Staffing for Better Outcomes

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A patient-centered care model can lead to downstream cost avoidance.

There is growing evidence showing that patient- and family-centered care improves outcomes and patient satisfaction, while also lowering downstream readmission costs because patients are more likely to follow their prescribed recovery regimen.

But what about the human resources issues around PFCC? Will your hospital have to increase staff? Will staff members require extensive training and other adjustments that might take them away from the bedside?

"This won't require you to add or subtract staff, but it does cause staff to understand that this circle is larger than just that individual patient," says Ray Kendrick, senior vice president of human resources and chief diversity officer at Memorial Healthcare System in Hollywood, FL, which has embraced the PFFC model for more than a decade.

"It's not a destination; it's a journey," Kendrick says. "You start with the concept of paying attention to who is around you and being inclusive rather than exclusive. You can do that this afternoon, as long as you remember to do it. The key is you have to listen to everybody."

Neil Johnson, vice president of patient care services and CNO at Bronson Healthcare Group in Kalamazoo, MI, says PFFC isn't about "more people or a different model, but a different philosophy of who the right people are."

"We expect the full package. We want the excellent technician with the communication and teamwork skills who can collaborate with peers and multidisciplinary providers and involve the patients and families in the care," Johnson says. "That may seem like a lot of easy speak, but that is a hard mix to find. What you are looking for is the person who is open to the concept, and we in our culture interview and train to that concept."

Johnson credits PFFC, which was fully implemented at Bronson in 2005, with playing a role in considerable downstream savings. Bronson's skin pressure ulcer improvement to the National Database of Nursing Quality Indicators best practice rate has resulted in more than $12 million in cost avoidance. In 2002, Bronson's RN turnover rate was 12%. In the past four years it was under 1%.This resulted in savings of more than $9 million for recruitment and training. The dramatic reduction in turnover has occurred as patient volume has increased by 43% over the past seven years.

"Additionally, the low turnover resulted in a more tenured staff contributing to better quality outcomes such as best practice rates for skin pressure ulcers, ventilator-associated pneumonia, and hospital core measure quality outcomes—each with hundreds of thousands of dollars in cost avoidance annually," Johnson says.

When you're talking about a warm-and-fuzzy philosophy of care delivery, the details of implementation can get lost. But there are fundamental steps that should be taken. For starters, the Institute for Family-Centered Care recommends that hospitals create a steering committee that can provide an assessment of the hospital to set priorities and draft an action plan. From there, PFCC concepts, such as improving communication and creating patient and family advisory boards, can be incorporated into the hospital's strategic priorities.

If you're concerned about staffing needs, Johnson recommends using benchmark data from hospitals within your peer group that have taken up the model. "It's not just 'throw a dart at the board and say I need more staff.' Look at professional nursing models of care and who you want to emulate . . . and set that raise-the-bar mentality and say, 'Here is where we want to be in five or 10 years,'" he says. "The onus is on nurse administrators like me to say, 'I looked at 15 Magnet hospitals, or our peer group in Michigan, and this is what the benchmark is today.'"

Johnson recommends using the National Data Base of Nursing Quality Indicators to compare nursing hours per patient day and total worked hours per patient day, which includes unlicensed personnel. "Then we look at quality metrics related to that. What is our fall rate compared with other hospitals? What are our quality metrics and how do we measure up?" he says. "You would want to visit these places, but before you did that you could ascertain through data where you're at today."

John Commins

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