Geographic teams save agency 4,425 miles
Use these tips to slash your own mileage
Agencies continue to search for ways to cut unnecessary costs. With the struggle to stay afloat more difficult than ever, this may be the right time for your quality manager to tackle the problem of high mileage.
Bennington (VT) Area Home Health Agency successfully cut its driving miles down by 4,425 miles in one year's time, although staff made the same number of patient visits, says Julia Maroney, RN, CDE, performance improvement supervisor for the agency, which makes about 45,000 to 50,000 visits a year.
Previously, the agency's nurses and aides would be sent to patients' homes based on whichever person happened to be available. This meant a nurse could be visiting a patient in the southern end of a county one morning and then have to drive 50 miles in the opposite direction that afternoon to handle a patient emergency in the northern end of the county.
This haphazard approach to referrals was inefficient, and it did not give patients any continuity in their care, Maroney says. "If you had a patient with twice-a-day dressing changes, that patient could see the same nurse all week or a different nurse each visit," Maroney explains.
Clearly, it was in the patients' and agency's best interests to change the process. The agency initiated a quality improvement project. Maroney offers these guidelines to help other agencies achieve the same success in cutting down staff mileage:
1. Divide service area into regions.
Maroney says the agency's supervisors took a map of their coverage area and divided it into four sections. The borders of the sections were altered according to how difficult a particular region is to travel.
For example, the southern area has many rural dirt roads that don't connect with other roads. The southern area team might have fewer patients to cover because it takes them longer to visit those rural homes, she says.
2. Choose four team leaders.
The team leaders had to be full time, and they had to have the most experience, preferably as head nurses, Maroney says.
Also, the team leaders must spend more time in the office to handle staff problems and to complete evaluations and supervision. This means they have a much smaller patient load than the other nurses, she adds."There were five people who were eligible to be supervisors. We asked them who would be interested, and one person didn't want to do it," Maroney says.
3. Assign nurses to teams.
Using computerized data, Maroney and other supervisors could see where patients and staff lived. This information was important during the transition period when a patient was switched from a nurse he or she had been seeing to another who was on a new geographic team that covered that patient's area.
"We tried to put the staff in the vicinity they requested to go and also where most of their patients lived," Maroney says. "But everybody had patients all over the place, so it was hard at first to figure out how to assign areas."
The agency transitioned patients gradually. In a few cases, particularly with dying patients or patients who would soon be transferred to a nursing home, nurses remained with patients outside of their geographic areas for the patients' benefit.
When nurses transferred patients to other nurses, they gave their reports to the new nurses and discussed goals and care plans. "Our biggest fear was that we'd forget a patient through poor communication," Maroney says.
The agency put in place a safeguard against this eventuality. Each week, team leaders would check the computer system to pull up the names of all patients who were supposed to be receiving visits to make sure they were being seen.
4. Place aides on teams.
Six months after the nurses were assigned to geographic teams, aides were divided into those teams as well.
It was difficult to divide aides between teams because, unlike nurses, aides couldn't be divided according to the number of patients in an area, Maroney says. Instead, aides were divided based on how many patients were receiving aide visits.
"We separated aides so each team had at least a few full-time aides and some part-time aides," Maroney says.
As with the nurses, the aides first were asked which teams they wanted to be on.
"A lot of aides chose areas where they wouldn't have to be with patients they had seen for a long time, saying they needed a break," Maroney says. "So that happened, and we got some patient complaints."
Some compromises were made, and eventually the patients became accustomed to changes in their schedules. "We told the staff from the outset that we can't please everybody," Maroney says. "There were some patients who requested to keep their aides, and we said,'They really need you, so is it OK with you?'"
Occasionally, if an aide needed a break from a particular patient, then another aide would be scheduled to visit that home. "When we switched aides, we asked the primary nurse to speak to the patient and ask them who else they would want to visit them out of the other aides who had been in the home," Maroney says.
The aides' schedules remain flexible so aides may be moved from geographic team to geographic team according to the agency's changing census.
5. Adjust when problems appear.
It's important to remember that geographic teams always are subject to change, Maroney says. "We've had the teams for two years now, and we're still not satisfied yet," Maroney says.
Nurses say they like the new arrangement because it gives them a little more flexibility in their schedules. For example, a nurse might be able to drive by her home and put dinner in the oven on her way to visiting a late afternoon patient, Maroney says.
But agency staff also had some difficulty accepting the team leader concept. Previously there was one nurse supervisor to handle all scheduling conflicts. Now there are four nurses fulfilling that role.
"The most difficult thing for the staff was to see someone who was their peer become their team supervisor, their leader. It was hard for them to accept at first," Maroney says.
Staff also were reluctant at first to bring their problems to the team leaders. Instead, they'd walk into Maroney's office or visit another agency manager. "We had to say that they needed to have their team leader do that, and we would not step in and handle it because it takes away from the team working effectively," Maroney says.
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