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.
Healthcare merger and acquisition activity was 16.3% higher in 2014 than in 2013, and similar activity is projected for 2015[i]. The economic realities of the market today more often than not serve as the catalyst for a merger or consolidation. Controlling expenses is a top concern for most healthcare organizations, consolidation or not. However, when an organization consists of 5, 10, 15 or 20 different facilities and spans the entire continuum, deploying creative workforce management strategies have the best potential to make the greatest impact on cost controls.
One of these strategies is the use of centralized staffing. Sometimes called float pools or resource centers, the purpose of a centralized staffing system is to optimize internal labor resources across an entire organization. Premium labor expenses such as overtime and external contingent staffing resources can be expensive and costly to an organization’s bottom line. Through the use of central staffing, large organizations can better control labor costs, create more engaged employees and create a culture of shared governance.
Successful centralized staffing strategies all consist of several key characteristics. The first, and possibly the most important is the use of technology and data for staffing. For centralized staffing to work, scheduling managers need to have access to actionable data for every single employee. This would include skill sets, competencies, hours worked and availability. The only way to do this effectively is if the data is provided electronically, on a real-time basis. This is especially true if you are trying to schedule more than 100 employees, which is another necessary component of a successful central staffing system.
Traditional float pools tend to operate like a series of small puddles where units or departments can pull matching resources from a ‘puddle’ of 10-20 employees to fill scheduling gaps. A centralized staffing system should operate more like a community center, comprised of hundreds of cheerfully mobile and highly competent service-line nurses, all with varying skill levels. There should also be a healthy supply of SWAT nurses, or nurses who are brought in to work a crisis until things have stabilized. Once their job is done they can move on to the next unit and next crisis.
Successful central staffing programs have also done a great job at creating a sense of community. Something as simple as a weekly newsletter and updates will help create a sense of shared governance and pride among employees.
As organizations look for new and fresh strategies to optimize their workforce, central staffing is a trend that is quickly becoming commonplace. Merger or not, when an organization services the entire continuum of care, the cost-effective deployment of resources through strategies like centralized staffing presents the greatest potential to achieving financial and care quality goals.