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MUSTREADS Fall 2017

For Healthcare HR Executives to Excel


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Interim & Permanent Placements CEO through First-Line Manager Nursing | Ancillary | Support Administration | Finance

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CONTENTS 10 MUST-READ ARTICLES

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19

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The Premium Pay Challenge – It’s Not Rocket Science

Is your hospital struggling to meet its financial targets? Most are, but have you scrutinized two of your largest expenses: salaries and wages?

Employee Engagement Improves Patient Satisfaction, Safety & Quality

Hospitals across the country are learning that employee engagement leads to greater patient satisfaction, improved safety and quality.

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Patient Throughput: How ADT Nurses Can Help

One of the most effective practices to help alleviate the bed constraint challenges we’ve found is the use of an Admission, Discharge, Transfer (ADT) nurse.

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Q&A: How Predictive Data Analytics and Proactive Recruiting Can Improve Nurse Retention

Looking to improve nurse retention at your hospital? Learn how predictive analytics and proactive recruiting can help. Two of our team answer some of the most common questions we hear from clients on this complex subject.

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Hospital Staffing Benchmarks: The Tip of the Iceberg

Aligning Payroll Practices to Policies

In light of the tightened operating budgets to which hospitals are bewing forcedc to adapt, C-suite leaders now more than ever must find ways to do more with less.

Impact

Innovative Application of Workforce and Census Data Yields Bottom Line

As a result of new hire turnover, this hospital had new graduate RNs sign a contract to repay orientation costs should they leave within a certain time period from the date hired.

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Are you Delivering on Your Hospital’s Mission Statement

Every day, hospital leaders across the country are challenged to manage their organization’s day-to-day operations in a way that allows them to deliver their mission statement.

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Improve Your Teams Performance: Start Keeping Score and Stop Giving Participation Trophies

In order for employees to understand how they’re performing on lead measures, a dashboard or scorecard will need to be developed that provides the right focus.

Hospital staffing and productivity benchmarks should be treated as directional and cross-checked with department-specific analysis, data and insight.

CASE STUDY

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Interim Perioperative Director Improves Employee Satisfaction 30%

Novia’s interim OR Leader used several techniques to increase communication, resolve conflicts, and improve staff and patient satisfaction.

These articles were originally written by employees of Novia Solutions’ former sister company, Novia Strategies. Used with permission.

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DESIGN & PRODUCTION

Kristine Thom / Marketing Coordinator

SUBSCRIPTIONS

Kristine Thom / Marketing Coordinator / kthom@novia-inc.com

NOVIA SOLUTIONS, INC.

Tina Wiseman, M.Ed. / Chief Administrative Officer Michelle Campbell, RN, BSN / Vice President of Client Relations Debbie Coffman / Senior Healthcare Recruiter Jenelle Frome / Administrative Associate Andrea Lakier / Client Account Specialist

INTERIM & PERMANENT NEEDS

Contact us today to discuss how we can help you reduce costs and improve quality Tel / 858-486-6020 Email / info@noviasolutions.com Website / www.noviasolutions.com Letters to the Editor / Please include your name, address and daytime phone number. Letters can be sent by email to marketing@novia-inc. com, and may be edited for clarity or space. www.linkedin.com/company/ novia-solutions-inc.

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Michelle Campbell, RN, BSN / Vice President of Client Relations / mcampbell@novia-inc.com Contact Michelle Campbell for your interim and permanent needs 858-486-6020

Novia Solutions is a Nurse-Owned Interim and Direct-Hire placement firm specializing in leadership positions ranging from Supervisors, Managers and Directors up to C-Suite for Nursing, Allied, Radiology, IT, Lab, Finance and Pharmacy departments. Our results-driven candidates promote positive change and can be onboarded in less than 10 days. 10 MUST-READS is published bi-annually by Novia Solutions, Inc. as a free publication. BUSINESS ADDRESS: 13025 Danielson Street, Suite 100, Poway, CA 92064. Tel. 858-486-6020. CHANGE OF ADDRESS: Please send email to kthom@ novia-inc.com or call 858-486-6020. Notice should include the old as well as the new address, including zip code. All material in this magazine is provided for information only. Š2017 Novia Solutions, Inc. All Rights Reserved. No part of this publication may be reproduced or transmitted in any form or by any means without permission in writing from the publisher.


PREMIUM PAY

The Premium Pay Challenge – It’s Not Rocket Science

I

s your hospital struggling to meet its financial targets? Most are, and yet many executives are often uncomfortable, unprepared, or under-resourced to scrutinize one of the largest expenses on the income statement— salaries and wages. Over the years, I’ve heard many reasons for this, including: “We have collective bargaining agreements. There is nothing we can do.” “Staff shortages create our overtime.” “We’ve already done that.”

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HUMAN RESOURCES

In spite of these perceived (or real) challenges, it is rare that an assessment of a hospital, of any size, does not yield opportunities for reductions in the use of premium pay. Identifying the drivers and specific reasons for premium pay utilization are essential. The list varies from organization to organization; however, here are some common themes: • Restrictive bargaining terms • Competition for staff • Disparate practices resulting from mergers and acquisitions • Staffing shortages • Poor scheduling practices • Inadequate information and reports • Outdated and inconsistent timekeeping practices

Setting a Solid Trajectory What prevents highly competent, responsible and motivated leaders from addressing the use of premium pay? Perhaps it is priorities or bandwidth. Perhaps the pain point is simply not great enough to exhaust limited resources needed to tackle the job. Perhaps it is the “big, black hole effect” with too many unknowns, making the starting point elusive. If the latter analogy resonates with your organization, consider adopting these 5 key steps to alleviate the anxiety.

5 steps to Reduce Premium Pay and Unnecessary Wage Expense

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Review payroll data Gain an understanding of the pay codes in use and determine which departments are high users of premium pay. This will enable the scope of

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the work to be more manageable and will also minimize the impact on resource utilization. Use the variation in data from department to department to aid in developing goals.

2

Develop and communicate organizational goals Establish targets and timelines that are achievable. These can be customized from data gleaned in the payroll review or from more formal benchmarking sources. In some departments, depending on operational challenges, interim and stretch targets may be needed. Except for organizations in dire financial circumstances, involving leaders in the development of the targets will increase buy-in and success. Create a mechanism for measuring progress to goals, preferably one that can be readily shared with all staff in order to engage them in the process.

3

Use data consistently and frequently Automate reports and distribute to department managers on a consistent basis. Depending on the type of data, timing of distribution may vary from daily to bi-weekly. Ideally, reports with overtime or incentive shifts (a shift paid at premium rates where overtime would not otherwise be required) should be distributed daily so the information is current and underlying causes of the incidents can be readily determined and addressed.

4

Identify and resolve inconsistencies Review any collective bar-


PREMIUM PAY

gaining terms and compare them to timekeeping practices. Understand and address variation to reduce the inconsistencies. Be aware that some bargaining agreements require notification periods, even when changing from a non-compliant practice to one that is compliant, so engage your organization’s labor relations counsel for assistance. Educate leaders and timekeepers when next steps are determined.

5

Create a culture of accountability Review departments that are high users of overtime and other premium shift practices. Department leaders should identify the underlying causes and develop action plans to address challenges and barriers. Review the action plans on a routine and regular basis with senior leadership to measure progress and identify barriers that require assistance.

