Addressing effectiveness can boost bottom line
Would you like to be responsible for a million-dollar increase in your hospital’s bottom line?
By complying with the staffing effectiveness standards from the Joint Commission on Accredi-tation of Healthcare Organizations, you can have a dramatic impact on your facility’s operations and impress surveyors to boot, says Lisa Mead, RN, MS, director of quality and organizational effectiveness for Scottsdale (AZ) Healthcare.
"This will be a key focus in the 2004 survey process," she underscores.
The new survey process enables surveyors to assess the unit manager’s understanding of the relationship between clinical and human resource indicators and determine if data are shared with staff, says Mead.
As a quality manager, your major challenge is to explain the importance of data analysis to others, she says.
"The biggest reward is when relationships are identified, and action plans can be put into place to improve outcomes for our patients," Mead points out.
To comply with the staffing effectiveness standard, do the following:
• Collect the right data elements.
At NorthEast Medical Center in North Concord, NC, data are being collected on patient falls, medication error rate, staff turnover, and understaffing, says Karen Holtz, MS, CPHQ, MS, CPHQ, the facility’s performance improvement specialist.
Indicators are population-based, notes Holtz. "Therefore, additional or substituted indicators are identified by departments or units to recognize special services, or in the case where there are no available data for a specific indicator," she says.
Each year, strategies are developed at Scottsdale Healthcare to meet the hospital’s critical goals, Mead. "Staffing effectiveness is a key measure for strategies that support two of our critical goals," she says.
Based on these strategies for the facility’s balanced scorecard, relevant indicators are chosen as key measures. Each area evaluates indicators to assess staffing effectiveness, Mead continues.
The facility’s indicators for fiscal year 2003 are as follows:
— staffing turnover;
— staff satisfaction;
— medication errors;
— length of stay for the diabetic patient
population;
— patient satisfaction: overall, pain relief, responsiveness of nursing and other staff;
— wait times;
— mortality;
— readmissions and unscheduled returns to operating room.
• Identify effective ways to collect and display information about staffing effectiveness.
At NorthEast Medical Center, data are collected through the facility’s self-reported quality management reports, which are compiled by corporate risk services, and through human resource and nursing administration electronic reports, Holtz says.
Excel charts and graphs are used to display staffing effectiveness data, she says. "Clinical directors use run charts to trend data and identify any correlation between their human resource and clinical indicators."
Use statistical analysis that all clinical directors can understand and use, Holtz recommends.
"One department wanted to use control charts, but in the end, all directors were educated on spreadsheets and run charts," she says. "We kept it simple."
At Scottsdale Healthcare, data are collected by system, service line, and department as appropriate, and are displayed in graph form and matrix tables, Mead says. "These data are available through our common drive, and can be viewed by anyone in our system."
Each area is reviewed by medical staff committees and the facility’s leadership and management councils, and graphs are presented with analysis to the board quality committee every two months, she says.
• When problem areas are revealed, act on them.
If you’re complying with the staffing effectiveness standards, you should be identifying areas for improvement and developing action plans to improve results, Mead emphasizes. "We have been utilizing this format for three years — one year before the JCAHO standard — so we have adopted this as a way of operating."
Retention programs and performance improvement teams are implemented on an ongoing basis, with the goal of having each area focus on their own needs and drill down to further analyze trends and develop action plans, she says.
During monthly and quarterly reviews, indicators are evaluated to identify potential problem areas, Mead points out. "Each indicator has targets based on internal and external benchmarks," she says.
For example, when indicators showed that staff turnover was 23% in 2001, an action plan was developed, which decreased turnover to 18.3% in 2002, and 15% this year. "Turnover is a huge indicator of many things," says Mead. "For every 1% drop in turnover, it’s a half-million dollar increase to your bottom line."
The following steps were taken to decrease turnover:
— Individualized professional development plans were developed.
"We sit down and work with individuals to assess their strengths and weaknesses and identify their career goals, and put a plan together with them," says Mead. "This makes a huge difference in turnover."
— Tuition is reimbursed up front even for part-time staff, and bachelor’s and master’s degree programs are offered on site.
"For the first class, the on-site BSN program had 11 graduates," reports Mead.
Staff satisfaction is measured in an annual survey, and since the measures were put into place, it has gone up significantly, she says. "In addition, costs have gone down, and profits are going up. We are seeing all the indicators move in the right direction, on top of the staffing effectiveness ones."
At NorthEast Medical Center, staffing effectiveness "Plan-Do-Study-Act" reports are compiled quarterly, with a written data analysis identifying areas for improvement, says Holtz.
For example, a unit’s clinical director would review a fall cause analysis report to discover why or when falls occurred, or a medication event report to reveal reasons why certain drug errors occurred, says Holtz.
"In addition, clinical directors review their staff mix, competency, and whether staff were in orientation, on medical leave, or resigned during the reporting period," she says.
Based on this data analysis, improvement opportunities are identified, which often include staff education, says Holtz.
Recently, there was a correlation between the fall rate (a clinical indicator) and nurse turnover and staffing variance (human resource indicators) on a floor, Holtz says.
Data analysis revealed that all the falls occurred on the night shift, with the majority of falls related to patients trying to get to the bathroom, Holtz says. In addition, it was determined that during the time period in question, a nurse had just transferred to another unit, another nurse had resigned, and a nurse was off the floor attending orientation, she adds.
The facility’s action plan included the following changes:
— Have nurses visit patients every two hours and ask if they need to use the bathroom.
— Hire two additional nurses for the night shift.
— Visit local colleges to recruit new nurse graduates and offer a sign-on bonus.
"The fall rate declined in the next quarter," Holtz continues. Nursing vacancies also are reviewed with the facility’s balanced scorecard, so the effect is seen in both the staffing effectiveness graphs and the manager’s scorecard, she explains.
After implementing these solutions, quarterly results decreased from 4.9 per 1,000 patient days to 3.5 per 1,000 patient days, and monthly results decreased to 1.6 per 1,000 patient days from 7.0 per 1,000 patient days, Holtz adds.
"You must continuously educate nursing leadership," stresses Holtz, adding that she continuously provides staffing effectiveness training at nursing staff meetings.
• Provide drill-down information to surveyors.
When NorthEast Medical Center participated in a Joint Commission pilot study of the new staffing effectiveness standards in July 2002, surveyors were looking for more drill-down information, such as units with the highest fall rates, fall rates by shift, and reasons for falls, Holtz reports.
This is something that surveyors will want to see for 2004 surveys," she says.
[For more information on compliance with JCAHO’s staffing effectiveness standards, contact:
• Karen Holtz, MS, CPHQ, Performance Improve-ment Department, NorthEast Medical Center, 920 Church St., North Concord, NC 28025. Telephone: (704) 783-3323. Fax: (704) 783-2080. E-mail: [email protected].
• Lisa Mead, RN, MS, Director, Quality and Organi-zational Effectiveness, Scottsdale Healthcare, 3621 Wells Fargo Ave., Scottsdale, AZ 85251. Telephone: (480) 675-4217. Fax: (480) 994-1597. E-mail: [email protected].]
Would you like to be responsible for a million-dollar increase in your hospitals bottom line?
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