A Journey from a Reactive to a yProactive Culture by a team of 

Frontline Clinical Leaders ManagingFrontline Clinical Leaders Managing Capacity and Staffing in a 600 Bed 

New Zealand HospitalMs. Sue Hayward RN, Director Nursing and Midwifery 

at Waikato Hospital, Hamilton, NZ

Arthur A Lambert LHIMSS Faculty at the Center forArthur A. Lambert, LHIMSS, Faculty at the Center for Clinical Workforce Planning Professionals,

Tamworth, NH, USA

Waikato District Health BoardWaikato District Health Board

• 600 Bed Teaching Hospital – Hamilton NZ600 Bed Teaching Hospital  Hamilton NZ• 25,453 Surgical Procedures92 000• 92,000 ER Encounters

• 7.7 Million Blood Tests• 4066 Births• 76 234 Inpatient Discharges76,234 Inpatient Discharges• 200,894 Outpatient Visits

AWorld Away but Closer Than You ThinkA World Away, but Closer Than You Think

NZ EnvironmentNZ Environment

Like many counties NZ has a single payer governmentLike many counties NZ has a single payer governmentregulated and controlled system, however, at anoperational level the challenges are similar world wide.In essence ensuring a patient can (a) be cared for bythe right physicians and nurses (workforce planning),(b) b d t d f i th i ht d t t(b) be accommodated for in the right department(capacity planning) and (c) have the right relevantphysical assets available (supply and asset planning)physical assets available (supply and asset planning).

The Global Healthcare ChallengeThe Global Healthcare Challenge

• Managing Tight Capacity – Through‐putManaging Tight Capacity  Through put• Significant Pressure to Constrain/Reduce Cost• Improving Quality/Safety/&Patient Experience• Improving Quality/Safety/&Patient Experience• Rising Patient Services ExpectationL T l f D l i T t t• Lower Tolerance for Delays in Treatment

• Demand Variability / Volatility• Staff Flexibility• Defining and Maintaining Safe Staffing

Waikato MotivatorsWaikato Motivators

• Long ER WaitsLong ER Waits• Patient Throughput Problems• Poor Linkage between Planning and Daily• Poor Linkage between Planning and Daily Operations

• Capacity Constraints• Capacity Constraints• Demand and Supply (Workforce) MismatchesS i H lid C I• Serious Holiday Coverage Issues

• Untimely – Inaccurate Data

Waikato Coping MechanismsWaikato Coping Mechanisms

• Primarily Reactive – FirefightingPrimarily Reactive  Firefighting• Personal Isolated Judgment

S O i Off• Just Say NO to Time Off Requests• Uncontrolled Overtime Use• Cancel Elective Surgery• Live With Back‐Ups In ERLive With Back Ups In ER  

Continuous Capacity andkf l kWorkforce Planning at Waikato

• Purchased a Vendor SolutionPurchased a Vendor Solution– 2008 Pilot – Opportunity Assessment– 2009 Central Administration and Planningg– 2010 Integration into Unit Level Inpatient Operational Workflow

– 2012 OR Optimization Module • What is Continuous Planning• How was it Introduced at Waikato

Continuous PlanningContinuous Planning

• Extracts (Near Real Time) from PatientExtracts (Near Real Time) from Patient Management Systems – Patient Movement and Status Events

• Developing Long, Medium, and Near Term Forecast/Projection Capability

• Linkage to Staffing Systems• Calculation of Capacity and Workforce NeedsCalculation of Capacity and Workforce Needs• Making it Visible to Operational Decision Makers at all LevelsMakers at all Levels

Forecasting the FutureForecasting the Future

• Statistical Pattern Analysis (DOW SeasonsStatistical Pattern Analysis (DOW, Seasons, Trends)

• Structured User Input What’s not in History• Structured User Input – What s not in History• Continuous Updates (Scheduling, Pay Period)• Care Path Modeling (Near Term)• Real (Near Real) Time Tracking( ) g

Care Path Modelingh h lEnhancing the Statistical Forecast

Introduction At WaikatoIntroduction At Waikato

• Product Implementation and Integration withProduct Implementation and Integration with Existing Systems

• Initial Opportunity Analysis and Christmas• Initial Opportunity Analysis and Christmas Planning – Top DownL i U / T h D B U• Learning to Use / Trust the Data – Bottom Up

• Integration into the Operational Work Flow• Emergence of a Proactive Culture

DashboardDashboard

Change Evolves at the FrontlineChange Evolves at the Frontline

• The primary focus was on the transformationThe primary focus was on the transformation of the Bed Meeting

• Top Leader C Suite Involvement• Top Leader – C‐Suite Involvement• Pushed back Later in the Day (11am)• Focus on the Future• Focus on reporting action taken vs getting on p g g gthe same page (information exchange)

• Focus on solutions and future actionsFocus on solutions and future actions

Projection GraphicProjection Graphic

Projection ReportProjection Report

AWorld Away but Closer Than You ThinkA World Away, but Closer Than You Think

Glossary of  TermsRoster = ScheduleTh ORTheater = ORWards = Units

Midwifery = L/D/R/P

Tipping Points for Frontline LeadersTipping Points for Frontline Leaders

• Confidence in the Data and the ForecastConfidence in the Data and the Forecast • Passive Delivery of Reports and Alerts

l i ki l i hi i h• Developing Working Relationships with Planners 

• Learning to Collaborate and Problem Solve• Focusing on the Futureg• Emergence of a Proactive Culture

Impact on the Frontline LeadersImpact on the Frontline Leaders

• More knowledgeable about the Status of their  o e o edgeab e about t e Status o t eUnit and Colleagues Units

• Visibility Up Steam to What’s Comingy p g• Visibility of Their Impact Down Steam• Expanded Understanding of Pressure Points and p gProblems

• Enhanced Set of Operational Actions• Positive Role Recognition / Professional Rewards• Expanded Administrative/Operational Skills   

OutcomesOutcomesPatient Professionals (RNs, MDs) Organization

Reduced Wait Times in Ed Better Balance to Patient Significant $ SavingsReduced Wait Times in Ed

Increased Elective Throughput

Better Balance to Patient Assignments

More Leave Allocation for 

Significant $ Savings

Increased Revenue

Significant Reduction of Elective Surgery Cancellations

the Staff

Safer Staffing

Reduction of Accrued Vacation Balances

Improved CoordinationCancellations

Ability to Treat More Patients

Increased Professional Satisfaction

Improved Coordination Across Organization

Thank YouThank You

Sue Haward RN & Liegh Singers RNSue Haward RN & Liegh Singers RNSue.Hayward@waikatodhb.health.nz

wwwwaikatodhb health nzwww.waikatodhb.health.nzArthur Lambert

A th @Arthur@ccwpp.orgwww.ccwpp.org603‐323‐0200

www.emendohealth.com