JCAHO, HR, and Your Health

Ever heard of JCAHO (pronounced “Jake-O”)? It stands for “Joint Commission on Accreditation of Healthcare Organizations.” It’s a pretty big deal among hospitals and other healthcare providers. If a healthcare organization does not pass its JCAHO audit (called a “survey”), they could have big trouble being reimbursed by government-funded programs like Medicare and Medicaid. Since Medicare and Medicaid is a HUGE source of healthcare income, JCAHO accreditations get serious attention. The purpose of JCAHO is to ensure patient care quality. Every year they choose a new initiative. Then, they travel from organization to organization inspecting policies and practices, and reviewing documentation to ensure compliance with that initiative. Fortunately for healthcare organizations, JCAHO has not really concentrated on HR practices like hiring standards, managing, training, and appraising. But it will only be a matter of time before they do. Why is this important? Healthcare HR is a simple subject, right? Think again. Some Background A few years ago I was in the hospital being treated for meningitis contracted in a third-world country (no, not New Jersey). One kindly nurse came in every day at the same time, carefully inserted a needle into my IV and took about five minutes to sloooowly inject its contents. When I asked why it took so much time, Nurse Kindly explained she was injecting a blood pressure medication that should never be given quickly. Neat. I was completely in charge of my medical destiny! A few days later, Nurse Kindly had the day off and Nurse Ratchet took her place. Nurse Ratchet came in with the syringe. Stick! Squeeze! Gone in 15 seconds flat. Just like injecting marinade into a beefsteak. Instantly, my precious bodily fluids stopped doing what precious bodily fluids normally do, and instead started casually meandering from organ to organ looking for some action while my brain drifted off to la-la land. Same training, same drug, same white uniforms, same medical protocol, same patient. Nurse Kindly followed the rules and Nurse Ratchet didn’t. Where was JCAHO certification when I needed it? Whole Person, Whole Job Do you think it is a good idea for a healthcare organization to use more than technical requirements to hire employees? How about a clear-cut set of competencies for each job? How about hiring people based on accurate measurements of matching competencies? Training employees on the competencies for which they were hired? Managing them on the competencies for which they were trained? Appraising them on the clear-cut competencies required of their job? Consistent performance messages? Wow, what a concept! Technical occupations are easy to view myopically. That is, because it is an obvious part of the job, technical knowledge often becomes the overarching hiring criteria. Now, that would be okay if technical knowledge was the only factor contributing to healthcare competency ó but it isn’t. There are an entire cluster of additional cognitive healthcare abilities, such as learning, analysis, and decision making; planning activities, such as organizing, following rules, and paying attention to details; interpersonal skills dealing with patients, doctors, and team members; and having an entire set of attitudes, interests, and motivations that affect willingness to use the first three sets of skills (an area where Nurse Ratchet was sadly deficient). Healthcare organizations are not exempt from using the same abysmal, archaic hiring practices used by many businesses. I understand these are strong words, but how else would you describe organizations that prefer to:

  • Rely on generic job descriptions instead of formal job analyses
  • Give tests that have no documented proof their scores predict job performance
  • Search for job competencies in reference books instead of studying their own jobs
  • Rely on casual interviews that research has shown are only about 50% accurate
  • Seldom follow up in any systematized way to identify successful and unsuccessful hiring practices.
  • Look at hiring primarily as a sourcing, not a quality, problem
  • Think a six- or seven-to-one hiring ratio is too hard to manage
  • Measure hiring success by open seats, not quality of placement
  • Ignore best practice hiring standards published by the government over 25 years ago
  • Are almost completely unfamiliar with the last 30 years of hiring and placement research, including associated federal laws
  • Admit that few employees fail because of technical deficiencies, but still fail to measure other critical areas like decision making, planning, interpersonal skills, or attitudes
  • Hire people on one set of standards, train them on a second, manage them on a third, and appraise everybody using the same questions
  • Promote people to management positions based on technical skills rather than the ability to manage people
  • Think job evaluation (what a job should be paid) and job analysis (how a job is performed) are the same thing
  • Think hiring, training, and management competencies are the same thing
  • Search for the elusive “best interview question” (as if an applicant would be brutally honest)

Now, the “only” consequence of these kinds of practices in commercial organizations is legal action and a few million dollars of incompetence poured annually down the drain. No big deal ó at least no one gets a full shot of BP medication and risks becoming a mental turnip. In healthcare, people die. Healthcare agencies be wary! There is more riding on good HR practices than just hiring people who can speak medical language and pass tests. Want to see a brief example of how a world-class healthcare HR system would work? Here is an example from a healthcare project I worked on a few years back. Space limitations and client confidentiality prevents more than a brief summary, but you can get the idea.

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Head Nurse in a long-term assisted care center. Job analysis Cognitive:

  • Appropriate technical certifications and licenses
  • Ability to make quick patient care decisions
  • Quickly learn any apply new medical technology Planning:
  • Schedule nurses and aides
  • Assure medical protocol is followed
  • File reports and records accurately and on time Interpersonal:
  • Effectively resolve issues with problem employees
  • Deal effectively with patients and their families
  • Manage professional relationships with physicians
  • Conduct periodic training and recertification AIMS:
  • Be dedicated to work and maintain consistently high standards
  • Enjoy managing and coaching a diverse group of people
  • Pay attention to detail and not make any mistakes
  • Be willing to work different shifts (Excerpts derived from interviews with head nurses and medical directors. Note how the whole job is broken into critical areas to ensure complete skills coverage.) Hiring/Promotion Process
  • Behavioral-type interviews using prepared questions and answer guides
  • Technical tests and certifications
  • Simulated patient-care and family scenarios
  • Simulated physician confrontation scenario
  • Planning test
  • Analysis and learning test (Note how different tests and exercises were designed to cover each important area at least twice. If you “gasp” at the idea of using any of these tools, ask yourself whether it is more important to screen for incompetence BEFORE hiring or to observe it on the job.) Management Process

    Each generic competency area is further detailed (based on the specific job) and discussed by both the medical director and nurse. Specific standards and expectations are documented and used as the annual performance plan. (Note how this bridges the gap between hiring standards and on-the-job performance expectations between manager and employee.) Appraisal Process

    If you are still into the “annual” thing (I prefer ongoing feedback), reviews can be conducted around documentation developed during the management discussion. (Note how this links performance directly back to hiring expectations.)

If you are in healthcare and these ideas make good sense, how long do you think it will take a bright organization like JCAHO to figure out the same thing? Are you ready?


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