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Examples of financial, operational, and cultural benefits that your organization may experience after implementing a dedicated on-call team. https://images.squarespace-cdn.com/content/v1/573233eb4c2f8518b0b858d9/1612879446608-UBCPUE6RCG4J86V9XZZ7/On-Call+Image+1.png Newsroom - Cara Cook Consulting - Is On-Call Burden Driving Chronic Turnover in Your Department? The "fatigue factor" often leads to scheduling challenges due to last minute call-offs and ultimately potential patient safety concerns. https://images.squarespace-cdn.com/content/v1/573233eb4c2f8518b0b858d9/1612879328833-84UDG2YZ79D57YT33PT7/On-Call%2BImage%2B2.jpg Newsroom - Cara Cook Consulting - Is On-Call Burden Driving Chronic Turnover in Your Department? Trending turnover by category can help identify ongoing pain points such as increased on-call utilization. https://images.squarespace-cdn.com/content/v1/573233eb4c2f8518b0b858d9/1612879639068-YFTY6QDZEDNDHHUC4SUV/On-Call%2BImage%2B4.jpg Newsroom - Cara Cook Consulting - Is On-Call Burden Driving Chronic Turnover in Your Department? Review exit interview data to determine if on-call is significantly impacting your staff retention rate. https://www.caracookconsulting.com/blog/are-you-using-contract-labor-effectively monthly 0.5 2021-10-05 https://www.caracookconsulting.com/blog/when-is-it-a-good-idea-to-use-contract-labor monthly 0.5 2023-07-18 https://images.squarespace-cdn.com/content/v1/573233eb4c2f8518b0b858d9/1608315105674-MWZUR0UBFSX494H6Y2H5/Car+Cook.jpg Newsroom - Cara Cook Consulting - When is it a Good Idea to Use Contract Labor? Cara Cook is an industry-leading expert in optimizing complex healthcare operations. 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Chad Moses https://images.squarespace-cdn.com/content/v1/573233eb4c2f8518b0b858d9/1745607615496-CP7EDVJM1DITVYEU2YNS/Susie.jpg Team Gallery - Susie Law Susan Law is a recently retired healthcare executive with extensive experience in hospital operations, nursing leadership, informatics, ER and OR operations, clinical process improvement and physician relations. Following her 30 year career with HCA Healthcare, Susan currently partners with Cara Cook Consulting to work closely with hospitals, large academic medical centers, and healthcare systems, assessing current state operations to develop and execute customized solutions designed to improve margin while simultaneously making a positive impact on patient and provider experience. https://images.squarespace-cdn.com/content/v1/573233eb4c2f8518b0b858d9/1745607512992-4QGBLXRT4VV50CP55KMQ/Paul%2BScott.jpg Team Gallery - Paul Scott https://images.squarespace-cdn.com/content/v1/573233eb4c2f8518b0b858d9/1745607603047-3LLL573QFO9SQ7M20LYE/ppt%252Bres.jpg Team Gallery - Becky Adix Becky is a former Vice President of Human Resources. With over 23 years of executive healthcare leadership experience, Becky possesses an extensive knowledge of all facets of human resources and healthcare operations. https://images.squarespace-cdn.com/content/v1/573233eb4c2f8518b0b858d9/1745608069861-GLNQMGYXVHM37V2WHE4B/Brian%252BSimmons.jpg Team Gallery - Brian Simmons https://www.caracookconsulting.com/newsroom1 daily 0.75 2024-10-17 https://www.caracookconsulting.com/our-team daily 0.75 2025-04-25 https://images.squarespace-cdn.com/content/v1/573233eb4c2f8518b0b858d9/97d55031-9a00-45c6-9ad0-8b7b913ee905/Paul+Scott.jpg Our Team - PAUL SCOTT Paul Scott is a seasoned finance executive with a strong background spanning public accounting, and financial planning & analysis. He specializes in building financial systems that support scalability, optimizing cash flow, and data-driven decision-making. read more » https://images.squarespace-cdn.com/content/v1/573233eb4c2f8518b0b858d9/e66ef566-1b97-4495-acd2-4ecf46998c79/ppt+res.jpg Our Team - BECKY ADIX Becky is a former Vice President of Human Resources. With over 23 years of executive healthcare leadership experience, Becky possesses an extensive knowledge of all facets of human resources and healthcare operations. read more » https://images.squarespace-cdn.com/content/v1/573233eb4c2f8518b0b858d9/c7bfe380-f58a-42c9-aa6c-4beddd11b3ff/_MPH9383.jpeg Our Team - Cara Cook Cara Cook https://images.squarespace-cdn.com/content/v1/573233eb4c2f8518b0b858d9/16f34319-58c9-4779-8fed-5dd011f1f7bc/_PMP4348.jpeg Our Team - Susie Law, RN Susie Law is a former System/Region VP of Clinical Operations and Chief Clinical Informatics Officer. Her healthcare experience spans executive leadership roles at the hospital, region and corporate levels. read more » https://images.squarespace-cdn.com/content/v1/573233eb4c2f8518b0b858d9/1745608092396-90D8WJ5CDMGUK1EDW7L8/_PMP4513.jpg Our Team - Chad moses Chad Moses is a former Vice President and CFO focused on financial performance improvement and system integration. His experience includes advisory work within the Healthcare industry and even a small stent in private business. read more » https://images.squarespace-cdn.com/content/v1/573233eb4c2f8518b0b858d9/1745608069861-GLNQMGYXVHM37V2WHE4B/BrianSimmons.jpg Our Team - Brian simmons Brian brings over a decade of hands-on experience supporting healthcare, financial, and professional-services organizations with reliable IT infrastructure and thoughtful cybersecurity solutions. He focuses on systems administration and IT improvement initiatives that keep our clients productive, secure, and connected. https://www.caracookconsulting.com/our-services daily 0.75 2021-02-10 https://www.caracookconsulting.com/our-team1 daily 0.75 2025-03-10 https://images.squarespace-cdn.com/content/v1/573233eb4c2f8518b0b858d9/16f34319-58c9-4779-8fed-5dd011f1f7bc/_PMP4348.jpeg Our Team - Susie Law, RN Susie Law is a former System/Region VP of Clinical Operations and Chief Clinical Informatics Officer. Her healthcare experience spans executive leadership roles at the hospital, region and corporate levels. read more » https://images.squarespace-cdn.com/content/v1/573233eb4c2f8518b0b858d9/7c0ea86f-2b7f-4e9c-9599-6ab38f23f29a/_PMP4475.jpg Our Team - Natalie Heidel Natalie has extensive expertise in inpatient flow and bed management operations. 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Perhaps the most common questions we regularly receive from department leaders is around productivity benchmarking. While many vendors provide peer performance comparison data to hospitals, the information is leveraged in the same way. This summer, we’ll explore the topic of productivity benchmarking and its many nuances. Please don’t hesitate to send us questions! https://images.squarespace-cdn.com/content/v1/573233eb4c2f8518b0b858d9/4790be31-2154-4e9d-903a-aa1d26b55f16/Top+Tip+3+-+Benchmarking.png Benchmarking Top Tips - STATS MATTER Benchmark synonyms! stat = statistic = volume = UOS (unit of service) = UOM (unit of measure) All of these terms reference quantified workload measurement for a department over a given timeframe. When performing peer comparisons, it is critical to ensure the stat – or denominator in the worked hour per UOS – matches the definition required for submissions. For example, if an Operating Room submits OR cases when peers submit OR minutes for the reporting period, the department will certainly appear overstaffed compared to peers. Similarly, if an Emergency Department submits annual ER visits when peers submit quarterly ER visits, the department will certainly appear understaffed compared to peers. Accurate peer comparisons rely on all submitting organizations to follow defined parameters for both statistics and hours. https://images.squarespace-cdn.com/content/v1/573233eb4c2f8518b0b858d9/2f9a5eb2-47d6-4471-82d2-f9fd9cddf3ca/Top+Tip+8+-+Benchmarking.png Benchmarking Top Tips - LOW PERFORMANCE OUTLIER While lowest performance is commonly tagged as "best", in actuality it is an outlier and should be evaluated for accuracy. Common drivers of low outliers include reference labs, centralized order entry for pharmacy, any outsourced function where FTEs aren't being counted, and ancillary test credit for test nursing staff performance. https://images.squarespace-cdn.com/content/v1/573233eb4c2f8518b0b858d9/73121dd1-5570-4349-8add-2ea91e5d2c24/Top+Tip+9+-+Benchmarking.png Benchmarking Top Tips - HIGH PERFORMANCE OUTLIER While highest performance is commonly tagged as "worst", in actuality it is an outlier and should be evaluated for accuracy. Common drivers of high outliers include lock-in, fixed hours of operation for low volume areas, minimum staffing requirements such as L&D, and covering services outside of your peer group definition. https://images.squarespace-cdn.com/content/v1/573233eb4c2f8518b0b858d9/c63778a0-50df-42ba-bbbb-e1cc27e2b1c9/Top+Tip+10+-+Benchmarking.png Benchmarking Top Tips - CREATE AN ACTION PLAN If you only picked up one tip from this entire series, we hope it is this one. Before adjusting a productivity target, develop an action plan and demonstrate results. Always consider the impact to other success metrics - such as patient satisfaction, quality care, staff effectiveness, market dynamics, and physician engagement before formalizing a change. https://images.squarespace-cdn.com/content/v1/573233eb4c2f8518b0b858d9/9322a32f-0401-4bef-bb19-f5b37571e3c6/Top+Tip+4+-+Benchmarking.png Benchmarking Top Tips - SELECTING STATS Stat selection can be challenging for some departments - and using a singular statistic to describe workload is never perfect. However, some stats do a better job of describing workload in departments than others. As an example, Central Sterile departments commonly report OR minutes when comparing staffing to peers. However, in ORs with a higher proportion of orthopedic cases, tray counts may tell a different story. It is important to remember that peer comparison benchmarks provide information about our performance compared to our peers. That information can be colored very differently, depending