Four ideas to improve staff management

March 24, 2010

The chasm between finance and nursing can be addressed with features and functions that safeguard the quality of patient care by optimizing appropriate and effective staffing.

Finance and nursing have different perspectives and priorities for hospital-information technology. This is particularly evident in the evaluation of enterprise work-force-management systems for staffing and scheduling. In fact, when it comes to staffing and scheduling, there is a chasm between finance and nursing.

When finance and nursing try to get together on a work-force-management solution, why is there such a deep divide between them? Are there features and functions for staffing and scheduling, which if understood by both, might bridge the divide?

By maximizing the scheduling of its own nurses, hospitals promote continuity of care by staffing open shifts with the nurses who have the most knowledge of their policies, standards and procedures.

What you see, and how you see things, depends on where you stand. Finance is back in the hospital's offices. Nurses are out on the floors. Finance looks at numbers and is focused on the bottom line. Nurses see patients and are focused on patient care.

So when staffing and scheduling are considered, finance is primarily concerned about the data that results from the application of work-force-management systems. Finance wants accurate labor cost data from the system — and, of course, the best possible price for the system.

Nurse managers and nurses use these systems and are directly affected by the application of the software day by day, shift by shift. How the data gets into a work-force-management system is not of particular concern to finance, as long as the data coming out is accurate for back-end analysis of labor costs.

The data results from nurses and nurse managers using the system for staffing and scheduling, so they do care. They demand usability, solid functionality and clinically meaningful features that support quality care.

How can finance and nursing get together on a solution for staffing and scheduling? They should look for features and functions that safeguard the quality of patient care by optimizing appropriate and effective staffing, improve the quality of life for nurses, and protect the hospital's bottom line. Four examples illustrate such features and functions.

Open-shift management: Managers use open-shift management to post unfilled shifts. Nurses sign on and access a list of open shifts specific to their own departments and those for which they are cross-trained. They can then offer to work any open shift they choose. The software applies a hospital's staffing and scheduling rules, such as preventing overtime.

Open-shift management gives nurses the opportunity to pick up additional shifts and increase their income. Filling open shifts with full-time, part-time or float pool staff reduces overtime. It also decreases the need for the staffing office to call in nurses from a staffing agency, every hospital's most costly nursing option.

Controlling overtime and agency staffing protects the hospital's operating margin. In addition, by maximizing the scheduling of its own nurses, hospitals promote continuity of care by staffing open shifts with the nurses who have the most knowledge of their policies, standards and procedures.

Self-scheduling: Some systems enable nurses to access units' overall schedules so that they can request shifts and swap shifts with their colleagues. This helps them better balance the demands of work and home life, and improves job satisfaction and decreases turnover.

Self-scheduling also encourages nurses to share responsibility with unit managers and their colleagues for ensuring that all shifts are covered and adequately staffed. Unit managers end up making fewer requests for nurses to stay a few more hours after completing their scheduled shifts. Such requests are a source of friction on nursing floors and increase costly overtime. Hospitals that use self-scheduling find they can reduce overtime and the need to bring in agency nurses.

Needs-based staffing: Over-staffing is inefficient and costly for hospital units. Under-staffing can create patient safety, quality-of-care and morale problems. Especially problematic is when some units have a surplus of nurses who have the skills, credentials and cross-training to work in other units struggling along with too few nurses.

Needs-based staffing accounts for patient acuity and ensures every unit has the appropriate number of nurses — with the skill sets needed — to provide good care given the complexity of patients' conditions and the intensity of services patients are likely to require during the next shift. Avoiding over-staffing improves the hospital's bottom line. Avoiding under-staffing protects patient safety and enhances nurses' job satisfaction.

Patient assignment balancing: When two nurses on the same shift each have three patients, all too often one nurse seemingly is assigned the unit's three patients with the most-intense care needs, while the other cares for three less-demanding patients. Staffing and scheduling functionality that balances assignments based on documented patient acuity solve the problem. This allows nurse managers to focus on managing their units rather than having to help overburdened nurses.

In 2008, as the economy sank, hospital finances tanked. According to the Center for Healthcare Improvement, a research division of Thomson Reuters, the median margin for U.S. hospitals was down to 0.37 percent in the third quarter of 2008. Hospitals reduced expenses, cut back on staffing to get back in the black and turned their finances around. The median margin was back up to 8.4 percent in the second quarter of 2009.

Thus, most hospitals have maxed out reductions in force. Demand for hospital care is increasing as the economy slowly recovers, and as more people reach the point where they can no longer delay getting the care they need. All the more important in today's environment is for finance and nursing to agree on features and functions for staffing and scheduling that safeguard quality of care by optimizing appropriate and effective staffing, improve the quality of life for nurses and protect the hospital's bottom line.

Michael Meisel is vice president of product management and marketing for Concerro, San Diego.

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