Time for Take-Off Deployment of these key steps will place your

organization on a turbo-boosted path to reducing premium pay and move closer to the financial targets, while promoting long-term stewardship of resources. As a rule of thumb, reductions in premium pay from a fully implemented premium pay reduction program can range from 1% to 3% of salaries and wage expense. In order to ensure a successful launch, secure the right talent to help you steer with precision and assist in anticipating the many hurdles that are typically experienced in this complex type of journey. Having the right team that can apply this process will help to make it a success the first time. It’s time to get started, and remember, no space helmet is required for this mission. •

This article was originally written by Theresa Brandon when she was an employee of Novia Solutions’ former sister company, Novia Strategies. Used with permission from Novia Strategies.

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HUMAN RESOURCES

Employee Engagement Improves Patient Satisfaction, Safety and Quality 6 www.noviasolutions.com


EMPLOYEE ENGAGEMENT

T

he healthcare industry is in the midst of dramatic changes, and as organizations struggle with new reimbursement models, employees are feeling the associated pressure. The changing environment has directly impacted employees through increased use of complex software, pressure for increased productivity, and revisions to supply preferences and inventory levels. The result for many hospitals: declining employee engagement levels. Employees are one of your organization’s largest investments and their commitment to quality patient care has a direct financial impact on your bottom line. In this highly competitive operating environment, employers

Engaged employees promote positive patient care experiences, are more likely to adapt to environmental changes and have less absenteeism.” are recognizing the short-term and long-term value of positive employee satisfaction. Engaged employees promote positive patient care experiences, are more likely to adapt to environmental changes and have less absenteeism than workers with low levels of job satisfaction. What then drives employee satisfaction? How can satisfaction levels be increased, measured and generate a return on resources invested?

What areas impact employee satisfaction?

Among our clients, we find workplace satisfaction is typically driven by two high impact areas: environmental factors and financial re-

wards. Both of these contain a multitude of inter-related elements that should be considered when seeking to improve satisfaction and retention. Environmental factors Improving employee satisfaction levels begins with understanding the needs of employees, and the value employees place on those needs. When the work environment is not appealing, symptoms such as high absenteeism, low productivity and poor work quality will exist. Employee satisfaction in the work environment can include a number of factors, such as: • Clarity of expectations • Tools and training for optimal job performance • Quality and safety measures • Recognition of value provided • Relationships with co-workers • Leadership qualities of supervisors • Integrity of executive leaders • Transparency of communication Often we find that employee survey results are the only mechanism utilized to measure levels of employee satisfaction. The survey results are often inadequate (and sometimes overwhelming) to provide direction on addressing underlying issues. We encourage our clients to dig deep to understand and address the underlying cause of employee concerns. Financial rewards While employees may be divided on whether environmental factors or financial rewards are the most important component of employee satisfaction, most executives will agree that addressing both is

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HUMAN RESOURCES

imperative. As strategic leaders, these professionals also recognize that financial reward programs must balance market competitiveness with organizational objectives and resources. These programs include base compensation and premium pay, paid leave programs, and other benefits such as health insurance. Oftentimes, anecdotal information, or real or perceived inequities, can result in low employee satisfaction levels. Best practices include: • Development of job code and grade structures, as well as associated job descriptions and salary ranges, to ensure internal and external equity • Enhanced policies to communicate rules and expectations to employees as well as supervisors • Appropriate use of premium pay, aligned with patient needs and fiscal responsibility • Paid leave programs and associated policies and processes, which align patient needs with employee work/life balance • Health, dental, vision and wellness programs that balance employee affordability, with employer sustainability Ultimately, a proactive employee engagement strategy that addresses the environmental factors, as well as financial rewards, will improve the organization’s ability to recruit and retain quality staff. • 8 www.noviasolutions.com

Checklist of employee engagement solutions • Alignment of skills and workload with expertise • Staff education and training • Improved scheduling practices • Leadership development • Employee recognition and performance incentive programs • Equitable compensation structures • Management of premium pay • Design of paid leave programs • Tools to monitor and sustain progress

This article was originally written by Theresa Brandon and David Murdock when they were employees of Novia Solutions’ former sister company, Novia Strategies. Used with permission from Novia Strategies.


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Mentor Placements

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HUMAN RESOURCES

Patient Throughput: How ADT Nurses Can Help

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anaging patient throughput creates one of the biggest challenges for nursing units. Length of stay for hospitalized patients continues to decrease, with patients discharged after only a few days on the unit. In addition, patients remain in the Emergency Department and Post-Anesthesia Care Unit because no beds are available on the unit or not enough nurses are assigned to the unit to care for all of the patients. One of the most effective practices we’ve found to help alleviate the bed constraint challenges is the use of an Admission, Discharge, Transfer (ADT) nurse on nursing units with high patient turnover rates. Most nursing units have the ability to flex their staffing up or down as the patient throughput volumes and needs change throughout the day. When that flexing ability isn’t sufficient to meet the throughput demands, adjustments to the staffing pattern may be needed – including the assignment of an ADT nurse role. Clearly, depending on the technology available, process and workflow design, and skill

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PATIENT THROUGHPUT

level, one nurse can effectively manage a number of admissions and discharges within a shift. A nurse who recently completed orientation may be able to manage one discharge with an immediate admission in an 8-hour shift; a seasoned nurse will be able to handle more. And as it relates to process, starting the discharge planning on admission, and automating it, will ensure a more efficient discharge process. A manual process that doesn’t start until the day of discharge requires significantly more time. Analyzing the amount of nursing time needed to complete ADTs, along with the hour of the day and day of the week of ADT activity, will help the nursing leader determine if the traditional shift start and stop times provide adequate coverage for the nursing unit. Armed with that insight, the nursing leader can then determine if traditional shifts will work for their unit, by the time of day and day of the week, or if flexible shift hours are needed. The two sample graphs from the same nursing unit show variances in the admission and

discharge data which a nursing leader could use to determine alternative shifts for the unit. One graph represents a Thursday and the other is a summary of the entire week. As this example shows, a nursing leader might create a 10 am to 6:30 pm shift to handle the increased volume of admissions and discharges that will occur during that time, ensuring optimal patient throughput. This overlapping shift may differ by the day of the week and may differ in length, depending on what the data shows and the ADT volume that is the identified “norm” for that unit. In conclusion, an ADT nurse can ensure optimal patient throughput and enable hospitals to manage units with high patient turn-over rates.•

This article was originally written by Chris Phifer when she was an employee of Novia Solutions’ former sister company, Novia Strategies. Used with permission from Novia Strategies.

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HUMAN RESOURCES

Q&A: How Predictive Data Analytics and Proactive Recruiting Can Improve Nurse Retention

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ith predictive data analytics becoming a hot topic in the healthcare industry, many of our clients are asking how analytics can help them with their staffing needs – beyond traditional productivity analysis. One of the opportunities we see is the use of predictive data analytics to develop a proactive recruiting model, which is a

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DATA ANALYTICS

proven method to improve nurse retention. In a recent webinar hosted by Novia Strategies, Novia Solutions’ sister company, and in a presentation at the ASHHRA conference, David Murdock, Managing Director and Staffing and Productivity practice lead for Novia Strategies, shared his thoughts on how proactive recruiting can improve nurse retention. We recently had the opportunity to sit down with David to ask him some more questions about proactive recruiting models. Here’s are highlights of that conversation.

