October 1 has come and gone, ushering in a "Brave New World" where Medicare payments are linked to quality outcomes.
To prepare for this, hospitals across the country have invested an incredible amount of energy to reduce readmission rates. In addition to rethinking discharge procedures and improving transitional care and follow-up protocols, many organizations are focusing on labor initiatives as a way to drive quality improvements.
Labor is the single largest operating expense for health systems, and few things have a greater effect on quality than the professionals providing patient care.
The following three labor management strategies can positively affect quality scores:
1. Decrease the Time Managers Spend in Administrative Duties
One of the most frustrating issues managers face in healthcare, whether they are nurse managers on inpatient units or managers of OR, ED, or women's services departments, is the amount of time they are forced to dedicate to the staffing and scheduling process and the detachment they feel from their staff and patients as a result.
Whether it is from time spent developing schedules, struggling with paper processes like PTO and trade requests, tracking licensure and credential details and expirations, or trying to recruit staff to fill open shifts, the activity of "staffing" can occupy 50% or more of a manager's time. The key to decreasing the time spent in scheduling and staffing is automation.
By automating the generation of schedules, the posting of open shifts, credential and licensure tracking, and implementing simple, paperless staff communications options (trade and PTO requests, etc.), managers can get several hours of time back per pay period - time they could be spending on patient care and mentoring staff.
2. Reduce Core Staff Floating
Excessive core staff floating disrupts continuity of care and is often cited as one of the biggest dissatisfiers among nursing staff. Floating can lead to internal conflicts, feelings of unfairness, and a culture of animosity which will erode morale and negatively impact patient care. In general, floating stems from inaccurate and/or incomplete core staff schedules.
Typically, schedules are inaccurate and unbalanced because they are based off of a flat budgeted target instead of a forecasted volume that is based on actual historical volume trends. It is crucial that health organizations have an accurate prediction of patient volumes four to six weeks out - before initial schedules are submitted.
Then, as the prediction gets refined in the weeks leading up to the shift, various strategies, including an automated, self-administered open shift management process, can be employed to fill in any gaps that may occur as a result of core staff unavailability for obligations such as Education, PTO, FMLA, etc.
Incomplete schedules are the result of staffing tools that do not highlight the difference between need and supply. Effective scheduling systems automate the creation of schedules and provide an easy, step-by-step process that alerts managers to upcoming events or areas of need.
While floating is occasionally unavoidable measures can be put in place to minimize it, and protocols can be embedded to ensure the decision process is fair, orderly, and follows policy to the letter.
3. Limit Overtime and Agency Usage
While overtime is considered by many to be a financial perk of the profession, it is not an effective long-term strategy for any organization. In fact, over the long term, overtime negatively affects the organization, the caregiver, and the patient. Providing quality patient care requires physical strength and endurance as well as mental sharpness. Excessive overtime leads to fatigue and eventually burnout - greatly reducing a caregiver's ability to perform as effectively as he or she typically would.
Currently, one in seven Medicare patients will experience some "adverse" event, such as a preventable illness, infection, or injury while in the hospital.1 A study released in the August issue of the American Journal of Infection Control noted the correlation of nurse burnout to higher healthcare-associated infection rates.
The frequent use of agency caregivers can also have negative effects on a unit, both from quality and financial perspectives. While agency staff can save the day as a source of last-minute contingency, excessive use of agency can cause a unit to miss its financial targets, disrupt continuity of care, and cause grumblings from core staff who are well aware of the difference between agency and core staff wage rates.
The key to decreasing overtime and limiting the use of agency comes from accurate patient volume forecasting, complete core staff schedules, and the development of right-sized and properly layered sources of internal contingency staff that can adjust to the ebb and flow of patient demand.
As quality care has become a major factor in ensuring hospitals receive payment for the services provided, organizations must look at a variety of ways to improve patient outcomes, safety scores, and lower readmission rates. Effective labor management strategies are of singular importance to these quality initiatives.
1. Accountable Care Organizations: Improving Care Coordination for People with Medicare. HealthCare.gov. Available at: www.healthcare.gov/news/factsheets/2011/03/accountablecare03312011a.html (last accessed Nov. 14, 2012).
Chris Fox is CEO, Avantas. For more on the latest healthcare labor management trends, visit Chris Fox's blog.