Now live: Interim staffing effectiveness standards

As of July 1, The Joint Commission's interim staffing effectiveness requirements are in effect for hospital and long-term care organizations, as it continues to research the issues associated with the standards.

The previous standard was "onerous," says Kurt Patton, CEO of Patton Healthcare Consulting in Glendale, AZ, and former executive director of accreditation services at The Joint Commission. In the previous versions, TJC "required all kinds of graphical analyses and different types of statistical analysis, and organizations kept saying that, 'No matter how much we analyze it, we're not seeing the numbers correlate to staffing issues."

"Really, most organizations pulled out that data when The Joint Commission surveyor was around and other than that it was fairly useless," says Susan W. Hendrickson, MHRD/OD, RN, CPHQ, FACHE, director of clinical quality and patient safety at Via Christi Wichita (KS) Health Network.

Patton says "the interim standards are actually a very positive change from the former standards. The key thing that I advise folks on is that this is a much easier requirement to fulfill — not something to get all worked up about."

The interim standards, he says, simply require that when a hospital has an adverse event, that it analyze the "potential effects" staffing had, looking at the number of staff and their qualifications.

He says to make your yearly report as simple as possible. First identify how many sentinel events occurred. Then look at the root-cause analysis done to analyze the impact staffing might have had. Look "at the numbers of staff, their experience in that work site, their competency in doing those particular jobs, and then whether or not they see anything that might have facilitated some of those adverse events from occurring," he says.

"And that is a narrative-type report. It just needs to show that you've tabulated how many incidents occurred and that you can summarize what the role of staffing, if any, was in each of those events, and then if you can draw some conclusions from it, that's great," Patton says.

"The idea is rather than trying to look at this data and find a correlation [with staffing] it's try to figure out if there are trends in these process failures that may or may not be related to staffing," Hendrickson says.

You're required, she says, to evaluate staffing with any untoward event. "For instance, let's say you get a fall, one of the things you look at as part of your analysis of that fall is who was working that day, how many people were working, what was their shift, what was their patient load, what was their competency, which is something I think we've all looked at for a long time and it makes sense," she says.

Let's say, though, that you see a large number of falls. You might discover you don't have a good method of evaluating the risks of patients falling. "So you would determine, maybe I need to put in a scoring system and maybe I need to train my staff on that. So you're still looking at the effectiveness of your staff, but instead of looking at it strictly in numbers — how many people did we have when these people fell — it's digging into it and doing more of an analysis of what's really going on with this staff," she says.

Multiple things can affect staffing effectiveness — orientation, training, supervision, work flow. "Your analysis is expected to show whether any of those processes had any effect on the event," she says.