Q

What is the primary benefit of a proactive recruiting model?

The proactive and predictive model of recruiting will allow you to improve the level of decision-making related to the timing of recruiting and hiring processes for which, in turn, will positively impact retention.

Q

What are some of the signs that an organization might benefit from a proactive recruiting model?

Some of the signs include: • Higher percentage of early tenured nurses compared to industry average • High levels of employee turnover • Ratio of less tenured nurses to more tenured nurses • High use of premium pay • Duration from vacancy to the time the new nurse is on the unit Let me give you some data behind this. Recent research shows that is takes an average

of 82 days to fill a bedside nurse vacancy (average across all specialties). When you add 6 weeks of training time, that means it will take an average of 140 days before the bedside RN would actually be on the unit and fully productive. The predictive analytics allows clients to predict a need, which increases the time to source and onboard “right fit” candidates.

Q

How does proactive recruitment improve retention?

Retention really starts from the application process when you begin to screen the applicants. Even at this early stage, effective recruiters are considering the organizational culture fit for the candidates. The predictive model of recruiting will allow you to be proactive and thus increases the time available for recruiting. This extra time allows recruiters to be more selective with those candidates, which in turn will positively impact retention.

Q

How does a proactive recruitment model work?

First, let me outline the traditional recruiting process that we see at many hospitals. To hold managers fiscally accountable for the positions they are requesting be filled, many organizations wait to initiate the recruiting process when a position becomes vacant or when a new position is created. In other words, the recruiting process begins with the position requisition based on an existing vacancy. Only then do recruiters begin to source, identify and interview candidates. Eventually a candidate is  Novia Solutions, Inc. 13


HUMAN RESOURCES

hired; but even after hiring, they still need to complete orientation and training before becoming competent and fully productive. During the “ramp up to competence”, those shifts are often filled with premium pay, overtime and agency staff. A proactive recruitment model collapses the time from when the need arises to when the need is filled. This model isn’t a one-sizefits-all approach. Rather, it’s a lean-inspired approach customized to each client. Simply stated, we review the recruitment process, zeroing in on opportunities to streamline this process. Through any streamlining though, it is critical to maintain clear lines of accountability for the hiring processes and staffing decisions. To further elaborate, decreasing the time from the need arising to the need being filled requires a disruptive approach. With the predictive analytical model of the proactive recruiting process, you’re able to predict a need. With that need being predicted, and having confidence in the need based on historical demand (workload) and supply (candidate pool, employee turnover and training needs), the recruiting process begins in anticipation of the need arising. By the time that need actually arises, the need is filled and the timeframe has reduced significantly.

Q

What data do you need to develop a proactive recruitment model? There are quite a few data requirements that the proactive recruitment model needs, including:

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• Granular historical workload data (e.g., census data points every four hours for nursing units) • Operational staffing plans that cover all levels of workload that you have experienced • Standardized roles and job titles where organization-specific job titles are mapped to standard job titles (e.g. RN1, RN3N are mapped to RN) • Up-to-date position rosters, ideally one position control that is centrally located and maintained for the entire organization and centrally located • Data to calculate true FTE turnover, which is different from industry standard calculations • Budget by skill mix • Recruiting data to include pipeline and time to fill • Training requirements for new and experienced staff

Q

What other information do you need?

It’s important to understand any process gaps that would impede having a fully integrated proactive recruiting model. For example, the model will benefit from having a position requisition process flexible enough that allows for the proactive recruiting of those positions. Based on the predictive need, you want to be able to release those positions even though they may not yet be vacant. Some of the leading organizations are actually doing this based on predictive need, and others are building


DATA ANALYTICS

a pipeline based on predictive need but then waiting until the position is closer to being vacant. It’s also critical to understand the onboarding and training expectations, and to ensure they are standardized and consistent. Of course there is some variability with regards to candidates’ skills and the amount of time it takes them to get up to speed, but being able to assign a timeframe is needed for the predictive model. Finally, a proactive recruitment model is best supported by a centralized, up-to-date position control process that provides contemporary visibility of what positions are available and what positions are filled. Recently, to help a client fill a process gap of having an up-todate position control roster, we developed a separate database that takes data from the cloud-based employee roster and produces a position control listing on a biweekly basis that is used in the proactive recruiting model.

Q

How flexible is a proactive recruitment model?

The most recent predictive recruitment model that we developed will predict the need for a 12-month period. There is the ability to override or update certain assumptions in the model as the recruiter performs analysis of various recruiting scenarios. For example, if there are upcoming retirements that haven’t typically occurred in the past, the recruiter and/or department leader can manually input that data in the model. The model enhances the partnership between recruiter and depart-

ment lead as they collaborate to ensure staffing levels are appropriate.

Q

What are some of the key lessons you’ve learned in designing and implementing predictive recruitment models for hospitals and healthcare systems? As with many of our staffing related projects, we learned that even the most highly performing organization can have data and process gaps that can impair the implementation of new staffing models. Projects like this will also reinforce the importance of ensuring that key elements are in place prior to initiating the “build” of the actual model. These include: • Strong project management coordination • Active involvement of HR, recruiters and department leadership • Support and partnership from Information Technology • Requisite data and clear understanding of any data gaps • Position control process and roster • Change control process and transition plan •

This article was originally written by David Murdock when he was an employee of Novia Solutions’ former sister company, Novia Strategies. Used with permission from Novia Strategies.

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HUMAN RESOURCES

Hospital Staffing Benchmarks: The Tip Of The Iceberg

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aving been in the healthcare industry working in some aspects of performance improvement, performance measurement and process design for two decades, we have seen significant advances in the application of benchmarking. That being said, our team of staffing and productivity experts often still have to help clients get past the fact that comparative data benchmarking is not an exact science. We ultimately find ourselves repeating multiple times during our work that “Benchmarks are Directional.” The image at top right is one we frequently use to lay the context of how benchmarks are the “tip of the operational iceberg”. Our team spends ample time (equal to or more than most firms, in our experience) with data normalization – the process by which staff hours and salary dollars are reallocated to better match a benchmark standard. What we really want to do is move as quickly as possible to the part of the process in which the data-related findings are augmented with the observations and interviews conducted by 16 www.noviasolutions.com


BENCHMARKS

subject-matter experts. This combination of data and domain expertise yields insights that result in higher levels of buy-in to performance improvement ideas and the resulting gains in staffing efficiency. Below is an example of the insights that can result from the operational review and drilldown. This example comes from a house-wide productivity review for a multi-hospital system and shows Laboratory Services at the largest hospital site. The findings have been scrubbed so as to not provide proprietary client information. The table is a great example about benchmarking being directional. When the team initially analyzed the data for the laboratory at the benchmarking layer, the variance was 3.0 FTEs greater than the benchmark percentile selected. Our subject-matter expert conducted interviews and completed observations on

multiple shifts to gain a first-hand perspective of the overall operation of the laboratory. We discovered that the initial variance calculated was not feasible without significant changes and that a more appropriate target was in order. After analyzing the operational factors, the subject-matter expert determined that the laboratory could potentially gain efficiencies by 1.0 FTEs if our process improvement recommendations were implemented. On the next page is another example, this time from perioperative services. This example also shows how the operational review and drilldown can influence productivity targets initially based on benchmarks. The hospital’s perioperative service line benchmarks initially indicated a high variance that warranted more detailed review. We analyzed additional data for staffing to demand analysis by hour of day and day of week, which is shown in this chart. We also analyzed how the benchmarks and actual staffing compared to AORN guidelines. The perioperative subject-matter expert worked with our productivity analytical team and identified operational inefficiencies as well as staffing mix inefficiencies. In this

