Like many hospitals, MercyOne Des Moines Medical Center in Des Moines, Iowa, typically found itself in crisis mode when it came to staffing. It constantly was understaffed because of regional nursing shortages.

THE PROBLEM

In response, a culture of unit-level staff protection had developed, where units held back on sharing staff because of the uncertainty of unexpected changes. The organization often was forced to float core staff to meet patient care needs. All of these factors led to a high level of premium pay to ensure appropriate coverage.

“We knew we had to take an entirely new approach to staffing as a business process,” said Shawna Gunn, RN, manager of operations at MercyOne Des Moines Medical Center. “The old ways simply didn’t work. It was chaotic and exhausting for staff and costly for our organization.”

MercyOne Des Moines relied on manual processes to manage nursing resources across the acute care units. Each week, managers built staffing plans in Excel. It was a time-consuming process, and despite best efforts the daily staffing plan ultimately was only a best guess of what was thought would be true for a given day.

“Staffing is a lot like trying to assemble a puzzle,” Gunn explained. “Who is on duty? What are their skills? To which unit are they assigned? What is our flex pool? What is the patient demand and staff level for each unit? Where can we put people? There are a lot of different pieces that come together to create a single picture. What we lacked was the ability to see all of those pieces at any given point in time in order to match our nursing staff to our patients.”

This is problematic because hospital environments are fluid. Change is expected. However, without a consolidated view of nursing resources, the healthcare organization struggled to adjust staff plans to in-the-moment changes.

"When staff demands shift or when we experience call-offs, it’s all in the system. We can see where everyone is at any time of the day."

Shawna Gunn, RN, MercyOne Des Moines Medical Center

Hours were spent each day refining the plan based on actual patient need. Staffing managers spent a large part of their day rounding units, constantly updating numbers, exchanging close to 100 texts. Charge nurses were pulled from patient care activities to address staffing issues.

“Our staffing situation had evolved into a 24/7 process,” Gunn said. “Our goal was to get out of crisis mode by finding a tool that would improve the efficiency and accuracy of how we deployed nursing resources. We wanted a solution that would allow us to collaborate in real time to evaluate our staffing needs and available resources. We also wanted a solution that allowed us the ability to plan ahead, and to work beyond the moment.”

Finally, the organization wanted to create a better work/life balance for nurses. Gunn began her career as a resource pool nurse. It wasn’t uncommon to find her on three different floors with three different patients during a 12-hour shift.

On a national level, nurses feel the burden of being asked to stay longer to cover staffing gaps. It was important that MercyOne Des Moines improve efficiency to allow staff to have a better work/life balance.

PROPOSAL

MercyOne Des Moines opted for health IT-vendor Hospital IQ’s predictive analytics and workflow system, Workforce, to automate and streamline the allocation of telemetry, med-surg and float pool nurses to ensure appropriate patient coverage each day.

Hospital IQ would integrate with the healthcare organization’s existing systems and provide a single source of truth to help adjust nursing resources in line with forecasted patient census. The system would automate the manual processes that staff had been relying on to help coordinate and validate staffing needs in real time.

“Beyond the automation, the solution would give us the insight to adjust staffing levels for both day-of activities and up to seven days in advance,” Gunn explained. “The system would notify staffing managers of potential issues, giving us the opportunity to proactively staff up units that needed support, while avoiding overstaffing on other floors.”

MEETING THE CHALLENGE

Staffing coordinators and managers, unit directors, charge nurses and department secretaries all use the Workforce system. Each user can access the system from anywhere inside or outside of the hospital via desktop or mobile device.

“Each morning, our teams meet for 15 minutes,” Gunn said. “During that meeting, we pull up Hospital IQ and make sure that everything is accurate. We can see updates from the units, evaluate where we are at, and make any necessary adjustments. Staff members use Hospital IQ to see the plan for each floor. All the confusion and ambiguity, all the back and forth, is gone.”

Managers also use the system to communicate why changes are made. For example, perhaps one unit received three staff, while another did not receive additional staff. Managers can communicate about the specific unit needs so that staff members understand why a particular decision was made.

This transparency enables every unit to work collaboratively on staffing. Everyone can see the resources that are available each day and understand how and why those nurses were deployed.

“After the daily plan is in place, we plan for the next 24 hours,” Gunn noted. “And from there we can look at the next week, up to seven days out. Hospital IQ lets us look at forecasted census, capacity, staffing plans, scheduled paid time off by unit – all of those puzzle pieces that we bring together to create our single source of truth.

“We can see the numbers overall for each unit and across the hospital,” she added. “We can make recommendations about switching someone from a day shift to night shift or from one unit to another.”

