[post by Bob Gleason, executive advisor for hospital transformation for Care Logistics]
Health systems have had to focus on both the revenue and cost sides of their profit and loss statements to stay viable in today’s healthcare market. On the cost side, the biggest category is labor. Of that, the largest is nursing.
Within the nursing labor cost management arena several elements have been a common point of focus for years:
- future schedule planning (ideally based on historical trends and budget targets),
- daily reconciliation of time scheduled to actual time worked and daily staff deployment (automated scheduling systems integrated with time clock systems)
- open shift filling.
What has not been a common point of focus, but is where the final hourly staffing decisions and changes can have the ultimate impact on the bottom line, is the intersection of staffing(capacity) and demand (patient throughput).
By answering these questions you may start to see the relevance of linking daily staffing activities with patient throughput:
Patient Placement Coordinator:
- Am I ever delayed from placing patients in beds because of inadequate staffing?
- Do I always know which unit is the best for placing a patient based on staffing capacity?
Chief Nursing Officer:
- Do some of the nursing units admit patients into beds even when staffing does not support this?
- Do I know when and how many patients are expected to be admitted to specific beds when I make daily staffing decisions like floating and calling in additional nurses?
- Has it ever occurred that one nursing unit which was overstaffed sent an RN home without me knowing, when in fact I could have floated the nurse to work on another unit (understaffed) and ended up having to call in a higher paid nurse?
- Why did I get two patient admissions this shift when the other nurse did not get any?
- Why is my patient load much heavier this shift than the other nurses?
The answers to these questions may be the reason labor costs are higher than budgeted, patient placement is delayed and staff satisfaction has been suffering.
By merging patient flow activity with the details of daily staffing adjustments across nursing units and adjusting patient assignments to nurse providers we can gain further operational efficiencies.
Here are some of the operational performance measures that can be favorably affected by a tight integration between patient throughput (demand) and staffing (capacity):
- Labor cost: specifically a decrease in high cost labor, like overtime and per diem agency
- Staff satisfaction: increased satisfaction due to having adequate staff to care for the overall number of patients on the nursing unit, as well as balanced workload among the nurses working
- Admission Order to bed assignment time: eliminating the patient flow barrier of inadequate staffing increases the efficiency of the patient placement
- Patient satisfaction: increased satisfaction due to appropriate nurse workloads and the ability to have sufficient patient bedside time for each patient.