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HUMAN RESOURCES

case, the additional insights gained from the operational drilldown identified greater opportunities for staffing efficiency than the initial benchmark variance suggested. This particular example and the greater learning around it led to the creation of a benchmarking tool that helps bridge the gap between industry guidelines and productivity benchmarks – for instance, staffing based on AORN guidelines as compared to staffing based on productivity benchmarks. It also led 18 www.noviasolutions.com

to a presentation that a colleague and I recently gave at the OR Business Management Conference. Not every department leader will require this level of review to buy into their benchmark-based (or more precisely, benchmark-influenced) target. However, many managers – for example, those facing major process changes to reach those targets and managers of departments where staffing changes have significant intra-departmental impact, such as nursing units – will benefit greatly from knowing what is beneath the surface of the benchmarks. So again – benchmarks really are directional and in our opinion they generally should not be used alone to set targets. •

This article was originally written by David Murdock when he was an employee of Novia Solutions’ former sister company, Novia Strategies. Used with permission from Novia Strategies.


PAY PRACTICES

Aligning Payroll Practices to Policies

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he hospital industry is one of the largest users of add-on pay practices, both in the number of pay practices, and in financial impact to the organization. Add-on practices, such as shift differentials, standby, callback, shift bonuses and overtime, can increase an organization’s payroll expense by more than 15% and generally cost millions of dollars, even for the smallest of hospitals. Yet many hospital HR leaders relinquish control to the finance and information service departments in the implementation and ongoing administration of compensation expense. As professionals, we all understand the need for segregation of duties to protect the finan Novia Solutions, Inc. 19


HUMAN RESOURCES

cial integrity of the organization. However, HR leaders have skills and knowledge that are crucial to ensuring that the deployment of pay practices is consistent with the intent of the programs. Critical information necessary to properly configure timekeeping and payroll systems is too often unknown to the individuals responsible for the actual set-up. Furthermore, after implementation, there is often little monitoring of the use of many of these practices.

and how to effectively address these issues, HR leaders can and should champion compensation reviews that reduce excess and unnecessary expense. In light of hospitals’ tightened operating budgets, C-suite leaders now more than ever must find these kinds of opportunities to maximize use of limited resources. While the task may seem daunting, breaking it down into three crucial steps will result in improvement opportunities or provide assurances that payments are in order.

The presence of bargaining agreements should not result in an artificial safety net that assumes the timekeeping and payroll systems are operating as intended, or are even addressed within the bargaining agreement language.”

Foster Collaboration and Understanding Between Key Stakeholders

These challenges are consistent in both union and non-union environments, although interpretations of contract language may add an extra layer of complexity. The presence of bargaining agreements should not result in an artificial safety net that assumes the timekeeping and payroll systems are operating as intended, or are even addressed within the bargaining agreement language. Armed with the knowledge of where to look 20 www.noviasolutions.com

While HR leaders can drive the change towards aligning payroll practices with policies, engaging the appropriate stakeholders from finance, information systems (IS) and high-use departments is a crucial first step. Just as HR leaders are experts of the intent of the policies, financial and IS team members have the knowledge and skills to configure the timekeeping and payroll systems to create outcomes as closely aligned as possible to the policies. Since no policy can address all of the possible scenarios that are likely to occur, this partnership with HR, finance and IS will allow for the necessary knowledge transfer in the set-up (or correction) of the configurations. In addition to finance and IS, collaboration


PAY PRACTICES

with operational leaders is also a critical success factor. This group brings insight into the “real life” employee scenarios that take place at the department level. Similarly, timekeeping staff members are also a valuable resource of potential disconnects between practices and policies as they have visibility to many types of manual adjustments, often subject to interpretation of the individual timekeeper.

Understanding how in information is shared between key systems, such as timekeeping, payroll and HRIS, is a critical component to ensure accurate payment. Beyond providing expertise on system configuration, IS can also offer valuable insight on system integration, or lack thereof. Understanding how information is shared between key systems, such as timekeeping, payroll and HRIS, is a critical component to ensure accurate payment. It’s important to avoid making assumptions about how integration is supposed to work, and test that it is working as planned. For example, a recent hospital client discovered that despite assurances of full integration of the HRIS and timekeeping systems, hundreds of employees were actually receiv-

ing incorrect overtime payments because their overtime rule in the HRIS file was not transferring to the timekeeping system.

Review Payroll Data to Gain Insights

Once the team of key stakeholders has been organized, HR leaders can begin with a comprehensive review of payroll data. This will require a strong analytical resource with the skills to understand and analyze data, and who can maintain the ongoing partnership with HR in this role since continued monitoring and maintenance is needed to sustain the integrity of the process. If the organization does not have an HR analyst with these skills, HR leaders can partner with the finance department for assistance. A methodical approach is recommended for reviewing the majority of pay codes in use, beginning with the highest dollar value or highest risk of misinterpretation. Two pay codes that usually meet both the high value and high complexity criteria are overtime and shift differentials. After the pay codes have been selected for review, their application can be investigated by selecting payroll samples at the employee level. HR should cross reference the actual payments with the associated timecards and trace the logic of the timecards and pay codes back to the policies to determine if the payments have been made in accordance  Novia Solutions, Inc. 21


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with the policies and bargaining agreements. In some organizations, data from HR systems may also impact timekeeping rules and the associated payment.

Once the sample selection and detailed reviews have been completed, HR leaders should discuss the findings with operational leaders and timekeepers to gain further insight into the indentified discrepancies.” Once the sample selection and detailed reviews have been completed, HR leaders should discuss the findings with operational leaders and timekeepers to gain further insight into the identified discrepancies. Review results can be categorized into groups of actionable items based on quick wins and longer term timelines and create implementation plans for each group. It’s helpful to engage labor relations and communication subject matter experts in the preparation of messaging and avoid multiples changes over short periods of time to reduce employee anxiety.

Maintaining the Improvements

Once the reviews have been completed, HR leaders can work collaboratively with key stakeholders in IS and finance to estimate the financial impact to the resulting changes. They should identify the metrics to monitor along with the accountability structure for reporting the improvement. Utilization of an existing 22 www.noviasolutions.com

venue, such as a finance committee, executive leadership or operations council will reduce “reporting fatigue” and create immediate visibility for improvement, or course correction if improvements do not materialize. It’s important to recognize that despite the best efforts of the talented individuals associated with systems configurations, there will be situations that simply cannot be automated. In those circumstances, HR, finance, IS and operational leaders can create processes and design reports to monitor and control manual adjustments requiring a higher level of diligence and oversight. Training manuals and educational materials should be updated to ensure outcomes are consistent with the changes, including new and revised policies.

