1. Green, Lauren

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The healthcare staffing industry, including the travel nurse industry, has enjoyed a meteoric rise in the past few years. Nevertheless, the industry's increase in numbers, but seeming lack of regulatory intervention, concerns some industry members. To address this issue, the Health Care Staffing Services certification program is under construction. Although officials from the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) wouldn't confirm a specific date, it's anticipated that an official manual will be available by October 2004.


Creating standards

The program, according to JCAHO officials, "will provide a comprehensive evaluation of key processes associated with healthcare staffing organizations, with standards that will address specific issues relating to health-care staffing firms." The program's benefits are similar to those most industries experience upon enacting a certification program, including competitive marketing advantages and the means to attract and retain superior staff. To become certified, companies will be required to comply with both the standards and the performance measurements. Marianna Grachek, executive director, Health Care Staffing Services Certification, says popular demand within the healthcare industry acted as a catalyst for the program.


"The idea for it actually came from two segments of the field," she says. "Our own accredited organizations were using more and more supplemental staff, and the staffing companies themselves were interested because there were so many cropping up and not all were licensed by the state. So there really was a need to provide national standards so ultimately it would improve the quality and safety of care delivered to the public."


The process of creating a certification program is careful and intricate. JCAHO uses its internal staff to work on standard development, survey process, and program design. To ensure that the industry is served in the best manner, JCAHO involves not only its internal staff, but also industry members who've volunteered to participate in the creation of the program.


Industry members comprise the standards task force, which is concerned with standards design and the survey process. Another external group, the Healthcare Staffing Advisory Council, is composed of potential industry users of the certification program and the healthcare staffing firms themselves. The group is charged with creating design systems and processes that'll support the program after it's launched.


The third external involvement is the field review process. "All of our draft standards are circulated widely in the field so industry members can respond and provide comments to draft standards," says Grachek. "We concluded that process on June 18. Our staff members then summarized the comments and they are now in the process of making revisions to the draft standards." The next step, the field test, began in July.


Once finalized, the standards to which the certified companies will have to adhere include leadership, human resources management, performance measurement and improvement, and information management.


Issues to consider

Some difficulties naturally arise when trying to create a certification program for such a large industry. To ensure the system that's put into place is effective for every organization, communication with and among the various groups is paramount.


"We've had open communication about the issues related to healthcare staffing," says Grachek. "Of course, there's a diverse group. It's an industry with a variety of ways of doing business, and our standards have to be designed in such a way that they have applicability to all kinds of staffing firms."


To ensure representation across various healthcare staffing organizations, industry member volunteers pilot test JCAHO's field review process of the draft standards. The Board of Commissioners will subsequently offer its seal of approval.


"We're currently recruiting our reviewers, who'll come from the industry and will have experience in staffing. So, in terms of our progress, we're on target," says Grachek, at press time.


Further, in early July, JCAHO accepted submissions of performance measures from industry members. When standardized, these measures are the means by which the certified staffing services will be compared. Upon initial application, the applicant organization will need to show that it's collecting data on one or more performance improvement measures of its choice. During the on-site review, the organization will need to discuss the areas it has been studying.


Industry response

Certification program feedback has been positive by all accounts. Grachek has seen a large response in the number of companies that have expressed interest in the program.


"We've had a great deal of interest; there are over 93 sites that have identified themselves as willing to become certified as quickly as possible after the program is launched," she says.


Eric Broder, president of FASTAFF Nursing, Denver, Colo., believes certification is necessary, but won't necessarily be easy. "I think it's going to require more work on the part of the companies to gain compliance," he says. However, the effort isn't stopping his company from jumping on board. "We think we're very well along in that process. There are many people who believe that the Joint Commission's involvement in hospital regulation has improved the quality of care and has improved the standards of care, and I'm sure it will have the same sort of impact on the staffing industry. We're looking forward to it."


The positive response hasn't just been limited to the staffing companies. "Nearly 80% of accredited organizations said they'd give preference to accredited staffing organizations," Grachek notes. "About 57% of staffing firms indicated that if such a program were available, they'd seek it. In terms of being prepared, this may be where the staffing firms may be ready sooner than others. The bottom line is that if staffing firms use these standards as guidelines once they're finalized for creating their systems and processes, they're doing the right thing, so it shouldn't be a burden. Certification should not be a goal, but it should be the outcome of having good systems in place." To view the Pre-publication Standards for the Health Care Staffing Services Certification, visit