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The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) last month announced its intention to revamp its approach to assessing the effectiveness of staffing in health care organizations nationwide. The new process will use performance indicators to screen for potential staffing issues and will be pilot-tested next year.
The good news for hospitals is that the new model will not include fixed staffing ratios or other mandates. Rather, JCAHO is seeking to improve upon its current practice, which requires accredited health care organizations to determine and provide the right number of qualified and competent staff to meet the needs of patients. Those needs usually are based on internal formulae that reflect numbers of patients and the severity of their illness.
Two groups of measures — one identified by the Joint Commission and the other one self-selected and defined by each health care organization based on its unique characteristics — will be used.
JCAHO spokeswoman Janet McIntyre says the new approach will reflect the consensus of a broad-based expert panel that was convened in September 2000. Roughly 100 participants offered their ideas on how to improve JCAHO’s current approach to the assessment and made recommendations about which indicators would provide the best screening mechanism for identifying staffing issues. McIntyre says the Joint Commission wanted to get input from people with expertise in patient care, operations management, performance measurement, and performance improvement. "The idea was to get a group of people together that came from all walks."
"We have standards that cover the management of human resources, and these new measures will complement those standards by combining the clinical outcome with the human resource measure," she explains. "It will provide a better picture." As an example, McIntyre says a hospital might decide to look at the incidence of bedsores as a clinical outcome and staff vacancies as a human resources measurement. "It would be very useful to see how these two relate to one another."
However, McIntyre says JCAHO has no plans to develop staffing ratios or other mandates. "We are maintaining the same approach the Joint Commission has taken before that each organization must look at the patients it serves and determine the staffing necessary to meet their needs."
That does not mean that health care providers won’t face mandates from other quarters, however. For example, California currently is searching for ways to implement a new law passed last year that includes rigid nurse-to-patient ratios. It is too early yet to know how many states may follow suit. But California often establishes trends, for better or worse, that are emulated across the country.