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A Case for Mandatory Nursing Levels More or Less
By Terence L. Maher
California’s decision to regulate nursing hours per patient day will in theory provide for improved patient care. Or will it? From an operational efficiency point of view more nurses are not necessarily better. In fact less may be better in some circumstances. But one thing is always true: better is better.
The point is that, regardless of whether you will be increasing or decreasing nursing staff levels to comply with the yet-to-be written guidelines, your focus should be on how to get the most out of whatever staffing level you eventually put into place. Optimal performance not staff size should be the goal. But what does optimal performance look like? Is it achievable? At what cost?
Optimal performance is the product of operating efficiency. Stated another way it’s getting the most of what needs to be done out of the least amount of resources qualified to do it. Improving operating efficiency can save you time and money while improving productivity, morale, patient services and, ultimately, customer satisfaction.
In a hospital, operating efficiency can take a lot of forms; for example, increasing availability of equipment from PCAs to IVACs by eliminating Bio-Med repair backlogs. Or, improving emergency case durations through better protocols and support area coordination. In the admitting process it might be reducing registration errors in order to reduce accounts receivable, late/no pays.There are potential operating efficiency gains in nearly every department of every hospital in the nation. The trick is to know where to look and how to find them.
Sure that’s easy for a consultant to say. I’m just angling for more business, right? Well, that’s only partly true. Consider this: if operating efficiencies are so easy to come by why is it that more institutions, including perhaps yours, aren’t performing better? You need only look at most hospitals’ bottom lines to know that something is wrong or at least not completely right.
The answer is that people (and care givers are a prime example) are so often caught up in the doing of an important task that they do not have the time to take stock and consider how to improve it. This is human nature and it’s why there will always be consultants in short supply. Operating efficiency is achievable but there are times when it’s appropriate even imperative to turn to outside resources for a solution. I believe the current healthcare situation-no crisis-is one of them.
So you ask “if I’m struggling to make sends meet today how can I afford to hire a consultant to help me tomorrow?” My answer is that you can’t afford not to. Our experience is that efficiency gains are usually accompanied by cost savings equal to or greater than the associated fees. In other words, over time they pay for themselves.
What’s more, the savings tend to be institutionalized and continue to pay dividends long after most consulting engagements have run their course adding to return on investment. Indeed, some assignments actually become “cash positive” before completion producing more savings than they cost.
There’s another aspect of operating efficiency worth mentioning. It’s when operating efficiency becomes operating excellence. At this level service delivery has become so good and customer satisfaction levels so high that it earns the institution the title of market leader. This is where labor costs actually become assets and begin to drive top line revenues.
Achievable? Absolutely! But only by those institutions with visionary leadership and a commitment to be the best that are willing to work at it starting now. The pay back is worth the investment in time required. But the time to start is now. With mandated nursing levels taking effect as early as 2002 it’s already later than you think.
Terry Maher is a senior operations manager at USC Consulting Group, a consulting firm specializing in operating effectiveness with a successful track record in the healthcare industry. USC offers a proprietary product called DeltaScan® that is designed to help senior healthcare executives chart a course to operational excellence for their institutions. Terry Maher can be reached by calling 1-800-621-6943 or via e-mail at tmaher@usccg.com.
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