Summary

With the increasing financial challenges facing hospitals today, HR leaders have tremendous opportunity to expand their role as executive members of the leadership team. Leading the charge to realign payroll practices with policies supports the financial goals of their organizations and creates equity among employees. Rarely do any other professionals within an organization possess both the intricate knowledge of policy intent and market practices of HR leaders, who are uniquely positioned to take on this challenge . •

This article was originally written by Theresa Brandon when she was an employee of Novia Solutions’ former sister company, Novia Strategies. Used with permission from Novia Strategies.


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Our Interim & Permanent Leaders Deliver Results Recent results include: • Joint Commission certification readiness • 30% increase in employee satisfaction • 75% reduction in overtime • 99th percentile in HCAHPS scores

Interim & Permanent Placements CEO through First-Line Manager Nursing | Ancillary | Support Administration | Finance

Call us for interim and permanent placements who positively impact your bottom line 858-486-6020 | www.noviasolutions.com


HUMAN RESOURCES

Innovative Application of Workforce and Census Data Yields Bottom Line Impact

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ny hospital that aspires to succeed must “break the code” to build an effective and efficient working environment for its nurses. What do your nurses need to feel successful and secure, to retain their drive and dedication, and to remain committed to your mission? Novia recognizes that stronger recruitment/retention tactics and better annual budgeting/scheduling are key. 24 www.noviasolutions.com


NURSE LABOR BUDGETS Retention: Stop Training Your Nurses for Other Hospitals

It is becoming a fact of life. Chief Nursing Officers and their organizations are training new graduates or less experienced nurses only to have a significant number of them leave shortly after becoming a fully functioning member of the clinical team. Hospital systems dealing with this situation are typically in diverse locales (rural South, Midwest, and Eastern urban city centers), so the phenomenon is not attributed only to geographic factors. At least one hospital in this scenario began requiring new graduate nurses to sign a contract to repay orientation costs should they leave within a certain time period from the date hired. The Problem Turnover rates for bedside nurses have increased from 11.2% to 16.4% in the past 4 years (reported by NSI Nursing Solutions in their January 2015 survey). Lower-tenured nurse turnover has been reported to be comparatively high with 17.2% of newly-licensed nurses leaving their first job within the first year (according to Policy Politics & Nursing Practice, August 2014). Reducing turnover rates is known to have positive financial benefit and should be expected to be highly correlated with improved staff satisfaction. These factors underscore the importance of making effective candidate selection choices. Unfortunately, when organizations are rushing to fill critical openings, they often are making hiring decisions more influenced by filling an opening than identifying the best fit candidate. This scenario can result in insufficient consideration for factors that will influence long-term retention. The nursing “brain drain” then occurs. Nurses, after having been trained

on the hospital’s proverbial dime, gain clinical experience and move on to find another opportunity, creating another critical job opening for the recruiter to fill. The Solution How do we limit the occurrences of this cycle? Predictive analytics is an area of study that uses historical data and statistical analysis to model trends and performance patterns. This methodology has been used in areas such as actuarial science and credit scoring, and is gaining momentum in healthcare. In particular, it can be applied to help reduce the nursing brain drain by providing nursing leadership and their recruiting partners within HR with data to improve their recruiting efforts. Acquiring data that is readily available and processing it with predictive modeling methods can enable recruiters to take a proactive approach to recruiting. More effective and predictive recruiting provides hiring managers with the ability to be more selective in choosing candidates from a larger pool that was methodically built with specific requirements related to organizational and unit “fit” versus the “we need somebody now” driven candidate pool. Proactive recruiting models are built using some of the foundational elements used in core and flexible staffing analysis: historical census data, staffing grids, competency requirements, and full time versus contingent staffing targets. In addition, in order to complete the proactive staffing model analytical engine, hospitals need to account for factors that specifically impact recruiting. These factors include staff turnover trends (seasonal and/or monthly by unit), orientation and training requirements by unit (new graduates and  Novia Solutions, Inc. 25


HUMAN RESOURCES

experienced hires), recruiting lead time, and local employment market factors (e.g., the timing of RN graduations). An effective model will produce a proactive recruiting schedule that empowers the recruiters with the ability to give hiring managers the luxury of time. This additional time increases the organization’s ability to scrutinize the applicant pool for the right fit and not just availability to start when needed. While use of predictive analytics in proactive recruiting models will not stem all of the tide of nursing “brain drain,” it is an effective tool to improve retention rates and reduce costs associated with turnover and premium pay resulting from the need to fill critical shifts.

Budgeting: Make Friends with Finance

Developing the labor budget for nursing units can be a challenging task that often pits nurse leaders against their peers in finance; when, in fact, it presents a great opportunity to collaborate and leverage each other’s strengths.

Predictive analytics and proactive recruiting are effective tools to improve retention and reduce costs.” Some visionary hospitals have managed to change the dynamic between nursing and finance from one of conflict to collaboration, resulting in increased awareness and higher levels of empathy for each other’s situation. Sometimes, all you need is a modified budgeting process. It also raises the level of accuracy

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of the established budget and increases the buy-in of the nurse leaders who will be held accountable to achieve budgeted targets. The Problem Many factors affect nursing unit staffing on a daily basis – issues such as patient turnover and fluctuating census – yet, they are frequently left out of the budgeting process. One of the analytical tools Novia Strategies utilizes with client hospitals is a census distribution model to help nursing leaders better understand their patient needs and the cyclical nature of patient census. Using these models to refine staffing grids, which have been developed with benchmark data and operational expertise, will result in appropriate staffing levels specific to the daily changes in patient populations. This helps organizations improve their budgeting processes and create a partnership between clinical operations and the finance department. Historically, budgets have been created with patient volumes and average daily census (ADC) as a basis of the FTE budgeting. The ADC is first identified, and then nursing leaders determine their staffing needs for that average census level. Staffing is then converted into worked FTEs and eventually Worked Hours per Patient Day (WHPPD). This methodology has been used at many facilities for many years, and is somewhat effective for units that have extremely stable census that fluctuates very little from the ADC. One of the challenges with this traditional methodology is that patient census is not the same 24 hours a day, seven days a week. This process assumes that it is. As a result, there


NURSE LABOR BUDGETS

will likely be shifts that are consistently overstaffed and shifts that are consistently understaffed. The high-level thinking from a finance perspective is that over time, the variances will cancel each other out and that the unit should be able to achieve budgeted performance for the year. When census is analyzed every four hours by the day of the week, a different picture often emerges. The Solution At Novia, we analyze census in 4-hour increments to capture variability throughout the day. All of this information is obtained and examined to determine the census distribution for each unit. While it’s important to know the ADC for a unit, this methodology illustrates why the unit’s census frequency distribution (i.e., how many times each census point is experienced) provides important data for budgeting. Once this data is analyzed, the next step in this process is to determine which census levels are least productive. For example: assume that for unit “A,” the worked hours per unit of service is budgeted at 10.50 WHPPD. The census distribution for unit “A” shows that 80% of the experienced census falls between 18 and 24 patients. With that knowledge, the nursing leader would know to carefully examine the staffing at each census level from 18 to 24 to determine how each level compares to the budget WHPPD. The Takeaway See for yourself… the grid following is at budget at the budgeted census level of 19. This represents only 12% of the experienced cen-

Traditional vs. Census Distribution Difference Traditional ADC Budgeting Method WHPPD

10.50

Census Distribution BUdgeting Method WHHPD

9.74

Traditional vs. Census Distribution % Change in Productivity

-7.8%

sus. If this unit used the traditional method for budgeting, as well as used the ADC of 19 to determine the staffing levels, this budget would overstate the staffing needs for the unit because the census level was only experienced 12% of the time. The census distribution method results in a more accurate FTE budget based on historical census. Units that have a more stable census can still benefit from this method as well.

