How Workforce Management Affects Clinical Outcomes
Workforce management plays a pivotal role in any organization’s success, but in healthcare, the stakes of employee optimization couldn’t be higher. Not only does poor workforce management pose a risk to the organization and its staff, it also negatively impacts patients’ health outcomes and the overall patient experience.
Staffing across healthcare systems is complex. Facilities must maintain sufficient staffing levels to manage their patients, but it’s equally important that they have the right staff for their patients’ needs, and at the right times and locations.
Labor costs account for more than 50% of a healthcare facility’s total operating expenses, and it’s not uncommon for financial considerations to influence staffing decisions. Unfortunately, this strategy often leads to understaffed departments or facilities and overworked employees and providers. Those unintended results of trying to save on costs can end up costing the organization more in the end.
Here are a few examples of how workforce management strategies can influence clinical outcomes.
Patient falls have negative effects beyond the risk of patient injury. For example, a fall can lead to a prolonged inpatient stay. If the fall could have been “reasonably prevented,” the patient’s insurer may refuse to reimburse for the cost of any necessary care arising from the event. Patient falls can also potentially expose a healthcare facility to legal liability—especially if inadequate staffing contributed to the incident.
A strategic staffing plan can help reduce patient fall rates, but it’s not simply a matter of having more staff: One study of 8,069 nursing units in 1,361 hospitals found that increasing non-registered nurse (RN) staffing did little to reduce unassisted fall rates. But simply increasing RN staffing was not the solution either; the real change occurred when hospitals used staffing plans aligned to their overall workforce management strategy. By ensuring that they had the right staff in the right places, fall rates dropped.
Patient length of stay
Length of stay (LOS) is an important indicator of a healthcare facility’s efficiency, and it’s also a key contributor to patient outcomes. The longer a patient remains in a facility, the greater the risk of:
- Medication side effects
- Other adverse outcomes
In addition, high LOS rates mean lower patient turnover, less efficient bed management, and decreased profit. Effective workforce management can help alleviate these problems.
Research indicates that higher ratios of nursing staff can lead to significant patient cost reductions and shorter LOS. Reductions in patient LOS benefit the facility and its patients, and with the right approach to workforce management, the facility can capture these benefits.
Missed nursing care
Like patient falls, missed nursing care is a key indicator of whether or not a facility is adequately staffed. And, like patient falls, missed nursing care can pose a significant health risk to patients, and healthcare organizations can face skyrocketing patient costs—or, worse, legal liability.
Research suggests that when it comes to workforce management and nursing workloads, facilities have an incredibly small margin for error. A recent study of post-operative patients found that “a one-patient increase in a nurse’s workload was associated with a 7% increase in the odds of a patient dying within 30 days of admission, and that each 10% increase in missed care was associated with a 16% increase in the odds of a patient dying within 30 days of admission.”
The same premise holds true for non-surgical patients. A review of more than 130,000 admissions to 32 general adult wards found that higher RN staffing reduced mortality rates, average LOS, and the risk of adverse events. Over the first five days of stay, each additional hour of RN care was associated with a 3% reduction in the hazard of death, the study found.
However, in an average hospital, nurses miss 2.7 of 12 required care activities per shift, and almost 75% of nurses report that at least one care activity was missed on their last shift. The majority of these missed activities do not pose a threat to the patient’s health and safety, but they can, and often do, adversely affect the patient experience. In many cases, nurses rightly prioritize clinical concerns over interpersonal teaching and support; unfortunately, this lack of comfort and education often leads patients to feel they have received mediocre or poor care.
Adequate staffing and appropriate workforce management can help mitigate these issues.
So how can healthcare organizations strength their workforce management strategies to improve clinical outcomes?
Use the appropriate skill mix
In a systematic review of 63 studies discussing nursing skill mix at acute-care hospitals, researchers found that in 12 cases, patient outcomes were improved by a higher nursing skill mix. These cases included ulcers, gastritis and upper GI bleeds, acute myocardial infarction, pneumonia, sepsis, UTIs, pressure injuries, and shock/cardiac arrest/heart failure. Among these cases, there was a correlation between a higher nursing skill mix and a shorter LOS, lower infection rates, and reduced mortality/30-day mortality rates.
Reduced nursing workloads does seem to improve the quality of care each nurse can provide for their patients, which in turn allows for a better patient experience and increased patient satisfaction. However, for facility leaders to effect change in clinical outcomes, the workforce management strategy must do more than ensure adequate staffing—it must also ensure that the facility has enough of the right staff to address specific patient needs as they arise.
Staff appropriately to avoid fatigue/burnout
Having the right skill mix not only improves patient outcomes, but maximizes staffing efficiency and minimizes labor costs within a facility. It can take two or three less-skilled nurses to manage the same number of patients as a nurse with the right skill mix for a facility. This increased efficiency helps reduce the likelihood of fatigue and burnout for both providers and staff.
Provider burnout is a legitimate and growing concern—especially in the age of COVID-19. Nurses who are overextended and burned out often deliver lower-quality care, which poses a risk to patient satisfaction rates, increases the rate of missed nursing care, and can have a significant negative impact on clinical outcomes.
How workforce management solutions help
To address workforce management needs, healthcare facilities and organizations first must identify the staffing model that works best for them. Once the right model has been identified, the next step is implementing it. Unfortunately, that task is often easier said than done.
Building and rolling out an effective workforce management strategy is a complex process, and if it isn’t properly managed, it’s unlikely to be a successful one. That’s why many hospitals and healthcare organizations have implemented software-based workforce management solutions.
Using these solutions, healthcare organizations can proactively address workforce management needs, rather than waiting until these needs affect patient care and clinical outcomes.
Organizations can use workforce management software to proactively plan as well as react faster and more effectively to unexpected changes, such as scaling staffing up or down as needed to ensure the available clinical resources match patient demand in terms of patient census and intensity of patient care.
With the right software, changes to workforce management strategies can be rolled out across an entire organization quickly and easily. From there, each facility can adjust their staffing strategy to accommodate system-wide changes while still addressing the unique needs of their patients.
Effective workforce management is about finding the right balance between labor costs and quality of care, employee satisfaction, and patient satisfaction. Software solutions can simplify that process. If your organization needs help optimizing your workforce strategies, one of symplr’s experts can provide a free assessment to help you determine how to achieve better outcomes.
Download our Workforce Strategy Assessment Tool.