3 Ways to Work Smarter Managing Labor

The phrase "work smarter, not harder," is one that tends to get a reaction out of people. Typically that reaction is one of two things. On one hand, there is a group that says, yes, we need to stop toiling and find a better, more efficient way to get things done. On the other hand, there are folks who feel the "work smarter" movement has more to do with individuals simply not wanting to work hard like those who came before them.

As is the case with so many topics that garner emotional responses one way or the other, both sentiments have merit. With healthcare that is certainly the case. We need to work harder and smarter. But working harder means something different in healthcare. Care staff, in most cases, cannot work harder. Study after study show that quality breaks down and staff suffer (as do their patients) when they are pushed beyond their FTE and are straddled with more patients than one can safely care for. It is a balance then of smart, hard work that is needed for health providers to focus their efforts to achieve their care and organizational goals.

3 ways to work smarter
1. FTE fairness
When we start working with a new client, the first thing we generally do is conduct a workforce analytics project. Essentially, we look at a number of metrics to help determine how many and what types of staff a hospital needs to effectively provide care. In almost all instances we discover an interesting paradox: 1) Too much overtime, and 2) Too many staff not working up to their FTEs (what we call FTE leakage). Correction of the second problem will have a big impact on the first.

I titled this section "FTE fairness" because it essentially boils down to that. Why should some staff work overtime when others are not getting their hours? While many see overtime as a perk of the profession, a way to earn extra money, it is a factor in staff burnout, fatigue and medical errors, not to mention excess cost for the organization. At the same time, staff who are not working up to their commitment are receiving benefits they are not technically earning — another source of excess cost.  

2. Policy and practice alignment  
In addition to workforce analytics, organizations can find tremendous value by conducting an audit relative to their scheduling and staffing policies and practices. These policies are already reviewed every three years and signed off on for Joint Commission review, but in most cases hospitals do not necessarily take this as an opportunity to improve, or compare to "best practice." With staffing polices, the general assumption is that what is in place is working just fine. Sometimes that is certainly the case, but often there is an evidenced-based alternative or tweak that could be made that will provide greater efficiency.

The next part of this, policy and practice alignment, is generally where organizations realize the greatest opportunities due to the number and severity of variances between policy and practice. These variances happen between hospitals in a system, unit-to-unit and even shift-to-shift. Again, in virtually every client environment we find vast differences between the way a policy is written and the manner in which it is carried out, i.e., practices. Policies exist to create uniformity and efficiency across the enterprise. When practices vary from policy it creates inefficiency. When it comes to staffing policies, inconsistency can destroy morale if it is interpreted as unfair. Examples of inconsistent practices that can cause feelings of unfairness are cancellation and float order, trade and PTO requests, and open shift availability.

3. Reassigning and reducing administrative duties
Nurse managers can allocate between 50 -70 percent of their time on scheduling and staffing duties. This can be time spent creating schedules, processing trades and staff requests, updating/tracking credential and license information, recruitment, etc. Most managers have earned their role because of their excellence as clinicians. It seems contrary that the recognition of leadership and experience comes with the burden of overwhelming administrative duties.

Organizations that have adopted centralized approaches to resource management typically are able to return several hours per week back to their nursing leaders. Additionally, centralizing resource management results in better staffing across the enterprise. To get maximum value from this approach, staffing analysts in the resource center must have the tools to view staffing at the system level to carry out the organization's deployment and alignment strategies, in addition to providing in-depth schedule analysis and reporting functions to improve performance.

Working smarter takes hard work
The three areas I outlined above all come with their fair share of heavy lifting. It takes strong leadership, excellent communication and determination to implement change and make it stick.

The point of working smarter is not necessarily to get "more" done. It can be simply to do better work. Nurses do not need more patients. They need fewer obstacles preventing them from providing the level of care and achieving the outcomes they and their patients desire. Additionally, working smarter means reducing the administrative work that keeps nursing leaders from being visible on their units, mentoring staff, working with physicians and communicating with families.

Chris Fox is chief executive officer at Avantas, a leading provider of strategic labor management technology, services, and strategies for the healthcare industry. He is an industry veteran and proven leader who has played a critical role in the company’s rapid rise to leadership in healthcare enterprise labor management.