Retention, Finance Training Key to Developing Nurse Leaders

With the advent of electronic health records (EHRs) and the increased ability to store and access data in those EHRs, hospital leaders (both financial and clinical) have the ability to make more informed and data-rich decisions related to staffing. This includes improving the ability to proactively recruit/retain staff and budget based on historical workload. Understanding the opportunities each presents in strengthening the nursing teams’ contentment and commitment will help place many hospitals on a path toward financial and human resource success. • This article was originally written by David Murdock when he was an employee of Novia Solutions’ former sister company, Novia Strategies. Used with permission from Novia Strategies.

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HUMAN RESOURCES

Are You Delivering on Your Hospital’s Mission Statement? 28 www.noviasolutions.com


LEADERSHIP DEVELOPMENT

R

emember looking at those “Magic Eye” pictures? They were pictures that looked like multicolored television fuzz at arm’slength, but when you held the picture close to your face and focused on “looking through the picture” you were supposed to see an actual image like a horse or a sailboat. This exercise was made even more difficult because you didn’t know what image you were actually trying to see. The image that was supposed to be visible was often noted on the back of the page or at the end of the book. I’ll admit, I rarely saw the sailboat and was left feeling cross-eyed and frustrated.

vision fuzz, the data. As more and more data is captured through electronic health records and other systems, hospital leaders quickly become overwhelmed with data and often experience analysis paralysis. In my next article, I’ll talk more about how to manage your organization’s data needs in a way that minimizes the television fuzz and keeps your leaders focused “seeing the image”. But before we can do that, let’s start by figuring out what image we’re actually trying to see.

The challenge for hospital leaders

Let’s be honest, we’ve all read a mission statement that makes for wonderful marketing material but when you ask yourself, “How would we actually measure our success towards this mission?” you find yourself at a complete loss for answers. This is because mission statements often use language such as: • Care/Resources/Support • Community/Employees • Health/Healthy/Wellness • Fiscally responsible • Accessible/Accessibility • Innovative/Leading/Leader

Whether you’re managing an individual department or leading a multi-hospital system, this is the same exercise healthcare leaders face on a daily basis with a couple of modifications. Replace that multicolored television fuzz with data and the image they’re trying to see, that’s their mission statement. Every day, hospital leaders across the country are challenged to manage their organization’s day-to-day operations in a way that allows them to deliver their mission statement. As with the Magic Eye pictures, there are two big challenges to make this happen. The first challenge is that hospital leaders don’t have a clear image in their mind as to what they’re trying to see; their mission statement. That’s not to say their organization doesn’t have a mission statement. The challenge is that mission statements aren’t typically written in a way that is measurable and actionable. The second challenge relates to all that tele-

The “Magic Eye” effect of mission statements

Again, these can be powerful marketing buzzwords but they are extremely difficult to measure with additional definition. When working with organizational leaders to improve operational performance, this is the first place I start. Before we can measure HOW WELL we’re  Novia Solutions, Inc. 29


HUMAN RESOURCES OPTIMAL OUTCOMES IN MED/SURG

doing, we first have to know WHAT we’re doing. What is it our mission statement is actually charging us to do as an organization? Let’s work through an example to describe what I’m talking about. Drawing from some of the most common language listed above, our mission statement might read something like this: Our mission is to provide access to high quality, innovative care throughout our community in a fiscally responsible way that promotes individual health and wellness. Sound familiar? Now let’s break this down into something we can actually measure. When working through this type of exercise, it’s important to remember that you don’t have to translate every single word into something that is measurable. Translate the key aspects that encompass what the mission statement is saying and don’t get hung up on every phrase. In our example, we might focus on further defining or translating the following terms: • High quality • Community • Fiscally responsible • Individual health and wellness

In this example, we’ve now gone from a mission statement that sounds good, to one that has been translated into terms we can begin to measure and work towards from an operational improvement perspective. A hospital leader would have much more success describing how his organization is delivering on its mission by describing performance on the latest quality scores, area of community coverage, bottom-line financial performance and ability to manage common diseases rather than speaking in a broader context about organizational activities that may or may not be related to its mission statement. Taking time to further define the mission statement is critical to improving operational performance for three reasons: 1. It removes ambiguity with respect to what the organization is working to achieve 2. It establishes criteria by which you can begin to measure how well you’re achieving your mission 3. It allows you to focus improvement resources in those areas where they are most needed, given current performance

Mission Statement Language

Translation to Measurable terms

High Quality

Achieve HCAHPS scores above the 90% percentile

Community

Within a 60 mile radius (or specified by area code)

Fiscally Responsible

Maintain a 10% operating margin

Individual Health and Wellness

Specify community health measures such as obesity rate, diabetes rate, hypertension rate, etc. that will be below national averages or other benchmarks

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LEADERSHIP DEVELOPMENT

Seeing your sailboat

Try this exercise with your organization: 1. Highlight the phrases in your mission statement 2. Develop clearer definitions for each phrase that are measurable 3. Evaluate how well your organization is delivering on each of these measures At this point, you now know what image needs to be seen through all of that television fuzz. This is a big first step and in my next article we’ll work through a process for removing the majority of that fuzz so that your entire organization has a crystal clear picture of that sailboat.

Why Data is the Strongest Leader in Your Organization

A photographer named Bill Owens once said, “True leadership lies in guiding others to success.” Bill was obviously speaking about what he felt was one of the qualities that makes someone a strong leader but I would argue that this very principle should be applied to data and metrics when working to improve performance within an organization. In The Four Disciplines of Execution, authors Chris McChesney, Sean Covey and Jim Huling build on this very concept through the development of what they refer to as “lead measures”. As the authors explain, these are measures that must meet two requirements: 1. The measures predict the achievement of a larger goal 2. The measures are something a team has the ability to influence

So how do lead measures come into play when working to improve performance? As leaders begin implementing performance improvement initiatives, be it at the department level or across a large hospital system, they often find themselves wondering, “Is the work I’m doing really having the impact I intended?”, or, “What can I do to have an even greater impact on performance?” Regardless of the size of your department or the size of improvement initiative you may be working on, there’s one critical step to every improvement initiative that can make or break your success. And it’s a step that even the most experienced leaders often overlook when working to improve their organizations. This step involves identifying what achievements need to be realized in succession to achieving the broader improvement goal. While this is a simple idea in concept, it is one that proves a bit more difficult in practice. This is because many of the metrics typically used to measure organizational performance are what can be described as lag measures. These are measures whose value can only be measured after an activity has occurred. One great example of a lag measure would be inpatient length of stay. How long a patient spends in a hospital can only be measured after it’s occurred. This means that once length of stay has been measured, it’s too late to improve performance on this metric. So what should leaders be looking at in order to improve lag measures such as length of stay? They need to review measures that are strong predictors of a patient’s length of stay which occur prior to patient discharge. Before we begin identifying possible lead  Novia Solutions, Inc. 31


