Enhancing quality patient care and nurse satisfaction with workforce management technology

The prevailing HR challenge in the healthcare sector has been a shortage of talent. Increasing demand for and short supply of healthcare professionals − nurses in particular − have affected the sector profoundly. Today, rising costs and limited budgets have left many hospitals in a precarious position financially − some without the means to hire, even when quality talent is available.

“We wanted to promote self-scheduling to enhance employee satisfaction by increasing autonomy with work schedules and giving nurses an ability to swap shifts with colleagues. We still needed to maintain the overall scheduling framework, but provide more flexibility and give nurses more power over their own schedules.”
-Teri Manning, Director, Nursing Operations Office, Thomas Jefferson University Hospitals

The talent shortage is of great importance because healthcare represents the United States' largest industry, both in terms of numbers employed and as a share of GDP¹. In addition, the growth in healthcare spending is so much greater than the rate at which the population is aging. According to the Congressional Budget Office, if current growth patterns continue, healthcare will consume half of GDP before the end of the century² - clearly an unsustainable trend. Moreover, talent shortages are sure to intensify as the economy improves.

Averting a major crisis in healthcare seems unlikely without fast and fundamental change. The combination of inexorable demand for healthcare services, talent shortages and strained budgets - each of which are likely to worsen year after year, for perhaps decades to come - places the industry under intense pressure.

With over 14 million workers, the healthcare industry provides an essential economic engine. Yet that engine is in dire need of repair, as strained budgets and spiraling costs prohibit simply training and hiring more people to fix the system. Perhaps more than any other industry, healthcare must be a leader in workforce innovation and technology adoption. It must offset financial and talent scarcities with increased worker productivity, particularly among nurses, who comprise the single largest component of the workforce in U.S. hospitals³.

Yet today, the nursing profession tries to solve its 21st Century workforce challenges using mostly 20th Century tools. Indeed, about 85% of the administrative work performed by nurses is paper-based, consuming between 30 and 60 minutes of every two hours nurses spend on duty⁴. In this paper, we examine the impact of workforce management technology on productivity. We believe that the use of healthcare workforce technologies can increase nurse productivity significantly and should be a top priority for healthcare leaders.

Why Healthcare Workforce Management Technology?

Over the past 10 to 15 years, increasingly sophisticated, web‐based and interactive technologies have been introduced to better manage the nursing workforce, cut costs and streamline work. These include nurse staffing & scheduling systems, interactive scheduling web sites, shift‐bidding systems and decision‐support tools.

Despite the successes of these tools, and the fact that automated workflow technologies have been available for years, an incredible 85% of the work performed by nurses is still paper‐based⁵. While the healthcare sector is tremendously advanced in its use of technology for patient procedures - especially in diagnostic tools and surgical methods - it is a laggard in adopting talent management practices, including technology for administrative and workforce improvements.

The research demonstrates that workforce management technology for healthcare not only drives higher levels of engagement and greater productivity, it also saves money through the reduction of manual, time‐consuming processes, reductions in costly overtime and nurse turnover, and the elimination or reduction of agency fees.

Finally, it has been shown that the level of nurse engagement is the top most predictor of mortality variation across hospitals⁶. Indeed, any technology that allows nurses to select their schedules based on unit needs while keeping a reasonable work‐life balance provides a boost to job satisfaction, recruitment, retention and even patient safety.

Healthcare and the Promise of Workforce Management Technology
The hospital environment today is marked with more patients, more staffing gaps and more paperwork than in recent memory. Better talent management practices, including productivity‐enhancing workforce management technology, offer an important solution to these challenges.

A growing number of healthcare organizations have implemented workforce management technologies to support nurses in various aspects of their work, and these organizations have seen many benefits. These tools, when properly selected, implemented and integrated, can increase the efficiency of nurses, make their work more satisfactory, save money and even improve patient outcomes. Below, we look at how and why these technologies are being implemented and used.

Our Lady of the Lake Hospital

In Louisiana, challenges already posed by a prevailing nursing shortage were exacerbated in recent years by Hurricanes Katrina and Rita. Seemingly overnight, the state lost 3,000 registered nurses, leaving 6,000 nursing vacancies across Louisiana. At Our Lady of the Lake Regional Medical Center (OLOL) in Baton

Rouge, La., that challenge was addressed innovatively with staff scheduling and workload management software.

Each year, OLOL treats approximately 35,000 patients and serves about 350,000 outpatients, relying on the support of more than 1,000 physicians and 4,000 team members. In the past, OLOL would create nursing schedules on paper and then enter them into scheduling software. But faced with a heightened nursing shortage, increasing competition and constant turnover challenges, OLOL realized it needed a solution to help alleviate scheduling challenges, gain access to real‐time productivity reports and tie salaries to schedules. Moreover, OLOL wanted to decrease the amount of time managers spent creating schedules, regulating premium pay, and filling gaps in the schedules with their own staff.

