HealthTrust members share best practices for staff efficiency & retention
The unprecedented workforce crisis faced by hospitals and health systems nationwide as a result of the pandemic was well documented. “And the staffing challenges that existed prior to COVID-19 were only exacerbated by the pandemic,” says Kim Wright, RN, AVP, Clinical Services at HealthTrust.
That’s why, in February 2023, HealthTrust hosted a two-day interactive summit to help participants better understand the drivers of this crisis, explore shared opportunities and incorporate innovative solutions into action plans. Summit participants included leaders in nursing operations, talent acquisition, human resources and workforce optimization from 11 acute care health systems and two ambulatory surgery centers.
In a panel session at the recent HealthTrust University Conference, four of those Summit participants—Orlando Health, Surgery Partners, Lifepoint Health and HCA Healthcare—shared key insights and updates on their action plans. Here are some of the highlights:
After the summit, the team at Orlando Health decided to focus on workforce optimization and redesign, starting with simplifying the documentation process for nurses. They discovered that nurses were spending a third or more of their time working in Epic, the electronic health record (EHR) system used at Orlando Health. By redesigning their admission navigator, they reduced the required rows of data from 379 to 120.
“It used to take 33 uninterrupted minutes to complete one EHR; it now takes just 18,” shares Darius Love, DNP, MHA, RN, CENP, AVP of Workforce Optimization and Redesign, Orlando Health. “We were able to give 15 and a half minutes per admission back to nurses.” Multiply that by the roughly 97,000 admissions Orlando Health saw last year, and that’s an extra 1.5 million minutes—or more than 3,000 eight-hour shifts—freed up for patient care.
The team has also been building its virtual infrastructure. Four sites are piloting virtual sitting, which allows staff to monitor multiple patients at a time using video and other technology, and one site is piloting virtual nursing, using technology to deliver care remotely and support bedside nurses.
“It’s all about eliminating wasted time and creating avenues of efficiencies to get our team members back in front of patients,” says Love.
“What we did in 2019 is not going to work for us now or in the future,” explains Sandra Vincent, MBA, Vice President, Human Resources, National Group Market for Surgery Partners.
The team identified a strong need to improve the messaging and technology that candidates experience during recruitment. For example, they are working on improving the website by adding videos to increase engagement and finding ways to deliver information in smaller-sized pieces.
“If we don’t optimize our processes, they’re going to go to the next location,” says Vincent.
Vincent adds that being a part of cross-functional teams at the summit was especially helpful: “It was a reminder that it’s not only about HR, but also connecting with IT and the operators. It is essential to collaborate across all areas of our operation to make sure we’re including everyone’s perspective.”
At Lifepoint Health, the focus was on tackling two problems: staff retention in the OB departments and finding internal capacity to support and build a virtual nursing platform.
Fourteen of Lifepoint’s facilities have fewer than 300 births a year, and this low volume can impact staff satisfaction and retention. But what if the organization could identify the OB staff with the skills, expertise and capacity to provide virtual nursing support for patient admission, discharge and transfer support to other departments within the system?
While designing this virtual nursing program, the Lifepoint team had to keep several important factors in mind when determining their ability to successfully implement such programs within its critical access hospitals. “We learned it was important to engage financial partners early in the planning process, along with an engaged executive and clinical leadership team,” says Michelle Watson, MSN, RN, Chief Nurse Executive and SVP, Clinical Operations for Lifepoint Health.
“Another takeaway was the need for strong project management support along the way for a major project like this to help keep the focus, drive momentum and reach our goals,” says Watson. She also notes that in the face of pressing workforce challenges, it is even more important for project teams and leaders to be nimble and have the ability to pivot quickly, particularly if any key players should change during the design and implementation phases.
HCA Healthcare’s team kicked off an extensive recruitment and retention effort across 21 facilities.
“We looked at high performers who had been able to maintain their retention through the pandemic,” says Marianna Heacock, MHS, AVP of Nursing Performance & Operations for HCA Healthcare. “We ended up spending more than 300 hours talking to staff and leaders to really zero in and identify the secret sauce to retaining staff.”
They found that facilities with low nurse turnover consistently embrace best practices, including using care team roles, such as patient care technicians, externs and licensed practical nurses, to support new nurses, providing shadow opportunities in other units and implementing flexible scheduling.
They’ve now further developed their action plan to replicate the experiences of these high performers to the rest of HCA Healthcare. Heacock recommends starting small when it comes to implementing big changes such as alternate models of care. For example, HCA Healthcare started its LPN practice model at just one facility—Horizon Medical Center in Tennessee—three years ago, and it now has close to 2,000 LPNs practicing in its hospitals.
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