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Since the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) launched the Orion Project in 1995, Russell Masaro, exe-cutive vice president of the Joint Commission’s accreditation operations, reports that several important innovations in the survey process have been gleaned and tested and spun off from the organizations that participated.
Currently, Orion’s attention is focused on staffing effectiveness, the use of self-assessments, and continuous survey readiness.
"Orion was and still is a research lab for the Joint Commission," says Masaro. According to JCAHO, the primary objective of the project is to provide the organization with an opportunity to continually test and refine new accreditation concepts, products, and services and eventually transition them into the mainstream accreditation process. Testing is done primarily in specific areas in Pennsylvania, Arizona, Tennessee, and Georgia.
"The major product of that activity early on was the continuous survey readiness service product that we now have available through our subsidiary," reports Masaro. But that was soon followed by an integrated survey process and a special survey process for smaller hospitals, he adds.
Among the ongoing innovations, Masaro says JCAHO plans to continue to develop and test are "the use of self-assessments and outcomes data as well as electronic interface with [JCAHO] and the future review of actions for reviewing staffing effectiveness."
In terms of staffing effectiveness, Masaro stresses, "we are not looking at staffing per se. The key here is that it is a broad subject and not merely staffing in terms of numbers but rather staffing effectiveness, which includes how staff are trained and how many staff are available with different backgrounds and experience."
According to Masaro, another innovation is modifying the way JCAHO conducts on-site survey processes. He says the Joint Commission’s Small and Rural Work Group was instrumental in that regard. That group, together with the Orion states, helped JCAHO develop services such as an integrated survey process as well as special kinds of survey processes that are more appropriate for smaller hospitals.
Masaro says those states are now helping JCAHO test and implement innovations for future accreditation processes, such as the possible use of self-assessment and outcomes data as part of the assessment with certain standards. That process also includes the use of an Internet-based automated interface with the Joint Commission, which he predicts will be up and running in 2003. "We will be testing that over the next year in the Orion states."
Masaro says each of JCAHO’s "customers" will have a private, secure Web site for on-line applications. "We can interact in an on-line fashion much like other businesses are doing," he says. "That will be tested with them, and the possible development of an approach to reviewing staffing effectiveness in organizations is going to be tested in the Orion states as well."
Jan Severance, PhD, associate project director, division of research, says more activity also can be expected in the area of continuous survey readiness.
The Orion-Georgia project was established in January 1997 by JCAHO and the Georgia Hospital Association. Now several other states are implementing similar programs. But she notes the Orion label is not being used in order to avoid confusion.
"We are working with the hospital associations in Arizona and New York," Severance reports. She says those states are being used for the Joint Commission’s Accreditation Process Improvement Initiative. She adds that New York is still in the preliminary stages in this area, while Arizona is just beginning to work on the research component.