Data-Driven/Outcomes-Based Staffing Is About to Happen!
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Karlene M. Kerfoot Watch Pigs Fly: Data-Driven/Outcomes-Based Staffing Is About to Happen! level of data/evidence-driven process that create EXECUTIVE SUMMARY exceptional outcomes. Now maybe the time has come and “Pigs will fly.” Appropriate staffing is integral to safe patient care. What’s Different? Why Can Pigs Fly Now? Yet, implementing that knowledge into practice has not met with the universal success one would predict. “Wind Beneath my Wings,” the song made famous by Bette Midler and written by Jeff Silbor and Significant winds blowing today will make it possible to turn the page on what has been traditional staffing Larry Henly in 1982, gives credit to helping one fly and scheduling and move into the new world of intelli - higher than eagles because of the wind beneath their gent, data-driven precision staffing that creates excel - wings. Significant winds blowing today will make it lence for patients, staff, and organizations. possible to turn the page on what has been traditional The revolution to add science to staffing is about to staffing and scheduling and move into the new world begin. of intelligent, data-driven precision staffing that cre - ates excellence for patients, staff, and organizations. CCASIONALLY WE HEAR LEAD - Historically there have been many significant pre - ERS and staff admonish cursors to this “Pigs will fly” moment that have pro - people with new ideas vided the wind, wings, technology, and energy to with the adynaton, “When move the world of staffing and scheduling to a scien - Opigs fly,” which tells the person tific and technologically enabled future. Many of his or her suggestion is impossible. these precursors are coming together simultaneously Thankfully, many of those nay- to create significant tailwinds that were not available sayers have been proven wrong in the past. Consequently, it is easier sailing for inno - and creative, innovative people vative staffing models than in previous decades. The have found ways around these following five factors are just a partial list of the forces blockers . working today to bring an end to opinion-based Karlene M. Kerfoot For years we have known staffing and usher in the new era of data-driven appropriate staffing is integral to safe patient care. A staffing and scheduling. large body of research on effective staffing and the Data and research. Many researchers stand out in consequent outcomes has shown data-driven sched - nurse staffing, but the accomplishments of Dr. Linda ules and staffing assignments based on the needs of Aiken, who was one of the first researchers to secure patients can produce a better world for patients, staff, significant funding for staffing research and publish and organizations. However, implementing that in prestigious peer-reviewed non-nursing research knowledge into practice has not met with the univer - journals and discuss her research at national forums, sal success one would predict. Staffing and schedul - signaled a call for everyone to think differently about ing traditionally start with patient numbers, not staffing. And think differently they did! The criticism patient needs. And nurses and other caregivers have of the research competed with the excitement that at been viewed as generic clinical widgets that can be last we had real data about what we always knew – moved anywhere on the staffing chessboard anytime. nurse staffing makes a difference to patient care out - We have not seen universal adoption of the comes. Her research spawned many other studies on research, demonstration projects, and new technolo - the many aspects of staffing on patient care, nurse gy that point to a safer world. But now, hopefully, turnover, and financial performance of organizations many forces are coming together to create a conflu - to name just a few. This research energized the appli - ence of data to move the world of staffing to the next cation of this information to change practices as the outcomes became more disseminated. It became clear that nurse staffing has an incredible effect on patient KARLENE M. KERFOOT, PhD, RN, CNAA, FAAN, is Chief Nursing outcomes. Officer, Workforce Management Solutions, GE Healthcare Digital, Value-based reimbursement : Based on data/ Wauwatosa, WI; and a Nursing Economic$ Editorial Board Member. Comments and suggestions can be sent to research, the Centers for Medicare & Medicaid Services [email protected] introduced reimbursement based on outcomes versus the traditional pay-for-service model. Avoidable hospi - NURSING ECONOMIC$/July-August 2 018/Vol. 36/No. 4 189 tal-acquired conditions were appropriate staffing, which no longer reimbursable and has six standards for achiev - the correlation with nursing ing that objective. This year, practice