on the stat chosen for comparison. This is a critical concept to consider when using benchmark data to address departmental perceived efficiency opportunities. https://images.squarespace-cdn.com/content/v1/573233eb4c2f8518b0b858d9/5aa127d6-3d7a-457c-b3ce-0a3524e8c13f/Top+Tip+6+-+Benchmarking.png Benchmarking Top Tips - UN-BENCHMARKED FTEs Very few FTEs are appropriate to not be benchmarked. Industry best practice is to review un-benchmarked FTEs annually for appropriateness. https://images.squarespace-cdn.com/content/v1/573233eb4c2f8518b0b858d9/f4b66643-8e21-49c6-a2c1-772187149062/Top+Tip+7+-+Benchmarking.png Benchmarking Top Tips - PERFORMANCE GOALS Know your benchmark compare group definitions! If your department includes non-standard functions, be sure to normalize. For example, if your emergency department cost center includes registration FTEs, it's important to assign these FTEs to the registration department for accurate benchmark peer comparisons. https://images.squarespace-cdn.com/content/v1/573233eb4c2f8518b0b858d9/9dcb6f30-8758-48ba-9ec9-40c75715247f/Top+Tip+5+-+Benchmarking.png Benchmarking Top Tips - NORMALIZATIONS MATTER Know your benchmark compare group definitions! If your department includes non-standard functions, be sure to normalize. For example, if your emergency department cost center includes registration FTEs, it's important to assign these FTEs to the registration department for accurate benchmark peer comparisons. https://images.squarespace-cdn.com/content/v1/573233eb4c2f8518b0b858d9/9f75ae19-e556-4647-b4a9-510d8d3783ec/Top+Tip+2+-+Benchmarking.png Benchmarking Top Tips - LEVERAGING DATA High performing organizations understand that benchmark comparisons provide directional information about peer performance to support long-term, strategic decision making. In contrast, productivity management tools should be used to drive daily, bi-weekly, and monthly performance to budgeted targets. A common mistake of inexperienced leaders is requiring performance to 50th percentile benchmark targets without ensuring the current department operations should perform to those targets. Leaders who manage to peer performance rather than budgeted targets run the risk of negatively impacting quality of care and strategic goals. https://www.caracookconsulting.com/labor-budget-top-tips daily 0.75 2024-02-27 https://images.squarespace-cdn.com/content/v1/573233eb4c2f8518b0b858d9/723b13bf-3fe5-4083-b232-b9297c1b6143/Top+Tip+2+-+Labor+Budget.png Labor Budget Top Tips - TARGET ALIGNMENT Ensuring all productivity targets reconcile between the budget system and the productivity management system is critical, as systems rarely synchronize without intervention. Managing department level productivity ultimately supports financial performance to budget, as labor represents more than 50% of all hospital expenses. Some labor managers update targets in the productivity management system early - 1 to 3 months prior to the budget start date. This provides managers and directors ample time to adjust before the budget year starts. https://images.squarespace-cdn.com/content/v1/573233eb4c2f8518b0b858d9/4f5fb432-0b04-410b-b08a-3d045ff5e96d/Top+Tip+4+-+Labor+Budget.png Labor Budget Top Tips - ORIENTATION HOURS Has your turnover increased after COVID? Accurately project and budget your orientation needs for the coming year. We recommend obtaining current vacancies and average orientation time by individual cost center for the most accurate estimate. Unfavorable budget performance due to orientation is common, and can result in reduction in force. Don't let it happen to you! https://images.squarespace-cdn.com/content/v1/573233eb4c2f8518b0b858d9/c67f2f1c-1280-4b08-91c5-856b6fb99eb3/Top+Tip+3+-+Labor+Budget.png Labor Budget Top Tips - NON-PRODUCTIVE TIME It can be tempting to set a flat non-productive % across all months in each department to save time during the budget process, but this can grossly skew anticipated performance. For example, if a large department has seasoned staff with higher-than-average PTO banks, significant unbudgeted non-productive FTEs can drive missed targets – particularly in November and December! Best practice, when possible, is to budget non-productive % by month at the department level based on prior year run rate. https://images.squarespace-cdn.com/content/v1/573233eb4c2f8518b0b858d9/481efa58-3ee5-4279-ab36-c3c9ee1db542/Top+Tip+1+-+Labor+Budget.png Labor Budget Top Tips - CONSIDERATIONS We have a lot more than five top tips for the annual budget process, but these are the big ones (#6 without a doubt would be “Do not plug negative FTEs into any department for any reason – including vacancies)! For those whose fiscal year is the calendar year, we hope this brief series provides some high-level checks to ensure your labor management plans support achieving financial budget goals. Stay tuned! https://images.squarespace-cdn.com/content/v1/573233eb4c2f8518b0b858d9/82be22d6-0054-40dd-a60f-9379a40106ed/Top+Tip+5+-+Labor+Budget.png Labor Budget Top Tips - 50% FLEX RULE When budgeting for volume growth or decline, a general rule for FTE growth is that your percent change in FTEs should equal half of the percent change of the volume, same store. This principle assumes that 50% of hospital FTEs are fixed and 50% are variable and flex with volume. For example, if budgeted adjusted patient days are rising by 6% over prior year, the budgeted FTEs should only rise by 3% from prior year. Similarly, if budgeted adjusted patient days are decreasing by 1%, budgeted FTEs should decrease by .5%. This concept applies both to budgeting against prior year as well as monthly actual performance against budget. https://images.squarespace-cdn.com/content/v1/573233eb4c2f8518b0b858d9/aceb2db3-5fa6-4ca4-bb5a-3d867b2e0b8b/Top+Tip+6+-+Labor+Budget.png Labor Budget Top Tips - POSITION CONTROL When budgeted FTEs are final, proactively update your position control to support performance to budget. Due to recruitment and onboarding lead time, update position control as soon as you can - start 1 to 3 months prior to the budget start date! This will help ensure departments do not hire over budget and support proactive recruitment for departments increasing FTEs in the budget. https://www.caracookconsulting.com/alternative-care-models-top-tips daily 0.75 2023-06-27 https://images.squarespace-cdn.com/content/v1/573233eb4c2f8518b0b858d9/be977943-3bb0-4bd6-97cc-2875b23d1e99/Top+Tip+3+-+Alternative+Care+Models.png Alternative Care Models Top Tips - EXTENDER MODEL The extender model utilizes LVN/LPN on Med/Surg units to extend RN patient capacity. Typically the LVN/LPN & RN will work together as a team to take 50%-60% more patients per RN. For example, if your current Med/Surg ratio is 1 RN to 5 patients, your extender team could take anywhere between 7 to 8 patients depending on acuity. https://images.squarespace-cdn.com/content/v1/573233eb4c2f8518b0b858d9/81c0d34d-6298-48f1-9d2f-d630d13c0f30/Top+Tip+2+-+Alternative+Care+Models.png Alternative Care Models Top Tips - FOUR EXAMPLES When short on RNs, what are your options to maintain your standard of care? The answer may be different – even among nursing units in the same hospital. https://images.squarespace-cdn.com/content/v1/573233eb4c2f8518b0b858d9/dacb756c-87fc-4a0e-9b4d-b0775a803eaf/Top+Tip+1+-+Alternative+Care+Models.png Alternative Care Models Top Tips - VACANCIES VS APPLICANTS Are vacancies and soaring contract labor rates causing you to reevaluate your patient care delivery models? You have more options than you may think! https://images.squarespace-cdn.com/content/v1/573233eb4c2f8518b0b858d9/dae9dbc1-6a7e-437d-8c10-fabd70c183ef/Top+Tip+4+-+Alternative+Care+Models.png Alternative Care Models Top Tips - REPLACEMENT MODEL In the replacement model, the LVN/LPNs will take their own patient load with RNs assigned to cover RN scope of practice duties such as assessments. The RNs will take patient assignment of their own but oversee RN duties for assigned LVNs. https://images.squarespace-cdn.com/content/v1/573233eb4c2f8518b0b858d9/cb57d36e-dacd-46b5-a149-e9917c18f252/Top+Tip+6+-+Alternative+Care+Models.png Alternative Care Models Top Tips - TEAM MODEL The team model is the most popular. It is especially efficient for units with census levels that correspond to the patient ratios per team. In the team model, a team of 1 RN, 1 LVN/LPN, & 1 PCA/Tech take a group of patients. For a med/surg unit the patient assignment size would be 10-12. The RN leads the team and coordinates care between the team members. This model lends well to each staff member working at the highest level of licensure. https://images.squarespace-cdn.com/content/v1/573233eb4c2f8518b0b858d9/a19dcee0-dd22-43a1-83a4-863a69867f64/Top+Tip+5+-+Alternative+Care+Models.png Alternative Care Models Top Tips - IN PLACE OF TECHS Some med/surg and intermediate units are able to increase RN ratios slightly when using higher functioning LVN/LPNs instead of techs. Depending on size of the unit, some techs may support patient bathing, stocking, and other specific duties while the others are replaced with LVN/LPNs to provide nursing support for RNs. https://www.caracookconsulting.com/contract-labor-top-tips daily 0.75 2023-06-27 https://images.squarespace-cdn.com/content/v1/573233eb4c2f8518b0b858d9/8c4c3f32-8d52-449f-b2fa-7a2eb9a65d58/Top+Tip+2+-+Contract+Labor.png Contract Labor Top Tips - EMBEDDED CONTRACT LABOR Contract labor is often defined as “embedded” when the same contractor is in the same role for more than 26 weeks. How long has your most tenured traveler worked in your hospital? https://images.squarespace-cdn.com/content/v1/573233eb4c2f8518b0b858d9/8a46a201-1f18-4af3-9678-0ed224d41631/Top+Tip+3+-+Contract+Labor.png Contract Labor Top Tips - MICRO MANAGEMENT When more than 10% of staff are contractors, it can be challenging to hardwire critical processes impacting culture, quality, and patient satisfaction. Our