By Rebecca Love, chief clinical officer, IntelyCare.
The news media has done an excellent job of covering the country’s ongoing nursing shortage since the pandemic began. But one problem I have with the coverage is that most of the reports suggest the pandemic and the subsequent burnout suffered by nurses is to blame for the shortage.
Let’s be clear about what we in healthcare know all too well.
Years before February 2020, when COVID-19 began to spread across the globe, a growing number of care facilities around the country were chronically understaffed. The truth is the pandemic exacerbated and brought dramatic downward pressure on an already strained workforce. The issue came to the forefront because nurses were on the pandemic’s frontlines and in the spotlight. It shouldn’t have surprised anyone that the many ways the healthcare system has failed them – going back decades – were thrust into full public view.
Earlier this month, the St. Louis Post Dispatchpublished a story about the high turnover in area hospitals. At one hospital system, out of a 8,500-person staff, managers are losing 160 nurses a month, according to the paper. The story is much the same around the country. The Bureau of Labor Statistics estimates that the nation’s care facilities will be short 1.1 million registered nurses by next year. A problem is particularly serious for post-acute care facilities, which were seeing a pre-pandemic annual turnover rate of 128%.
Before the pandemic, shortages at facilities didn’t draw much attention because there was always some way to patch shifts together. Managers could hire per diem staff or travel nurses. Then, the pandemic struck and the backup resources administrators typically relied on dried up. With so many hospitals overflowing with COVID patients, few places possessed extra nurses.
That’s what we’ll help you find out in this guide.
1. Simplify your staff scheduling
A key aspect of managing your healthcare personnel shift scheduling is to keep it as simple as possible.
The more complex your staff scheduling process is, the more time-consuming, inefficient, and likely it is to be filled with errors. This can easily lead to scheduling issues and inefficient workflows that prevent you from delivering quality services.
One such solution is Deputy. The software’s simple scheduling app lets you create your staff schedule with a few clicks. As a result, you can do away with using an often chaotic and confusing spreadsheet or other tool that requires manual scheduling.
This saves you and your managers boatloads of time while ensuring you maintain ideal staffing in all your facilities. On the Deputy scheduling interface, click a specific date to add a shift. Then, configure the details by assigning staff, choosing a department, adding break times, and other information.
Once you’re done, save the schedule and create other personnel shifts accordingly. If a staff calls in sick, fill in the shift with a qualified replacement efficiently by letting employees use the app to swap schedules with your other eligible personnel.
Predictive analytics and advanced labor management are the most important – and underutilized – methods to assure that provider organizations have the right caregivers in the right places at the right times.
A recent survey of nurse managers by AMN Healthcare and Avantas, Predictive Analytics in Healthcare 2016: Optimizing Nurse Staffing in an Era of Workforce Shortages, (available on the AMN website) brought the need for more awareness to light in just a few stats related to staffing and scheduling:
94 percent of nurse managers say that understaffing hurts staff morale
Nearly 70 percent say they are very concerned about the impact on patient satisfaction
More than 50 percent say they are very concerned about the effect on quality of care
The survey also revealed a lack of sophisticated scheduling tools being utilized:
24 percent use paper-based scheduling and staffing tools
19 percent use simple digital spreadsheets
23 percent don’t use any scheduling tools at all
Further, the survey found that while nearly 90 percent of nurse managers said that a technology that can accurately forecast patient demand and staffing needs would be helpful, 80 percent were unaware that such a solution exists.
Strategies to Fulfill the Potential Predictive Analytics
This process to predict future patient demand and strategically plan clinician scheduling and staffing is scalable, cost effective and accurate. First, staffing data are processed with advanced algorithms, then forecasting models are created and validated, customized for each unit or service area within the organization, allowing workforce projections up to 120 days prior to the shift. The forecast is updated weekly, and by 30 days in advance of the shift, the forecast of staffing need is 97 percent accurate.
Compared to how scheduling and staffing is conducted at most healthcare organizations today, predictive analytics may seem like something out of a sci-fi movie. The truth is, this sophisticated forecasting of labor needs has been leveraged in other industries with great success. And, in healthcare, it can lay the foundation for significant advancement in utilization of staff, leading to improvements in morale, quality, and financial results. The advanced labor management strategies and tools layered on an accurate projection of staffing needs – months and weeks in advance of the shift – will turn an accurate forecast into an effective resource management strategy.
Adopting Workforce Analytics Every organization’s staffing mix should be unique to the fluctuations in its patient volume. Once an organization understands its demand, it can then determine its supply – scheduling and staffing to meet patient demand in the most productive manner possible. The organization can analyze and solve the problems that reduce its available supply of core staff, such as leaves of absence, continuing education, training and other issues. This precision understanding of workforce availability is then layered with patient volume predictions, and the result is accurate insight into the core and contingency staffing levels needed to meet patient demand.
Guest post By Barry P. Chaiken, MD, FHIMSS, chief medical information officer at Infor.