and avoidable nurse- 2017-2018 AACN Presi dent sensitive injuries became atch the sky: Pigs are Christine Schulman, MS, RN, closely connected. Systems Wstarting to fly! CNS, CCRN-K, declared that thinking injected the evidence staffing was fundamental to that organization staffing was patient safety and excellence. correlated with good or bad She stated nursing has been outcomes. When reimburse - plagued by inappropriate ment was reduced because of staffing, leading to lack of avoidable conditions (readmissions, falls, etc.), it patient safety and nurse well-being, and even death. became clear that optimizing staff to realize the poten - She indicated AACN would take on this issue and, in tial of investment to improve outcomes could make a a true collaborative spirit, would work with decision difference . makers to design radically new models that would Effect of penalties. Unfortunately, we are often optimize patient outcomes. She noted AACN would driven by consequences. Basing reimbursement on look the challenge of staffing in the eye and utilize the positive outcomes and penalizing organizations for power of possibility in a multiyear project to address preventable events and poor patient satisfaction has inappropriate staffing and that the organization built support for the premise that appropriate staffing would work to realize the premise that staffing was a is a huge determinate of outcomes. Economic penal - crucial investment. ties of negative outcomes such as falls and infections were correlated with staffing. Reputational outcomes Summary: Leadership and Pigs Flying of the effect of penalties also was noted to be a major A common saying is that the art of leadership is problem. And regulatory penalties from organizations finding a parade and getting ahead of it. Others have such as The Joint Commission also brought up the noted leadership is the ability to look around corners question of appropriate staffing. The winds of penal - and lead where the world is going. The challenge for ties began to bring together the research on staffing nursing and healthcare leaders now is to recognize and the effect on outcomes. where the world of staffing and scheduling is going Technology and possibilities. With the power of and to lead ahead of the curve. To resist technology technology, we can now obtain directly from the elec - and to stand by while burnout, compassion fatigue, tronic health record the documented needs of and turnover have negative effects on staff is not what patients and match those needs with the competen - good leaders do. To watch the negative effects of inap - cies of the nurse utilizing information from workforce propriate staffing happen when we know there are management software. It is possible to obtain infor - solutions is not the legacy we need to leave. mation from the ecosystem such as predictive census, As noted by Johnson (1998) in the classic busi - admissions, transfers and discharges, and other infor - ness publication Who Moved My Cheese?, it is not mation that can be digested with algorithms and arti - unusual to become complacent and not plan for ficial intelligence. We now find ourselves in an indis - change and the future. Nurses have been doing putable situation where technology can incorporate staffing and scheduling very much the same way for data and research into assisting with the creation of decades. We graduated to spreadsheets, but now we appropriate staffing based on data and analytics. are on the verge of utilizing smart, intelligent systems What was impossible now has become reality as tech - that start with the patient and synergize patient needs nology reduces the burden of manual process to assist with the skills and numbers of staff required within with reliable and valid methods of staffing and sched - the context of the ecosystem to create excellence in uling. The power of technology is creating the posi - outcomes. As Gladwell (2006) noted in Tipping Point, tive tailwinds for the move to appropriate staffing. once there is enough acceptance, a movement is cre - Serious commitment from national nursing ated and it is difficult to turn back. What we thought organizations. The American Association of Critical impossible is now possible. The revolution to add sci - Care Nurses (AACN) was a pioneer in developing the ence to staffing is about to begin. Synergy Model, which described that care should Watch the sky: Pigs are starting to fly! $ begin with the patient’s needs. Those needs should then be matched with the competencies of the nurse REFERENCES Gladwell, M. (2006). Tipping point. New York, NY: Little Brown. within the framework of a healthy environment. Johnson, S. (1998). Who moved my cheese? New York, NY: G.P. Within the six standards for a healthy environment is Putman. 190 NURSING ECONOMIC$/July-August 2 018/Vol. 36/No. 4.