HUMAN RESOURCES

measures for length of stay, I want to first emphasize why lead measures are so powerful. There are two reasons that lead measures have the power to make or break your performance improvement initiative. First, resources are limited. Money, time and energy are all gone at some point and once that happens we’re no longer able to meet our deliver on our mission statement. This means it’s critical that we invest what resources we do have in areas that will have the greatest impact on the goals we’re working to achieve. The key words here are “greatest impact”. Almost everything we do can be tied to one outcome or another if we try hard enough, but there are typically just a few actions that occur which have the greatest impact on our ability to achieve our goals. In our length of stay example, one might argue that delivering a patient’s meals on time each day contributes to achieving an appropriate length of stay. While this is true to some degree, it’s also true that avoiding 24 and 48 hour gaps in patient care, conducting daily multidisciplinary care huddles and planning for the day of discharge all have a much greater impact on achieving length of stay targets. By identifying strong lead measures, you’re ensuring the greatest “bang for your buck” for the resources you invest in your improvement initiative. The second reason lead measures are so powerful is because of their relationship with the broader goal you’re working to achieve. By design, lead measures will be addressed in advance of the broader goal, or lag measure. In our length of stay example, gaps in care, daily

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care huddles and discharge planning all occur prior to the patient being discharged. If performance across these lead measures occur as required, we can expect the patient’s length of stay to be appropriate. If not, we can expect the patient’s length of stay to be longer than expected given their condition. The predictive nature of lead measure helps to remove the element of surprise regarding what level of performance your organization will achieve on its lag measures and allow leaders to more accurately plan for continuous operational improvement. Once you’ve identified where your department or organization has opportunities to improve and you’ve selected strong lead measures where you can focus your improvement resources, you’re ready to begin designing and implementing performance improvement initiatives. This work will likely occur over several weeks or even months, which presents the challenge of team fatigue and burnout. As you saw with our lead measures, a few thoughtful actions can make a significant difference in the results you achieve and the same holds true when it comes to maintaining improvement momentum which I will be discussing in my next article, so stay tuned! •

This article was originally written by Josh Johnson when he was an employee of Novia Solutions’ former sister company, Novia Strategies. Used with permission from Novia Strategies.


CASE STUDY

Interim Perioperative Director Improves Employee Satisfaction 30% The Client

This 120-bed acute care hospital which is ranked as a U.S.News and World Report Best Hospital as well as being named as a Leapfrog Top Hospital needed an Interim Director of Perioperative Services

The Challenge

The PACU area did not have a recovery room manager which created internal conflict, staff attendance issues and lack of consistency in the department. In addition, floor nurses were reporting several incidents/week of lack of pain management for patients discharged from PACU.

The Approach

Novia’s Interim OR Leader used several techniques to increase communication, resolve conflicts, and improve staff and patient satisfaction. • Creating an open forum to resolve conflicts: Providing an opportunity to share examples of how a situation could be handled to improve problem resolution, minimize conflicts and improve rapport and moral amongst the staff. • Conducting daily rounds: Meeting with direct reports to purposefully understand the challenges staff were facing and the obstacles creating barriers to their ability to efficiently do their job. • Sharing reports with staff: Sharing activity and productivity reports with staff to increase collaboration between management and staff related to the • department’s efficiency and effectiveness. • Investigating incident reports: Determining the cause of pain management complaints from patients dischared from PACU to the genearl floor.

The Results

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HUMAN RESOURCES

Improve Your Team’s Performance: Start Keeping Score and Stop Giving Participation Trophies!

A

few weeks ago, I found myself driving through central California on highway 154. I was headed home to Los Angeles, on a road I’d never driven before. As the sun set behind me, shadows grew larger until everything was eventually pitch black. The number of blind turns through the winding hills became more frequent and speed limit signs seemed sparse. As I continued down the twisting two-lane highway, I did my best to make good time while maintaining a speed I felt was safe, given the challenging conditions. My time on the winding highway lasted just 33 miles, a small fraction of the 461-mile journey I would complete that evening. But at the end

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TEAM PERFORMANCE

of the 33-mile section, I found myself mentally exhausted. I had spent the last hour constantly guessing which way the road was going to turn, and trying to determine if I was driving a safe speed. The next day, as I reflected on this challenging part of my drive I began to realize why this road was so mentally taxing. During my drive, I had one goal in mind; drive as fast as legally possible while remaining safe. But I was constantly challenged to meet this goal because I was missing critical information during the drive. I had very little, if any information regarding which direction the road might turn or how sharp the turn might be to help me determine an appropriate speed to drive. This meant I had to use my own judgement which resulted in me going faster than I should in some corners and slower than I should in other corners, and constantly trying to adjust accordingly. A long and stressful situation to say the least.

... I was missing critical information during the drive. I had very little, if any information regarding which direction the road might turn or how sharp the turn might be to help me determine an appropriate speed to drive. What many leaders don’t realize is that the challenges of my journey down highway 154 and the corresponding mental exhaustion are something many people experience at the end of each workday.

Driving Blind at Work

The exhaustion your team may be experiencing has the same root cause as the exhaustion I experienced during my drive; little or no feedback is provided to help determine if they are meeting their goals and help them improve performance. In my last article, “Why Data is the Strongest Leader in Your Organization” I highlighted the importance of developing strong lead measures that are aligned with the organization’s core goals. Once these measures have been developed, every employee should clearly understand whether their daily performance is meeting each of these goals.

Start Keeping Score

In order for employees to understand how they’re performing on lead measures, a dashboard or scorecard will need to be developed that provides the right focus. In the best-selling book The Four Disciplines of Execution, authors Chris McChesney, Sean Covey and Jim Hueling establish four rules for developing a powerful team scorecard.

1

Keep it simple: Many organizations have increased their use of operational scorecards over the past five years. Unfortunately, the excitement to measure performance has often resulted in scorecards with complex measures that can leave employees scratching their heads to interpret what the data is really telling them. Avoid this pitfall by keeping metrics simple and limited in number. Depending on your team’s level of sophistication, you may want to avoid measures in the form of a ratio

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HUMAN RESOURCES

where possible. Ratios can change as a result of the numerator, denominator or both which can blur performance.

2

Make it visible: In order for a team to respond to what the scorecard is telling them, they first have to see the scorecard. A simple idea that is often overlooked. To accomplish this, two things have to happen. First, the scorecard needs to be refreshed on a regular basis. Second, the scorecard should be distributed to team members or posted in a location where team members can easily see it.

3

Include lead and lag measures: As important as it is to track performance on lead measures, it’s equally important to track the lag measures as well. Remember, lag measures represent the organization’s broader goals. If you’re performing well on lead measures you should see strong performance across lag measures as well. As you track performance across lead and lag measures and do not see a strong correlation in performance, this is an indication that you need to identify alternative lead measures that are more strongly linked to the organization’s lag measures.