recent article (linked below) reviews how attentive management can support cost-effective utilization of premium labor resources. www.caracookconsulting.com/blog/when-is-it-a-good-idea-to-use-contract-labor https://images.squarespace-cdn.com/content/v1/573233eb4c2f8518b0b858d9/a16a4dd1-9d39-4d0a-9a6d-9f9d39881b5e/Screenshot+2023-06-27+at+5.26.35+PM.png Contract Labor Top Tips - CONTRACT LABOR In cases of dynamic volumes, flexible labor options are needed to ensure we schedule the right number of nurses in the right place, at the right time. https://www.caracookconsulting.com/budget-performance-top-tips daily 0.75 2024-02-27 https://images.squarespace-cdn.com/content/v1/573233eb4c2f8518b0b858d9/e7da4682-8abd-4ece-b714-8a7f6a66b836/Top+Tip+4+-+Drivers+of+Budget+Performance.png Budget Performance Top Tips - LENGTH OF STAY Hospital labor hours and dollars should always be compared on a “per stat” basis, as with department productivity targets, to determine if a hospital responded to volume changes appropriately. We recommend reporting per AA and APD to most accurately diagnose opportunities. It is important to use per APD metrics to determine productivity opportunity and per AA metrics to determine total financial impact of inefficiencies of productivity and LOS. https://images.squarespace-cdn.com/content/v1/573233eb4c2f8518b0b858d9/572fb684-8fbe-44c1-80e5-47d7a1b83a0c/Top+Tip+6+-+Drivers+of+Budget+Performance.png Budget Performance Top Tips - ACUITY AS A DRIVER Departments with higher patient ratios or higher labor cost per volume can drive labor intensity impact on a budget variance while the department is favorable to their productivity target. Individual department volume comparisons to budget can quickly identify FTE impact due to labor intensity, which should translate to the bottom line. https://images.squarespace-cdn.com/content/v1/573233eb4c2f8518b0b858d9/a89afdc4-dc17-4aad-ac06-0dd82544b530/Top+Tip+2+-+Drivers+of+Budget+Performance.png Budget Performance Top Tips - WHAT WENT WRONG? It is very important to correctly diagnose the drivers of unfavorable labor and productivity performance to ensure action plans are effective. If it takes multiple months to course correct, you may risk your organization's annual budget performance! This series explores our top tips for identifying the root cause of common labor variance drivers and the healthcare industry's best practices to get back on track. https://images.squarespace-cdn.com/content/v1/573233eb4c2f8518b0b858d9/786babd1-84db-497b-bc37-4563395eb394/Top+Tip+3+-+Drivers+of+Budget+Performance.png Budget Performance Top Tips - MISSED TARGETS Hospital labor budgets are a roll up of department productivity targets. If productivity targets are not met, there will be an unfavorable labor budget variance. We recommend focusing on individual department missed targets to identify back-to-budget opportunities, rather than only reviewing overall hospital productivity index percentage. https://images.squarespace-cdn.com/content/v1/573233eb4c2f8518b0b858d9/4192674d-ac33-4e26-9a2d-a5e8ed8aaa8a/Top+Tip+5+-+Drivers+of+Budget+Performance.png Budget Performance Top Tips - RATE VARIANCE If you’re favorable to budgeted FTEs but not salaries per patient day, this indicates a rate variance! Especially in today’s climate, many hospitals are flexing to volume appropriately, but still missing their labor budget due to increased contract labor rates and utilization. In this situation, ensure identified improvement initiatives are focused on reducing premium pay, rather than a staffing reduction. https://images.squarespace-cdn.com/content/v1/573233eb4c2f8518b0b858d9/560c63e4-66fd-4314-bd7a-bb69036326d9/Top+Tip+1+-+Drivers+of+Budget+Performance.png Budget Performance Top Tips - MISSING BUDGET ALREADY? If you've already been asked for a back to budget plan, you are probably not alone! Unfavorable variances are incredibly common in the first month of the year, as budgets can change significantly from one year to another. Salaries, wages, and benefits represent the largest and most controllable expense category - we recommend to start there! https://images.squarespace-cdn.com/content/v1/573233eb4c2f8518b0b858d9/43205b03-d082-4730-b737-8c4dd31c2ba2/Top+Tip+7+-+Drivers+of+Budget+Performance.png Budget Performance Top Tips - ACTION PLANS Before creating your back-to-budget plan, ensure you have thoroughly reviewed performance and accurately diagnosed unfavorable drivers to ensure action plans actually drive improvement! https://www.caracookconsulting.com/emergency-department-top-tips daily 0.75 2023-07-13 https://images.squarespace-cdn.com/content/v1/573233eb4c2f8518b0b858d9/d7dd9846-2696-456f-8390-82043793699f/Top+Tip+5+-+Emergency+Department.gif Emergency Department Top Tips - FAST TRACK What time is your Fast Track open on Mondays? High performing Emergency Departments typically utilize a "Fast Track" for low acuity patients to ensure all are seen in a timely fashion and fewer leave without being seen. The Fast Track is optimized for low acuity patient treatments, ensuring timely and effective care while optimizing resources. #EmergencyCareOptimization #FastTrackApproach #PatientCentricER #EfficientCare https://images.squarespace-cdn.com/content/v1/573233eb4c2f8518b0b858d9/09ac5277-de09-4134-b75e-7e421d695124/Top+Tip+6+-+Emergency+Department.gif Emergency Department Top Tips - ER DASHBOARD Is course correction needed in your ER? A dashboard with meaningful metrics and trending is critical for self-awareness and performance improvement. Consider creating a heat map and metric trending visuals to immediately identify strengths and opportunities. From here, monitor data monthly to target improvement initiatives that align with your goals. For more dashboard considerations, check out our "Nobody Cares About Your Dashboard" article! #emergencydepartment #erdashboard #performanceimprovement #emergencymanagement https://images.squarespace-cdn.com/content/v1/573233eb4c2f8518b0b858d9/d73c8310-57b6-46cd-9a4e-356d6ee2311c/Top+Tip+1+-+Emergency+Department.png Emergency Department Top Tips - LEFT WITHOUT BEING SEEN Did you know that every year in the US more than 1.5 million people who come to the ER for help leave without being seen?? This serious problem, exacerbated by the pandemic, delays care for untreated medical conditions and amounts to significant lost revenue for hospitals who need it desperately to support their staff. I think we can all agree that ensuring patients receive care when they need it is absolutely critical to effectively support the communities we serve. By working together to streamline emergency department processes, we can help ensure that no patient is left without care they need to live a healthy and fulfilling life. We can do better! #emergencymedicine #leftwithoutbeingseen #emergencydepartment #operationsmanagement https://images.squarespace-cdn.com/content/v1/573233eb4c2f8518b0b858d9/d881dae6-735c-4dfe-8448-1d79d0ae64e5/Top+Tip+2+-+Emergency+Department.gif Emergency Department Top Tips - DOCTOR STAFFING ALIGNMENT When preparing to provide emergency care for patients, first we must ensure staff are available at the right time! Aligning physician staff schedules with patient arrival rates is a critical first step, without which patients will very likely be forced to wait too long for emergency care, ultimately causing them to leave the ER before receiving the care they need. For example, if only 2 patients arrive on a Monday morning between the hour of 4:00 AM and 5:00 AM, 1 provider should be able to greet each of them and enter orders without delays. However, in that same afternoon between the hour of 2:00 PM and 3:00 PM, 15 new patients arrive. The inevitable backup caused by the workload mismatch for the overloaded (and probably frustrated) single provider will cause such a backlog it will create a surge that will likely not decompress until the following morning. This scenario is of course a clinical care risk, but also a revenue and reputational risk for the Emergency Room. When creating provider schedules, always review historical patient arrival rates by day of week and time of day to attempt to plan for this variation. Your results will be even better if you interview providers to learn more about their daily workflow considerations! #EmergencyCare #PhysicianSchedules #PatientArrivalRates #WaitTimes #ProviderScheduling #WorkflowConsiderations https://images.squarespace-cdn.com/content/v1/573233eb4c2f8518b0b858d9/c6716ff8-2309-4b98-8f5d-8b00d616ea1c/Pinball.gif Emergency Department Top Tips - NURSE STAFFING ALIGNMENT When creating the ER nursing schedule, it is critical to consider workload via patient census data, which varies based on day of the week and time of day. Ensuring consistent staff-to-patient ratios is the first way to support high-quality patient care delivery, whether it's a tranquil Sunday morning or a manic Monday evening. Top Tip: Don't forget to include boarders/holds in workload calculations! #EmergencyDepartment #NursesRock #ERNurse #NurseLeaders #StaffingSolutions https://images.squarespace-cdn.com/content/v1/573233eb4c2f8518b0b858d9/32d34e9a-54da-416d-83e2-38f70c2f3021/Top+Tip+4+-+Emergency+Department.gif Emergency Department Top Tips - PULL TILL FULL Triage is a process, not a place! In high performing Emergency Departments, the concept of "pull till full" has been commonplace for more than a decade. Immediate bedding is the practice of moving patients back into a room before they find a seat in the waiting room. This creates the most efficient care process and SIGNIFICANTLY reduces the number of patients who leave without being seen, as most who leave are simply tired of waiting. Emergency Departments occasionally get caught up on the idea of triage as a place. Remember that triage can easily take place anywhere - including in a treatment room! Immediate bedding not only constantly works to optimize physical