Staffing standards require look at multiple indicators

(Editor’s note: This is the second of a two-part series on effective staffing for same-day surgery programs. Last month, we looked at how to determine how many people and what skills are needed for a successful program. This month, we look at accreditation standards on staffing effectiveness and how the standards will affect same-day surgery managers.)

You expect your overtime pay to increase if you have an unusual increase in volume during a month, but have you ever looked at employee sick leave in relation to an increase in volume?

The Joint Commission on Accreditation of Healthcare Organizations in Oakbrook Terrace, IL, is putting staffing effectiveness standards for ambulatory organizations through a pilot test. One of the organizations involved in the pilot test looked at the comparison of sick leave to volume increase. The data showed that during times of increased volume, sick leave taken by employees also increased.

The next step for this organization is to investigate further and find out if employees were ill or were just trying to take time off when vacation leave would not be approved, says Wilma Delaney, staffing effectiveness team leader for the Joint Commission. An issue such as this one might result in a change of policy, she says. For example, the facility might allow some scheduled vacation time during busy months in an effort to better plan staffing levels without having to incur overtime or additional expense for per-diem help, Delaney adds.

This type of study is a part of the staffing effectiveness standards that the Joint Commission implemented for facilities accredited under the hospital standards in July 2002. Results of the pilot program for the staffing effectiveness standards for ambulatory facilities will be evaluated in 2003, with implementation probably occurring in 2004, she says.

The purpose of these standards is to have same-day surgery programs look at how staffing issues affect clinical outcomes, explains Delaney. "We don’t intend to create more work for the organizations; in fact, many of the indicators used to meet the staffing effectiveness standards already are reviewed by organizations as part of ongoing quality assurance," she points out. (See list of indicators at end of article.)

The standards require an organization to select two human resource indicators and two clinical indicators and track the data to see if trends in the human resource indicator have affected results measured by the clinical indicator, says Delaney. For example, a same-day surgery program might evaluate the effect that an increase in volume has on post-op infection or how an increase in overtime affects medication errors, she says.

Because an organization may choose indicators that don’t produce significant results, a same-day surgery program probably should measure multiple indicators, suggests Delaney. "If after six months of data, it is clear that the indicators chosen are not producing any valuable information, the organization can stop collecting the data and switch to another indicator," she explains.

While the standards call for one year of data for the studies, Delaney points out that the some organizations surveyed soon after implementation of the standards may not have a full year’s worth of data. "We’ll implement the standards gradually," she says.

JCAHO indicators address clinical and HR issues

In the pilot study of the ambulatory care staffing effectiveness standards for the Joint Commission on Accreditation of Healthcare Organizations in Oakbrook Terrace, IL, some indicators have been identified as appropriate for ambulatory care programs. They are as follows:

Clinical/Service Indicators

  • patient complaints
  • turnaround time from order to time of completion for diagnostics or lab work
  • pathology turnaround time
  • medication errors
  • rescheduled/delayed/postponed procedures
  • transfer to hospital
  • patient injuries
  • surgical site infection
  • cycle time (time patient enters facility to time patient leaves

Human Resource (HR) Indicators

  • staff vacancy rate
  • overtime
  • staff turnover rate
  • outside agency/contract use
  • staff injuries on the job
  • staff satisfaction
  • number of education hours per staff
  • understaffing compared to organization’s staffing plan
  • sick time