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Boosting safe patient care through effective staffing

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There are two pressures facing almost all developed health care systems. The first is the need to improve the quality and outcomes of patient care, and the second is the requirement to manage tighter budgets and cost savings programs.

Yet, when it comes to managing the health care workforce, history is littered with examples of organisations treating these two pressures of managing quality and cost as competing demands. This seems like a missed opportunity when we consider the workforce uniquely represents both the largest single cost for health care organisations, as well as being the frontline for quality care delivery.

The idea that investment in quality initiatives can contribute to savings or better productivity is not new. It’s just that all too often organisations approach workforce optimisation projects such rostering solely as a cost saving project, rather than a quality improvement program that can free up staff to deliver better quality care, reduce negative outcomes and unlock savings at the same time. While subtle, the difference in emphasis reflects a misconception that increasing the quality of patient care will always lead to an increase in workforce costs, while reducing staffing costs will lead to a decrease in patient care. What this misconception fails to address is that the savings made by ensuring you deploy your permanent workforce in such a way that ensures you have the right people, in the right place at the right time, can also have a positive effect on patient care and productivity.

At Allocate, this means e-rostering is as much about matching skills and numbers of staff to patient needs as it is about managing time and attendance. It is about empowering frontline staff so that they are freed from unnecessary admin, releasing more of their time for care. It is about using the permanent workforce effectively, reducing spending on agency staff. To do this, it is essential senior teams have a deep understanding of where the workforce is deployed effectively and where there are still inefficient practices.

As workforce legislation and industrial awards in health operate at a State level rather than under a single national framework, in-hospital practices vary throughout the country. One thing all hospitals do have in common though, is the major expense of their workforces, and it is our experience that there are some common areas for executives to focus on to uncover what is working and where, as well as what isn’t and why.

The first step is to increase transparency regarding budgets, leave, overtime and the staff skill mix.

A recent Allocate Software roster assessment of hospital wards found that poor knowledge regarding staff availability, employee skills and award constraints were common. In one assessment of a seven-day period, Allocate discovered that, despite 68 unnecessary extra shifts being assigned, 10 per cent of the duties necessary to meet patient needs weren’t fulfilled. The organisation had rostered additional staff, which increased costs, yet failed to deliver the skills to ensure improved patient care. While this was not intentional, the lack of visibility regarding staffing and skill gaps made effective rostering much more difficult.

Without sufficient visibility about staff availability, organisations can overspend on unnecessary shifts, agency staffing and excess overtime. Improved visibility enables the rostering manager to cost a roster as it is being created, as well as to evaluate the roster in terms of quality and safety. This provides the opportunity to evaluate and improve the roster before incurring avoidable costs or unacceptable risk. Through recommended changes to rostering practices, the above-mentioned organisation saw a 49 per cent reduction in overtime, a 95 per cent improvement on the accuracy of leave entitlement recording and a 15 per cent reduction in agency costs. Each department also saved 16 hours per week in roster creation and administration. This illustrates the substantial effect that efficient staffing can have on the bottom line.

Poor workforce management can have a major financial impact on any industry. But in health care the stakes extend beyond economics. A poorly managed workforce can have an unacceptable effect on patient care.

So what are the signs that an organisation is missing the opportunity to use workforce optimisation and e-rostering as both a quality and productivity program? Well, these can vary, but board members are encouraged to pay attention to projects that solely focus on time and attendance or awards interpretation, and instead ensure your program uses these key elements as a foundation for patient demand-driven staff deployment.

By increasing the visibility of staffing practices, skill mixes and budgetary implications, organisations can move beyond rostering based on availability to staffing based on clinical demand and required skills. This not only helps meet compliance and audit goals, but leads to higher quality patient care and improved patient outcomes.

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