Why Workforce Management Strategy is a Priority for Sanford Health
Hospitals and health systems are under extreme pressure to contain costs, deliver high quality patient care, engage staff, comply with regulatory and reimbursement policies, and provide both patients and employees with a positive experience. Changing dynamics and increased expectations from both staff and patients are leading to innovations in both strategy and technology, and many health systems are re-thinking the way they manage their workforce and how they make staffing decisions. As Meghan Goldammer, JD, RN, Chief Nursing Officer at Sanford Health explains, “While we all know that staffing challenges are nothing new to health care, we really are committed at Sanford Health to increasing our sophistication in how we tackle the issue.”
During a webinar hosted by Becker’s Hospital Review, Meghan and Diana Berkland, PhD, RN, FAAN, Vice President of Nursing and Clinical Services at Sanford Health shared how they are building a workforce management strategy that is helping them increase organizational resiliency and crisis-readiness.
In this post, we’ll examine why Sanford Health has made workforce management a priority across their entire organization, from the senior leadership team to the front-line staff.
Who is Sanford Health?
Located primarily in South Dakota, North Dakota and Minnesota, Sanford Health is a large integrated health system with $6.2 billion in annual revenue, six large medical centers, 40 critical access hospitals, over 210 clinic locations, and nearly 50,000 employees spanning over 400,000 square miles. A merger nearly two years ago with Evangelical Lutheran Good Samaritan Society added 158 skilled nursing and rehabilitation sites across 24 different states and significantly increased their footprint across the United States.
External Pressures Driving Workforce Management to the Forefront
Projections of a nursing shortage continue to loom. With an aging population and increasing rates of chronic conditions, employment of registered nurses is projected to grow 7 percent from 2019 to 2029, faster than the average for all occupations. And, it’s still unclear how COVID-19 will affect future early retirements and enrollments in nursing schools. For many health systems, the dealing with a lack of qualified nurses ready and willing to work in an acute care setting is not just a projection; it’s already their reality.
Additional external pressures driving the need for a more thoughtful approach to workforce management include the shifting dynamics of healthcare and reimbursement structures, the shortage of nursing faculty which in turn limits nursing school capacities, and a multi-generational workforce that requires different recruitment and retention strategies.
These external pressures are causing Sanford Health to approach their workforce management initiative thoughtfully and deliberately. Megan explains, “Those external pressures that we all see out there, with the continued demand for nurses and what the workforce projections look like as well as facing retention challenges – that’s the ‘why’ for us, why this became a strategic priority for all of us at Sanford Health.”
Looking Upstream to Solve Problems
Sanford Health is building their strategy based on the strong connection between workforce management and key financial, clinical and operational outcomes. Meghan explains, “Through our NDNQI (National Database of Nursing Quality Indicators) Practice Environment Survey results from direct care nurses, we saw some areas of opportunity regarding staffing. That made us sit down and really come together as a team and say, ‘We have to be more sophisticated around what we're doing. We can't look at reports two weeks later to notice that we had a problem. We need to get more proactive and go upstream to start to solve some of our problems.’”
Here are the key issues that Sanford Health is addressing:
- Significant manager time spent on addressing gaps in schedules, chronic over/under staffing
- Frequent last-minute calls to staff to pick up shifts
- Unpredicted fluctuations in acute care patient census challenge leaders to staff departments efficiently and effectively, and can lead to variation in results
- Hiring decisions based on retrospective budget projections
- Non-standardized pay practices and incentives
- Suboptimal use of API Healthcare workforce management software solution
- Use of agency staff and increasing RN turnover
- Inexperienced front-line managers
Capturing the Full Value of the Workforce
Not only is their workforce a health system’s largest operating expense, it’s also their most valuable asset. So, it’s important for healthcare leaders to determine whether they’re going to consider their staff an investment or an expense. The team at Sanford Health is very clear about recognizing that they want to invest in their team, and their workforce management initiatives are focused on balanced outcomes.
Meghan shares, “For our entire management team, not just nursing leadership, but our H.R. leadership, finance leadership, data analysts--everyone agreed that we really saw the workforce as an investment and not an expense in our organization. The vision that we have and the story we need to tell, all the way down to the point of care: this is going to be a balanced approach. It’s not going to be all about productivity. We have to bring in the clinical outcomes in order to see this vision and its reality for us come to life. As we started this initiative, it was important that we all recognize that. That balanced approach has really brought our culture forward for this project.”
Recognizing and Measuring the Powerful Impact of Nursing
Some of the perception that nursing is an expense is linked to the way hospitals bill for nursing care. Because nursing care is buried in the room charge, nursing services are often viewed as an average cost per room. With only that perspective, it’s easy to lose track of the individual value each nurse brings to the care of each patient and to the health system overall.
Sanford Health is building a workforce management strategy that recognizes the value of the nursing team and makes it possible to measure their impact on the patient experience, as well as clinical and financial outcomes. According to Diana, “We need to give voice to the work and clearly articulate the value that nursing brings to the table. As a profession, we’ve struggled with that. Now, with balanced scorecards, we can begin to quantify that value both objectively and subjectively.”
Meghan explains how Sanford Health is working to capture the full value of their nurses: “Nurses have the ability to go from the most trusted profession, as we’ve been for the last 18 years, to the most influential. By that, I mean how are we changing the healthcare delivery model, how are we utilizing nurses to take even better care of our patients in the right settings as we are all moving towards our value proposition. Almost all of our organizational strategies now involve some component of nursing, and not only how nursing helps deliver better clinical outcomes, but better value for our patients.”
Staffing Decisions that Lead to Better Outcomes
Like many of our customers, Sanford Health is re-imagining their workforce management strategy and re-evaluating how they make staffing decisions so that their organization can achieve better clinical, financial, and operational outcomes. For them, time and attendance and staffing and scheduling are not simply transactional, tactical functions. Instead, they recognize that creating an integrated, thoughtful, deliberate, and collaborative system-wide workforce management strategy must be an enterprise-wide priority for their health system.
Want to learn more about Sanford Health’s workforce management strategy? We have lots of resources here, including a recording of their webinar, “How a strong workforce management strategy became a stabilizing force at Sanford Health”, a summary of the Q&A session from that webinar, as well as the slides. And, watch for future blog posts, which will discuss how Sanford Health is meeting nurses where they’re at and the critical success factors for their workforce management initiatives.
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.