Leaders in children's hospital emergency departments develop ground rules that can help any department operate more efficiently.
A lot of data and experience goes into scheduling the appropriate number of people for emergency department (ED) shifts. No one schedules a visit to the ED, so creating an accurate staffing matrix requires a mixture of math, history and educated guesses. To help children's hospitals model successful staffing plans, CHA analysts compared four staffing criteria from PROSPECT, a financial and operational children's hospital data program, to identify high-performing pediatric EDs. The people leading the successful operations have developed practices to guide staff and create the best environment to deliver quality care in any area of a hospital.
Leadership is a philosophy
The charge nurses at Children's Hospital of Orange County (CHOC) operate with latitude to meet the patient and caregiver ratios set by the state of California. Melanie Paterson, D.N.P, M.H.A., RN, chief nursing officer at CHOC, works with the philosophy that every nurse is a leader, and she supports their responsibilities by openly discussing finances at every meeting. “If you're in charge, you're the CEO of your area,” says Paterson. She finds the repetition of financial information and transparency allows managers and charge nurses to get a clear picture of productivity levels and understand staffing strategies.
Use data to get results
At Children's Hospital of Philadelphia (CHOP), ED managers use data to uncover trends in care, predict when to expect variation in patient volume and determine how to staff for volume change. Staff and providers receive a data report to stay up to date on census trends. If events, such as the flu, produce a volume spike, managers are prompted to develop strategies so the unit can prepare to treat more patients.
Leaders at Ann & Robert H. Lurie Children's Hospital of Chicago receive data metrics daily. The metrics are also displayed on a visual management board for staff and patients to view. The ED operations committee reviews the data weekly looking at trends. “Our philosophy supports a collaborative environment and shared decision making,” says Dan Skarzynksi, M.H.A., manager of operations at Lurie Children's. “Leadership and staff need to be involved and understand the big picture.”
Keep the finance door open
All four of the identified high-performing EDs attribute transparency with the finance department as a key to operational success. Every two weeks, the ED manager and director at Dell Children's Medical Center of Central Texas receive financial reports noting activity and overtime use. The manager meets with the labor management committee consisting of the chief nursing officer, chief operating officer and finance representatives to discuss exceeded goals.
CHOC shares organizational finances to demonstrate how and why data is used to influence staffing decisions. If a leader makes a staffing decision not in line with the available data, it's discussed as a teaching moment to positively reinforce understanding for future decisions.
CHOP begins the staffing planning process by establishing a budget that matches projected patient volumes. “Managers pay close attention to nursing productivity so they can schedule the right type of care based on patients' needs,” says Jackie Noll, RN, senior director of Emergency Nursing at CHOP. “Deciding on staffing levels is a collaborative process that includes nursing, medicine and finance.”
Align staffing models with providers
The CHOP staffing model is flexible to respond to increases or decreases in volumes daily. To make adjustments effective, charge nurses huddle with the physician leaders to make decisions. “It's a true partnership,” says Jane Lavelle, M.D., associate director of CHOP's ED. “To add a physician to the mix without adding a nurse partner doesn't help.” As part of a quality improvement project exploring how to better match physician schedule with ED schedules, CHOP added workforce management software to manage shift structure and staff to patient volume.
Providing care for behavioral health patients or children with complex medical conditions presents a different set of challenges. Managers at Lurie Children's are working to fully understand the time and resource intensity of these children. “We align our staffing model with the provider's side,” says Skarzynski. “When managers make decisions about adjusting staffing patterns, it's done in tandem with physicians, nursing and in cohesion with faculty.”
Managing staffing and productivity is a year-round challenge. Read more about the strategies helping these four hospitals staff efficiently and effectively.
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