Harnessing ward‐level administrative data and expert knowledge to improve staffing decisions: A multi‐method case study

Abstract

Aim:The aim of this study was to investigate the impact of changes to bed configuration and patient mix on nurses' workload in a single ward.Design: Multi-method case study. Method:The study was undertaken in an acute 28-bed ward in a tertiary referral public hospital in Queensland, Australia. Ward-level administrative data were obtained for a 2-year period, 12 months before bed configuration changes in October 2015 and 12 months after. These data included patient activity (bed occupancy, transfers, length of stay and casemix) and nurse staffing (budgeted and actual staffing levels, employment status and skillmix). Semi-structured interviews were conducted with ward nurses (N = 17) to explore the impact of the bed configuration changes on their workload. Results:Administrative data showed that the bed configuration changes resulted in more complex and dependent patients, increased patient transfers and greater variability in casemix. The interview data found these changes to patient complexity and activity intensified workloads, which were further increased by staffing decisions that resulted in greater reliance on temporary staff. Conclusion:Hospitals already possess the data and expert knowledge needed to improve staffing and bed management decisions without the need for additional, costly workload systems. Impact: Determining appropriate nurse staffing in light of the complexities and variation of patient needs at the ward level remains a challenge. This study identified increases in patient complexity, dependency, variability and churn that increased workload. Staffing grew but hidden factors associated with temporary staffing and skillmix further intensified nurses' workload. Harnessing existing data and the expertise and experience of nursing unit managers (NUMs) would help staff wards more efficiently and effectively, providing reasonable workloads and appropriate skillmix that can enhance the safety and quality of patient care. To facilitate this, NUMs

Beyond ratios - flexible and resilient nurse staffing options to deliver cost-effective hospital care and address staff shortages: A simulation and economic modelling study

“…However, our findings challenge a number of key assumptions underlying such an approach. Distributions of demand are not symmetrical for many units, and understaffing was far more common than overstaffing in both our simulation and our empirical observations ( Griffiths et al. 2020 ; Saville et al., 2021 ).…”

“…In our models, we assumed that temporary staff were equally as efficient as permanent staff. In some cases, for example where the flexible staff are staff from the home unit undertaking overtime, this assumption may be warranted but in most circumstances, this is unlikely to be the case ( Duffield et al., 2020 ). There is little indication that this flexible staffing plan achieves a more efficient deployment of a scarce staffing resource or substantially reduces overall demand for that scarce resource.…”

“…Other studies have highlighted that modest use of internal redeployments have the potential to be beneficial, although unconditional use of floating staff between units is problematic and may lead to poor outcomes ( Maenhout and Vanhoucke, 2013 ). The presence of staff who are unfamiliar with the unit means that such staff are unlikely to be as efficient as permanently assigned staff ( Duffield et al., 2020 ). The potential harms associated with use of temporary staff might be minimised by the use of dedicated float pools of staff who are specifically trained to work in a range of areas and rostered with the intention of being available to float between units, although there is limited direct evidence ( Dall'ora and Griffiths, 2018 ).…”

Costs and consequences of using average demand to plan baseline nurse staffing levels: a computer simulation study

“…Our particular assumptions about the relative productivity of temporary staff were untested, but our sensitivity analysis suggested that this assumption made little difference to the overall estimate of understaffing, 39 although recent studies highlight the potential that supervision of temporary staff may reduce the productivity of the team as a whole. 32 We used data from four hospitals in England and saw consistent patterns, but the results may not transfer to other settings.…”

Beyond ratios - flexible and resilient nurse staffing options to deliver cost-effective hospital care and address staff shortages: a simulation and economic modelling study

“…In our models, we assumed that temporary staff were equally as efficient as permanent staff. In some cases, for example where the flexible staff are in fact staff from the home ward undertaking overtime, this assumption may be warranted but overall this is unlikely to be the case (Duffield et al, 2020). There is little indication that this flexible staffing plan achieves a more efficient deployment of a scarce staffing resource or substantially reduces overall demand for that scarce resource.…”