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Joint Commission (JCAHO), seeks to devour any healthcare related business…

September 7, 2009

Interruption of healthcare, actual patient care, to do paperwork is indeed the goal of strategies such as Cloward -Piven.  It causes angst in most caregivers who actually care for people, which become identifiable to the group or the whole of staffing.  Then the staff can continue to pile upon this person, either until they no longer care, or until they quit.  If one actually shows they care about another human being, then others feel as if they have not done right or enough, (even if they have not done right or enough) .  In order “not” to feel as if they “have” to do better patient care, or in order to feel OK about themselves even though they know they do not care, they must dissuade others from “actually” caring at all!

By making the paper work in triplicate and redundant something must be sacrificed, so that is patient care, or paperwork!  If the paper work is not done, the patient care was not done, but if the paperwork is done, than they must actually take action against you to prove you did not do the patient care.

So they keep piling on more non-sense paperwork upon people because those with a conscience will stay on their own time to complete it.

In healthcare, it is very easy to identify those who care!  It is grade school bully time.  The bully will decide when to care and blame you for not caring when he/she is good and ready.  Trust me they will!

Take the bullying to the accreditation level…..There are so many people with their hand in the healthcare care jar fighting over the money, long before you get to the hospital.  Small business who supplement staffing, some small some large, are comprised of STATE or NATIONALLY licensed healtcare practitioners who show up at a moments notice to fill in or add to staff levels.  They must complete usually 24 CEU biannually to keep their license.

You now have hospitals treating them as employees making them go through class upon class as if they were permanent employees…and these are already seasoned vet of the industry…..and may be filling in at 5 different hospitals, suddenly you are not giving patient care but are just getting paid to fill in the blanks on paperwork.

UNACCEPTABLE!  Government buttinsky ( not for profit) into yet another small business!  JCAHO other wise known as Joint Commission, a mafioso style of not-for-profit business predator seeking new customers like a hungry wolf that has never been fed!  Surprise, surprise, they are located in Chicago!  They have no competition and Medicare and Medicaid like it that way!  It is an uncontested triangle relationship that decides who will get paid and who will not! If you are a small business dealing with healthcare you are a target! If they can stop you there will be no independent business in helathcare. So far…I do not see safety as the real factor!

Read below the letter form one such agency!

Terry Whitlow
PR 719-633-2280 x101

For Immediate Release

JCAHO Certification, Hospitals and Medical Staffing Agencies
2005 will be a difficult year given the market conditions, nurse availability, competition,
pricing and margin contraction, and it is about to be compounded by a certification

q Shift Travel Nurses has communicated with hospitals and many travel nurse agencies to
get a pulse on the pending JCAHO certification for medical staffing agencies.
Having 100’s of visits during and after the Health Care Staffing Summit in June with
hospitals’ and agencies about the proposed JCAHO certification, we find it is
overwhelmingly out of favor. The following information is a compilation of beliefs and
attitudes that do exist.

Under a certification program, JCAHO creates a new customer. This is their primary
motivation. There are a “few” agencies communicating that all reputable agencies will
acknowledge the certification as being good for patient care, hospitals and agencies. This
is accurate, though it does not mean reputable agencies agree with certifying if there is
not appropriate value. Why aren’t hospitals and the majority of the medical staffing
industry we communicate with warming up to the idea?

100+ companies have registered to acquire JCAHO certification. q Shift Travel Nurses
was an early enrollee though we adamantly oppose it. We believe once agencies openly
discuss this with their clients, fewer will certify with JCAHO due to the existence of
appropriate requirements by their hospital clients and processes within their
organizations. We are considering, along with hospital clients nationwide, to evaluate the
program in the first year prior to rushing to cost increases it will entail.

JCAHO governs more than 16,000 entities. If JCAHO accreditation of hospitals and
state surveys are effective, why would medical staffing agencies need to be certified? Is
JCAHO also trying to strong arm and pressure non JCAHO institutions as well as the
staffing industry?

Some hospitals choose to be accredited and others do not. Accreditation is not the end all
to Quality. In fact, emphasis on quality is more visible now due to industry wide
competition for nurse services. Agencies do not pretend to compare our accredited and
unaccredited hospital clients; we operate the same with both entities to best serve them
with highest nurse quality and patient care. Certification will not be a significant vehicle
to improving quality, but add layers of paper work, time and cost to agencies and
hospitals. It is a very contentious contemplation for the medical staffing industry and

One of the first publicly stated institutional dissents to this program was at the Health
Care Staffing Summit conference and repeated again in October’s issue of Staffing
Industry Review. Three hospital executives spoke against JCAHO certification of
Medical Staffing agencies as they felt it would “increase the costs and workloads to
agencies and hospitals.”

Hospitals throughout the country have been telling us the same thing.

1.)   JCAHO accredited hospitals already require their agencies to follow JCAHO
guidelines and standards. Hospital contracts require agencies to represent and warrant
they are JCAHO compliant. Staffing agencies are required to send hospitals all
applicable information for permanent record. Any agency that does not conform must
come into compliance or they are not an agency a JCAHO accredited hospital uses. This
is standard practices.

