Your Nurse Churn Rate Doesn’t Have to be 50%: Improve Scheduling & Workflow Efficiency to Improve Employee Engagement

Hospital administrators, particularly nurse administrators, have been facing increasing pressure to balance cost and quality of care.  At the heart of this challenge is a critical resource – nurses.  Often specialized, always in demand within the hospital, nurse resources are essential to almost every aspect of the care process.

Yet, managing their schedules with myriad workload needs and staying attuned to the bottom line of profitability is a very difficult challenge without the right tools.  All too often, the nurse leadership has to schedule nurse shifts with manual tools, limited visibility to other departments, and limited data on expected demand.  These challenges are mitigated by setting up float pools and S-O-S pools from which the head nurse at any given shift can draw resources from.  These can provide short-term fixes to immediate problems, but they drive much higher costs.

Shift scheduling and staffing have near term tactical implications and longer term strategic implications.

Tactical Implications of Scheduling

Tactically, without transparency of the nurse population across all floors, imbalances of workload and staff availability often appear when one floor is overwhelmed with patients.  Lacking visibility to the other floors’ nurse availability, occupancy rates, and projected demand creates an untenable situation where the charge nurse needs to make requests for overflow assistance but has no idea where or who to pull. The charge nurse also has no insight into whether moving nurses to different floors is going to make problems worse somewhere else.  These frequent periods of high stress and chaotic work environment degrade the patient experience, the quality of care, and take a deep toll on the nurses themselves.  These events erode the nurses’ positive outlook on the hospital environment and can lead to perceptions that are hard to turn around, and ultimately higher nurse turn over.  Consistently, we find that doing everything to put the nurses in a positive environment with all the tools to be successful, creates a virtuous loop of better quality of care, better patient experience, and lower nursing staff churn.

Strategic Implications of Scheduling

Strategically, many staffing and administrative leaders need tools to look further on the horizon to forecast workload demand and resource availability.  They face the classic conundrum of needing to provide optimum resources for patient care, with the right timing and right resources, yet also needing to avoid overstaffing and overtime as these costs rapidly erode operating margins.  Often, the staffing leaders do not have tools to collect the relevant, contextual data necessary to make useful predictions and simply use historical, sometimes anecdotal, data for projection.  This inherently doesn’t account for what kinds of patient experience outcomes were observed in the past (Why project a schedule replicating a historical one where the patient experience and care flow was not good?).  Nor does it account for the unknown – a previous schedule may have worked fine, but it’s unknown how close to NOT working it was if one event may have pushed the nurse schedules into overflow conditions.

Inefficiency in a shift schedule is another insidious force that adds cost to the system.  The most obvious symptom is patients waiting consistently for the next “event” in the care cycle.  Underlying this symptom is nurses, technicians, physicians, and other resources in the care cycle are incorrectly matched to the demand, and thus even under the best conditions simply cannot get through the care process in a timely manner to avoid these bottlenecks in care.

How are Other Healthcare Organizations solving Scheduling Inefficiencies?

These inefficiencies are fairly common, with similar symptoms and business issues that have been addressed by other enterprises in other industries. The application of workforce management and optimization tools greatly improves all aspects of the workforce to demand scheduling process.  For example, providing nurses with schedules reflecting expected demand, work contract rules, business rules, and various other elements in an open and visible manner greatly reduces anxiety about “fairness” and increases positive outcomes in perception.  Also, having a mobile-enable workforce management system for nurses to engage with offloads the manual impact for the schedulers and greatly improves flexibility for the nurse.  This all leads to more efficiency in the system, better outcomes, and happier nurse and administrators.

Additionally, workforce management solutions allow schedulers the ability to look at historical schedules and data, and forecasted information allows them to create better schedules.  Workforce solutions also provide that unique ability to run “what if” scenarios against projected schedules.  This unique attribute lets the scheduler see how close they are to having negative outcomes in care and cost, thus making better decisions about staffing.

Finally, the rich data provided by workforce solutions can be fed back into HR, ERM, and other business analytic solutions to provide operations and finance teams enhanced visibility into workforce, load, outcome and efficiency.  This virtuous cycle then can be fed back into the overall business plans and patient care cycles to assist with bringing up Press-Ganey scores.

The cost of losing valuable nurses to scheduling inefficiencies that cause distrust and burn out is high. With 50% of nurses moving jobs per year and a 6-week training cycle, healthcare providers are beginning to automate scheduling and reporting to improve employee and patient engagement.

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