Issue #10: Pandemic Staffing: Our "New Normal"

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PANDEMIC STAFFING: OUR “NEW NORMAL” Revisiting workload volumes and shifting staff schedules to support alignment in the COVID 19 environment Our team of Healthcare Industrial Engineers created this newsletter to share the industry’s best practices with leaders who can apply operational efficiencies in their daily work.  Across the country, hospitals have been forced to close their doors due to revenue headwinds and increasing costs due to the COVID 19 pandemic.  All are working to closely manage costs to keep their doors open for the communities they serve.   Perhaps the most approachable and impactful strategy to reduce cost while improving care is demand matching – the process of reviewing staff schedules and patient workload volumes to align staff with volume by hour of day.  Even if you’ve done this in the past, it’s important to reevaluate as patient volume patterns have shifted in hospitals across the country. TOP TIP Be sure to use department-specific volume data.  Compare staff schedules to historical volumes by season of year, day of week, and hour of day.   Psst... consider excluding atypical data, such as peak months of COVID 19 (March – June 2020, for example) when analyzing volume patterns.  The goal is to align staff with volume patterns that we anticipate in the future. STAFFING SOLUTIONS IN THE NEWS Does your Staff Schedule Address Variable Workload? Leveraging the concept of demand matching in the healthcare setting is critical to delivering quality care, as patient workload can vary significantly by time of day, day of week, and season of year. Workload fluctuations can drive understaffing during certain times while inadvertent overstaffing during other times can drive unfavorable performance to the department’s labor expense budget. read more >> Shifting the Mindset for Staff Modeling “You could go a level deeper and trend your data by hour of the day and by day of the week – and look at the actual bedded times, ESI acuity data, and length of stay. Then, you can layer in the nursing and facility staffing levels to ensure that you have real bed capacity and available resources to treat incoming patients efficiently.” read more >> Wide nurse staffing variation across hospitals poses a threat to the public's health The report documented staffing ratios that varied from three to 10 patients for each nurse on general adult medical and surgical units. ICU nurse staffing was better, but also varied significantly across hospitals. read more >> INDUSTRY BEST PRACTICE GUIDE 1) OBTAIN DATA TO PERFORM ANALYSIS Collect financial budget expectations such as productivity targets and clinical operations requirements such as nurse ratios. Collect 18-24 months of hourly patient volume data for targeted departments.  Work with the department leader to obtain staff schedules. 2) BUILD CURRENT STATE STAFFING MODEL Combine all data collected to build the current state model.  Compare hourly patient workload volumes to the current staff schedule. Displaying this information graphically instantly highlights times of day when schedule modifications are warranted to better accommodate workload variation.   3) DESIGN IDEAL FUTURE STATE SCHEDULE Once schedule realignment opportunities are identified, dig into the detail to recommend specific shift adjustments that are approachable for the department. Begin by addressing areas of the staffing model that appear overstaffed and adjusting these shifts to areas where the model appears understaffed.  4) IMPLEMENT RECOMMENDED SCHEDULE CHANGES For some shifts, changes can be made immediately. Other adjustments should be implemented over time or through attrition. When recruiting, thoughtfully consider which shifts should be advertised for new positions. Remember that the goal is improved alignment. When adjusting, leverage change management best practices. Be sure to explain the purpose of making staff decisions and offer new shifts to volunteers. Communication is vital in making schedule changes.

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