Over the nearly 20 years I’ve worked at API Healthcare, I’ve had the lucky opportunity to talk with many, many clients about their challenges and successes with workforce management. It seems that each of our clients has a unique story. They are so savvy, thinking about new ways to manage and navigate as the healthcare industry undergoes monumental changes.
That’s certainly true for the team at Mary Washington Healthcare. They have been proactive, recognizing that they needed to focus on making operational changes to address the changing dynamics in healthcare. They created several ‘Affordable Healthcare Initiatives’ to look at the workforce and identify how to do things differently without sacrificing quality.
On the front line of those changes is Meg Pemberton, Director of Capacity Management at Mary Washington Healthcare. I initially tracked Meg down at the API Healthcare User Group Conference because I was intrigued by her job title. It turns out that the efforts that Meg has been a part of are just as fascinating as her title.
The workforce management initiative at Mary Washington has been focused on providing data transparency so that they can make better staffing decisions, for both their clinical staff and then looking beyond to non-clinical staff as well. They’ve broken down silos so that they can staff better across their entire organization.
Meg sums up their results, explaining, “We now have insight into the complete skill mix of available staff across both hospitals and the freestanding emergency department, something we didn’t have before. As a result we are able to better match qualified staff with patient needs, and we can better prioritize available internal resources instead of utilizing premium external labor.”
You can learn more about Mary Washington Healthcare’s workforce management initiatives by reading their case study.
In most markets today, patients have a choice in healthcare. As the industry shifts towards an accountable-care model, success metrics are tied to satisfied patients. Technology has made it easier than ever before for patients to evaluate their hospitals in advance. As their financial responsibility grows, so does their desire to find the best care for their hard-earned dollar.
It’s not just consumers that are taking this trend to heart. Medicare shares similar values and has actually implemented value-based purchasing bonuses or penalties that can equal as much as 1.5% of a hospital’s Medicare reimbursement. Medicare determines 30% of these metrics through patient satisfaction surveys called Hospital Consumer Assessment of Healthcare Providers and Systems, or HCAHPS[i].
One metric that has an impact on patient satisfaction is overtime. Overtime is expensive. Not just in dollars, but also in human costs. It has been well documented that nurses who work excessive overtime are at greater risk for error[ii],[iii]. Extreme cases can be harmful or even deadly to patients, but a more common scenario manifests itself in patient satisfaction. Nurses spend almost half of their time on direct patient care. The longer they work (in hours and shifts), the more dissatisfied they, and patients become[iv].
Compared to nurses who work 8-9 hour shifts, nurses who regularly work shifts of more than 13 hours are:
- 2.7 times more likely to burn out
- 2.4 times more likely to be dissatisfied with their jobs
- 2.6 times more likely to quit their current job within the next year[v]
Burn out and dissatisfaction are felt by patients too, as evidenced through HCAHPS reports that point to a decline in satisfaction rates when nurses are reported to work more than 13 hours in a single shift. In hospitals where nurses work longer hours, patients tend to give lower satisfaction ratings through HCAHPS surveys[vi]. Patients who provide a 7 or lower score on the survey have a 38% likelihood of returning to that hospital in the future. When the score is higher than 8, the return rate jumps to 80%[vii].
The connection between patient satisfaction and length of a nursing shift is something that we must begin to pay closer attention to. This is especially true in today’s market, where financial metrics are closely tied to patient satisfaction rates. As healthcare leaders, we must be doing everything possible to not only ensure their continued health and well-being, but also their overall satisfaction with the hospital experience.
For more information about the impact overtime can have on the patient experience, check out the white paper, “Unveiling Overtime’s Total Costs: How OT May Be Harming Your Business and Your Patients.”
[i]Kaiser Health News. “Methodology: How Value-Based Purchasing Payments are Calculated.” Accessed December 22, 2014. http://kaiserhealthnews.org/news/value-based-purchasing-medicare-methodology/
[ii]Rogers, Ann, et al. The Working Hours Of Hospital Staff Nurses And Patient Safety. Health Affairs, 23, no.4 (2004):202-212.
[iii]Bae, Sung-Heui. Presence of Nurse Mandatory Overtime Regulations and Nurse And Patient Outcomes. Nursing Economics. March/April 2013; 31, no. 2: 59-89.
[iv]Stimpfel, Amy, et al. The Longer The Shifts For Hospital Nurses, The Higher The Levels Of Burnout And Patient Dissatisfaction. Health Affairs, 31, no. 11 (2012): 2501-2509.
[vii]JD Power and Associates cited in Sisneros, Dorothy M. Employee Focus in a Time of Change, Thunderbird Leadership Consulting and Leebov Golde Group, May 12, 2012. http://www.lonestarhfma.org/files/file/Presentations/2012_05_Sisneros_Dorothy_CreatingAnEngagedWorkforce.pdf