space, but it also demonstrates our commitment to providing timely and patient-centric care. Let's redefine emergency care and ensure that every patient who walks through your doors receives the care they need… when they need it! #ImmediateBedding #TriageIsAProcess #EmergencyMedicine #ERbestpractices https://www.caracookconsulting.com/float-pool-top-tips daily 0.75 2023-06-27 https://images.squarespace-cdn.com/content/v1/573233eb4c2f8518b0b858d9/977f5214-ca87-4e25-bf30-0e540010c838/8.gif Float Pool Top Tips - EFFICIENT REQUEST AND FILL Your departments don't request Float Pool resources through email… right? If they do, requests are inevitably missed and reporting on time-to-fill, cancellations, fair assignments, and more are unavailable for review. One of the most common frustrations leaders have with Float Pools is related to the request process. When department leaders send requests and never hear back, they commonly over-request resources in an attempt to super-prioritize their needs. When this happens, assignments may be perceived as unfair or biased. Once this begins, the float pool manager will have a very hard time rebuilding trust. The solution is an efficient system for open shift request and assignment. Our team partners with organizations to assess, diagnose, and implement improved Float Pool solutions, including our tailored shift request and assignment tool from FlexSmart Solutions. Visit us at www.caracookconsulting.com to learn more. #floatpool #healthcare #staffing #bestpractices #requestandfill #solutions #efficiency #equity #bias #fairassignment https://images.squarespace-cdn.com/content/v1/573233eb4c2f8518b0b858d9/70cf9da3-ba69-4b9d-9ee2-accc4a86f77a/4.gif Float Pool Top Tips - THE RIGHT WAY TO RIGHTSIZE How many shifts can you reliably fill each day/night with your float pool? If you don’t know how many FTEs (not to be confused with headcount) are in your float pool, you might be at risk. If you only hire PRNs into your float pool, you are definitely at risk, as it is impossible to know the commitment level of your staff! For your float pool to successfully meet the needs of your organization, you must first rightsize the float pool resources to accommodate regularly occurring day and night requests for supported departments. Remember, you’ll need a separate solution to cover irregular/temporary needs such as seasonal volumes and vacancies! #floatpool #rightsizing #staffing. #operationsmanagement #scheduling #healthcare https://images.squarespace-cdn.com/content/v1/573233eb4c2f8518b0b858d9/6b573ffc-889e-4db8-a7ae-d466066358e5/Float+Pool+Top+Tips.gif Float Pool Top Tips - SINKING THE BUDGET Hospitals use emergency bonuses to fill shifts in emergencies, but some organizations play with fire when they use these bonuses to fulfill long-term needs. This drastically increases the risk of “baking in” premium pay into expenses. Worse still, staff members can become accustomed to bonus payments over the long term and, for example, purchase homes they could not afford otherwise. This scenario should be avoided at all costs, as it disables the organization from making good choices in the long-term. While we won't get into the details here, one of our clients used emergency bonuses for so long that staff fully adapted to the increased income level, ultimately leaving them with no other choice than to place their hospital system up for sale. Then, when they were forced to remove the bonuses to support viability, some staff members lost their homes. It is a heartbreaking scenario. Our goal in sharing stories like this is to prevent hospitals from this pitfall, as it is nearly impossible to course-correct without collateral damage once staff members become dependent on regular shift bonuses. Alternatively, a well-designed float pool and thoughtful management of seasonal volume fluctuations and vacancy management can set hospitals up for complete schedules and ultimate long term success. #floatpool #bonusabuse #premiumpay #seasonaljobs #hospitaloperations #finance https://images.squarespace-cdn.com/content/v1/573233eb4c2f8518b0b858d9/5e18a50c-3836-4d40-85c7-48e704315180/6.gif Float Pool Top Tips - IMPORTANCE OF GUARD RAILS Some Float Pool best practices are so important that they ultimately determine the success or failure of the program. Perhaps the most frequent mistake we see is in not incentivizing or even requiring flexibility from the Float Pool team. To determine your Float Pool's flexibility, ask yourself these questions: - Do we pay more to incentivize flexibility? Team members that will work during different shifts, for multiple departments, or at multiple locations - Do we monitor this flexibility? Review shifts worked to take advantage of flexibility - Do we hire full-time float pool staff? Or only PRNs with no commitment to us… - For our full-time team members, do we review commitment (actual shifts worked)? 0.9 consistently working 3 12-hr shifts a week Allowing Float Pool nurses to refuse to work in committed locations or shifts, while maintaining pay differentials drives staff dissatisfaction and increases avoidable labor spend. #floatpool #healthcare #flexibility #guardrails#commitment #staffing #incentives #bestpractices #requirementmonitoring #shiftvariation https://images.squarespace-cdn.com/content/v1/573233eb4c2f8518b0b858d9/a7435d98-b248-4fdb-b803-b741f5f9ed55/2.gif Float Pool Top Tips - PERMANENT STAFFING NEEDS Successful float pools are designed to support permanent staffing needs, including daily call-outs and FMLA. However, many organizations also attempt to use their float pool to cover temporary staffing shortages, such as gaps created by seasonal volume fluctuations and vacancies. This misstep can cause your float pool to quickly drain resources needed to support daily staffing levels. While seasonal volume fluctuations and vacancies are also critical to address, they require different strategies (such as hire ahead, flex plans, GN programs, etc.). Organizations who size float pools to address seasonal needs waste significant resources in low season. Make sure your float pool has a targeted strategy for each specific staffing need! #floatpool #staffing #FMLA #seasonalworkers #healthcare #operationsmanagement #strategy #vacancies https://images.squarespace-cdn.com/content/v1/573233eb4c2f8518b0b858d9/c4b68fb6-422f-4c12-a6ca-c5e9f0899f95/10.gif Float Pool Top Tips - FAIR ASSIGNMENTS One particularly frustrating float pool challenge is the perception of favoritism. Requestors often perceive that "they always get the float pool resources, while we never get any!" This accusation makes float pool managers feel defensive, but it's important to consider - how do you prioritize placement? Most hospitals assign based on request volume alone, which naturally gives an advantage to larger departments. However, leading practice float pools assign resources based on the percent of open shifts on the unit rather than request volume alone to prioritize patient care. They appreciate that 5 open shifts in a 6 bed ICU is more critical than 5 open shifts in a 50 bed ICU! To ensure your float pool prioritizes shift assignments to areas with the greatest need, establish an equitable assignment methodology and regularly publish a float pool dashboard - or reach out to us for help at admin@caracookconsulting.com! #floatpool #healthcare #staffing #favoritism #fairassignment #equity https://www.caracookconsulting.com/hire-targets-top-tips daily 0.75 2023-06-27 https://images.squarespace-cdn.com/content/v1/573233eb4c2f8518b0b858d9/4f0a3fde-b210-4f7c-ac98-cc41f05aa04e/Top+Tip+3+-+Hire+Targets.png Hire Targets Top Tips - HARDWIRING PREMIUM PAY Approving positions based on productivity performance can be considered advanced, but use caution! Any single labor metric can be misleading without context. Be sure to consult multiple metrics when approving positions, including premium pay utilization and temporary needs, like orientation. Inadvertently holding on necessary FTE approvals can create gaps in schedules as volume seasonally increases. This can lead to increased overtime to fill schedule gaps and increases the likelihood of staff burnout and turnover. Remember - once we approve positions, new employees cannot begin work immediately. They must be oriented, which not only delays premium pay relief, but these orientation hours can cause another productivity miss. Think strategically - do not get caught in the premium pay death spiral! #hospitalmanagement #hospitalfinance #hospitaloperations #nurseleaders #healthcareleadership #hospitaladministration https://images.squarespace-cdn.com/content/v1/573233eb4c2f8518b0b858d9/b21339b7-cb79-4896-8e6c-7a4cc9cf7fb4/Top+Tip+1+-+Hire+Targets.png Hire Targets Top Tips - PROBLEM WITH BUDGET-BASED Hiring to budget sounds intuitive - and it certainly is for fixed departments. However, in variable departments, it's not so straightforward. Annual budget FTEs are simply an average of monthly FTEs, regardless of the distance between the min and max months. This means that seasonal areas (Emergency Departments in Maine, Florida, etc) are almost never staffed correctly. If your organization approves positions according to department budget, consider reviewing volume fluctuations closely and consider alternatives that optimize the hired-in FTE value in variable departments. You will likely identify significant staffing pain points and you may find significant savings in premium pay! #hospitalmanagement #hospitalfinance #nurseleaders #healthcareleadership #hospitaloperations https://images.squarespace-cdn.com/content/v1/573233eb4c2f8518b0b858d9/18de1341-be7b-4977-92d1-5858ce920a32/Top+Tip+2+-+Hire+Targets.png Hire Targets Top Tips - CFO TELLING YOU NO? Raise your hand if you've been forced to use premium labor because your department was unfavorable to productivity The philosophy behind holding on positions when missing target is, of course, a relatively