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5 strategies for optimizing staffing and care delivery

A side effect of the COVID-19 pandemic has been the so-called “great resignation.” Across industries, employees are rethinking the work they do, their career paths, and what they want for the future. It’s probably not surprising to any of us that healthcare was especially hard hit. Physical and psychological fatigue, employee burnout, and other challenges have driven high turnover rates.

On top of these issues, healthcare organizations are now facing a second crisis: financial challenges. Expenses have skyrocketed due, in part, to the shift in the workforce. But what many may find surprising is that at least part of the solution to all of those problems lies in optimizing staffing and care delivery.

Healthcare is in flux

Health systems and hospitals are experiencing enormous budget shortfalls. In some cases those shortfalls are prompting layoffs and driving healthcare organizations to reinvent the way care is delivered. For employees who have already endured long hours and difficult working conditions, changes in care delivery can further erode engagement and morale if not done in a thoughtful and sustainable manner.

The great resignation has not been limited to bedside clinicians. As experienced managers and clinicians have burned out and left their organizations—or the industry entirely—new people have stepped into management positions. But there are often growing pains, as talented individuals transition from on-floor care provider to manager. If someone is an excellent clinician, it doesn’t necessarily mean they’ll make an excellent manager: The job requirements and skill sets needed are vastly different. And when that transition happens in a time of chaos and uncertainty, it can be particularly rough.

While in crisis mode, organizations also paused critical financial controls at the department level and, in some cases, lost the expertise needed to manage systems that would support them and allow them to bounce back as the crisis diminished.

5 ways to optimize staffing and care delivery in healthcare

1. Invest in nurse leader training

Being an outstanding clinician is a different skill set than being an outstanding nurse leader. Nurse leaders need to both understand what is required to deliver care and also possess the leadership skills to bring out the best in staff, increase workforce engagement, and properly utilize the available resources.

Specific skill training needs to help nurse leaders be proactive in thinking about the day, and plan for things that seem simple. Things like: How can staffing resources be better deployed to prevent gaps during breaks or surge? What actions can prevent patient discharge delays? Developing the skills that allow leaders to manage their teams properly is the first step.

2. Get back to the basics

One of the current issues in many healthcare settings is that new leaders understand best practices in a theoretical sense, rather than in practicality. Between the forced changes to workflows during the height of the pandemic, and new leaders who may not have a firm grounding in established best practices, some things—like huddles at the beginning of a shift and bedside shift reports—can fall by the wayside. Add in personnel gaps, and best practices can, at a surface level, seem like a waste of time.

Nurse leaders who spend all of their time putting out fires end up exhausted and frustrated. When every shift ends with unfinished tasks, disengaged staff members, and broken workflows, returning to basic best practices is a crucial element in improving the work environment, decreasing turnover, and ultimately addressing budget shortfalls.

3. Examine your team structure

Another element in balancing big workloads with small labor pools is reconsidering the care setting and care delivery. For example, integrated units rather than a team dedicated to a specific population can help, but staff members need to understand the structure and be comfortable with it.

Along with how the care setting is structured, implementing some technology-based care delivery solutions could prove useful in working with a smaller-than-desired staff. Using virtual care models, like monitoring patient rooms remotely, can ease the burdens of short-staffing.

4. Ask, listen, and follow up

Leaders don’t have all the answers. But often, the staff can fill in the blanks themselves. They know why the patient in room 206 didn’t get an MRI in time to be discharged on Tuesday. Or why labs were missed. And they have ideas to solve for them. Leaders need to first understand what gets in the way of their staff, and then co-design solutions with their team.

Elevating staff voices, designing solutions to specific problems, then following through are all components of employee engagement and, ultimately, employee retention. Leaders must solicit honest feedback, listen to it, and follow up based on what they learn. Following up can be as simple as telling staff an issue has been escalated, or letting them know their idea can or can’t be implemented for whatever reason, and why.

5. Step back to see the bigger picture

In many instances, leaders can't see the forest for the trees. An external point of view may help to pinpoint key issues and bring forth insights that can help teams resolve issues. For example, a nurse leader who doesn’t feel like there’s time for daily huddles doesn’t have time to plan to integrate LPNs into daily staffing and help their RN staff understand how to leverage them. A consultant can provide a big-picture view, along with targeted solutions.

Identifying how a team got to the point where they’re all exhausted and frustrated is another area where an employee experience consultant can help. Were signals missed? What kinds of controls could prevent reaching a crisis state in the future?

Understanding nuances to workload is also a key opportunity. Average daily census is only one piece of the puzzle that doesn’t necessarily reflect daily unit activity. An outside consultant can often spot patterns in volume that can be crucial in right-sizing staff depending on the department, day of the week, or even month of the year. Even in in-patient departments, considering where patients come from and how much work is involved in getting them settled can make a difference in staffing needs.

Moving from acute problems to sustainable solutions

Tactics for dealing with day-to-day issues are one thing. Strategic solutions to prevent future problems are another—or so it seems. In reality, implementing techniques to treat the acute pains related to staffing and engagement helps prevent longer-range issues. Right-sizing staff, establishing efficient and effective care paths at the departmental level, and lowering employee frustrations are key to reducing turnover. With lower turnover, institutions rely less on staffing agencies and traveling nurses, which, in turn, saves money.

Similarly, giving nurse leaders the training they need to be excellent managers improves engagement among the nursing workforce—and that improves the quality of care. Education for nurse leaders that helps them operationalize and apply learnings can reduce churn and contribute to creating an optimal practice and work environment.

Budget cuts are disruptive, and they typically don’t work. They create an insecure environment and start a snowball effect across the organization—lowering morale while increasing anxiety and disengagement. Giving nurse leaders the tools to make positive changes within their own departments can break the cycle of budget cuts, staffing issues, frustration, and turnover.

To learn more, reach out to our nursing and operational experts.

About the author

Shelly leads engagements for the Clinical Improvement solutions team in Strategic Consulting, partnering with clients to guide policies and procedures, strategic plans, and patient care models. She restructures case management so patients and physicians are partners in planning treatment. Shelly steers clients through accreditation surveys, helping them rethink staffing and turn finance and efficiency metrics around. Prior to joining Press Ganey, Shelly was an administrative leader and held executive level positions like Chief Nursing Officer.

Profile Photo of Shelly Turner, DNP, MBA, BS, CPHQ