Nurse Staffing Optimization ProjectReducing CSO Shift Requests

2007 Dec 2008 Jan Feb Mar Apr May June July Aug Sept Oct Nov Dec 2009 Jan Feb Mar Apr June July Aug Sept Oct

Overview Progress Since Last Update

Key Metrics Issues / Concerns / Roadblocks

• Linkage to: Best Patient Experience: Coordinate care so that it meets each patient’s

unique needs.Best People: Assure a meaningful work experience for each employee.

• Problem Statement: Current nurse staffing model does not involve coordination of all nursing resources across units. During FY07, 7320 shifts were requested to be filled by the float pool. Of those, 937 shifts remained unfilled, requiring 36.15 FTEs and $391,105 of agency usage. The causes of these unfilled shifts is not clear.

• Goal/Benefit: Reduce the use of agency staff to 0 for FY09 for unapproved variances.Reduce the number of unfilled shifts to 0 when the schedule is posted

beginning June 2008.Reduce the number of unfilled shifts to 0 for FY09.Reduce shifts requests through the CSO by 50% to 3660 for FY09.Increase nursing satisfaction with the overall floating experience from 3.66/5

to 4.3/5 based on the Staff Satisfaction Survey (N=77).• Scope: Feinberg and Oncology Inpatient Staff Nurses scheduling process and floating

practices.• System Capabilities/Deliverables:

Revision of Nursing Staffing Policies/Guidelines to ensure optimization of current inpatient Staff Nurses.

Standardized process to fill shifts and request staff from the CSO.A process to ensure that nurses who float are more supported and

comfortable.

Next Steps

• Collection and analysis of key metrics and process metrics• On-going follow up emails to Managers of units non-compliant

with workflows and floating tools• Rapid design sessions held with staff nurses to find solutions to

further reduce amount of unfilled shifts.• Checklist created for Clinical Coordinators and Central Staffing

Office created to improve compliance with daily schedule workflow process metrics.

• Nurse floating guidelines retooled based on feedback from rapid design sessions.

• Nursing post float satisfaction survey link transitioned to NM Connect from central staffing office.

D M C

Number of unfilled shifts Number of requested shiftsAmount of agency hours usedSatisfaction of nurses floatedSupplemental hours used

I

Executive Sponsor: Michelle Janney Sponsor: Robert Fortney Process Owners: Cindy Darrah, Alan Pietrowski Improvement Leader: Alan Pietrowski

A Completion

•Revise process as necessary to achieve all project goals•Implement new inpatient floating guidelines•Transition project to Central Staffing Office

Nurse Staffing Optimization Project– Results – Outcome

Metrics

D M A I C

Since implementation of the project in July 2008, it can be determined that we have achieved the goal of decreasing agency usage to zero.

While reducing Supplemental hours was not a goal, we have seen a continuous monthly reduction in usage since September.

Agency Hours

0

500

1000

1500

2000

2500

FY07

FY08

FY09

Supplemental Hours

0

1000

2000

3000

4000

5000

6000

7000

8000

9000

10000

Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb

FY07

FY08

FY09

Nurse Staffing Optimization Project– Results – Outcome

Metrics

Monthly Average of Shift Requests

704

663

640

660

680

700

720

pre-implementation post-implementation

73%

27%

Pre-implementation

Post-implementation

Filled shifts Unfilled shifts

Since implementation in July 2008 we have seen a decrease in the number of average monthly shift requests

while also seeing an improvement in the percentage of the shifts

requested filled though not a significant increase.

75%

25%

Nurse Staffing Optimization Project– Results – Outcome

Metrics

D M A I C

Nursing Satisfaction with Float Experience

4.35

3.38

3.56

3.66

0.00 0.50 1.00 1.50 2.00 2.50 3.00 3.50 4.00 4.50 5.00

received float tool

did not receive float

tool

current total

baseline

Goal-4.3