good one. The thought is, if we are missing productivity, we don't want to add more staff to miss by even more hours. That said, in variable hospital departments the equation is a bit more complex. Is more volume coming in 60 days? Are you missing due to 5 orientees that will be replacing contractors in a few weeks? Did 3 night RNs resign and will be leaving soon? If we hold on positions in each of these scenarios, we will spend more on labor than if we had approved them - or we will be understaffed. #hospitalmanagement #hospitalfinance #hospitalfinance #nurseleaders https://images.squarespace-cdn.com/content/v1/573233eb4c2f8518b0b858d9/12832379-dbd2-42d5-9a11-c15a3264a2a6/Top+Tip+4+-+Hire+Targets.png Hire Targets Top Tips - HIRING TO PAID FTEs Be sure you do not neglect the final step to implementing department FTE hire targets - adding nonproductive time! Worked shifts represent productive FTEs while hired-in FTEs must also include paid employee time on top of worked hours. These "nonproductive hours" represent PTO, bereavement, jury duty, etc. Departments that make the mistake of hiring to productive instead of paid FTEs will be will be short staffed in excess of 10%! #hospitalmanagement #hospitalfinance #hospitaloperations #nurseleaders #staffingsolutions https://www.caracookconsulting.com/on-call-top-tips daily 0.75 2023-06-27 https://images.squarespace-cdn.com/content/v1/573233eb4c2f8518b0b858d9/57594587-d8ff-4623-b5c8-fb8add20a4b5/Top+Tip+3+-+On-Call.png On Call Top Tips - STAFF TURNOVER Quantify the impact of your department’s “fatigue factor” by measuring the contribution of on-call burden to staff turnover via exit interview data. Don’t forget to review declined employment offers due to on-call requirements too! https://images.squarespace-cdn.com/content/v1/573233eb4c2f8518b0b858d9/a6203820-9833-4db5-aa82-0b098a53731b/Top+Tip+4+-+On-Call.png On Call Top Tips - CALLED IN TOO OFTEN Do you know how often your on-call staff are called back? Is it negatively impacting department culture? Read our recent newsletter linked below for the steps required to complete this analysis. http://www.caracookconsulting.com/blog/are-on-call-schedule-demands-impacting-your-teams-engagement https://images.squarespace-cdn.com/content/v1/573233eb4c2f8518b0b858d9/8c12bc77-f1ce-4dec-8de0-49082a5f3813/Top+Tip+1+-+On-Call.png On Call Top Tips - DEDICATED ON-CALL If your department experiences significant turnover driven by an on-call scheduling burden, you might consider Dedicated On-Call. Our team’s upcoming article reviews our experience quantifying on-call burden and creative solutions that save dollars and make a significant impact to staff satisfaction. https://images.squarespace-cdn.com/content/v1/573233eb4c2f8518b0b858d9/f81aa74f-cf72-493c-b963-c86d8ee002a9/Top+Tip+2+-+On-Call.png On Call Top Tips - ON-CALL FATIGUE As hospital leaders work to attract and retain a new generation of staff, work-life balance is coming into sharper focus. On-call requirements negatively impact both recruiting and retention throughout the industry. In this month’s article we explore alternatives to the traditional on-call model and methods to evaluate if these solutions are right for your department. Read more at the link: http://caracookconsulting.com/blog/is-on-call-burden-driving-chronic-turnover-in-your-department https://www.caracookconsulting.com/premium-pay-top-tips daily 0.75 2023-06-27 https://images.squarespace-cdn.com/content/v1/573233eb4c2f8518b0b858d9/ef85c7d5-1afb-44fa-8b6f-760e55faf3c5/Top+Tip+1+-+Premium+Pay.png Premium Pay Top Tips - FLEXIBLE WORKFORCE In hospitals, premium pay is defined as any rate of pay in excess of the base employed rate. This takes many forms including differentials, overtime, and contract labor. Premium pay is designed as an incentive to level-set shifts and ensure we have the right staff in the right place at the right time. As labor spend constitutes more than 50% of all expenses, unmanaged premium pay can become a problem large enough to put a hospital out of business. While premium pay plays a critical role in our country’s hospitals, some premium pay is avoidable. In this series, we’ll clearly delineate which types of premium pay are critical to operations and which can be avoided. https://images.squarespace-cdn.com/content/v1/573233eb4c2f8518b0b858d9/cfdfe2b0-85f3-4523-838f-044e2c328f44/Top+Tip+5+-+Premium+Pay.png Premium Pay Top Tips - AVOIDABLE OVERTIME Identifying avoidable overtime (OT) and shift differential abuse is another top expense strategy that can provide timely bottom line relief. The first step is to establish categories for OT utilization and begin regular reporting by category. The table below is an example of categories that can be reviewed for appropriate utilization. https://images.squarespace-cdn.com/content/v1/573233eb4c2f8518b0b858d9/6a0a3252-88b6-41de-9e4a-a48268c28483/Top+Tip+2+-+Premium+Pay.png Premium Pay Top Tips - CONTRACT LABOR When we hear premium pay, we almost always think of contract labor. In some organizations, contract labor is considered a “dirty word”. However, when appropriately used, it can be significantly more cost effective than other premiums staffing resources. High performing organizations categorize their contract labor utilization and create targeted action plans when addressing inappropriate uses. In this series, we’ll dive further into these scenarios and our recommended actions to address these. https://images.squarespace-cdn.com/content/v1/573233eb4c2f8518b0b858d9/a562bdc2-c378-46f7-82b3-876b776265c6/Top+Tip+3+-+Premium+Pay.png Premium Pay Top Tips - FILLING VACANCIES If you answered yes to this question, what other strategies have you implemented to fill vacancies? Some recommendations that come to mind include: * Investing in new graduate nursing programs to create an employee pipeline * Incorporating hire ahead into your position approval process to stay ahead of staff turnover * Evaluating the controllable aspects of the hiring process to decrease fill timeline Haven’t selected hire targets at your hospital? In our next series, we’ll explore how to select targets that optimize labor spend, taking into consideration each department’s ability to flex and the cost of premium labor. https://images.squarespace-cdn.com/content/v1/573233eb4c2f8518b0b858d9/5ab7b468-8fe4-4385-b071-b82335b44ed5/Top+Tip+4+-+Premium+Pay.png Premium Pay Top Tips - PRODUCTIVITY Missing a productivity target is painful to your bottom line, but missing a target using premium dollars is especially damaging. When not managed properly, this can balloon into a large budget miss to the bottom line. https://www.caracookconsulting.com/vacancy-management-top-tips daily 0.75 2023-07-17 https://images.squarespace-cdn.com/content/v1/573233eb4c2f8518b0b858d9/e0ca981a-e62d-460a-97cf-33018e45d5d1/Top+Tip+5+-+Vacancies.png Vacancy Management Top Tips - ANALYZING DATA Looking for a silver bullet? Join the club! Unfortunately, there are no easy answers in the world of retention. We talk about data-driven decision making frequently, but particularly when it comes to retention, each department/shift is different and generational differences matter! Work with HR to understand the differences between groups and curate strategies that support retention for each population. Be sure to monitor improvement monthly for course correction! https://images.squarespace-cdn.com/content/v1/573233eb4c2f8518b0b858d9/2435f460-e66f-48ba-aef2-94f3d3fa406b/Top+Tip+8+-+Vacancies.png Vacancy Management Top Tips - STAY INTERVIEWS While exit interviews are relatively commonplace (although few utilize findings from them effectively), stay interviews are rarely seen. Hospitals who have the insight to implement stay interviews know that when resignations occur, time is of the essence! Some hospitals have identified first year turnover as the top driver of their contract labor spend and decided to treat resignations much like a sentinel event, including timely escalation protocols. While labor-intensive for HR, data demonstrates that this method is impressively effective in solving problems for the resignee and retaining their employment, even if it means moving them to a different department. https://images.squarespace-cdn.com/content/v1/573233eb4c2f8518b0b858d9/16b8d656-cd5b-4505-b537-9eac56fb8f3d/Top+Tip+2+-+Vacancies.png Vacancy Management Top Tips - DIAGNOSING THE PROBLEM When solving a problem with many variables, it is important to break it apart into pieces. When it comes to not having enough people to do the work, we first break it down into 1) too many people are leaving and 2) not enough people are replacing them (aka retention and recruitment). However even recruitment can be broken down into pieces such as 1) posting the right number of positions 2) compensation 3) marketing of positions 4) delays in the interview or onboarding process and more. In this series, we’ll break best practices into 3 parts: Intake, Retention, and Exit. https://images.squarespace-cdn.com/content/v1/573233eb4c2f8518b0b858d9/9e7e7853-f106-472b-8048-5035e1004f6c/Top+Tip+7+-+Vacancies.png Vacancy Management Top Tips - FIRST YEAR Have you ever seen a hospital with first year RN turnover that is lower than tenured RN turnover? We haven’t either. Perhaps this is because addressing turnover in the first 1-3 years of employment requires very different tactics than for our tenured team members. Part of the difference is generational, and part of it isn’t, but the moral of the story is – to meaningfully impact turnover, you must have a specific strategy curated for this high-churn population of RNs. https://images.squarespace-cdn.com/content/v1/573233eb4c2f8518b0b858d9/12119193-d03b-4d02-86a0-004da3aa9d33/Top+Tip+4+-+Vacancies.png Vacancy Management Top Tips - NEVER COMPROMISE In the face of such an intense need to replace vacancies with new team members, it can be tempting to skip the important steps that support