JCAHO also says that the currently shared files and information for permanent file would
not be required by the JCAHO accredited Hospital from a certified agency as told to us
by a JCAHO spokesperson. This is a monumental mistake and ultimately would add risk
and exorbitant costs to an already litigious environment. Information must be shared in
advance as in current practice, not as it may need to be subpoenaed by the courts.
Healthcare is a science practiced with predominant prudence by physicians and nurses
who can not be expected to be perfect. The intended JCAHO standards would add to
litigation costs and damage awards. Detractors may scoff, but certification and the
absence of sharing information is beneficial to the legal communities.

Under this certification program, JCAHO states to accredited hospitals that if they are
using certified agencies, JCAHO will not require review of the records from the agency
services. If a certified agency works with accredited hospitals, they should have the same
privilege. JCAHO policy such as this to the hospital sector should be seen for what it is,
preferential treatment in exchange for support of the new program.

2.)   A non-JCAHO accredited hospital also has annual state audits requiring them to
maintain standard practices for patient care, Management, Administration and overall
system appropriateness. q Shift Travel Nurses serves non-JCAHO accredited hospitals
in rural and urban settings across America and have no differences in our processes as with
our JCAHO accredited clients.

Non-JCAHO accredited hospitals generally require their agency(s) to satisfy standard
JCAHO compliance since agencies are already doing it. Additionally, credible staffing
agencies prefer consistency in documentation for either type of hospital client; hence they
prefer to follow JCAHO compliance requirements.

3.)   Having a dual certification (if you will) can often put the hospital and agency in
an equal relationship as it pertains to specific policies and patient care. This is not
constructive or conducive to partnership building environments. Our industry
exists to be of service to our institutions, not policing them. We do not believe either
segment wants to scrutinize services so a finger may be pointed to say an incident
“was and is your fault”. We do not pretend to exist to manage a hospitals patient or
system affairs, nor do Hospital clients exist to manage the staffing industry.

4. )  The added administrative and associated costs to participating agencies will be added
to staffing fees. The pending program has a cost of $5,000 to $10,000 per free standing
company or corporate office and a 25% fee above the maximum charge of $10,000 for
multiple locations above three being reviewed. Each reviewed location can cost an
additional $5000 per day. Hospital contacts concur that in the long run they will be
paying for the certification and compliance of agencies. Where is the value in this when
checks and balances already exist? The cost of certification is not thought out and is
absolutely prohibitive. It needs to be reevaluated based on size. It should not matter how
small an agency is, if they are willing to certify and adhere to the program, then they are
meeting the objectives of the proposed program. However, the largest agencies want
reduced competition. All agencies are for reduced competition to achieve good
competition, but for the right reasons. Eliminate those who should not be competing, do
not eliminate those who compete well, but are small. It will serve JCAHO well to be
reevaluating the programs cost structure. If JCAHO is truly serving the industry for two
main objectives, quality care and patient satisfaction, they will offer certification based
on size at significantly lower costs.

5.)   Serious contention lies in the policy that many of the JCAHO reviewers will be
agency competitors. There is a rule they must come from small organizations (define)
and if it is a concern for an agency, they can request a non-competitor reviewer. This
does not promote an environment of program objectivity, integrity or effectiveness and
efficiency measuring their success. It does nothing to maintain client confidentiality
between competitors, and it may promote subjective or bias reviews.
Proprietary and confidential information will always be at risk whether agency reviewers
receive information first or second hand. The industry wouldn’t be concerned about the
revealing of competitive differentiators as they are difficult to find today. It is about
program integrity.

6.)   Accredited Hospitals without infractions are usually surveyed once every three years,
otherwise it is done annually. Yet it appears certified agencies will always be surveyed
annually as communicated by a JCAHO spokesperson. Why?

7.)   What happens when a JCAHO certified agency communicates during an audit that
some of its problems were due to client hospitals not cooperating with their requests?
The JCAHO accredited or non JCAHO accredited hospitals’ next survey may be quite
different from previous ones. Who will accept this type of spurious activity?

8.)   JCAHO is going to review records to ensure there has been limited floating.
According to one of their audio conferences, said certified agencies can monitor floating
in the hospital environment. This is inappropriate for both hospital requirements and
nurse skills. Hospitals and agencies work very well to manage floating without edicts
being placed on our relationships. Floating is related to but not synonymous with
inappropriate or unsafe patient care. There are times when it enhances care. If floating
needed to be further monitored or regulated, it doesn’t require a new program from a
third party.

9.)   A few large staffing agencies believe they can accomplish a competitive edge and at
the same time eliminate competition in their service sectors. While we agree there are
many small agencies opening and closing around the nation all too often, the primary
concerns is not nurse quality, but the lack of current insurances and proper paperwork
create issues. Certification isn’t needed to balance the competition in our industry.
Balance comes from hospitals and agencies following the current standards.
Certification talk came about due to the proliferation of agencies, and the unwarranted
negative press about agency quality. Agencies by their very existence are a quality
enhancer. The medical staffing industry nurse stands shoulder to shoulder with their
institutional employed peers. None the less, it has led to nurses reevaluating if, how and
where they will practice their career.

