01. Run your nursing department like a business.
“Everything we do is for our patients. But in order to do it, our hospital must stay financially viable.”
—Eric Allen, Senior Business Financial Analyst
Hospitals aren’t like typical businesses. They don’t sell merchandise. And they don’t slash prices. Instead, they have a clear, singular mission: To care for people.
But here’s the conundrum: In order to provide the best patient care, hospitals must think and act like the best-run businesses—and that’s not always easy for organizations that think and act like, well, hospitals. “Hospitals need more than just a clinical model,” says Margaret Pearce, our CNO. “They also need a business model.” And that’s exactly what we created for our nursing department.
Building a 5-year business plan.
Together, we developed a nursing business plan devoted to making our hospital nationally known for the professional practice of nursing. We identified gaps in quality, efficiency, and patient satisfaction, and we used them to drive our strategy for improvement. We knew that to achieve our ultimate goal of providing excellent care without compromise, we’d have to add two more goals: improving our fiscal responsibility and increasing our quality outcomes
Improvement is a science.
We’ve developed each of our creative nursing ideas with a structured, systematic approach. Here’s how we do it:
- Analyze the data
Listen to staff concerns, examine financial performance data, and pinpoint any gaps in quality or patient safety.
- Develop a pilot
Try out the new idea on one unit and measure results.
- Expand the program
Bring the idea to other units after a pattern of success has been established with the pilot.
$1.2 Million Saved— By predicting vacancies and staffing globally, we’ve increased our labor management efficiencies, resulting in annual savings of $1,248,000.
Bringing nursing experts and process experts together.
Our nurses worked closely with the process engineers on our Performance Excellence Team to identify ways to work smarter, leaner, and faster—all while providing better patient care than ever before. We assigned a quality specialist to each unit to ensure consistent collaboration, ongoing analysis, and continual improvement. “No one is sitting in an office, evaluating data and telling nurses what to do,” says Mike Swanicke, a management engineer on the Performance Excellence Team. “We’re working together to solve problems.”
When it comes to staffing, look at the big picture.
For a hospital to stay financially viable, every department—and every person within that department— must work efficiently. But we couldn’t get there when we staffed nurses unit by unit. We’d bring in agency nurses only to find that we didn’t need them. We’d staff up to meet a perceived need only to find that we had too many nurses for the tasks at hand. We’d send nurses home on one unit, while hiring someone new on another. It didn’t make sense.
Global staffing changed all that. We put our entire nursing department on a centralized staffing grid and made hospital-wide staffing decisions based on our census status to ensure an ideal nurse-to-patient ratio. With this one change, we were able to optimize our staffing 24 hours a day.
Improve efficiency—and quality—with smaller, more flexible units.
To further improve efficiency and staffing, we designed each of our new units with three smaller pods and three separate nursing stations. Now, if our census is low, we can simply shut down a pod—so we don’t have to staff up on a unit that’s not fully loaded. This strategy can be used in conjunction with the opening and closing of our Flex Unit (see Idea #6).
But that’s just the beginning. Our pods also allow us to co-locate patients based on their clinical needs, so we can assign specialized nurses to very specific areas. What’s more, the smaller pods keep nurses in closer proximity to their patients and create a quieter and less chaotic environment. “It’s a great way to give more personalized care,” says Margaret. “And it’s incredibly cost effective.”