candidate quality, ensure good department fit, and are proven to reduce turnover. Be sure to stay strategic with the recruitment process or your turnover can increase significantly - especially in the first year! https://images.squarespace-cdn.com/content/v1/573233eb4c2f8518b0b858d9/33cf6e00-19d5-4938-9c32-65fadb9df5be/Top+Tip+3+-+Vacancies.png Vacancy Management Top Tips - INTAKE - RECRUITMENT Many organizations believe that they monitor SLA (service level agreement) data because they publish TTF (time to fill), but this drives a false sense of security. In reality, there are many steps and responsible parties involved in the process of replacing a team member. Often the lack of available data prevents us from creating a “who has the ball” dashboard, but this is critically important piece to solving this problem. Without it, the root cause analysis required to drive improvement is impossible! https://images.squarespace-cdn.com/content/v1/573233eb4c2f8518b0b858d9/d0118842-0c56-47a8-8baf-f6ed70706e46/Top+Tip+1+-+Vacancies.png Vacancy Management Top Tips - RECRUITMENT & RETENTION While chronic vacancies have always been a pain point in the hospital and healthcare sector, it somehow feels worse than ever. While it is difficult to define in a single metric, the impact of the post COVID environment and Great Resignation seem to have facilitated unprecedented recruitment and retention challenges. Unlike many challenges in hospital operations, recruitment and retention truly has no silver bullet. However, there are many proven best practices in this space and we are excited to share with you some that we see used infrequently in the field over the coming weeks. https://images.squarespace-cdn.com/content/v1/573233eb4c2f8518b0b858d9/3faa94c6-e702-4a0d-9561-00418cfede22/Top+Tip+6+-+Vacancies.png Vacancy Management Top Tips - ONBOARDING True or false: we are so busy in our jobs – and relieved to finally have some help – that we often overlook the first impression new employees have in their first days at work. Based on our experience, this is unfortunately very true. It is tough to prioritize a new person who does not know where the bathroom is or where to sit at lunch when we are appropriately preoccupied with critical issues. While this is just a small part of onboarding, consider reflecting on the golden rule when designing the first 30 days for your new team member. Success in retention depends on it! https://www.caracookconsulting.com/chad-moses daily 0.75 2025-04-25 https://images.squarespace-cdn.com/content/v1/573233eb4c2f8518b0b858d9/1692970755355-IZTMWOT70PZ5NYYP04L9/_PMP4513.jpg Chad Moses https://images.squarespace-cdn.com/content/v1/573233eb4c2f8518b0b858d9/1582818337126-FBIMFX7XO2UUKYLQ3TSW/LinkedIn+Icon.png Chad Moses https://www.caracookconsulting.com/bed-management-top-tips daily 0.75 2023-12-05 https://images.squarespace-cdn.com/content/v1/573233eb4c2f8518b0b858d9/6f2bc1b5-bf6f-4d59-8e3e-62e93f49a954/Untitled+design-4.gif Bed Management Top Tips - BED HIDING Have you ever rounded upstairs on a Monday at 7:30pm? If so, did you find patients in beds as expected based on your EMR? Or were there empty beds where patients should be, according to the system? When patients depart, it is critical to discharge patients electronically within the system immediately to avoid delays due to empty beds incorrectly appearing occupied. While this documentation may seem a low priority compared to other discharge activities, the miscommunication driven by missing or delaying this step has a direct impact on patient care. We rely on this communication tool to alert housekeeping to clean the room, and allow the Bed Manager to assign clean and empty beds to patients waiting in a less than ideal care area. High performing hospitals' Nursing Supervisor or Bed Manager rounds on inpatient units twice per day to identify undocumented discharges to expedite patient flow and ultimately decompress the ER. Try it out and notice the reduction of boarders and patients leaving without being seen from the waiting room! #bedmanagement #hidingbeds #hospitalthroughput #capacitymanagement https://images.squarespace-cdn.com/content/v1/573233eb4c2f8518b0b858d9/b678d178-7f0e-47aa-acc4-146ea32d592a/Bed+Mgmt+Top+Tips-9.gif Bed Management Top Tips - CONDITIONAL DISCHARGES Are inpatient care teams playing Discharge Hot Potato at your hospital? Answer… PROBABLY As we work to understand and address avoidable throughput delays (and reduce expensive-and-complication-inducing extended length of stay for our patients), often the best place to start is with the discharge order. When analyzing discharge orders, it is important to understand the subtle, yet critical, difference between conditional and unconditional discharge orders. - Unconditional discharge orders imply that the patient is ready to go - like right now! No conditions. The physician has cleared this patient for discharge and zero additional information, clearances, or actions are required before their departure. - Conditional discharge orders imply that something is needed before the patient leaves. This "something" could be almost anything - clearance from a specialist, specific lab results, line removal or almost anything else. These "somethings" are considered discharge delays and should be brought to the bed huddle for troubleshooting and intervention, as discussed in our last post. If you are feeling overwhelmed in solving this very complex problem, consider first using data to quantify and distinguish between unconditional vs. conditional discharge orders. From here, focus on these things: - Moving unconditional discharges earlier - Piloting solutions for the top 2 most common reasons for conditional discharges #bedmanagement #conditionaldischarges #bedhuddles #patientthroughput https://images.squarespace-cdn.com/content/v1/573233eb4c2f8518b0b858d9/e2103ab3-b5ac-48d0-a06c-6264def4a448/Bed+Mgmt+Top+Tips-8.gif Bed Management Top Tips - BED HUDDLES Are your bed huddles moving the needle on patient throughput? If not… we aren't surprised. So many bed board meetings we attend do not seem mindful of the meeting's goal. Most have each department monotonously state how many patients they have, and how many anticipated discharges…but there is no problem solving - and more importantly, no action! If this sounds familiar, it's time to move to a more effective bed huddle model. In your morning bed huddle, ensure each nursing unit is covering not only their planned discharges, but also the source of delay along with a specific request to resolve. Do we need labs back, a ride home for the patient, a last dose of antibiotics, sign off from the hospitalist? Requiring the right leaders to be in the room is the most effective way to expedite these orders. During your afternoon huddle, the group should be following up on the morning huddle's discussion, and continuing to problem solve for any newly identified discharges. Best practice is to support a constant conversation, and engaging the night shift in discharge preparation, by holding a 3rd bed huddle at 3am. Last but not least, if you aren't sure - you can always attend yourself! You might be surprised what you find. #bedmanagement #bedhuddles #patientthroughput #capacitymanagement https://images.squarespace-cdn.com/content/v1/573233eb4c2f8518b0b858d9/0c4f83c3-77e5-438d-90e1-e449349a4f3e/Bed+Mgmt+Top+Tips.gif Bed Management Top Tips - COLLABORATION Who is responsible for bed management and patient throughput at your hospital? Take it from us, problems with so many variables - and responsible parties - are some of the most difficult problems to solve. Even with a stellar bed manager/bed czar/nursing supervisor, this is far from a one-man job. While accountability is an art that few have mastered, managing so many people that do not report to you truly is a next-level challenge. Try this: Attend an interdisciplinary team round! Who attends to help solve the problems? Does the conversation support streamlined care for our patients? How often do they occur? #bedmanagement #patientthroughput #streamlinecare #capacitymanagement https://images.squarespace-cdn.com/content/v1/573233eb4c2f8518b0b858d9/fe0c8dde-b171-4392-8d68-818c49623a74/Bed+Mgmt+Top+Tips-10.gif Bed Management Top Tips - OUTLIERS ARE PATIENTS TOO How long is too long to wait for an inpatient bed? Well, it depends on your perspective. As a leader viewing data in a report, you might not think much of a 24+ hour wait, but for a sick patient in a chaotic ER's hallway bed, even 30 minutes feels like forever. Do you know how many admitted patients waiting longer than 12 hours in the ER for an IP bed? What about 24? How long was the longest wait last month? This is why it's important to think critically about dashboard design. Which metrics tell the story we need to hear, with respect to hold times? Consider reporting average hold time per patient as well as the distribution of hold times. Leveraging this data for a better understanding of patient experience in your ER can inspire great change! #bedmanagement #patientswaiting #ERdashboard #patientthroughput https://images.squarespace-cdn.com/content/v1/573233eb4c2f8518b0b858d9/f09ba3f9-18cb-4bbc-b49c-dfdcf7f8ce39/2.png Bed Management Top Tips - BOARDERS Is the ER solely responsible for hold hours at your hospital? If so, #youredoingitwrong! While patients with admission orders waiting to go upstairs for hours or days are physically within the ER, the drivers of their delay has very little to do with the ER itself. The truth about boarders is that they are primarily driven by inefficient processes on the inpatient side, while the ER pays the price. REMEMBER: every hour that a patient is waiting for a bed in the ER is approximately .25 hours of avoidable RN labor! This means that if your ER is missing their productivity target, it might not even be in their control due to an overflow of inpatients requiring care. As