Perhaps you've heard it said, "A little chaos is good for the soul." Maybe it's true, but it's bad for nerves AND staffing plans.
It's especially hard to understand why an event that occurs every year creates the most staffing uncertainty. What is it? Flu season. Across the continuum of care, the several month cycle of infectious disease frequently turns the most well-conceived plan into a nightmare of staffing chaos.
The CDC and other organizations have made tremendous strides in forecasting when, where, and how influenza will strike. Despite widely available predictions, staffing issues persist. Why? Perhaps we are studying and attempting to solve the wrong side of the supply and demand equation.
Demand, as measured by patient census and acuity, often increases during flu season. However, having a precise forecast of when flu season will impact your region is truly of little value unless you have solved the staffing supply side of the equation.
To illustrate that point let's ask the question one more time. What event impacts staffing each and every year but creates the most staffing uncertainty? Valentine Day. Everyone knows when it occurs. No prediction is required and patient census will not likely be impacted. Why then do staffing professionals groan at the mention of February 14? Another example that makes experienced workforce planners shudder is Halloween.
These and other "non-holiday holidays" are notoriously difficult staffing days. Why? The supply of available staff decreases on these days thereby a shortage occurs (with little or no increase to patient demand). It doesn't end there. We live in Nebraska, where Cornhusker football reigns supreme on Saturdays during fall. The bigger games of the year have been known to sabotage a staffing plan in our region, and different events may impact other states in similar ways.
The first course of action to wrap your head around the supply/demand equation is to understand and solve issues that diminish the available supply of your most valuable resource – core staff.
Core Staff Availability
Initial improvement steps may include:
1. ANALYZE factors impacting the supply of available core staff.
• For the purposes of this discussion, core staff is defined as full- and part-time employees who are assigned to a single department and are working within their designated FTE.
2. INVESTIGATE further to gain a full understanding of trends especially damaging to staffing outcomes. The following are two examples of issues you may uncover.
• FTE leakage is particularly harmful. Hours dedicated within your budget for core staff FTEs but are not scheduled or worked have "leaked" from your available staff resources.
• Same day or near-time absences among core staff members can derail any staffing plan. Carefully analyze past events by day of the week, shift, department, and individual to plan the depth of replacement staff that will be needed.
3. PLAN improvements to address each issue discovered. Set goals and timelines and report results. Once initial goals are met, take actions to hold the gain and move on to your next set of improvements.
Improving core staff availability is a great place to start, however it is not the full remedy to every staffing woe. Once these improvements are underway, it'll be time to consider contingency staff availability.
Contingency Staff Availability
Initial improvement steps may include:
1. ANALYZE demand for contingency staff to fully understand the minimum and maximum required depth to right-size expansion and contraction capacity.
• For the purposes of this discussion, we define contingency staff as all those EXCEPT full- and part-time employees who are assigned to a single department and are working within their designated FTE. This would include core staff members working above their FTE, including overtime.
2. DEFINE the purpose of each segment of contingency staff, assigning highest value and depth to layers with the greatest float attitude and aptitude. Seek adaptability.
• Limit unit-based PRN to extreme cases of clinical competency such as burn unit or high risk OB.
• Dedicate the highest volume of hours to an internal float pool tiered according to the needs of the enterprise.
• Include meaningful use of external agencies who have proven ability to supplement with high-quality staff in times of high need.
• Prevent burnout by reserving core staff working above the FTE, including overtime, to times of most extreme need.
3. PLAN infrastructure needs, including selection and competency models, similar to other proven and successful models. Give contingency pools a distinct identity including leadership separate from core staff.
Begin to drive uncertainty out of your staffing plan using these strategies and continue on the road to success by adapting more advanced methods. It's a worthwhile journey out of chaos.
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