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Joint Commission International, the Singapore Ministry of Health Partner on Zero Harm Initiatives

2 June 2022

By Bonnie Quinn, Executive Director, Global Strategy, Joint Commission Resources/ Joint Commission International

As many of you know, Joint Commission International has been on the high reliability journey for more than a decade. Now we are expanding our efforts to Singapore.
The new “Ensure Safer Systems” Program was developed jointly by Joint Commission International (JCI), Joint Commission Center for Transforming Healthcare (the Center), and the Singapore Ministry of Health (MOH). 

ESS provides the MOH with specific performance criteria that are globally relevant, yet locally applied by addressing Singapore culture, laws, regulations, and patient care needs. As part of the ESS program, JCI and the Center will deliver:

  • a customized evaluation system, including contextualized standards and assessments,
  • high reliability workshops and training that embed sustainable change management skills,
  • ongoing support from JCI coaches,
  • JCI’s Tracers with AMP® digital platform to identify key improvement areas for each institution and to help maintain compliance with standards.


The ESS program started rolling out in August 2021 to Singapore public health care institutions, including ten hospitals, four ambulatory care centers, and three primary care centers under the National Healthcare Group, SingHealth, and National University Health System Clusters. This is a 5-year program that represents a significant investment in quality and patient safety by the Singapore MOH.

History of Collaboration

It is worth noting that it is not the first time the Singapore Ministry of Health hospitals have collaborated with Joint Commission International. Singapore was one of the first countries to embrace international accreditation in 2004.

Program Overview and Goals

Part of this new collaboration involves outlining shared goals. The ESS Program has five core components, including:
  1. Core Infrastructure and Leadership Involvement. Getting the right professional mix in the project is the first key to success. Singapore’s strong commitment is apparent from appointment of ESS Leaders at each organization, program managers from the MOH, and clinical leaders who form the Steering Committee. This core infrastructure works with JCI and the Center to co-create the program.
  2. High Reliability Organizational Assessment. Its hallmark is the use of the Oro 2.0 High Reliability Organizational Assessment tool that assesses each organization’s maturity across 14 key domains. The tool embeds change management in its improvement toolkit via programs on Capacity Building and Train the Trainers.
  3. Customized Evaluation Systems. This is the intersection of JCI’s setting-specific standards within Singapore’s local context and patient care environment. The assessment will combine the use of JCI’s evidence-based standards with local regulations and each institution’s individual progress. The goal is to establish a baseline level of performance followed by annual thematic self-assessments conducted by local ESS Leaders. Tracers with AMP, a digital platform for real-time data entry and assessment, is a critical component that uses real-time analytics to target specific improvement areas.
  4. Training and Capacity Building. Different participant groups (senior leadership, quality leaders, change facilitators, and core staff) have specified training topics and outcomes, relative to their roles. For example, senior leadership is charged with setting organizational vision, while core staff led by ESS Leaders across the system will champion implementation and spread on the frontline.
  5. Ongoing Support. Arguably one of the most important aspects of the ESS program is sustained support from JCI coaches, realized through combination of on-site trainings, off-site coaching, and sharing of system-level perspectives across organizations.
In recent months, this effort has been introduced in Kick-Off Roadshows to 1,500 individuals across 17 organizations. Introduction to High Reliability webinars and Leaders Facilitating Change courses took place earlier this year, introducing the Center’s high reliability principles and Facilitating Change® framework to over 300 leaders across the system. We are starting to see hospital baseline assessments occurring and the wheels are in motion for many more. Though this is very early in the roll out, we are optimistic about meeting high level goals by 2026. The Singapore MOH has been one of our strongest partners and we can’t think of a better affiliate to take the concept of zero harm worldwide!