CASE STUDY:
Quality of Care: Compliance with Legislated Staffing
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OVERVIEW:
The client facility identified the need to alter current nurse to patient ratios and nursing staffing practices in preparation for legislated staffing requirements. The leadership team asked the consultants to confirm their current actual staffing ratios and practices. In addition, it was requested that operational issues impacting effective staffing be identified.
The objective was to evaluate the current nurse staffing practice, available labor resources and compare that to what was needed to meet nursing ratio legislation. Simultaneously we evaluated staffing to maximize productivity. Consideration was needed to ensure that patient aggregation and variability from unit to unit was appropriately understood including unit admission and utilization practices. Since nursing practice is influenced by patient care needs, variations in patient populations were evaluated as a component of this study. Existing patient care delivery models were identified and described.
Identification of needed staffing changes was completed. Recommendations for implementing these changes were provided that would facilitate standardizing care and improving patient outcomes. The organization also used this process to ensure that there was congruence between the current budgeting and the staffing process.
Although the thrust of this study was to identify needed changes and facilitate preparation for staffing ratio compliance, the final results needed to be financially acceptable. Staffing changes also needed to be sensitive to potential role and function changes that would preserve needed jobs while respecting individual contributions to the teamwork of every department.
The Sullivan Lakier Group, a consulting team, was engaged to perform this assessment, report its findings and recommendations, and develop realistic labor targets. Well defined staffing patterns and staff changes were needed so that resulting added costs to the organization could be predicted and minimized.
OBJECTIVE:
DEVELOP STAFFING TARGETS BASED ON IN-DEPTH UNDERSTANDING OF THE PATIENT POPULATION, EXISTING SYSTEMS, PROCESSES, AND SUPPORT STAFF THAT WOULD ACHIEVE LEGISLATIVE COMPLIANCE WHILE ENHANCING PATIENT OUTCOMES.
APPROACH:
Recognition of the quick turnaround required of this study led leadership to request a two-phase project. The first phase consisted of an assessment of the medical-surgical inpatient nursing units and the emergency care unit since they were expected to have the greatest impact. The remainder of the acute nursing units comprised the second phase of this study.
Managers, staff, and other key stakeholders were interviewed to determine all aspects of employee operations, including the expertise and experience of the patient care staff, and the complexity of delivering care. On-site observation occurred on all units, on all shifts. Customized analysis was established based on departmental patient care needs, support systems, and external experience. Two sets of targets were provided. First, conservative targets were identified that could be achieved in a relatively short time without significant impact on the department’s operations. Second, aggressive staffing targets that involved system and process redesign were identified as longer term goals. Both sets of targets met the legislative requirements, the aggressive staffing targets however, provided improved productivity as well.
The consulting team developed and discussed recommendations across the various levels of management, which positioned the organization for buy-in and support from managers. They also presented the overall projections and departmental targets to leadership. Short-term targets were selected and an implementation plan was developed. System changes that would have distinct impact on nursing practices and processes were identified and included in the recommendations. Patient safety and enhanced clinical and financial outcomes as well as staff satisfaction were considerations for all aspects of changes.
RESULT:
Unit by unit staffing plans that are consistent with California staffing regulations and that ensure quality care were delivered. Thorough evaluation also identified multiple opportunities to standardize care delivery systems, increase efficient utilization of existing labor resources and refocus provider delivery for improved patient outcomes.
RESULT:
Staffing practices revealed opportunities to modify staffing and achieve legislated compliance. An estimate, by the client, of the increased cost of staffing with their current grids and adding staff to comply with both the ratios and break regulations was $15 million. With implementation of consultant recommendations a savings of $4.3 million could be realized and result in better staff availability for improved patient care and outcomes.
CONCLUSION:
The hospital was positioned to achieve compliance with legislated staffing guidelines. By tightening staffing where possible, additional staff was available to meet regulatory requirements in other areas. Financial implications of these labor changes were evaluated and minimized such that patient populations were continuously provided quality service.
CLIENT PROFILE:
- 496-bed acute care hospital publicly owned and operated
- Recognition for its integrated teaching programs
- World-class rehabilitation program as well as regional expertise in trauma, burn and neonatal intensive care services.
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