Staffing and workforce management is a huge portion of a hospital’s budget. Now hospitals have the data to make intelligent staffing decisions and create cost-effective systems for better outcomes and an improved bottom line.
At the Becker’s Hospital Review 7th Annual Meeting in a session titled “Less Cost, More Value for Your Workforce,” key thought leaders discussed how to optimize the hospital staff in addition to cost containment.
“The workforce just isn’t numbers anymore. It’s not the number of nurses, respiratory therapists. Instead, it’s really thinking about what those folks can do better. If we can optimize the workforce, certainly it can be cheaper, more cost-effective and the outcomes can be better,” said Karlene Kerfoot, PhD, RN, chief nursing officer at API Healthcare. Hospitals can leverage their current workforce by allowing staff to practice to the top of their license and do more work that they want to do. Do more with less; but do more with the right type of people.
“You’re looking at 50 to 60 percent of expenses in staffing. How are you investing in that to get the best workforce you possibly can versus a generic workforce that is just numbers. You can’t get there without integration,” she said. The first step is to gather data; the second step is to effectively apply that data. “We need to come up with innovative workforce solutions to optimize what the staff is doing and match the patient needs with the competency of the workforce and look at the systems we already work with so all the systems can go together.”
Currently, many of the systems and decisions are made based on opinions. But hospitals now have enough data to make evidence-based decisions. The challenge is to use the data for intelligent decisions, especially as many hospitals are seeing staffing costs increase while productivity doesn’t necessarily improve.
“How is it that labor productivity can be flat but wages go up? How can this happen? It’s because you all have to pay more to attract nurses to keep them from doing something else besides nursing,” says David W. Lee, PhD, general manager and head, market access at GE Healthcare. Most hospitals set their outcomes around cost, clinical outcomes and revenue. There are three things correlated with the outcomes: how satisfied nurses are, level of staffing and patient satisfaction, which all link to the outcomes.
“When you have the right staffing levels you can staff to nursing satisfaction, you can manage retention, turnover and willingness to show up on shifts. All that is related to staff satisfaction which can affect cost,” Dr. Lee said. Recent studies show the relationship between HCAHP scores and profitability show there is a strong relationship between satisfaction and profitability. An increase in satisfaction improves profitability some, but a decrease in satisfaction hurts profitability a lot.
Justin Evander, CFO, hospital operations, and interim COO at Kaiser Sunnyside Medical Center, shared ideas from Kaiser Sunnyside that increased the value of the hospital’s workforce. The hospital has four out of five stars on the HCAHPS summary star list. “Our productivity is pretty flat and wages are going up. We’ve improved our productivity over the years slightly, but nothing to bend the cost curve back down,” he said. “We have to be able to invest in the cost structure so we can affect outcomes.”
The hospital put a model in place focused on teambuilding to empower the staff to make decisions in staffing and scheduling, among other areas. They created a “unit-based team” for every cost center at the hospital. The unit-based teams include physicians, front line staff, nurses and improvement advisors. That team sets goals based on regional goals, reviews and evaluates performance, initiates projects and contributes to staffing, budgeting and scheduling.
“We make sure we invested in allowing these teams to meet on a regular basis to drive outcomes,” said Mr. Evander. The hospital has 65 unit-based team developing new ideas; in the last four months, the hospital reported more than 1,100 projects the teams put in place, or wants to put in place. The hospital management now will figure out which projects have the greatest value. Currently around 230 projects are ongoing.
“We look at our quality outcomes and use our UVTs to focus on outcomes,” Mr. Evander says. “We were struggling with falls at Sunnyside. That’s one of the issues we assigned to the UVTs — to take on falls.”
The team developed a program called NOWA — No One Walks Alone. A nurse at one of the hospitals didn’t have any falls, and hospital executives found it was because he never allowed his patients to walk alone. The hospital developed a program on a large scale to ensure nobody walked alone. Patients can opt out of the program, but otherwise any staff walking through the hall who sees someone getting out of bed immediately approaches that patient and walks with them.
“We know this is impacting our financials and we are putting that into our utilization management too,” said Mr. Evander. The hospital’s electronic health record also stores information about the program, who is opting out and the number of falls, in addition to other information about patients. Staff can share the information during daily operations briefs each morning.
“It’s really about value; cost is important, but value is really important and we know how to get greater value: by optimizing, investing and helping people think differently about what they do,” said Dr. Kerfoot.