About Us

The Joint Commission To Certify Health Care Staffing Companies:
An interview with Laure Dudley of the Joint Commission and Frank Shaffer,Ed D, RN, FAAN of Cross Country Staffing

By Leah L. Curtin, RN, ScD(h), FAAN, Journal of Clinical Systems Management

The Joint Commission plans to start certifying supplemental staffing agencies by September 2004 to help assure safe care to patients through assuring high standards and greater consistency among health care staffing companies. And for good reason. In 2001, the American Hospital Association surveyed its accredited organizations and found that 56% of them spent $71 million a year for supplemental staffing. In 2003, the Joint Commission again surveyed 1200 of its accredited organizations to ascertain whether or not they wanted and would support a program of certification for health care staffing companies: 80% said that there was a need for quality and standards in the industry, and 79% said that they would give preference to a Joint Commission certified health care staffing companies. Moreover, the health care staffing industry itself supports Joint Commission certification: when the Joint Commission surveyed 504 health care staffing companies, ranging from small local organizations to large, multi-site organizations, 58% said they would be interested in seeking Joint Commission certification if it was offered.

Armed with this information, Joint Commission staffers approached industry experts to form and Advisory Council to explore certification. Accordingly, The Journal of Clinical Systems Management (JCSM) arranged to interview Laure Dudley, executive director of marketing and product development for the Commission, for its perspectives and Dr. Franklin Shaffer of Cross Country Staffing for the industry's perspectives.

JCSM: Ms. Dudley, how would certification of health care staffing companies benefit your accredited organizations?

Laure Dudley: We have received calls from both our accredited organizations and from the staffing industry in regard to certification of staffing companies. Thus the Joint Commissionundertook market research on 1200 hospitals and health care organizations, and found widespread support for certification among our organizations and the staffing companies themselves. Among the benefits, from the health care organization's stand point are:

1. Certified health care staffing companies would have the framework and processes in place to help assure high quality personnel - and. Of course, there would be far less diversity of quality among certified companies, so health care organizations could be assured of high levels standardization.
2. Standardizing health care staffing company processes would help assure that contract staff have been properly trained in terms of their competencies.
3. The Joint Commission may be able to give some survey advantages to accredited organizations (or those seeking accreditation and/or renewal) for using only certified health care staffing companies. For example, currently the Joint Commission requires organizations to demonstrate that any additional staff they use are competent and to demonstrate the processes through which they ascertain the competencies of supplemental staff. Facilities will, of course, still be responsible for orienting agency personnel to their facility and its unique policies and procedures.
4. Health care organizations will also be benefited because their patients will benefit from higher quality supplemental personnel. And while a recent IOM study indicated that supplemental staffing personnel make more medication errors as the number of shirfts worked by supplemental staff increase. such has not been reported to the Joint Commission in any of its field research. And, as you know, the Joint Commission's primary mission is to help assure safe, high quality patient care.

JCSM: Dr. Shaffer, what advantages do you see in certification for supplemental staffing industry?

Dr. Shaffer: There are many advantages from our perspective.

1. Currently, many hospitals have developed unique processes for contracting with staffing companies - and needless to say, many of them differ! Thus, agencies have to deal with a lack of standardization among the expectations/requirements of their clients. Certification should help us streamline the contracting process. We have standards that fit most hospitals but then there are hospital specific requirements. However there already is a core of requirements or standards (OSHA, CDC and state level ones) that cover most of the clients.
2. It will 'level the playing field', and by that I mean that it will help the health care industry differentiate among high quality staffing companies and those who are less concerned about quality. Moreover, Joint Commission certification will go far to give the credibility to our industry.
3. Certification will provide a framework for thinking about quality, safety and improved performance. Using standards as a guide will help supplemental staffing agencies achieve and maintain excellent operational systems. It will also help standardize industry practices as well as the scope and level of expected outcomes. Also, and very importantly, it provides external validation of an agency's quality.
4. Certification also will provide access to consultation, best practices and innovation on an ongoing basis.
5. Certification will certainly be a valid marketing tool and will lead to enhanced contract opportunities.

JCSM: Ms. Dudley, what is the Joint Commission’s process and timeline in regard to this certification?

Laure Dudley: The process, planning, field review, public response and field testing will all be occurring in the next few months. Currently, we are working with the Advisory Council and developing the Expert Panel that will, in turn, develop the Standards, Application Process and determines the qualifications of the Surveyors. Over 100 health care staffing companies have already indicated an interest in certification, and we do have some excellent frameworks to use as models for standard development. We already are working on agency eligibility criteria and will publish them soon at our website (www.jointcommission.org) and on our Listserv to elicit public comment. These frameworks have been in use - and been effective in states like Arizona for some time. This, we believe that we can move through our process fairly quickly. We also plan to publish proposed standards at our website, on our listserv and in our appropriate newsletters, once again to elicit public comment. Thus the Joint Commission:

1. intends to pilot test the processes on the health care staffing industry in late July/early August of 2004,
2. plans to accept start accepting applications in September of 2004
3. will conduct its first survey in early October of 2004.

We are in the midst, right now of determining eligibility for certification, and as soon as the processes are in place, pricing -- most likely differentiated by size and number of locations – will be addressed. All, of course, with plenty of feedback from the Advisory council which held its first meeting via conference call on 2/27/2004.

JCSM: Dr. Shaffer, how do you think that the staffing industry will respond to the certification process and to the Joint Commission’s public disclosure requirements?

Dr. Shaffer: I think I can say with confidence that the majority of the good citizens in our industry will welcome certification with open arms. Certainly Cross Country Staffing is delighted that the Joint Commissionwill be helping to assure quality in our industry. The development of Joint Commission certification and quality standards has been one of my career goals since I joined Cross Country in 1995. Moreover, I believe that certification will also help relieve the perception/opinion expressed in the recent IOM report on staffing, that all supplemental personnel are more error prone.

The setting of standards, and the publication of those companies that have met those standards should relieve a great deal of the concern held by some people in hospitals and health care organizations. As sitting member of both the Advisory Council and the Expert Panel, I am fully aware of how carefully the Joint Commission's working to assure continuity and communication between both groups.

Laure Dundley: Also, I must add that the Joint Commission's public disclosure requires that we list those who have passed certification. , Certification does not result in a grade, but rather is on a pass/fail basis only. We do not disclose who has applied and failed - the Joint Commission keeps that information confidential.

JCSM: The journal thanks Ms. Dudley and the Joint Commission, and Dr. Shaffer and Cross Country Staffing, for taking the time to share your perspectives with our reading audience on this important, development in the staffing of health care organizations.