A voluntary process, HCSS certification through JCAHO will involve compliance with set standards and performance measurement. Draft standards have been available for review on the Joint Commission's website since May, with opportunities for the public, staffing company and hospital representatives, healthcare professionals, and other interested individuals to respond. JCAHO continues to refine information gathered from its Advisory Council and Health Care Staffing Task Force, amidst strong opinion.

Since JCAHO's Board of Commissioners approved the concept last November, reaction has been mixed. "None of our members would dispute the need for standards in the industry," states Edward A. Lenz, senior vice president of public affairs and general counsel for the American Staffing Association (ASA), headquartered in Alexandria, Virginia. "The question is whether they need to be external standards and, if so, whether this is the right vehicle, whether this particular program is the one that will best satisfy the industry's need."

ASA's role, he notes, has been primarily to provide members of the healthcare staffing sector an opportunity to have a collective voice in this process. "Our main objective was to have critical input to the standards so that they would reflect the unique operating characteristics of staffing firms. ASA was given a seat on the Advisory Council and on the Task Force so that the industry could be represented."

Fine-tuning the standards One major point of contention with members of the staffing industry revolved around a standard requiring HCSS companies to directly observe or arrange for the direct observation of staff to determine competency. "The primary role of staffing firms," explains Mr. Lenz, "is to ensure that the professionals assigned to clients have been properly recruited and screened, their educational and licensing credentials and requirements have been verified, and the individuals have the necessary background, skills, and capabilities. Staffing firms cannot readily assess clinical competency at the workplace—certainly not without close cooperation from clients, which frequently do not have systems in place to provide reliable, regular, and systematic feedback of temporary personnel's performance. We spent a good deal of effort trying to ensure that JCAHO understood this point because some of the initial proposals seemed to reflect something less than a full appreciation for that."

This human resources (HR) standard has since been omitted. Other HR and business practices standards, such as those requiring HCSS firms to collect data on total number of hours worked and its effect on performance, to disclose overtime worked per week (other than self-reporting by employee), and to take steps to determine ongoing financial stability of the firm, have also been removed.

The current product Presently, the HCSS certification program identifies four major content areas—Leadership, Human Resources Management, Performance Measurement and Improvement, and Information Management—each with its own standards, rationales, and elements of performance. Companies must demonstrate data collection on at least one performance improvement activity at the time of initial application and address findings during an annual on-site review. The cost structure for HCSS certification has yet to be finalized, although insiders report that JCAHO is promoting an opportunity to pay $1,000 prior to standards being finalized, with the idea that companies could market their intentions to clients early, receiving a competitive advantage and helping to broaden the reach of the concept.

Benefits of certification This assumption that participation will provide a competitive advantage—since certification would validate commitment and quality—is one of the main benefits touted by JCAHO. An added advantage, say proponents, would be the ability to attract and retain employees who wish to work for firms adhering to rigorous national standards. Other promised perks include retention of relationships with healthcare organizations and the potential for preferential consideration of certified staffing firms.

Healthcare organizations, JCAHO reflects, would also benefit from a greater level of confidence that staffing firms have met rigorous requirements set by "the preeminent standard-setting and accrediting body." Plus, HCSS certification—which supports improved quality and safety of patient care—would provide an additional source of information that facility representatives could use to make informed vendor choices.