4

Know if you’re winning: The most important element of a strong scorecard is to know if you’re winning or losing. If the scorecard includes the right measures, has been kept simple and distributed to team members on a regular basis then you’re team will have a clear view of whether or not they’re winning or losing, and what they may need to do differently to improve performance.

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TEAM PERFORMANCE

Stop Handing Out Participation Trophies

One of the greatest benefits leaders will realize once they’ve implemented a robust scorecard is the power to reward high-performing employees. Without a clear scorecard, leaders often find themselves giving out participation trophies; a pat on the back or “good job” to every employee to help maintain team morale without recognizing those individuals on the team who are truly driving the overall success. With the right scorecard in place, you’ll have a clear picture of how each employee is helping your team support the organization’s goals and can reward and challenge employees accordingly. You’re scorecard will also give you the ability to hold each team member accountable to achieving departmental goals.

One Item That Will Make or Break Your Scorecards

As of 2015, over 80% of acute care hospitals had adopted a basic electronic health record with the ability to capture clinician notes. As a result, digital healthcare data is expected to reach 25,000 petabytes by 2020. To provide some perspective as to the size of this data, that’s enough storage space to hold every DVD sold in the past 8 years! There’s no doubt this figure has continued to grow and this expansion has resulted in two major outcomes: 1. The healthcare industry is now creating and capturing more information than ever before 2. Healthcare leaders have greater op-


TEAM PERFORMANCE

portunities to leverage this information to improve the quality of patient care while reducing the cost While these two outcomes are exciting for the industry, they are also the reason many healthcare leaders are feeling the effects of paralysis by analysis. The increased generation of electronic information combined with an ever-growing focus to improve patient care and reduce costs has created an environment where leaders feel significant pressure to leverage this newly developed information, but don’t always know where to begin. The go-to approach is to develop scorecards. Everybody gets a scorecard!

In the increased generation of electronic information combined with an ever growing focus to improve patient care and reduce costs has created an environment where leaders feel significant pressure to leverage this newly developed information, but don’t always know where to begin. In my previous three articles, I’ve addressed how to develop a scorecard that is aligned with the organization’s broader goals by leveraging lead measures and developing a scorecard that is simple to understand and is updated on a regular basis. But if all you do is develop a scorecard, you shouldn’t expect to see any significant improvements in performance.

What’s Missing

Perhaps the lack of improvement following scorecard development has to do with the old adage; “It’s not what you do, it’s how you do it”. While it’s important to develop a scorecard that includes lead measures that are actionable for your team, what’s equally, if not more important is how you then utilize your scorecard. Developing a scorecard and simply posting it in the hallway or emailing it to team members does not qualify as utilizing the scorecard. Utilizing the scorecard requires a conversation among team members who discuss performance and work together to continuously improve. In the best-selling book The Four Disciplines of Execution, the authors recommend weekly team meetings with the following agenda: • Leader reviews the scorecard • Each team member reports on last week’s commitments • New commitments are set for the week ahead An example of how this meeting flows might be: Leader: Josh, last week you committed to delivering the monthly length-of-stay report to each nurse manager by Friday at 5 pm. Were you able to meet your commitment? Josh: No. The Chief Financial Officer requested my assistance with an ad-hoc analysis that was needed for our board of directors. I contacted each nursing unit manager and informed them the reports would not be delivered until Monday at 5 pm. Leader: Is there anything we could have

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HUMAN RESOURCES

done to address the CFO’s request proactively, or was it completely unexpected? Also, is there any support you need from the team to meet your Monday deadline? Josh: The CFO was not expecting to need this report so there is little we likely could have done in advance of the request from the board of directors. At this point, I am in a good position to meet the Monday deadline but will let the team know if I need any support. Leader: How will this new deadline impact your deliverables for next week? Josh: Next week, I am committing to provide the Revenue Cycle team with a breakdown of charges and payments by patient so that they can analyze our payer contracts. At this time, I do not foresee any barriers to meeting this commitment.

The individual responsible for leading the meetings is less important than what is said during each meeting. The individual responsible for leading the meetings is less important than what is said during each meeting. I’ve seen the leadership role rotate from week to week, giving each team member an opportunity to lead the meeting which can be empowering. In this example, the leader accomplishes three important things: 1. The leader holds me accountable to meeting deliverables that are required 38 www.noviasolutions.com

for the team to meet our goals, which will ultimately help the organization meet their objectives 2. The leader is offering support, if needed to ensure commitments continue to be met 3. The leader proactively addresses future deliverables, determines what if any risks exist to meeting these deliverables and works with the team to develop a plan to ensure future deliverables will be met Without establishing a cadence of accountability your scorecard will look great, but accomplish very little. Remember, it’s not only what you say, but how you say it. So leverage your scorecard to establish individual and team accountability for meeting those critical deliverables that are necessary to drive change in your team and across the organization. • https://dashboard.healthit.gov/quickstats/pages/FIGHospital-EHR-Adoption.php

This article was originally written by Josh Johnson when he was an employee of Novia Solutions’ former sister company, Novia Strategies. Used with permission from Novia Strategies.


TESTIMONIALS

Our Clients and Candidates Say It Best... • Interim Director of Perioperative Services “As Interim Director of Perioperative Services, I spearheaded initiatives to improve productivity, maintain first case on-time starts, and contribute to reduced room turn-over time. I’m proud to work with Novia Solutions to deliver measurable results for clients.” Mary Justesen, Interim Director of Perioperative Services • O’Connor Hospital “We come back to Novia Solutions again and again because they provide with us high-quality interims who deliver results.” Dawn Goeringer, Chief Nurse Executive & Julie Hatcher VP of HR, retired O’Connor Hospital • Interim CSSD Director “Serving as a mentor to hospital executives has been a rewarding aspect of my career. It feels great to help these rising stars achieve their career goals while also creating a safer environment for patient care.” Derek Mudd, BS-HCM, CRCST, CHL Sterilization and Perioperative Mentor

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How Much Do Leadership Gaps Cost Your Hospital? HEALTHCARE LEADER SEARCH CAN TAKE UP TO

6 MONTHS

1

1 IN 3 OPEN POSITIONS GO UNFILLED FOR

4 MONTHS

2

$8M

ANNUAL LOST REVENUE FROM CRITICAL POSITION VACANCIES3

Can you wait that long?

How will that gap affect the rest of your staff?

Can your department budget afford that hit?

The Impact of Hospital CEO Turnover In U.S. Hospitals, prepared for the ACHE Lean Human Capital by HealthcareSource survey, 2016 3 National Healthcare Retention & RN Staffing Report 2016 1 2

Stabilize turmoil, manage change and produce results with interim and permanent leaders from Novia Solutions. Learn more about us at www.noviasolutions.com

Michelle Campbell VP Client Relations 636-346-6868 mcampbell@novia-inc.com

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Contact us today to schedule your free consultation!

© 2017 Novia Solutions, Inc. All Rights Reserved

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10 Must-Reads For Healthcare HR Executives to Excel  

A collection of substantive thought leadership to provide you with fresh insight and knowledge as you continue your efforts to excel

10 Must-Reads For Healthcare HR Executives to Excel  

A collection of substantive thought leadership to provide you with fresh insight and knowledge as you continue your efforts to excel

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