When the payment model for healthcare was focused on fee-for-service, the primary goal for a productivity initiative was typically reducing labor costs. That’s changing as healthcare reform moves healthcare to a value-based industry. While driving down labor costs is still important, workforce productivity initiatives now need to focus on improving the patient experience and employee engagement as well.
A recent survey done by HealthLeaders asked 126 healthcare executives about the outcomes they desired from a workforce productivity initiative. The results showed a nearly even split between financial metrics, patient experience measures and employee engagement.1
What’s the key to achieving results beyond cost savings from a productivity initiative? First, it’s important to recognize that financial, clinical and employee engagement outcomes are tightly interlinked. For example, when nurses need to work long hours to complete their work, patient satisfaction suffers and HCAHPS scores are lower.2 That impacts reimbursements.
Next, healthcare leaders need access to the workforce analytics that empower them to make data-driven decisions. For example, how can productivity be improved so that nurses no longer need to work as many long shifts to meet patient care needs? How can each shift be right-staffed to match patients and caregivers so that patient care needs can be met in the most effective way possible?
As patient satisfaction and clinical outcomes continue to have a greater impact on reimbursements, the need for productivity initiatives to deliver results beyond just cutting labor costs will grow exponentially. Finding a way to harness a wide range of diverse, complex analytics to reveal a clear picture of how staffing and workforce decisions impact clinical, financial and employee outcomes is a necessity. The need to understand what’s happening and what needs to happen will drive the next generation of workforce productivity strategies.
For a closer look at the connection between workforce productivity and patient satisfaction, take a look at a recent white paper: “The Rising Importance of Patient Satisfaction in a Value-Based Environment.”
1“Targeting Better Outcomes & Patient Satisfaction Through Workforce Management Initiatives.” HealthLeaders and API Healthcare, 2015.
2Stimpfel, Amy, et al. The Longer the Shifts for Hospital Nurses, The Higher the Levels of Burnout and Patient Satisfaction. Health Affairs, 31, no.11 (2012): 2501-2509.’
Productivity is the use of resources to the greatest benefit for everyone—nurses, patients, and the organization. It makes very little sense to have your most credentialed nurse working with a patient that doesn’t need sophisticated care. Optimization for productivity is just as important as the numbers, and surveys and research tell us the trend is quickly catching on. Any information about productivity must be correlated with patient, employee and financial outcomes. What might look like a very efficient productivity system can only be measured in the outcomes it produces for the patient, the staff and the organization.
There is no shortage of technology available to us today. As a result, we have a fantastic opportunity to integrate information from multiple employee and patient-related sources, and leverage that information in a way that creates a more productive and optimized staff and ensures quality outcomes.
How do you achieve success?
Creating a staffing plan is a great place to start, as long as the plan takes into consideration a wide range of factors and evidence. For example: what kinds of patients are coming through your doors? What kind of skills and credentials do your nurses have? When do you experience the greatest flux in census and why? Factors like nurse fatigue, patient engagement and quality outcomes evidence related to staffing should also be included in the mix.
While every organization will have different factors and sets of evidence to consider, all organizations should aim to create an enterprise-wide staffing plan with integrated unit-based staffing plans as support. The information we get from the unit level will help determine the level of core staff and flex staff necessary to achieve productivity benchmarks. Units that tend to flex heavily and unpredictably will have a greater need for flexible staff that can come in and respond to those situations. Units that don’t experience a lot of unpredictability will have a greater need for more core staff. Every unit within every organization is different, which is why it is critical to plan for the enterprise, but look at the unit when establishing benchmarks.
The use of resource pools should be embraced. Resource pools are the less-costly alternative to overtime and premium external staffing. However, you can’t just fill your resource pool with any employee. The resource pool should be equal to your core staff in terms of quality, skills and credentials. By filling your resource pool with highly credentialed specialized staff and highly competent leadership, it will be easier to recruit and retain the best people in these pools. As we all know, retention is critical for creating consistency in care delivery.
Competency training should also be a priority, specifically as it relates to staff scheduling. Everyone in the organization should be an owner of staff scheduling regardless of whether you are the CFO or the unit manager. It is important for the CFO to know how staff scheduling works, and it is equally important for the front line nurse to know what happens in the CFOs office. The partnership between finance and clinical is critical to an organization’s long-term success. Walls that used to exist have begun to fall, and organizations that have removed the boundaries between these two groups are realizing better financial and quality related results.
Of course we can’t measure success without establishing benchmarks. It goes without saying that these are critical, but it won’t help to simply throw out a set of numbers without any understanding for why that specific set of metrics was established. With technology, we now have the opportunity to develop internal benchmarks within systems that will tell us the leading practices for the system. Learning from each other in a system is a very effective way of “raising the bar” for staffing practices. With all of the available evidence showing there is a strong and holistic connection between quality and productivity, we need to tie them together in the internal benchmarks and create shared accountability for everyone in the organization. The way we look at productivity must be different than it was five years ago and include quality outcomes because the opportunity to create a high reliability organization that benefits patients and staff has never been greater.