How a Patient-Centered, System-Wide Workforce Management Strategy is Delivering Results for Legacy Health
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Danielle Bowie, DNP, RN, NE-BC Karlene Kerfoot, PhD, RN, NEA-BC, FAAN System Director of Clinical Resource Management Chief Nursing Officer Legacy Health API Healthcare 3
Legacy Health Danielle Bowie, DNP, RN, NE-BC System Director of Clinical Resource Management
This is Legacy Health Northwest Regional Integrated Delivery System with revenues of 2 billion+ • 13,500+ employees • 4200 nurses 8 Hospitals • Regional trauma/burn center, specialty surgical, pediatric, behavioral health and community based hospitals • 64,000 Discharges • 290,000 ED visits • 42,000 Surgeries LEGACY HEALTH 8
This is Legacy Health • 108 ambulatory settings – 795 provider multispecialty group – 1.1 million Ambulatory Visits • Joint ventures in outpatient surgery and urgent care • Retail pharmacy • Cancer Center • Hospice • Regional Laboratory • Research Institute • Health plan 9 LEGACY HEALTH
Legacy’s Integrated Workforce Strategy How a Patient-Centered, System-Wide Workforce Management Strategy is Delivering Results for Legacy Health LEGACY HEALTH 10
Legacy Nursing Workforce History - Background • Centralized staffing office developed in the late 90’s • Centralized staffing for inpatient departments utilizing a common technology platform • System Wide Resource Pool - specialty based • Centralized contract labor management Issues • Enterprise technology platform had high variability of use amongst nursing units • Unit centric control and decision making • No acuity system or daily productivity LEGACY HEALTH 11
Legacy Health Reset LEGACY HEALTH 12
Legacy Health Nursing Workforce Project Overview • Staffing and Scheduling 126 inpatient nursing units, 5000 end-users (June 2016 – October 2017) • Open shift notification 60 inpatient nursing units, 3500 end-users (December 2016 – August 2017) • Mobile time management app (All Legacy Health) (October 2017) • Business Analytics 126 inpatient units (May 2018) • Patient Classification 46 inpatient nursing units (March 2018 – November 2018) LEGACY HEALTH 13
Legacy Health Nursing Workforce Technology Integration Plan 2. Staffing and 1. Time and Integration Scheduling Attendance 3. Broadcast 4. Patient 5. Business 6. Attendance to Work Classification Analytics Plus (recruitment) (acuity) LEGACY HEALTH 14
Integrated Workforce Goals & Outcomes Staff by acuity – End user Standardization Workforce data engagement of workforce & analytics Future work and adoption technology and workflows LEGACY HEALTH 15
End User Engagement Strategies & Outcomes LEGACY HEALTH 16
Strategies for Staff Engagement Shared Governance • Four-day 3P event to re-envision nursing workforce management- (75 system-wide representatives) July 2015 • Governance and workgroup developed- ( See next slide ) September 2015 • System-wide work group for selection of workforce technology products- (30 members) Feb 2016 • Rapid Process Improvement for Staffing and Scheduling Policies (45 representatives) July 2016 • Pilot Phase- Every implementation had pre and post-go live user meetings to test build, workflows and receive feedback ( over 75 meetings) December 2016 – October 2017 LEGACY HEALTH 17
Organizational Structure Executive Steering Committee • System CNO • CNIO • System Director of Clinical Resource Management • Nurse Executive Council/Hospital CNO’s Project Team • Operational Business Owner • Project Manager • Manager of Central Staffing Office • Training Coordinator: Nurse Educator • Functional System Administrator: • Trainers: Staffing Specialists IS, Staffing Application Specialist Core Work Group Broad Support Team Responsible for project team deliverables. • Site based “Staffing Committee” frontline reps Attendees are representatives from… • Site based “Staffing Committee” dept manager reps • 3P event • System wide staffing committee • Unit based staffing committee Frontline Nursing Staff and Nurse Managers LEGACY HEALTH 18