Staffing coordinators can look at a problem area one week in advance, communicate with unit leaders, and determine ways to resolve the problem with “next Thursday” by applying or shifting the appropriate resources, she added.

“We can look at real-time numbers – how many staff on hand, who is where, who is staying late,” Gunn said. “It’s all there. When staff demands shift or when we experience call-offs, it’s all in the system. We can see where everyone is at any time of the day.”

MercyOne Des Moines has removed the back and forth in real time. For example, if a nurse calls in sick, or another nurse is added to the resource pool, charge nurses and department secretaries simply update the system. Staffing coordinators then receive real-time updates and use the system to communicate with charge nurses about the staff allocation for that shift.

The Workforce system integrates data from MercyOne Des Moines’s Cerner EHR, Kronos scheduling system and TeleTracking bed management IT, and gives staff a complete picture about patients, census and capacity so managers can align nursing resources accurately.

RESULTS

The system gives MercyOne Des Moines a consolidated view of staffing resources that it could not get before. It has become the organization’s source of truth across the hospital, Gunn said. It has broken down all of the silos – data, processes and people – that stopped the organization from working collaboratively, she said.

“MercyOne Des Moines’s entire staffing process has become more efficient,” she noted. “We know exactly which resources we have on hand and where they are located, and this saves a tremendous amount of time. The automation and efficiency has reduced the time spent aligning daily staffing by 70 hours per week.

“Our staffing coordinators have re-focused their time looking for ways to improve the patient experience,” she explained. “Unit directors have re-focused their time on patient care-related activities at the bedside since they are no longer being pulled away by text or phone to address staffing issues.”

When needed, staffing coordinators now can serve as a second set of hands in the units. In nursing, there can be periods when the floor is very busy, such as when staff coordinate discharges, Gunn explained. Those busy times only last for a short period of time, but now staffing coordinators can jump in and assist. They do not need to bring in another nurse for an 8-hour shift.

“Hospital IQ has enabled our teams to work collaboratively to create a balanced staffing plan for all units,” she said. “In the past, it felt as though we were working against one another at times. Now, we know if we have staff to give and if we can assist other units by letting those resources go to another unit.”

The system also allows managers to look beyond immediate bedside needs. For example, MercyOne Des Moines has a lot of open-heart surgery patients. If, in using the system, a manager is able to see that she will have three patients ready for discharge in two days, she can begin to align resources to facilitate those discharges in a timely manner. That, in turn, opens up a bed for a surgery patient.

“The system has enabled us to improve patient care and staff satisfaction,” Gunn said. “Because we can shift schedules to meet patient demand days in advance, we’ve significantly reduced the frequency with which we ask nurses to either come in on a day off or stay late. As such, we are now using shift-based incentive pay programs and overtime pay in a more strategic way rather than as a last-minute solution to staffing gaps.

“While there is surely a financial impact,” she added, “the main impact is a less chaotic environment and a more predictable schedule for nurses, which reduces exhaustion and ultimately leads to better patient care.”

And finally, the technology has improved how the organization manages and deploys its resource pool. Shifts are divided into four-hour increments. With the system, resource pool nurses receive a notification informing them of where they will spend the next segment of their shift. They can begin patient care earlier, rather than waiting to find out where they’ve been assigned. The improved efficiency also means that they are moving between units less often.

ADVICE FOR OTHERS

“To meet the rising demands of healthcare, we are all challenged to continually improve efficiency,” Gunn stated. “Our ability to improve processes each and every day is what our patients and communities truly need and deserve. If a healthcare organization can identify an area for improvement, that should become a priority focus.

“When it comes to staffing, where time and resources are already stretched to the limit, tackling one more project may feel overwhelming,” she continued. “It’s tempting to put off investing in a new process or technology. The catch, however, is that innovation is the only way to achieve process improvements. We already know that manual methods aren’t working well.”

In taking the step to embrace technology, MercyOne Des Moines has transformed its staffing processes, Gunn said.

“In less than one month, we saw process improvements and eliminated a chaotic, manual workflow,” she said. “The technology helps us automate the cumbersome processes: phone calls, endless texts, staffing rounds and daily meetings. Our staffing coordinators and unit directors can quickly convey staffing changes and requests through the system – in a matter of minutes. This comprehensive view of resources breaks down staffing silos and lets you work collectively to align nursing resources to the right patients and units at the right time.”

The efficiency improvements gained through the technology – those successes – will allow for more time at the bedside, and even more time to focus on driving greater levels of care, she concluded; and that’s always the end goal.

Twitter: @SiwickiHealthIT
Email the writer: bill.siwicki@himss.org
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