Right Staffing: We Can Eliminate Understaffing AND Overstaffing if We Stop Being Lazy!

tirednurse_380x250Everyone agrees that understaffing a hospital is dangerous and will lead to unhappy staff, poor clinical outcomes, and an increase in sentinel events and related liability. Many states have implemented required staffing ratios to ensure hospitals are not dangerously understaffing their units intentionally (to save a buck) or unintentionally due to lack of knowledge. There are hundreds of articles and studies that focus on the impact of understaffing hospital inpatient units.

But What About the Opposite:  OVERSTAFFING?

Overstaffing is easier to correct than understaffing, so why aren’t your Managers taking the steps and why aren’t you holding them accountable? In a consulting white paper titled “The Key to Budget Success: Optimal Staffing and Scheduling Management”1, CFO complaints regarding missed budgets are on the rise. In their study group, 90% of hospitals operated outside of the 1-3% flexible staffing budget that was set for Patient Care Services.

Gut Check

There are multiple factors that may cause a patient care department to operate out of their budget range, but can YOUR organization answer the following questions affirmatively:

  • Managers are proactively taking steps daily to ensure they schedule staff within budget?
  • CNOs and VPs of Patient Care Services care about (and know) what it costs to staff the inpatient units in the hospital, and what part of that is overstaffing waste?
  • Leadership is paying attention to these operating costs in a manner that enables taking corrective action on a daily or regular basis?
  • Your managers are setup for success with a Plan of Care, Budget and Daily Staffing Guides?
  • There is accountability for staffing costs, and if so, leadership knows at what level that accountability disappears?
  • Your managers and leadership have the scheduling tools and real-time data flow they require to proactively address staffing and scheduling needs with an eye on budget?

Mindset Can Drive Waste

I have worked with many hospitals and healthcare organizations where budget always took a backseat to “getting my units staffed.” These leaders didn’t even consider the budget impact of staffing and scheduling decisions made on a daily basis (maybe some paused for a second before filling their needs with Agency workers). Obviously these managers were not held accountable for their budgets, but if they were understaffed they could be sited by the state (for those with staffing ratios). This “I don’t care what it costs to staff my units” mentality can only come from the top, but lets face it – when overstaffing occurs, with that mindset it is also easy for mangers to be lazy and do nothing – and it is pure WASTE!

In my experience, the opportunity for “Right Staffing,” defined as neither under- nor overstaffed for any given shift, exists in every hospital, every day. As census changes and patients flow through the facility, overstaffing exists and many times nothing is done to move staff to places of need or sending them home for their shift with close to the same urgency usually seen with under-staffing. And maybe rightly so, but with the average RN hourly rate at $332, an extra hour of unneeded and wasteful RN time racks up quickly. In a single 12 hour shift, one unneeded RN can cost an organization $366 if not in overtime, and much more if in overtime or even double time. Multiple instances a day, every day, can quickly add up and have a real impact on a healthcare organization’s bottom-line.

Software Can Help Achieve “Right Staffing”

It IS possible to arm your Managers (and you) with the information that is necessary to identify overstaffing situations and provide data that will assist with decisions on how to best handle it.

There is new online staff scheduling software available that can make filling or calling-off shifts a much easier task for your managers to accomplish. Built-in functionality to directly address “Right Staffing” can even pro-actively alert users to understaffing AND overstaffing for every shift via Internet access and by leveraging communication channels such as email and cell phone texts. Your managers will have the organization’s needs, staff availability, and the cost of the different options at the point of decision. Real-time data showing fiscal impacts is available to everyone involved at every level of staffing. With these online scheduling systems, there is really no more excuse for your staffing decision makers to be lazy and you now have visibility to decisions and can hold people accountable.

As stated in the paper above, one of the 10 steps to successfully staffing and scheduling outcomes is developing a staffing and scheduling system. The “right” system implemented with new staff scheduling software delivering the appropriate functionality will enable “Right Staffing” to be carried out proactively multiple times a day and give your managers and senor leadership visibility to the economic impact of scheduling decisions as they are made.

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