Work Breakdown Structure Core Work Group Made up of representatives from… • 3P event • System wide staffing committee • Unit based staffing committee Responsible for Project Teams Guiding Leadership IS Design and Principles Education Communication Implementation Deliverables Deliverables Deliverables Deliverables • Timely • Review policies • Foundational Edu • Software selection • Transparent • RPI to develop core guidelines – Core • Design – Position control • Consistent • Recommend decision points • Implementation – Forecasting – System • Stakeholder Specific – Order • Standardization – Unit – Executives – Staff Edu – Mgr Edu – specialty – Managers – Frontline – Reports Team Lead: – Project Team Team Lead: Nurse Leader Team Leads: Nurse Leader Team Lead: Project Team Member Nurse Leader & Nurse Rep LEGACY HEALTH 19
Nurse Engagement Outcomes Diff from: % Units above Adequacy of resources and staffing item 2018 LH April 2018 Natl Avg April 2018 Natl Avg 2017 I get the tools and the resources I need 3.83 46.00% -.02 -.01 to provide the best care/service for our clients/patients I have the sufficient time 3.56 56.00% +.06 +.03 to provide the best care/service for our clients/patients My work unit is adequately staffed 3.53 74.00% *.39 +.13 Adequacy of resources and staffing 3.64 64.00% +.14 +.05 LEGACY HEALTH 20
Standardization of workforce technology and workflows LEGACY HEALTH 21
Standard Use: Staffing and Scheduling Technology Certifications tracked in E+ or excel spreadsheets at unit level (ACLS, BLS etc.) • Automated notifications Competencies at both the unit and • Standard reports organizational level (Balloon pump, ABG etc.) • Recruitment Unit roster, employee shift Staffing and • Audit trail and history and phone lists (if paper copy exists) Scheduling Condenses multiple Vacation sign-up, employee data entries into availability, extra-shift, trades “one source of truth” (unit paper method) HR Lawson: Licensure (RN), New Hires, Transfers, Position, FTE, Employee contact information LEGACY HEALTH 22
Legacy Centralized Staffing Office Key Service Metrics • Open 24/7 • 4 staffers 0300-0800 & 1500-2000 – 1 staffer overnight • 8 Hospitals • 53 Inpatient Units • 7 Procedural Areas • 5 overflow units - census driven • 11 float pools • 4000 end-users • 14,000 calls a month LEGACY HEALTH 23
Daily Staffing Workflow Critical Care/IMCU/Respiratory Staffer 11 units + 2 pools, core of 140 Med-Surg Staffer of the 3 largest hospitals 12 units + 2 pools, core of 280 Peds/Med-Surg Staffer remaining hospitals 10 units + 2 pools, core of 110 Women’s/ED/Unity Staffer 17 units + 3 pools, core of 235 LEGACY HEALTH 24
Legacy Enterprise Float Pool • 11 Pools – 225 Employees • Float across the system within their cluster • Minimum FTE of 0.6 • Held to the same staffing/scheduling policies and clinical competency expectations • Receives their department assignment 1½ hours prior to the start of the shift – Notification through Centricity, Mobile App or email preferences – May also call an automated phone line to get assignment • Minimum of 3 years of experience within their specialty • Dual licensure – OR & WA LEGACY HEALTH 25
Staffing office overview – staffing multiple hospitals with a float pool LEGACY HEALTH 26
Central Management of Extra Shifts Recruitment Process • Utilize our current Staffing and Schedule Software, Broadcast to Work technology or Open Shift Notification (OSN) • Technology was built to align with the premium pay practice • Recruit for all units below core, by shift, proactively • Only CSO staff has access to activity codes for premium pay • Engages staff with technology and recruitment process • Staff must be signed up to receive OSN LEGACY HEALTH 27
Central Recruitment Workflow 7 Day Recruiting 7- Days prior to the shift the CSO will send a broadcast/ “Open Shift • Notification” (OSN) to all employees who have made themselves “AVAILABLE” in the system that are qualified for the shift. OSN will be sent out for any that is below core. • 2 Day Recruiting • 2-Days prior to the shift the CSO will evaluate core staffing needs, projected census/staffing needs and resources available for the cluster. If there is a staffing need not met by current resources, the CSO will • send out additional text pages to all staff that are qualified for the shift. • CSO will filter the qualified staff list for those that match the shift and are not currently working or have made themselves unavailable (meetings, educations, vacations, etc.). Day of or last minute needs • Will continue to send OSN as needed LEGACY HEALTH 28
Reduction in Annual Nursing Contract Labor Spend Nursing Contract Labor Spend $3,232,000 FY17 FY18 $2,102,000 FY19- YTD $1,485,000 LEGACY HEALTH 29
Workforce Data & Analytics LEGACY HEALTH 30
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