How Legacy Health improved nurse satisfaction & cut costs with a new approach to workforce management

Nurses, patients and physicians aren't numbers, but most workforce management programs treat them as such. By adopting a patient-focused workforce, management systems can properly pair patients and caregivers together to help achieve topline patient outcomes. It's time for health systems to take a more human approach to workforce management.

API Healthcare CNO Karlene Kerfoot, PhD, RN and Portland-based Legacy Health System Director of Clinical Resource Management Danielle Bowie, DNP, RN, shared details behind Legacy Health's patient-centered workforce management solution during a Feb. 19 webinar hosted by Becker's Hospital Review and sponsored by API Healthcare.

To address an overly complex and dated staffing process, Legacy Health implemented a systemwide program that takes a balanced, patient-centered approach to workforce management. For the workforce management reboot, Legacy Health tapped API Healthcare.

The workforce management needs of the healthcare market are evolving. No longer can workforce management strategies focus only on labor cost containment. Now, health systems must also take into account the impact staffing has on both patient outcomes and staff engagement.

"[In the past] a patient was just a number, a workforce just a number, a nurse just a number." Dr. Kerfoot said. "We're moving towards patient-centered programs where we look at the needs of the patient, match the caregiver characteristics with the needs of a patient and do it in a helping environment. Legacy has taken a strong approach to that and has some real outcomes."

During the webinar, Dr. Bowie and Dr. Kerfoot discussed Legacy Health's journey toward a more human-centric approach to workforce management.

Legacy Health's story
With eight hospitals, 13,500-plus employees and 4,200 nurses, Legacy Health boasts more than $2 billion in revenue. In 2014, the health system partnered with API Healthcare to implement a new enterprisewide electronic time and attendance system. In 2015, Legacy deepened its partnership with API Healthcare and embarked upon a reboot of its staffing solution that had been implemented in the 1990s. The outdated system had several flaws.

The system included a centralized staffing office, a systemwide resource pool and a centralized approach to contract labor management, Dr. Bowie said. A lack of unit customizability and occasional lax utilization prevented the staffing office from functioning properly. The system also lacked an acuity system and daily productivity trackers.

"Due to the high variability of use and engagement from end-users concerning our workforce technology and staffing practices, Legacy felt it was necessary to hit the reset button and start fresh," Dr. Bowie said.

In 2015, Legacy embarked on a workforce management strategy that utilized integrated time & attendance and staffing & scheduling at its foundation, with other systems such as a patient acuity system and a productivity tracking tool amplifying their outcomes. In June 2016, Legacy launched the new staffing and scheduling tools across its 126 inpatient nursing departments. The implementation was done over four waves ending in October 2017. The new system featured open shift notification, a mobile time management system, analytics, a patient classification system and an attendance monitoring system.

The new technology, complemented by Legacy Health's commitment to drive engagement, yielded positive results. In a post implementation survey, 74 percent of nurses reported feeling their unit was adequately staffed. The new system also standardized Legacy's terminology, policy practices, workflow and technology designs. A nurse at one Legacy hospital could go to any of Legacy's other seven hospitals and utilize the exact same framework.

Dr. Bowie highlighted Legacy's float pool as an example of the system at work. Legacy uses an internal agency with no per diem staffing and very few travelers. Legacy's float pool serves 11 departments. When building a staff schedule, the central staffing office can view enterprisewide resources and schedule nurses accordingly.

When it comes to filling shifts, the system allows nurses to mark whether they're available for extra work. Then when the system is seven-days away from an opening the staffing office sends an open shift notification to all who are available. If the shifts are still available two days out, the system will send additional notifications to all staff qualified for the shift, continuing until the shifts are filled.

In addition to the increased nurse satisfaction, the system also decreased Legacy's nursing contract labor spending, relying on its own nurses instead. In fiscal year 2017, Legacy spent $3.2 million on contract labor. That figure dropped to $2.1 million in 2018. So far, Legacy has only spent $1.5 million in fiscal year 2019.

"Our workforce strategy was to look at everything and ensure we were managing our resources well and really asking the question, 'do we need contract labor, or can we actually use our employees who are cross trained to fill staffing needs," Dr. Bowie said. "Our technology and build help us easily scan and understand who's available to do the work and has the right competencies to care for the patients' needs."

While Legacy's results have been impressive, the health system is planning to implement more tools to drive further improvements. Legacy wants to develop additional workforce and labor management dashboards, develop better compliance tracking software and partner with vendors to enhance the end-user experience.

"The Legacy team is proud of where we are today, but we're always planning for the future," Dr. Bowie said. "We have the ultimate dream of creating the full staffing picture by reporting patient outcomes and workforce metrics together."

To view a recording of the webinar, click here. Check out more workforce management success stories here.

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