Staff the Halls

The holidays are supposed to be the most wonderful time of the year, but for supervisors planning hospital employees’ work schedules, the timing couldn’t be worse. Each year when hospitals face a barrage of winter ailments and injuries, everybody wants to take a vacation. Even with fewer elective procedures scheduled, the emergency department and the ICU can be affected by inadequate staffing elsewhere if beds can’t be made available.

“The key to adequate staffing during the holidays is planning in advance and making sure everyone has the same understanding and expectations before we move into the holiday season,” says Lisa Schott, human resources director at 216-staffed-bed Memorial Hermann The Woodlands Hospital north of Houston and a board member of the American Society for Healthcare Human Resources Administration. If the HR department is proactive, shortages can be avoided without upsetting employees.

1. Plan ahead

Require employees to request holiday time off early so you can set schedules in advance, HR experts say. This avoids setting false expectations and allows employees to plan with their families. Consider asking an employee who doesn’t celebrate a particular holiday to cover for someone who does, says Schott. Just make sure they are free to take their own religious holidays in exchange.

2. Give employees a say

Employees feel empowered when they’re invited to participate in creating vacation policies. At Shodair Children’s Hospital, an 86-staffed-bed psychiatric hospital in Helena, Mont., employee focus groups gave feedback about their time-off policy. “It’s surprising how many things come up that management doesn’t always see,” says Gary L. Willis, an ASHHRA board member and Shodair’s director of human resources.

3. Use fair and consistent parameters

Memorial Hermann employees know that by taking a holiday off one year, they’re expected to work that holiday the next. Besides the prerequisite lead time for requests, Shodair employees are limited to one week off during the end-of-year holiday period. Time off is granted on a “first-come, first-served” basis with seniority as the tiebreaker, says Willis.

4. Be flexible

Sometimes it’s best to let employees work schedules out for themselves. For example, Memorial Hermann nurses can “split shifts,” meaning a parent of small children can be home Christmas morning and switch out later in the day with someone whose family has an evening meal planned. Split shifts may be posted, or employees may split them on their own.

5. Have a contingency plan

Monitor your census and look at historical trends for the holidays. If you’re expecting the census to ramp up, review your plan for agency coverage early, says Schott. Memorial Hermann has an internal staffing agency that requires employees to commit to working a certain number of holidays each year.

Considerable responsibility rests on the shoulders of unit leaders who are on duty. “At the first sign of being short-staffed, whoever is handling the staffing should be well-trained in putting their plan into place and calling people who are off duty to come in and work,” says Schott.

—Kara Olsen

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Holiday Risks

Even if a hospital is fully staffed during the busy holiday season, research suggests that patients may not be as safe as they should be. Duke University Medical Center researchers have found higher mortality rates for heart attack patients admitted over the holidays than the rest of the year.

One possible reason for the discrepancy is having more employees with less experience and less time off manning facilities. Another is “the psychology behind the season,” says Matthew M. Rice, M.D. “Anytime people are distracted it can cause problems with patient flow, efficiency of care and sometimes safety,” says Rice, senior vice president of Knoxville, Tenn.-based, ED management company Team Health.

To combat this, Rice says Team Health sends out memos reminding physicians to be aware that their environment may not be running as smoothly as it should be and encouraging them to practice more carefully as a result.

—Kara Olsen