Benchmarking Deconstructed
In the healthcare sector, the significance of adequate nurse staffing cannot be overstated. Nurses are the backbone of patient care, and their availability, skill level, and workload directly impact patient outcomes, staff morale, and the financial health of the institution. Historically, peer to peer benchmarking nurse staffing in hospitals has been utilized as a method of identifying potential savings opportunities within clinical or administrative departments. While this is an important process and control mechanism to ensure labor spending is in the range of similar organizations, there is a lack of connection between these metrics and what is needed to manage labor in realtime. This blow will explore how these benchmarks have and should be utilized in conjunction with other data points and solutions to appropriately and effectively staff nursing units.
The Challenge of Staffing Benchmarks
While the benefits of benchmarking nurse staffing are clear, there are several challenges to consider:
- Data Collection and Analysis: Gathering accurate and comprehensive data can be time-consuming and requires sophisticated data management systems.
- Customization for Different Units: Nursing units have unique geographical nuances as well as staffing models that are difficult to compare when benchmarking. If a unit has beds in multiple physical locations (i.e., different floors), core and variable staffing levels will be higher than a single physical location. Additionally, there are specific needs based on the type of patients cared for in that unit as well as other non-nursing personnel. Even with a normalization effort, these differences are often not captured fully by simple employee headcount or FTEs which are the basis for most benchmarking tools.
- Patient Volume: Peer benchmarking accounts for high-level characteristics of organizations like total staffed beds, total operating revenue, total admissions, etc. While these are helpful to size and scope the complexities within each hospital’s patient volume, again making an ‘apples to apples’ comparison quite challenging.
- Patient Acuity: Arguably the biggest issue with historical benchmarking methods is that acuity as measured by each specialty is not accounted for within staffing metrics. At best, the Case Mix Index (CMI) is included in the attributes used for peer grouping which is a global metric measuring overall acuity. The end result is not specific, adding another layer of inaccuracy to datasets.
- Balancing Cost and Quality: Finding the right balance between maintaining high-quality care and managing costs is a continuous challenge. Overstaffing can be financially unsustainable, while understaffing can compromise patient care.
Nurse staffing benchmarks have served as a standard measure to evaluate and compare the staffing levels across different hospitals or healthcare units. These benchmarks help identify gaps and areas for improvement, ensuring that hospitals maintain optimal nurse-to-patient ratios. That being said, there are some challenges with the data as each hospital is quite unique in terms of unit structure, patient volume and acuity.
Application of Benchmarks in Productivity
Several approaches can be employed to benchmark nurse staffing in hospitals, through there are two that are commonly used in acute care settings. There is a more ‘old school’ hardline approach that assumes the benchmark is accurate and should be used as the target for productivity within each unit. This ‘old school’ approach makes a broad assumption that the data submitted by those peer organizations has high integrity and the normalization has considered the nuances of unit structure, patient volume and acuity. As explained previously, there is a high likelihood that this is not the case. This often leads to a frustrated nurse leader that understand these differences have not been accounted for and thus, there will always be a variance which can be significant. At the end of the day this is not helpful or productive to nurse leaders.
The other is a self-improvement approach fused more ont he opportunity and takes the benchmark into account directionally to set improvement goals but uses the actual current productivity targets as the baseline to which a specific percentage goal is applied. This entails using benchmarks to identify whether there is an opportunity for improvement and then applying a targeted percentage of progress each quarter or year. This approach considers the uniqueness of each unit while still working towards the benchmark targets over time. While it may not be as aggressive, all those nuances that were not captured in the benchmarks are acknowledged and the nurse leader has flexibility on how to achieve the targets.
There are reasons for each approach and the financial pressures on healthcare are real and continue to increase, though framing these benchmarks as objective is a stretch. Nurse leaders should be voicing their perspective to encourage a more patient-centric method for creating staffing targets. Benchmarking nurse staffing in hospitals is a critical strategy for ensuring that patients receive high-quality care while maintaining the well-being of nursing staff and the financial health of the institution. However, assuming that the benchmarks are fully accurate and account for nuances in each organization make adopting these as gospel often leads to a frustrating and ineffective result. To overcome these challenges, using a self-improvement method promotes collaboration and innovation that can lead to buy-in from nurse leaders and have positive outcomes. .
Conclusion
Benchmarking nurse staffing in hospitals is a critical strategy for ensuring that patients receive high-quality care while maintaining the well-being of nursing staff and the financial health of the institution. However, assuming that the benchmarks are fully accurate and account for nuances in each organization make adopting these as gospel often leads to a frustrating and ineffective result. To overcome these challenges, using a self-improvement method promotes collaboration and innovation that can lead to buy-in from nurse leaders and have positive outcomes.