Best Practices for Creating Healthcare Staffing Plans
Your staff is the foundation of your health system’s success. The COVID-19 crisis is having an enormous impact on health system operations, and the pandemic will have far-reaching effects on how health systems manage their staff. Going forward, healthcare leaders need to expect more from their workforce management strategy as they depend on staffing strategies that empower them to develop and deploy an agile, flexible workforce. An emphasis on leveraging healthcare staffing and scheduling systems and defining clear processes will play a critical role in achieving success over the long term.
Core principles for effective healthcare workforce management
Determining how to optimize the workforce can be a daunting task. After working with hundreds of health systems, we’ve found that the following core principles are the foundation of a successful staffing plan.
- Technology and software solutions: The technology should be designed for staffing a healthcare organization and serve as the foundation for building your model. Healthcare-focused technology partners can provide strategies, functionality and services that expertly address your unique needs as a health system. Smart technology allows for predictive and prospective intelligent staffing. In addition, technology should assist with evidence-based decision making by leveraging acuity data and matching caregiver competencies with patient needs. Interactive technology allows for real-time decisions and links staffing offices across the entire enterprise, ensuring more cost-effective and efficient staffing decisions throughout the entire continuum.
- Analytics: Dashboards that collect and distribute actionable data, and are updated with regularity, ensure the most accurate picture of the available staffing mix.
- Infrastructure: The infrastructure must be flexible to accommodate multiple roles and include both short- and long-term support. There must also be support for handoff processes with regard to multiple roles, and the model must support team-based work as individuals often move in and out of teams.
Three Types of Staffing Models
Your organization should have a documented staffing plan so that policies and processes are consistent within each unit. Wherever possible, standardized staffing policies and processes across the entire organization enable better resource utilization and make it easier to match staff with patient care needs. The staffing plan is more impactful if it’s been developed by a shared governance committee that includes representation from both leadership and front-line staff.
Here is an overview of three staffing models and the pros and cons of each method.
- Finance and Budget-Based Staffing
This staffing model is based on pre-determined financial allocations or budget determined based on census and available financial resources. It operates on averages and does not reflect natural or artificial variability.
Pros: It is easy to staff and schedule based on pre-set parameters.
Cons: This ‘one size fits all’ method does not recognize individual patient differences, which can make it difficult for staff to provide care. And, while averages are important metrics for an overall evaluation of performance, staffing plans based on averages can cause more instances of both under- and over-staffing. That leads to staffing plans that are often a mismatch to actual patient care needs.
- Ratio-Based Staffing
In this model, staffing is based on a legislatively-mandated or a locally-practiced ratio of numbers of nurses to each patient. Flexing staff up and down is solely based on the number of patients.
Pros: It’s easy to do nurse/patient assignments based on ratios. It also ensures a least a minimal level of staffing.
Cons: Since this model accounts only for the number of patients and does not account for patient needs, equitable staffing is difficult. While each nurse in the unit is assigned the same number of patients, workloads can vary greatly from nurse to nurse because the patients need different levels of care.
- Acuity-Based Staffing
Acuity-based staffing takes into account each patients’ unique needs and each nurses’ skill set, credentials, and availability. It’s predicated on the value of balanced workloads, where the measure of nursing workload for each patient is based on the patient’s individual needs for nursing care. Innovations in technology have made objective acuity-based staffing that also accounts for professional nursing judgment a reality rather than an aspiration. When acuity-based staffing is done well, it leads to data-driven, patient-centered staffing; this is the path forward for many health systems. Click here to learn more from nursing leaders about the future of staffing.
Pros: The patient’s needs for nursing care drive number and skill set of staff assigned, leading to a better match of patients with caregivers. This can drive higher patient satisfaction, improved clinical outcomes and increased staff engagement.
Cons: When acuity is based on subjective rather than objective measures, there is a fear that the acuity system will show a need for more staff. Related to that, there is concern that the system will not measure patients’ needs correctly. Using an acuity-based staffing solution that uses information directly from the electronic medical record to determine patient care needs can help overcome these issues.
Every organization is different, so any strategy should be tailored to meet that health system’s unique needs and challenges. There is no magic formula for creating the optimum staffing model, however these best practices can serve as an effective guide towards achieving quality-driven success metrics.
Whatever model works best for your organization, it is important to ensure that you take the time to understand your challenges and build a model based upon your needs. Good technology will play a large component in achieving your goals, and a good technology vendor will recognize that one size does not fit all and be able to provide you with tools that can be customized and configured to meet your unique challenges.
Would you like to see some success stories? Check out how Memorial Hermann, Legacy Health, and Swedish American are achieving meaningful, balanced outcomes with their staffing models and strategies.
About Dr. Karlene Kerfoot
As CNO, Karlene is responsible for integrating the science of patient care, staffing, and clinical informatics into symplr solutions. Prior to joining symplr in 2011, she was the Corporate Chief Nursing and Patient Care Officer at three of the largest US healthcare systems. Previously she held positions in clinical practice, healthcare consulting, project management and academic appointments in Business Administration and Nursing. She holds a PhD from the University of Illinois, Chicago, an MA and BSN from the University of Iowa and has completed executive leadership programs at the Wharton School for Nurse Executives. Karlene has published over 400 articles in the areas of data-driven staffing, workforce management, leadership and patient safety. She writes a popular column on leadership for Nursing Economic$ and serves on the DAISY Foundation Board. She was elected as a Fellow to the American Academy of Nursing (FAAN), and has received numerous awards and honors.