In many ways healthcare is like a symphony orchestra. Although information technology can enhance care planning, assist in medication administration and reduce duplicative testing, it cannot replace the people required to deliver care services to patients. Nurses are needed to administer medications, therapists are needed to provide treatments, and physicians are needed to diagnose illnesses and provide treatment plans. On average, hospitals devote close to 70 percent of their budget to labor costs. Until robots replace humans in the delivery of patient care, selection of the proper skill mix and number of professionals remains a significant factor that determines cost in provider organizations.
Although information technology cannot replace the staff delivering care to patients, it can assist organizations in choosing the best talent available, help develop that talent and determine the best way to utilize the skills of these professionals.
To identify the best talent, information technology tools allow the extraction of an employee’s “behavioral DNA” – the measurement of behavioral, cognitive and cultural traits. Organizations then compare this prospective employee’s “DNA” to the “DNA” of existing high performing employees within the organization in an effort to identify individuals who possess a high probability of excelling within the organization.
Chris Fox, CEO of Avantas, discusses how he and his firm help physicians improve their operational performance; healthcare staffing; the need for addressing operational efficiencies across a health system without following some traditional approaches — like layoffs; and market trends that continue to perplex, yet offer opportunity for growth and development.
Avantas started as a group within Alegent Creighton Health more than a decade ago with the goal of optimizing its workforce across the health system. Its efforts were so successful that it became a separate company and began offering its expertise to the entire industry.
In 2007 Avantas developed a healthcare scheduling software, Smart Square, as no other solution on the market offered the flexibility and customization necessary to fully automate our strategies and provide a transparent view of staffing, scheduling, and productivity at the enterprise level.
Avantas executives provide thought leadership in healthcare labor management.
What keeps your passion for this mission, and the organization, alive? Tell me more about what excites you about your work and why you love what you do?
Very simply, if we are successful as a company it is because we have helped our clients – healthcare providers – improve their operational, clinical, and financial performance. Stronger healthcare providers means more services, more community outreach, basically, better, more affordable healthcare for everyone. It’s pretty easy to be passionate about that.
What draws you to healthcare? Did you seek out the sector when you began your career?
I’ve worked in software development and innovation for more than 15 years within a number of industries. It’s a funny story, but I actually got involved in healthcare because of a chance seat assignment on an airplane almost 10 years ago. I was seated next to Lorane Kinney, Avantas’ co-founder. We got to talking about Avantas and what she was trying to build there. Hearing Lorane’s passion for the company and the need to automate a new approach to labor optimization in healthcare was very inspiring. I knew I wanted to be a part of it, and I knew I could play a big role in bringing Lorane’s vision to fruition. Avantas has a compelling story and big aspirations. As Avantas’ CEO, I, like Lorane, seek out individuals who are passionate about the vision we have for the industry and want to be part of that change.
Tell me more about the evolution of Avantas, from where you started to where you’ve come today? Where are you headed and why?
Avantas started as a group within what is today Alegent Creighton Health more than a decade ago with the goal of leveraging economies of scale and standardizing its labor proactively across its then five Omaha hospitals. Our purpose was to develop and implement strategies that would leverage the system’s care staff, both proactively and in the moment to cost effectively adjust to the natural rise and fall in patient volume. Our efforts were so successful we became a separate company in 2001 and began offering our workforce management expertise to the entire industry via consulting. In 2006 Avantas conducted an RFP to find a scheduling solution we could use within our client base to automate the labor strategies we had developed. After we were unable to identify an appropriate solution we developed our own healthcare-specific enterprise scheduling solution, Smart Square. Now Smart Square is being utilized in more than 200 facilities across the country. Our strategies and technology solutions are packaged in a comprehensive methodology called HELM, which stands for healthcare enterprise labor management. HELM takes a step-by-step approach at restructuring an organization’s labor management strategy by first right-sizing its staffing sources, standardizing policies, and implementing best practices. Next we automate those policies with Smart Square. We also work with our clients to develop centralized methods of managing staffing resources as well as helping them build out the necessary layers of contingency staff, enabling them to cost effectively adjust to constantly changing patient demand. We help our clients implement these strategies across their systems: inpatient, ancillary and outpatient areas, like medical group practice sites.
According to a new report from AMN Healthcare, a healthcare staffing firm, 78 percent of hospital executives believe there is a shortage of physicians nationwide, 66 percent believe there is a shortage of nurses, and 50 percent believe there is a shortage of advanced practitioners. The survey also indicates that the vacancy rate for physicians at hospitals approaches 18 percent, while the vacancy rate for nurses is 17 percent, considerably higher than when AMN Healthcare conducted a similar survey in 2009.
“Change in healthcare is a continuous evolution, but the one constant is people,” said AMN president Susan Salka. “No matter what models of care are in place, it takes physicians, nurses and other clinicians to provide quality patient care, and the fact is we simply do not have enough of them.”
AMN Healthcare’s 2013 Clinical Workforce Survey asked hospital executives nationwide to comment on clinical staffing trends affecting their facilities. More than 70 percent rated the staffing of physicians, nurses, nurse practitioners and physician assistants as a high priority in 2013, compared to only 24 percent of hospital executives who rated staffing these professionals as a high priority in AMN Healthcare’s 2009 workforce survey.