Today, nursing managers post their schedules and available shifts to the hospital's intranet at least six weeks in advance. Nurses log onto the site and bid on shifts. This way, they are able to establish their schedules in advance and know when their extra shifts will occur. As a result, OLOL has managed to decrease its contract labor and incentive pay. In one shift, incentive pay decreased from between 24 ‐ 48 hours of pay‐per‐pay period, to only 4 ‐ 8 hours. More importantly, staff morale improved across the board, even to the point where many nurses were more willing to pick up extra shifts. In part, the willingness to work more was the result of being able to plan weeks in advance as opposed to being forced to decide at the last minute.

OLOL has seen significant value from the investment. In addition to reductions in incentive pay, they expect to eliminate their entire contract labor spend soon. Attrition also has decreased, as staff morale has improved. Nurses are now better able to "control their destiny" and plan in advance for extra shifts - and extra pay - and this has made a tremendous difference in their ability to manage life and work.

Thomas Jefferson University Hospitals
Thomas Jefferson University Hospitals (Jefferson), located in Philadelphia, Pa., is an academic medical center that firmly believes hospital nurse staffing impacts patient safety and quality of care. But their scheduling system was manual, labor intensive and lacked the ability to identify system‐wide staffing needs. Jefferson wanted to improve scheduling and employee satisfaction for staff that provided care 24 hours a day, seven days a week, across three sites.

Jefferson faced the following scheduling challenges:

• No centralized process to provide accurate, real‐time views of staffing ratios skill mix;
• An inability to effectively monitor the number of shifts and hours staff were working, to comply with patient safety guidelines;
• No way to efficiently manage open shifts with a unit and utilize available staff for coverage across a six‐week scheduling cycle.

To resolve these challenges, Jefferson wanted a system that would enable effective staffing decisions related to budget and census. Jefferson also wanted to improve the accuracy of charge‐backs to departments for the number of hours nursing staff worked.

Ultimately, Jefferson chose a solution that enabled them to meet their goals and achieve a myriad of benefits, such as:

• Reduced costs and enhanced ability to deliver quality patient care;
• Proactive insight into staffing decisions, showing effects on labor rules, cost and employee preferences;
• Staff scheduling autonomy and a confirmed schedule six weeks in advance, with nurses able to communicate electronically if their needs change;
• Enable managers to float staff for entire or partial shifts depending on needs, and enable staff to float based on competencies and unit needs;
• Reporting capabilities that help monitor staffing compliance to internal and Joint Commission recommended shift lengths, helping improve employee and patient safety;
• On‐call scheduling that allows staff to self‐schedule and manage time;
• And much more.*

The solution has led to improved satisfaction levels from nurses who are now better able to control their schedules. "I have a staff of 30‐plus employees that would never want to go back to paper," said Kathy

Jaffe, a Clinical Charge Nurse at Jefferson. "Nurses can do their schedules from home at their leisure.

We're gaining a greater understanding of what the system can do for us, which has increased managers' enthusiasm for using the system." 

Reduction in Patient Error and Increase in Quality of Care

According to several reports, as many as 100,000 Americans die needlessly in hospitals each year due to lack of adequate medical care⁷.

The Institute of Medicine of the National Academies has cited inadequate and poor information management as a major cause of the high rate and level of medical errors in the U.S. It has also identified technology as one key to patient safety⁸. Technology can provide healthcare professionals with the most up‐to‐date information to better ensure that patients receive the most current and best treatments possible. More to the point, workforce management technology can help ensure that the right mix of talent is in place for each shift. It also increases the likelihood that nurses on shift will be better rested and more highly engaged in their work - a formula that is likely to result in fewer errors.

Conclusion
With the recession ending and demand for nursing services set to increase just as supply is shrinking, now is the time to explore and implement workforce management technologies in the healthcare industry.

After all, the business case is clear and compelling. The Return on Investment (ROI) of hard dollars is typically rapid, often positive even in the first year. The less tangible returns are even greater, including improved nurse morale and engagement, enhanced recruitment and retention, and better patient outcomes.

Please note: This white paper is excerpted from Enhancing Quality Patient Care, Nurse Satisfaction and Cost Containment through Workforce Management Technology, available online at www.lawson.com/workforcetech.

References

1 "The Long‐Term Outlook for Healthcare Spending", Congressional Budget Office, 2008

2 Ibid

3 "Your Nursing Career: A Look at the Facts", American Association of Colleges of Nursing, March 10, 2004
4 Dr .Bill Crounse, M.D., "Nursing faces a critical shortage of the right technology," (http://www.microsoft.com/industry/healthcare/providers/businessvalue/housecalls/nursing.mspx), 2005
5 Ibid
6 Gallup, "Nurse Engagement Key to Reducing Medical Errors," (http://www.gallup.com/poll/20629/nurse‐engagementkey‐reducing‐medical‐errors.aspx), 2005
7 Betsy McCaughey, PhD, "The Human and Financial Costs of Hospital Infections", Committee to Reduce Infection Deaths, 2006
8 Jeanie Croasmun, Error Rates for Nurses Increase With Length of Shifts, Ergonomics Today, July 12, 2004, http://www.ergoweb.com/news/detail.cfm?id=959