for ACC (mean = 4.95 ± 1.38) and the lowest for IPSGs (mean = 4.46 ± 1.48). Self-reported nursing performance was moderate (mean = 4.64 ± 1.39). The standards explained 67.2% of the variance in self-reported performance (R² = 0.672, p < 0.001), with MMU (β = 0.277), IPSGs (β = 0.208), and PCC (β = 0.137) emerging as the strongest correlates of self-reported nursing performance, although the cross-sectional same-source design precludes causal inference. ACC, AOP, and COP did not reach statistical significance. Measurement invariance testing achieved full scalar invariance (ΔCFI = 0.008), validating direct mean comparisons across hospital types. Nurses in private hospitals reported significantly higher levels of JCI standard implementation than nurses in public hospitals across all six domains (p < 0.001; Cohen's d = -0.60 to -0.89). The common method variance (CMV)-adjusted R² was 0.59.

JCI patient-centered standards showed significant positive associations with self-reported nursing performance in Yemen. Given the cross-sectional, same-source self-report design, these findings should be interpreted as correlational rather than causal, even after common-method-bias adjustment (CMV-adjusted R² = 0.59). Targeted training in medication safety and patient safety protocols, coupled with equitable resource allocation and systemic investment in public hospitals, is recommended to close quality gaps and improve outcomes for vulnerable Yemeni populations.

Nurse leaders should treat medication safety, IPSG-anchored supervision, and patient-centered communication as priority levers for quality improvement. They should also advocate for equitable resourcing and structural support of public-sector nursing to close the implementation gap with private hospitals.