Maximizing Data Resources to Drive Staffing Decisions

JenniMay 17, 2019

What we know

Aging population10,000 baby boomers turn 65 every day

Nursing shortage1.1 million

Turnover costsLoses $5.7 million average

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What we know

Operating margins2.7%

Operating margins2.7% and narrowing

Overtime 33% of nurses work longer than scheduled

shift

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What I know…1. There is no silver bullet

2. Research is solid

3. Must adapt findings

4. Things can not stay the same

5. We all need to challenge our thinking

6. Everything is interrelated and connected

7. Oregon is known for innovation and we CAN be the example

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Five outcome areas

Clinical Financial Compliance Staff engagement Patient experience

Must be balanced!

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Research-Patients• Decreases in RN direct care hours lead to increases in safety issues Increased mortality rates- 7% increase within 30 days for each additional patient

added Numerous hospital acquired conditions: UTIs, pneumonia Increased readmission rate and longer length of stay

• Delayed or Missed CareRequired patient care that is omitted or delayed due to multiple demandsAmbulation, assessment of medication effectiveness, turning, oral care, teaching, and

PRN meds One study cited 50% of nurses reported missed care from prior shift

• ExperienceHigher experience scores correlates with hours nurses spent with patients per day

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Research- Nurses and Work Environment• Missed CareMoral distress

• Job SatisfactionNegatively impacted

• BurnoutHigher turnover and intent to leave

• FatigueUnderstaffing linked to adverse events and higher turnoverUnderstaffed organizations encourage staff overtime leading to adverse

outcomes • Turnover Experienced nurses leaving

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Research-Healthcare Organization• Hospital Readmission Reduction Program (HRRP)Better staffed hospitals had 25% lower odds of being penalized Nursing interventions such as teaching, care coordination fundamental to

lower readmissions• Patient Care Costs savings Shorter lengths of stayDecrease adverse outcomes

• Nurse Turnover costsCosts range from $38,900-59,700 per nurse

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Actionable Items• Flexing staff relative to patient care needs• Using EMR and ADT data for better staffing decisions Admission entry points

• Balanced, equitable nurse workloads• Continuity of care

• Patients to nurse vs nurses to patient

• Professional variability • Professional governance

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Actionable Items• Self-Scheduling

– Better work/life balance for nurses– Managers spend less time creating schedules– Templates

• Open Shift Management: Visibility to staffing needs enterprise-wide– Nurses have more scheduling flexibility – Nurse working to the top of their license– Larger pool of nurses to fill open shifts

• Central Staffing Office View of all needs Partner with patient placement office

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Actionable Items Make scheduling systems effective Culture of accountability and standardization

Clocking's, attendance, lunch attestation and self-scheduling

Track real-time productivity and budget tracking Capacity project Focused on people, process and technology

to create more capacity without more beds Manage patient volumes more effectively

Variability –patient

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Next steps

Challenge your thinking Collaborate Evidence Based ProjectsDoesn’t mean cookie cutter implementation

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Thank you!

Jennifer Mensik PhD, MBA, RN, NEA-BC, FAANDivision Director, Care ManagementOHSUmensik@ohsu.eduP: 503 494 6017 13

REFERENCES 1. http://www.pewresearch.org/fact-tank/2010/12/29/baby-boomers-retire/2 The US Bureau of Labor Statistics (2018)3 2018 National Health Care Retention and RN Staffing Report": http://www.nsinursingsolutions.com/files/assets/library/retention-

institute/nationalhealthcarernretentionreport2018.pdf4 Becker's Hospital Review: https://www.beckershospitalreview.com/lists/224-hospital-benchmarks-2018.html5 https://www.advisory.com/daily-briefing/2018/05/24/nurse-overtime6 https://www.beckershospitalreview.com/finance/cutting-costs-top-2019-priority-for-healthcare-finance-execs-other-survey-findings.html7 Hee Lee, K, et al (2011). Do staffing levels predicts missed care? 8 Needleman, J. et al (2011). Nurse staffing and patient mortality. 9 Guiliano, K. et al (2016). The relationship between nurse staffing and 30-day readmission rate10 Blouin, A. Podjaek, K (2019). The continuing saga of nurse staffing.11 Press Gainey Associates, Inc. (2015) The Influence of nurse work environment on patient, payment, and nurse outcomes in acute care settings. 12 Aiken, L, et al (2002). Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction13 Blouin, A, et al (2016). Caregiver fatigue: implications for patient and staff safety. 14 Needleman, J. (2016). The economic case for fundamental nursing care. 15 McHugh, MD, et al (2013). Hospitals with higher nurse staffing had lower odds of readmissions penalties than hospitals with lower staffing. 16 Aiken, L, et al (2018). Nurse’s and patients' appraisals show patient safety in hospitals remains a concern. 17 Nursing Solutions, Inc. National Healthcare retention & RN staffing report (2018)

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