Let’s face it, appropriate staffing ratios are critical not only to nurses, but health systems as a whole. The varying impact of adequate and inadequate staffing ratios has been evident for some time as health systems across the United States continue to adjust and move the staffing needle to meet volume demands, while carefully balancing cost savings initiatives. However, the last two years of the COVID-19 pandemic have shined a well-deserved spotlight on the ongoing need to have a reliable method to monitor, measure, and adjust staffing to ensure that nurses are able to deliver safe and quality care to the patients they serve.
As a UKG customer for almost 20 years, Allina Health System, also recognized this need and made the choice to pair their EPIC system with the use of UKG Workforce Scheduler Extensions for Healthcare as one of their key drivers to improving patient care, nurse retention, operational balance, and mitigating potential risks associated with patient safety as a direct result of staffing issues. After working with Allina during this implementation and to date, I thought it would an amazing opportunity for them to share a few lessons learned during their Extensions journey, so I caught up with their Lead Business Analyst and Champion for UKG Acuity, Tabitha Spike to discuss a few takeaways and lessons learned. Let’s take a look at some of the key highlights of our chat:
The why’s and the wins
Allina currently utilizes UKG Workforce Central®, Workforce Scheduler, Analytics, and now Extensions, which makes up an amazing workforce management portfolio to drive favorable outcomes in terms of operations, patient care, and indirectly controlling costs. Please share some considerations you made in terms of how Allina could utilize Extensions to improve patient care, specifically, what were some of the key focus areas and benefits you have seen through its use since going live?
Tabitha: We are using Extensions for a variety of reasons but more so to have a better understanding and constant awareness of patient and staff acuity/workload particularly, electronic retention of assignments for regulatory requirement, increased accuracy in our core staffing and target numbers, and communication between charge nurses, staffing office, and other house‐wide leaders. Our system provides patient need resource allocation, instead of being driven solely by raw patient numbers. The ability to assist our charge nurses with being able to predict staffing needs as well as adjust staffing based upon demand, were key factors and ongoing benefits of using Extensions. In addition, these capabilities have led to favorable impact regarding labor productivity, as it led to the freeing up of more time for our charge nurses.
The burning question—Extensions for healthcare and Epic Acuity
A common question that we have seen is why some health systems may choose Epic Acuity Orders to measure patient workload in Extensions. Can you talk a little bit about why Allina opted for this, as well as the related benefits or challenges?
Tabitha: Understanding patient acuity/workload is something we have tried to do using other subjective means throughout the years. The problem is that no two people can necessarily agree on a patient’s rating. Pulling acuity/workload based on flowsheet documentation requires that nurses are real‐time charting most of the time to ensure accuracy. As noted with the current COVID crisis, many organizations are turning to crisis documentation which impacts the number of flowsheet rows and which ones are used to capture “essential” patient information. Therefore, orders felt like the best fit.
Across our units, an order can generally be assigned the same point value as the assigned nurse. This is largely based upon pre-existing standards of care, grid/matrix, etc. One challenge is that we didn’t fully understand how Extensions would process orders, so we have noticed that there are orders that are weighted too high or low. We also did not anticipate the frequency in which some orders are on a majority of patient charts, for example: Narcan or D50 for hypoglycemia. The work associated with these orders are time‐intensive, but most of the time nurses are not needing to do this with patients and they are ordered on most patients. So, it is important to think in terms of the 80‐20 rule. The last challenge is the volume of orders we have. The initial weighting process will take time and you must be prepared to re‐evaluate your initial weighting after users have started using the tool.
The most impacted interfaces included beaker orders, diet orders, EKG orders, blood bank orders, and referral orders. This required work in all those interface order areas to “piggy‐back” or split off existing order feeds to send a parallel feed to UKG. The work to setup and test was time consuming for all teams involved.
I appreciate your time Tabitha! Do you have any final words of wisdom regarding your implementation to share with others?
Tabitha: Implementation is a significant change. Adequate super users/experts at‐the‐elbow during go‐live is essential. There are so many different tips/tricks, features, and functions that they can’t be taught all at once, so small bits of information at a time is best. If I had to do the implementation over, starting with our first unit/site, I would first have users move to requesting staffing needs through Extensions. Then I would have a pilot with at least 1 unit from each site (this could be concurrently with the transition to requesting staffing), and work through workflow issues for 30 days. Then move to implementation to the site level, but having the knowledge and expertise to understand the workflow, any known barriers, and help create those “super users/experts” to be used during implementation. Lastly, ICU and Mom‐Baby workflow can be more challenging. It is okay to adjust workflow, even post‐implementation, to support the work the charge nurses are doing and what leaders need. I would suggest considering Information System (IS) change management processes for streamlining.
Nurse staffing continues to reign as a complex issue for most health systems. However, utilizing systems, such as Extensions, coupled with progressive organizational culture, effective change management strategies, and access to relative resources, has proven to be a reliable approach to optimizing quality patient care. The benefits of this can be immeasurable in various ways, but even more importantly, in helping to retain the amazing nurses who render and support these services to the patients of our surrounding communities every day.