executives, we owe it to the ER - and to our patients - to better understand the drivers of pain points and ensure they have the right staff, at the right place, at the right time to care for these waiting patients. Follow along in this Top Tip series to learn more about industry best practices for bed management! #bedmanagement #holdhours #patientflow #capacitymanagement #hospitalthroughput https://images.squarespace-cdn.com/content/v1/573233eb4c2f8518b0b858d9/83871efe-a498-41e4-9623-8a41f73fcbe4/Untitled+design-3.gif Bed Management Top Tips - DISCHARGE TIME OF DAY Already tracking conditional vs. unconditional discharges? Great! Now, you can begin working on the most impactful throughput tactic: Discharge Time of Day. What time of day are beds requested at your hospital? Your OR probably peaks between 12pm to 4pm and, while we know the ER stays pretty busy admitting between noon to midnight, they typically peak between 3pm to 8pm. If we need clean and ready beds as early as noon, with a peak is between 3-8pm, what time should we discharge patients to allow housekeeping enough time to clean the rooms? Now you see why many hospitals track discharges before 11am. Do you know when the majority of your discharges are occurring? If it is after 4pm, you probably have a slew of ER boarders, PACU holds, and an overall gridlock that creates headaches for all involved. No matter where you are on your bed management journey, discharge time of day will be an ongoing challenge. If you don’t know what time your hospital discharges on average, data discovery is the best place to start! #bedmanagement #capacitymanagement #bestpractices #hospitalthroughput https://images.squarespace-cdn.com/content/v1/573233eb4c2f8518b0b858d9/8322c68b-9c92-4528-8892-003812ffee4d/Copy+of+Bed+Mgmt+Top+Tips.gif Bed Management Top Tips - EVS: HEROES OF THE NIGHT Environmental Services appreciation post!! Often out of sight and commonly taken for granted, this impressive team carries the water for us all when it comes to hospital capacity management - ESPECIALLY between 3pm and 10pm M-F. As we work to reduce ER boarder time, inpatient room turnover times become a primary focus area. This is because, even if we succeed in getting an inpatient bed open, we cannot place a patient until it is cleaned! This is where Environmental Services (EVS) steps in. To ensure EVS team members are supported, make sure we have the right number of staff to quickly turn rooms. Learn more from our Demand Matching video: https://youtu.be/wuSW7hxZV_o?si=aEoyrnCHAgdLZh9x. Tell an EVS team member you appreciate them today! #bedmanagement #environmentalservices #EVS #patientthroughput #capacitymanagement https://images.squarespace-cdn.com/content/v1/573233eb4c2f8518b0b858d9/d3068402-7674-4717-8df2-062cae12f25a/Bed+Mgmt+Top+Tips-7.gif Bed Management Top Tips - SURGE PLANNING Want to freak yourself out this Halloween?! Ask to review your surge plan! Hospital surge capacity plans are the only thing standing between current state and a lot worse than diversion. Your hospital surge capacity plan should define saturation levels using easily measurable triggers such as hospital census, ED census, # ED boarders, hold times, etc. When these triggers are tripped, everyone pivots and springs into action! For example, immediately prioritized focus areas can include: Case Management - call physicians to help with potential discharges Hospitalists - round on potential discharges Lab and Imaging - expedite testing and results for potential discharge patients Inpatient nursing - process discharge orders and instructions with patients Bed manager - round on units to identify discharges not entered into system Housekeeping - reallocate staff to discharge room cleans (from non-critical areas) All directors - additional bed huddle to remove discharge barriers What is your job when the hospital is surging? Is there a plan? Please say yes….?! #surgeplan #bedmanagement #capacitysurge #patientthroughput https://www.caracookconsulting.com/staffing-grids-top-tips daily 0.75 2024-03-06 https://images.squarespace-cdn.com/content/v1/573233eb4c2f8518b0b858d9/d902e013-714b-4693-9f5b-aada354c9a8f/Staffing+Grids+Top+Tips-5.gif Staffing Grids Top Tips - STAFF TO YOUR GRID Are your nursing units staffing in alignment with their grids? How do you know? Where is the grid located on each unit? Has each charge nurse been educated to make flex up/down staffing decisions based on patient volumes? How often are we rounding to audit compliance? If you are unsure about answers to these questions, we strongly recommend finding them! The key to achieving desired results in almost all efforts is making a plan and following it. While it may sound overly basic, this is the most commonly overlooked opportunity when it comes to staffing in hospitals. #staffinggrids #staffingsolutions #nurseratios #hospitalstaffing https://images.squarespace-cdn.com/content/v1/573233eb4c2f8518b0b858d9/7cba35af-2764-4520-b6eb-0d961a006760/Staffing+Grids+Top+Tips-6.gif Staffing Grids Top Tips - CONSISTENT RATIOS How do you ensure consistent nursing ratios between units? Across multiple hospitals in a health system? Summarized information from staffing grids can be very valuable when working to understand current state ratios between units, but if grids are in different formats or stored in various locations, finding the answer can prove incredibly difficult. High performing organizations create, maintain, and annually update a centralized repository of all staffing grids, including their attributes, in a standardized format. This practice establishes a single source of truth and enables the production of valuable reports highlighting inconsistent ratios, skill mix by unit, outliers for orientation or sitter utilization, and even financial reporting that supports the annual budget process. While this does require work, can you afford to "fly blind"? Consider establishing your own standardized staffing grids - or reach out to us for help at admin@caracookconsulting.com! #staffinggrid #staffingsolutions #staffingreports #consistentstaffing https://images.squarespace-cdn.com/content/v1/573233eb4c2f8518b0b858d9/78d868a8-a0e1-45c0-af1f-20d648ca5b7a/Staffing+Grids+Top+Tips-2.gif Staffing Grids Top Tips - ENSURE CONSISTENT RATIOS What is a staffing grid? Do you know? If you aren’t 100% sure that you could teach a new charge nurse how to use one, consider tuning in to this series! Staffing grids are the OG connection between clinical and financial guidelines. We aren't sure how long they've been around, most likely long before any of us given how beautifully simple and impactful these little pieces of paper can be. In its most basic form, the staffing grid is a staffing guide. It tells us how many of each role (nurse, tech, unit secretary, etc.) should provide care based on each census - or number of patients on a given unit. We call it a grid or matrix because it is literally a table that we can trace our finger across the row from the census column to identify how many team members are needed based on the census count. Staffing grids are critical as we plan for and ensure to staff consistent ratios for caregivers. If loving staffing grids are wrong, we don't wanna be right! #staffinggrids #nurseratios #patientratios #hospitalstaffing https://images.squarespace-cdn.com/content/v1/573233eb4c2f8518b0b858d9/04fb52b0-b298-4397-9795-e78572458e86/FSS+Posts-2.gif Staffing Grids Top Tips - FLEXSMART SOLUTIONS STAFFING GRID TOOL While every organization we've worked with has staffing grids in place, we've found that many clients have opportunities to optimize them. A few key staffing grid challenges we've come across relate to version control, misalignment with budget, and unclear staff ratios. With these in mind, we've created a staffing grid tool that offers the following advantages: ️ Standardized Format - Easy to follow staffing grids with specific sections for variable staffing, fixed staffing, education/orientation, and budget information Centralized Repository - A single source of truth location to store all grids, addressing version control issues Ratio Comparison - Compare planned nurse to patient ratios across like departments within a hospital or across a system Financial Analysis - Easily identify if your staffing grids are built to align with your budgeted productivity target and what the associated FTE variance is - or take it a step further and build a zero-based productivity target based on grid inputs To learn more about FlexSmart Solutions, visit our website at www.flexsmart.com #staffinggrids #staffingsolutions #hospitalstaffing #hospitalfinance#hospitaloperations https://images.squarespace-cdn.com/content/v1/573233eb4c2f8518b0b858d9/bfbed890-4053-4c20-9dff-8e5e78cbd4b6/Staffing+Grids+Top+Tips.gif Staffing Grids Top Tips - CONTRACT LABOR Does your nursing unit's staffing grid align with the budget financially? How do you know? Remember, the purpose of the staffing grid is two-fold: 1 - to help charge nurses consistently staff to the intended ratios to support clinical guidelines and employee engagement and 2 - to function as a staffing plan that aligns with our financial goals. Given that labor makes up more than half of total hospital expenses, staffing grids are a very important tool to keep us in line with our budgeted goals (which, in publicly funded hospitals, is a commitment to tax payers). As a part of the arduous annual budget development process, the finance team is tasked with finalizing department productivity targets (the number of worked hours allotted per patient). In high performing organizations, nurse leaders connect with their financial counterparts regularly, including partnership to finalize the nursing budget together. Team work makes the dream work! #staffinggrids #staffingsolutions #hospitalfinance #budgetmanagement https://www.caracookconsulting.com/support-accountability daily 0.75 2024-05-27 https://images.squarespace-cdn.com/content/v1/573233eb4c2f8518b0b858d9/649c00c8-6ae8-41bd-9441-dc4ac44b791d/Smart+Tip+6+-+Managing+Through+Influence.gif Support & Accountability Top Tips - MANAGING THROUGH INFLUENCE One of the most challenging aspects of leadership is holding others accountable - especially when they don’t directly report to you! However, this is a very common occurrence in healthcare, particularly when you have corporate resources responsible for both support and accountability for their hospitals. 