The issue of staffing never seems to go away, I have dealt with it for over 30 years in healthcare and learned that there are fundamental mistakes to avoid and proven strategies to employ to have successful results.
I noticed a pattern in my professional life, I am often called into help manage the most difficult situations. When leaders need to: Make meaningful data useful, Ask the crucial questions, Provide unconventional ideas, Or engage the courage and wisdom of a developing team, there is help out there.
From troubleshooting staffing in a fast paced, demanding level I trauma and open heart ICU to overhauling staffing in hospitals experiencing critical staffing needs, I find the challenge invigorating and the people I work with full of great ideas.
There Are Big Dynamics Operating Underneath The Daily Problems
I learned early on that there are underlying dynamics that seem to be competing, but, when managed well, offer a balanced approach and reduce resistance. These are called polarities. I was educated and trained by Barry Johnson, who wrote the book, “Polarity Management:Identifying and Managing Unsolvable Problems.”
For instance, can you hear these questions rumbling around in your head?
- Should we be reactive or proactive?
- Do we address Unit/Department needs or global needs?
- Should we focus on recruitment or retention?
- Is Cost or Care more important in our decisions?
The answers are yes to each question! If our plans don’t have actions for each of these equally, we will find ourselves swinging from one extreme to the other. Are you experiencing staff dissatisfaction, short staffing, concerns about patient safety, or stress related to meeting your accountability in managing the salary budget and meeting workforce demands? Examining the following mistakes can lead to working with scheduling and staffing in more effective ways. Are your leaders aware of these undercover dynamics or how to effectively manage them?
5 Common Mistakes
1. Living in a reactive rut by over-focusing on daily fire fighting
Yes, we have to be responsive, staffing in healthcare changes frequently. Being flexible and creative in the daily decisions is important and we also need to be proactive. It starts with a solid flexible budget process, based on data, to assess volume needs, as well as forecasting patterns. Are you holding too many patients in the ER? Maybe opening a unit would be more cost-effective and offer better quality. How about adding FTE’s to replace overtime? Who helps you balance fire-fighting and proactive planning?
2. Working in silos and minimizing global needs
A very big mistake is to not have enough contingency options. It’s important to keep staffing decisions closest to where the care is given, yet as leaders we have to bring a sense of the whole hospital staffing needs. We will never survive if departments defend and protect only themselves and operate in silos. One option is to have the right amount of core and contingency staff at the unit level AND develop a floating flex pool with contingency staffing as well. We are not talking about the same old float pools anymore, in fact, many hospitals have a central resource center that has contingency staff offering staffing help to nursing units, and ancillary departments. I recently assisted an organization in using an approach to determine right sizing of unit per-diem staff and Flex pool growth.
First, it was necessary to clarify terminology. Core and contingency staff terminology is standard in healthcare. This is one example.
Further clarifying the desired size of each staff contingency category and conducting a core staff analysis of each unit’s core and contingency staffing. Do you have collaborative directors who could engage in this activity to honestly, equally address local and global needs?
3. Focusing on recruitment at the expense of retaining
Recruitment is important; in fact, you need a hire-ahead protocol to get ahead of vacancies, especially in hard to recruit areas like ICU, OR, and NICU. I also think it’s equally important to “Grown Your Own”. Good, experienced nurses, techs, etc. are hard to find these days and shortages in health care labor are predicted to rise within the next 5 years. I have found that investing in new graduate residency programs and specialty internships are a sure way to keep your positions filled. This goes for leadership succession planning as well. Instead of spending thousands of dollars on hiring search firms, it makes sense to promote from within your organization. Do you have a process in place to identify and groom potential leaders? If not, there is a high probability you will lose very capable and committed people.
4. Not balancing Cost & Care in our decisions
Some managers over-focus on advocating for their staff, at the cost of upholding the expense side of salary decisions. Quality is the result of managing cost and care.
A manager that blames the organization or executive leadership for all the problems does not understand their accountability to learn finances, and teach staff about their role healthcare cost management. I once met a manager that consistently said; “we are always short-staffed”, “patients will die” “staff will leave in droves”, “this place is a disaster”. This made the staff feel insecure, and it indicated to senior leadership that he was incapable of taking action to address the problems. Do your managers, directors, and executives have the tools and practical guidance to assume their accountability
5. Ignoring your own intuition
The 5th mistake, is to dismiss your own wisdom and intuition. Is it natural to pay attention to your gut? Like a muscle, I have had to exercise this practice. I do know, that when I ignore my intuition, it hasn’t gone well. The best decisions are made by leaders who use data, best practices, staff input, patient care results and their own intuition. Do you have ways for leaders to learn and access information about meaningful data, best practices and intuition?