The onset of COVID-19 made optimizing healthcare delivery more critical than ever. Clinical and nursing leadership have been at the forefront of the change. During a recent interview Betty Jo Rocchio, Senior Vice President and Chief Nursing Officer at Mercy, discussed her health system’s key objectives in managing capacity as a system and how has pandemic has accelerated the transformation.
Because she currently leads more than 15,000 nurses across Mercy's four states, Rocchio is in the unique position synthesizing the impact of COVID-19 on clinical operations. We asked her to share some key learnings for others.
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Question: As you reflect on the past year, what are some of the biggest takeaways that come to mind?
Betty Jo Rocchio: COVID-19 has really highlighted three major issues that already existed. While these are often discussed separately, what the pandemic brought into focus was how connected workforce management, capacity management and patient outcomes actually are. Using predictive analytics helped our team at Mercy “connect the dots” to solve for the ever-changing challenges we faced. In many ways we improved on seemingly unchangeable processes which in fact quicky adapted to their new reality. It also helped to work with the right outside partners to unlock and empower our own resources, or to employ fresh perspectives or tactics we maybe hadn’t considered before.
Q: Workforce management was a significant challenge for hospitals during the pandemic. How did Mercy deal with staffing shortages?
BJR: As I’m sure other Chief Nursing Officers will agree, we were well aware of a nursing shortage beofre COVID-19. I don't think we realized, though, just how short we would become. We suddenly faced increased demands and priorities, along with an acute patient population.
In the past, our inpatient departments had a general ebb and flow in the type of patients that we saw. As other CNOs can also attest, that did not happen in the pandemic. As a matter of fact, what was such a shock to us as a health system and everywhere nationally, was that we lost the patient population we were used to treating. In the early days of the pandemic, patient volumes at many hospitals initially dropped. Then, like many other hospitals, we faced surges of COVID-19 patients displacing regular populations. We were forced into an unprecedented and frankly scary spot, to do demand planning around an uncertain population. Our team saw a solution by asking an equally unprecedented question: “Do we have a nursing shortage, or are we not designing the care model to fit and manage within our workforce market?”
When you do take a look at total workforce, the issue isn’t nurses alone. It’s the total clinical help at the front lines that needed to be managed. The wildly variable volume of patients and sharp change in types of patients that COVID-19 brought to Mercy ultimately led to permanent changes in workforce management.
Q: What capacity management challenges did Mercy face?
BJR: In the process of a patient journey across our whole system, we touch so many departments. Any hiccup along that path for the patient affects capacity management, and every single diagnosis causes a variation in the patient population. There are so many factors to consider, it’s obvious how this would become a huge math problem with no easy answers.
This is where workforce management and capacity management intersect. When you have a workforce shortage, or believe you do, looking at demand hours for patient care is based on a pre-determined ratio of licensed and non-licensed personnel. If the patient need isn't correct, or we're not optimizing patient need, demand hours become variable or a “best guess.” This leads us once again to the question -- are we just not optimizing capacity management for the workforce or do we have an actual shortage in the workforce?
Q: Considering those major challenges, what role did technology play when it came to improving patient outcomes at Mercy, especially during the pandemic?
BJR: Those health systems who were already leveraging technology and analytics heading into this pandemic, I guarantee had more successful outcomes. Our long-term investment in technology clearly paid off as we pivoted quickly to meet the new demands.
As workforce and capacity management were inextricably linked to patient outcomes, the use of predictive analytics to improve performance was critical. Being a nurse leader means understanding how to use analytics to improve performance, care, patient experience and nurse engagement. Automated analytics systems helped us know how much personal protective equipment we had on hand, and in turn acquire what we needed. Mercy was able to get out in front of the market and acquire what we needed faster. There was not a day that we didn't have what we needed.
From a mathematical modeling perspective, our predictive data was also appended during COVID-19. We had to quickly adapt models to say, “what problem am I really trying to solve?” Is it opening up more capacity, for example, to get more elective surgeries done? With most ORs utilizing Block Time management, COVID-19 presented an opportunity. We could go back to handing blocks of time to individual surgeons or groups, because it’s the way it was always done, or encourage collaboration to work through the huge backlog, knowing everyone’s patients were important. We ended up finding that the problem statement and capacity management was less about predicting and prescribing based on historical data.