Healthcare is undergoing transformative change on the heels of a global health crisis that exposed extensive and systemic weaknesses across the entire care continuum. This prolonged event, although one of the most challenging moments in history, has supercharged a period of earnest examination and learning in which our industry has identified many opportunities for bold and critical change.
Among them is an opportunity to improve total organizational performance: to deliver on value and outcomes, to do more with less and to cut costs. Given nursing’s extensive impact on healthcare delivery in all dimensions, nursing productivity can, and should, be a key driver of these goals.
However, interviews conducted by UKG in Summer 2021 with chief nursing officers and other hospital and industry executives have highlighted numerous issues with current methods and processes aimed at measuring the impact of nursing work. Through these conversations, UKG found that many measures of nursing productivity today disproportionately highlight financial metrics, rely on outdated and retrospective data, or fail to assess both the short-term and long-term implications of decisions and investments.
The primary purpose of these interviews was to capture leaders’ experiences with nursing productivity, elicit their suggestions for contemporary and consistent practices, and to seek their recommendations for organizational changes necessary to enhance total performance. Here is what we learned:
To enhance organizational productivity in value-based care environments, many organizations have engaged in exciting approaches to prioritize and optimize the work of their nursing staff. The following actions have been identified and prescribed by healthcare leaders to stimulate discussion and organizational change across all care settings.
1. Involve the full senior leadership team.
Start by convening a diverse group of senior leaders and stakeholders to assess your organization’s current approach and performance related to nursing productivity. Together, this group will be responsible for establishing an organizational framework and shared philosophy about issues affecting the workforce and productivity.
This team must be invested in addressing the critical issues affecting the nursing workforce — including patient volume and intensity and workplace stressors — and creating a culture that supports inclusion and engagement of all participants. This includes investing in recruitment and retention strategies that capture and engage staff at levels that extend beyond a work shift or pay period.
2. Standardize definitions and use common metrics, tools, systems and processes.
Developing a consistent and mandatory blueprint for use by all functions, units, and service lines will help standardize how an organization assesses nursing productivity and will make cross-disciplinary discussions more productive. Beyond using shared language, however, this standardization must extend to equipment used across the system — such as IV pumps, electronic health records, beds, medication dispensing systems, etc. — and shared databases capable of integrating key outcomes in real time.
3. Revise budgeting processes.
Institute a rolling budget based on real-time information and forecasting. In a rapidly changing environment, budgeting should not be an annual activity, but a cyclical one where nursing leaders actively engage leaders of other disciplines to provide input.
4. Educate and engage staff to understand concepts of nursing productivity.
Start by establishing regular listening sessions with frontline staff, as well as learning sessions that underscore the full impact of the care they provide and how they can affect quality and resource usage. By creating opportunities to get their input and instituting a culture that is respectful and inclusive, organizations are encouraging staff to speak up and are more likely to see fresh ideas from the frontline brought to the table.
To drive further participation from this group, establish mechanisms to support long-term engagement of staff through shared governance, professional development, and career pathing.
5. Design staffing and leadership models that support integration across the care continuum.
In institutions where nursing departments report to different senior administrators, establish open meetings for nursing leaders and nursing staff to come together and discuss issues of common concern. Or, where feasible, consider appointing one nursing leader to oversee a single service line, and similarly recruit and orient nurses as “service line nurses” rather than assigning them to individual units. Doing so will make it easier to monitor data and measure performance within a particular service line.
Cross-training, coaching, and float pools additionally provide exposure to different ways of thinking and increase staffing options and career paths for frontline nurses, which must be a top priority given staffing shortages and turnover in many areas.
Other considerations include using technology to connect with care delivery options outside the four walls of the hospital and to support 24/7 virtual nursing, which should be established as a specialty that focuses on patient care management across the continuum.
Given nursing’s significant footprint, improving nursing productivity is a critical element that is largely, but not exclusively, under the control of nursing leaders. Long-term investments, new partnerships, and innovative practices are essential if organizations are to enhance performance in a value-based care environment. Organizations in which leaders collaborate across departments and disciplines and encourages exploration of new approaches to optimize care delivery will ultimately perform well.
To explore this topic further, read the full paper, Rethinking Nursing Productivity to Enhance Organizational Performance, researched and written by Nanne Finis, RN, MS, and Joanne Disch, RN, PhD, FAAN.
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