The typical agency nurse is of the highest quality and professionalism. Unlike
institutional employment, “confidence” is a prerequisite for nurses to step out of the
traditional environment and practice their profession with agencies. The scrutiny in the
application process by agencies requires nurses to be among the finest in skill, education,
and practice. If a hospital’s utilization experience is unsatisfactory with staffing partners,
they should eliminate the agency(s) as is current practice. A certification program is not
an indicator for this process.

The American Staffing Association in partnership with The University of Pennsylvania is
preparing to study and examine the quality of agency nursing and outcomes of patient
care. Based on our experience and many agencies we know, the rate at which hospitals
hire agency nurses, and consistently request repeat services of nurses, it is a study where
the outcome is already known.

The hospital executives referenced above also commented that “Hospitals want to partner
with agencies during the best and worst times. Partnering is sharing concerns and
making people and environments better”. This is a powerful statement which must be
honored in the partnership and this is consistent of our conversations.
The medical staffing industry exists to serve appropriately and honorably with
strong, healthy relationships. The policy is to follow and comply with JCAHO
requirements. We are in this business to add value to hospital services and patient
care, not to disrupt or take away.

There are commendable staffing management alternatives already in existence which
meet and exceed JCAHO standards. The Arizona Hospital Association (AzHA) is
exhaustive in its processes to ensure quality, professionalism and compliance with
JCAHO requirements as well as each of their institutions unique individual requirements.
AzHA’s program is far-sighted and genuinely committed to working as partners
dedicated to excellence with their staffing agencies.

AzHA also makes its program available to interested parties. There are other outstanding
state associations which mandate the highest levels of agency quality and compliance.
q Shift Travel Nurses and QS Nurses isn’t among the very largest agencies, though we
are a very good and fair competitor who is growing for the right reasons. We work with
numerous associations throughout the nation and are consistently ranked in the top 5%
for compliance with each association. Success is due to the outstanding hospital
associations programs, and industry competitors who operate knowing the value of
quality assurance and quality improvement for the benefit of patients and communities.

In summary, it is true if you are under a JCAHO program your business can be viewed
and received with more prestige. Accreditation programs carry merit, however, it never
makes sense to duplicate a program, and medical staffing certification doesn’t make
sense for the travel and per diem agency sector. JCAHO certification will not add the
intended value.


  1. Tamara permalink
    October 9, 2009 2:53 pm

    Yes, my family thinks I am burnt out, i am disappointed in the lack of humanity, at times. There are many very good people in healthcare.

    What I have found is that those who decide they are not accountable to the patient run in pacts. I have found patients who were in sever distress, and the entire nursing floor acted as if I were bothering them, only to have to rush the patient to ICU or call a code.

    I was in a code once when the doctor was listening to the patients heart tones, I looked up and he did not have the stethescope in his ears, it was still around hi neck, and he never adjusted it! 😦

    It exhausts me and (angers me) to think about how difficult they make it on someone who cares.

    I think we have to keep talking and working on this, because it was not always that way. I remember a time when it was enjoyable to go to work.

  2. Kellyann Curnayn permalink
    October 8, 2009 10:21 pm

    I must rise above myself daily to choose the patient first. This article is the only (documented)affirmation of what I’ve been saying is true. Verbally people affirm it’s truth but also state they are afraid to talk to me after reading what I have published. People succumb to the system and then try to tell themselves, they gave poor care because they had no choice. The only thing you do have is a choice. Having courage or gaining courage does not come from following the crowd. It only comes from rising above the crowd.

  3. Tamara permalink
    September 7, 2009 9:16 pm

    Absolute Truth Kelly, and trust me joint Commision is tied to the labor unions I assure you ! It is a matter of time. Their demands are far too unreasonable for this to be safety concerns!

  4. September 7, 2009 10:36 am

    Great work Tamara, everyone who has functioned at the bedside within the last 5 years KNOWS your right. Nurses are scampering away from the bedside secondary to the overt inability to be unable to ‘care’ for their patients. Once the problem is no longer theirs they no longer acknowledge it as a problem. People search for the solution that eases their own pain, while the problem persists……..
    Why have we not heard one government official or news station even question the authoritative (mafioso) power and massive revenues poured into The Joint Commission? So they go unchallenged by the Government as you so eloquently pointed out and they go completely unchallenged by the media. Ultimate power corrupts ultimately.
    Sorry, forgot to add great post! Can’t wait to see your next post!

  5. Kellyann Curnayn permalink
    September 7, 2009 9:33 am

    Great work Tamara, everyone who has functioned at the bedside within the last 5 years KNOWS your right. Nurses are scampering away from the bedside secondary to the overt inability to be unable to ‘care’ for their patients. Once the problem is no longer theirs they no longer acknowledge it as a problem. People search for the solution that eases their own pain, while the problem persists……..
    Why have we not heard one government official or news station even question the authoritative (mafioso) power and massive revenues poured into The Joint Commission? So they go unchallenged by the Government as you so eloquently pointed out and they go completely unchallenged by the media. Ultimate power corrupts ultimately.


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