1) Show You Care: It's more than setting targets; it's about understanding and supporting your leaders. Ask your leaders if they understand what's being asked of them, and if they have the resources needed to get there. If the answer to either of these is "no," you've got some work ahead of you! 2) WIIFM Approach: "What's In It For Me?" is a strategy used to motivate and engage individuals by highlighting the personal benefits or incentives they will receive from achieving a certain goal or undertaking a particular task. In the context of support and accountability, the WIIFM approach involves discussing with leaders how reaching a specific goal will benefit them personally, whether through improved patient outcomes, enhanced team dynamics, career advancement opportunities, or other rewards. Engage your leaders by highlighting how achieving goals benefits them, whether it's their patients, team, or the hospital system. 3) Leverage Project Plans: Utilize project plans and heatmaps to streamline accountability. It can be helpful to make the project plan "the bad guy." Once you and your leader have agreed on the action items, owners, and due dates, let the project plan do the talking! #HealthcareLeadership #Accountability #StrategicLeadership #HealthcareManagement https://images.squarespace-cdn.com/content/v1/573233eb4c2f8518b0b858d9/d8d24ee6-4c4d-4d10-ba4d-28fe5f2f429d/Smart+Tip+2+-+Setting+Expectations.gif Support & Accountability Top Tips - EXPECTATION SETTING As a young leader, a new employee on my team was struggling to manage her schedule. The problem was so significant that executives would call trying to find her more than 20 minutes after important meetings she was leading should have started. Our colleagues felt increasingly disrespected, and it was clear I must address the problem. When I shared the feedback that chronic lateness was impacting relationships and ultimately her effectiveness, she was incredulous. She said, "In my old job, if I was running late, my boss would have trusted that I prioritized my time appropriately." I wasn't getting through to her. Frustrated, I connected with a coach for advice. My coach at the time said to me, "Have you shared your expectations with her?" Now, it was my turn to be incredulous. How could someone in a corporate leadership role require instructions to understand that she should be on time?! She responded, "You are right. It is ridiculous, but the fact is that the best way for someone to meet your expectations is to know what they are." While I still find the whole situation absurd, I also realized that my coach was right. Now, I share my top 10 expectations with new team members - and I let them share their expectations with me too! Everyone is unique and you might be surprised how easy it is to meaningfully improve relationships with your team just by listening and communicating. #support #accountability #expectationsmanagement https://images.squarespace-cdn.com/content/v1/573233eb4c2f8518b0b858d9/09afba96-134c-4716-aa03-461419439cea/Smart+Tip+4+-+Feedback+is+a+Gift.gif Support & Accountability Top Tips - FEEDBACK IS A GIFT Feedback is a gift. Isn't that what they say? Well, why doesn't it always feel that way? Having the respect to challenge a colleague while coming from a personal caring perspective is the key to #RadicalCandor feedback. Top Tip: if you trust the person providing feedback cares about you personally, consider their perspective - even if you aren't ready to consider it until a few days afterward. Feedback is information that can help the recipient, even if the person providing the feedback has a questionable perspective! #support #accountability #feedbackwelcome #themoreyouknow https://images.squarespace-cdn.com/content/v1/573233eb4c2f8518b0b858d9/dc1ea1ff-e6b0-4503-bfae-31bb06148a09/Smart+Tip+1+-+Support+v+Accountability+Scale.gif Support & Accountability Top Tips - SUPPORT VS. ACCOUNTABILITY Once, in my mid-20s, I had the audacity to question a corporate finance executive about how his behavior had changed toward me after being promoted. His answer surprised me. He said, "Every job has a balance of support and accountability, Cara. My new job shifts that balance - I am now 98% accountability and 2% support because I review reports all day and point out my concerns to those responsible for performance." This was the beginning of a new way of looking at my job - which, at the time, was about 50/50 support/accountability. Now, 15 years later, I still think about this concept. Both support and accountability are required to drive results, so understanding your role in this respect is critically important. Support includes activities like education, 1:1 time, tools, communication, setting expectations, and other activities that help individuals achieve their goals. Accountability, on the other hand, facilitates individual responsibility including leveraging reports to ask tough questions, ensuring deadlines are met and that rules are enforced. In the education field, our job is almost 100% support. What about yours? #support #accountability #leadershipexcellence https://images.squarespace-cdn.com/content/v1/573233eb4c2f8518b0b858d9/2146fa82-e783-4a5f-a1f4-5f1c4c998e84/Smart+Tip+5+-+What+is+Your+Style.gif Support & Accountability Top Tips - YOUR ACCOUNTABILITY STYLE While the balance of support and accountability in your work life is largely determined by your current role, you have much creative freedom! Some style questions to consider for each role category include: - How do you receive feedback? Positive? Constructive? When you feel resistant to information about how you are perceived, what do you do next? How do you interact with coworkers - those who align with your tendencies and those who do not? How do you provide feedback? - What is the difference between a leader and a manager to you? Which are you? What does guidance look like? Coaching? How do you handle disappointments for your team that are beyond your scope of control? When you are frustrated with a member of your team, how do you provide feedback? (Idea: "Feedback Fridays" are a practice that many use to ensure that non urgent, but important, feedback stays top of mind during busy times) How do you receive feedback? - How do you think you are perceived at work? Do you care? Many of your peers also care, but report experiencing such a fast paced work life that they often miss the gist of important interactions. If this is you, how do you seek feedback from those who may not feel safe to provide it? (Idea: 360 Analyses can provide valuable insights to executives about how their behaviors impact others. Note: this can be painful, but very valuable in the long run!) Do you have conscious habits around feedback and course correction? Does your feedback allow enough time for your organization to course correct? ⭐️ Remember that feedback, and other thoughtful communication with coworkers, is a critical piece of providing both support and accountability! What support and accountability practices have you found valuable in your role? #support #accountability #leadershipstyle https://images.squarespace-cdn.com/content/v1/573233eb4c2f8518b0b858d9/992b166d-aabf-484e-90c5-b8e4e938e269/Smart+Tip+3+-+Monitoring+Progress.gif Support & Accountability Top Tips - MONITORING PROGRESS Now that you understand the expectations, it's time to track progress towards the goal. It's critical that everyone is on the same page to understand if we're making forward progress, or need to course correct. To do that, make sure the whole team can answer these questions: What reports are we using to measure progress? -What level of detail? Where do these live? Are these pushed out to the appropriate team members? Who is reviewing these and what is their role? -The leader accountable for the performance? Supporting resources? The manager holding the team responsible? How often are we discussing results? -Weekly? Monthly? What forum are we using to discuss performance? -1:1 meetings? Monthly operating reviews? #measuringproductivity #measuringperformance #reporting #support https://www.caracookconsulting.com/becky-adix daily 0.75 2024-07-22 https://images.squarespace-cdn.com/content/v1/573233eb4c2f8518b0b858d9/e66ef566-1b97-4495-acd2-4ecf46998c79/ppt+res.jpg Becky Adix https://images.squarespace-cdn.com/content/v1/573233eb4c2f8518b0b858d9/1582818663607-P3QMA7T35A7QY6LKR8Z1/LinkedIn+Icon.png Becky Adix https://www.caracookconsulting.com/paul-scott daily 0.75 2025-04-25 https://images.squarespace-cdn.com/content/v1/573233eb4c2f8518b0b858d9/97d55031-9a00-45c6-9ad0-8b7b913ee905/Paul+Scott.jpg Paul Scott https://images.squarespace-cdn.com/content/v1/573233eb4c2f8518b0b858d9/1582818337126-FBIMFX7XO2UUKYLQ3TSW/LinkedIn+Icon.png Paul Scott https://www.caracookconsulting.com/brian-simmons daily 0.75 2025-04-30 https://images.squarespace-cdn.com/content/v1/573233eb4c2f8518b0b858d9/1745608069861-GLNQMGYXVHM37V2WHE4B/Brian%252BSimmons.jpg Brian Simmons https://images.squarespace-cdn.com/content/v1/573233eb4c2f8518b0b858d9/1582818337126-FBIMFX7XO2UUKYLQ3TSW/LinkedIn+Icon.png Brian Simmons https://www.caracookconsulting.com/workforce-assessment daily 0.75 2025-10-31 https://images.squarespace-cdn.com/content/v1/573233eb4c2f8518b0b858d9/c5e4aeec-fc27-4d26-855e-3427401acad5/Screenshot+2025-06-24+at+1.44.58%E2%80%AFPM.png Workforce Assessment - 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