Over the last several years, healthcare staffing problems have escalated, and the COVID-19 pandemic has only increased pressure on organizations to find lasting solutions.
Healthcare workers are facing burnout en masse, and staffing shortages are occurring not just in hospitals but also in ambulatory clinics and rural settings. More than 30% of nurses are considering leaving direct patient care, and there will be a projected shortage of 500,000 nurses by 2026.
Staffing Challenges Healthcare Organizations Are Facing
Due to a variety of reasons — including the pandemic, an aging workforce, a decreasing number of clinical sites and resources, hospital expense reductions, and burnout — healthcare organizations are facing significant staffing challenges now and in the future. Unaddressed problems like staff shortages and fatigue, changing job responsibilities, rising salary and recruitment costs, and higher pandemic-related expenses lead to organizational risks, such as:
- Reduced bed capacity and clinical service lines
- Quality and safety concerns
- Adverse events
- Morale and culture imbalance
- Financial strain
- Dissatisfied patients
Waste — which, in healthcare, is any expenditure of time or resources that does not contribute to the efficient delivery of patient care or add value to the patients’ experience — negatively affects workflow and puts additional burden on staff. Waste can be exhibited in many different ways, from underutilizing employees’ talents on non-value-added work to spending unnecessary time searching for patients or medication.
Waste has a detrimental effect on patients, staff, and the organization as a whole, leading to:
- Bad patient experiences
- Long wait times for essential services
- Increased stress
- Less time for care, education, and research
- Redundancy in information and treatment
- Decreased staff morale
- Unpredictable work schedules
- Redundant paperwork
- Reduced time for education and psychosocial care
- High staff stress and turnover
- Limited operational options
- Full capacity, leading to declining new patient transfers and admissions
- Limited clinic hours
- Increasing costs from physical materials and staff
Stroudwater’s 4-Part Solution
Stroudwater works with healthcare facilities to address staffing challenges and achieve workflow optimization. Our team implements a four-step solution:
- Team Development
Select team members using the “3-3-3 method”:
- One-third: Frontline staff of the focus department (for example, a floor nurse or MA in the clinic)
- One-third: Key stakeholders (others who interact with the department, such as lab personnel or registration staff)
- One-third: Other staff members who don’t have knowledge or direct interaction with the focus department (people with fresh eyes often ask more questions and come up with great ideas)
Designate a sponsor, a leader who can authorize organizational change (such as a CEO, physician, or CNO), and a neutral facilitator to keep the team on track (such as an educator or HR representative).
Establish clear rules of engagement for smooth collaboration. Some good rules to start with are:
- Leave your title at the door
- If you oppose, you must propose
- No sidebar conversations
- There’s no such thing as a bad idea
- Be respectful and on time
- Everyone participates
- Never leave in silent disagreement
- Laugh a little and have fun
In the discovery phase, paint a picture of your current state by asking the following questions:
- What is the purpose?
- What is the “burning platform” (specific goal)?
- Why now? What are we trying to accomplish?
Your “burning platform” should single out a specific process to focus your efforts in a manageable way, identify the starting and ending points of your process, list the benefits of what you hope to accomplish, and list the imperatives to lend a sense of urgency to your work. You can write a simple outline to guide the discovery phase:
- We aim to improve:
- The process begins with:
- The process ends with:
- By working on this we expect to:
- It’s important to work on this now because:
Begin by retrieving department-specific baseline data to assist in the development of a gap analysis of the current and future state. Then interview and observe within the department to gain insight into current processes, roles, responsibilities, and results, with a focus on perceived
strengths, gaps, barriers, and improvement opportunities.
- Opportunity Identification
Use a technique called value stream mapping (VSM) to analyze current processes and identify inefficiencies, as well as give team members with varied experiences the chance to contribute their ideas.
VSM allows your team to document and fully understand a current process, asking questions like:
- Why do we do it this way?
- I already do that step, why do they do it again?
- Why are so many people involved?
- Why is that step necessary?
- Action Plan Development
Once you have identified pain points within a department, you need to develop an action plan to create change. Ask: What changes can we make that will result in an improvement?
Utilizing a priority matrix will help you determine the sequencing of rapid improvement events (RIEs) with recommended gap-closing options and expected impacts based on VSM. For each RIE, your team will determine specific action steps.
Where appropriate, you can implement immediate (short-term) process changes and monitor them for success. For more complicated (medium-term and long-term) action steps, create an implementation plan with owners and timelines for completion.
Improve implementation with the following actions:
- Determine how you will know when a change is an improvement
- Monitor action plans to sustain the processes changed or improvements made, or proactively address areas where countermeasures may need to be created
- Develop the discipline and pace of improvements based on your team’s needs. These types of events are helpful in maintaining a good rhythm:
- Daily: 5–7-minute huddles to focus on the day and review the change that the team is testing
- Weekly: Improvement meetings to lead initiatives and brainstorm and select change ideas to test
- Monthly: All-staff meetings to reflect on the prior and current month and track the overall progress of improvements
- Yearly: All-staff retreat to review the past year, plan for the upcoming year, and celebrate as an organization
Contact Stroudwater to learn more about addressing staffing challenges and improving workflow optimization.