Danielle Miller, PHD(c), MSN, RNC-OB , January 8, 2017
Nurse scheduling problem (NSP) is a phrase used to describe the multiple complexities associated with nurse scheduling in healthcare. While nurse leaders may dread hearing anything about NSP, I think we all know that challenges exist. And the challenges are likely to get even greater, since our ability to schedule and staff appropriately is crucial as we transition from fee-for-service to a value-based care delivery model in healthcare organizations across the globe.
When I was in a leadership position in labor and delivery, just like many of you, I had to deal with NSP. Staffing for patient needs can be overwhelming, since the needs of patients change from moment to moment and meeting those staffing requirements can be like shooting a moving target. When I published the schedule for staff, I only had historical data to make staffing decisions. What I didn’t have was access to the peaks and flows in the daily schedule and when I would have an influx of patients.
Every six weeks I faced the challenge of publishing a schedule for what I thought I needed. Every day, I would then try to staff based on what was actually happening in the unit and on the unique needs of the patients we cared for. I also needed to constantly work toward minimizing labor costs, maximizing quality indicators and outcomes, and maintaining patient and employee satisfaction. I really needed access to real time data in order to make the best staffing decisions to truly impact patient care.
Inadequate staffing and schedule management are contributing factors to a poor work environment, burnout and eventually turnover in any healthcare organization. Having the tools to publish a fair and equitable schedule and staff accordingly is the Holy Grail in Healthcare. Having access to data in real time would have made my job and the jobs of my nurses much easier. On more occasions than I care to remember, leaving for the day with adequate staff only to come in the next morning to find out the census changed dramatically and more nurses and support staff were needed to provide appropriate care to patients was never a feel-good moment.
The operational management of inpatient nurse labor through nurse scheduling and staffing techniques is not as simple as supply and demand. When I was in the inpatient setting, staffing decisions had many variables to consider. Part of the complexity includes nurse and patient characteristics, length of shifts worked, number of available staff, geography of the unit, and regulations of the nurse bargaining units. All of this must be considered when trying to provide an improved work environment and for healthcare providers to deliver great care to their patients. Having the ability to schedule according to the needs of patients and provide assignments that are fair and equitable leads to employee and patient satisfaction. The burden of losing experienced nurses has significant financial ramifications for health care institutions related to replacement costs as well as the possibility of adverse patient outcomes.
If you can impact and improve the experience of the providers of care, you can impact the care patients are receiving. Improved provider experience leads to a boost for patient care. A happy and engaged workforce leads to a more engaged patient population with better health and better outcomes.
So what is the solution? Organizations need to provide front line leaders with the tools to make appropriate staffing decisions. For example, the ability of acuity systems to pull objective data from the EMR allows for nurse leaders to predict staffing needs based on the needs of the patient. Since acuity systems are based on documentation, the need for real-time data capture becomes even more critical to create a foundation for decision-making. The more data the acuity system has, the better able it will be to provide direction for scheduling and staffing.
The advances in healthcare technology provide us with an opportunity to be creative and innovative in addressing and finding solutions to the nurse scheduling and staffing challenges in healthcare. Ideal scheduling and acuity based staffing are linked to operational and clinical excellence. By leveraging technology, you’ll be able to provide high quality care to patients while being fiscally responsible to your organization.
Danielle Miller, PHD(c), MSN, RNC-OB , November 8, 2016
IHI’s Triple Aim, focused on improving patient care quality and satisfaction, boosting population health and reducing costs, is central to all of our work. However, while the tenets of the aim are well defined, how we go about achieving the aim remains a lot less clear.
Lately, I have been pondering the barriers to truly achieving the Triple Aim. And I have noted one vitally important—but missing—ingredient in the quality, care and cost formula: the caregiver.
By caregiver, I mean anyone in the healthcare ecosystem: physicians, nurses, and every person who supports the patient, from physician assistants, to dietary aids to environmental services. You can’t provide quality care without a satisfied staff, and I think it is now time they be included in what should be a fourth tenet: ensuring staff satisfaction and engagement. It’s time for the Quadruple Aim.
The high cost of burn out
Unfortunately, data and anecdotal evidence shows us that healthcare providers everywhere face burnout. That fizzling staff engagement goes hand-in-hand with lower patient satisfaction, reduced health outcomes, higher costs due to low productivity, and a very concerning risk for medical errors.
The statistics are disturbing: A 2012 paper published in the Archives of Internal Medicine found that an "alarming" 46 percent of 7,288 physicians surveyed reported at least one symptom of burnout. Burnout rates for nurses are startling as well, with 34% of hospital nurses reporting burnout symptoms, according to a 2011 report in the journal Health Affairs. When healthcare providers feel fried, consistently overworked and disengaged, the well being of the patient relationship and patient-centered approach are quickly at risk.
As healthcare professionals (and patients, ourselves) we know that happy and engaged providers offer better care and instill a sense of trust. For patients, that leads to better medical regiment compliance and overall satisfaction, and means less costly turnover for providers.
Achieving the Quadruple Aim
So how do we go about improving the work life of care providers, especially in light of changing payer models and increased regulation?
A leading point of caregiver dissatisfaction is the inability to access and exchange crucial patient information that impacts patient outcomes. That’s why it’s time to look at true interoperability. How can we give caregivers easy-to-use technology that gives them comprehensive, longitudinal pictures of patients’ clinical histories and treatments, regardless of where it was received in the hospital, post-acute system, or even the clinic setting? A fully integrated system enables better, faster decisions. It also aligns hospital policies to promote the use of HIT with processes and workflows, focusing on value rather than volume.
At the bedside, this reliable clinical decision support system encourages best practices and collaborative standardized care. Costs decrease when real-time data and access eliminates unnecessary duplicate testing and frustrating, time-consuming manual tasks.
A happy and engaged workforce provides enormous and essential benefits for both patients and healthcare providers. When organizations are able to fully leverage HIT systems, care providers can streamline, automate, and enhance their work. They are left free to spend more time doing what they entered the healthcare profession for—providing care for patients. When all these steps are in place, hospital organizations will transform their Triple Aim to the Quadruple Aim, a key in both provider—and patient—satisfaction.