Give nursing managers the teeth to do their job
Evidence-based systems that highlight staff shortages in real time
will help directors of nursing and ward managers to safeguard the
quality of patient care and avoid risk, says Tristan Spencer
20 March 2013
Several stories reported recently by the BBC have talked about
NHS hospitals failing to operate with safe staffing levels,
according to the Care Quality Commission, including the now
notorious case of Stafford Hospital.
Roy Lilley, NHS commentator from NHSManagers.net has said that
nurse directors must have known that the trusts concerned were
operating with dangerously low staff levels.
The Royal College of Nursing has been warning for several years
that some areas in some NHS trusts are understaffed, and a recent
poll of 600 nurses by Nursing Times found that 75% had
witnessed situations that they considered ‘poor’ care during the
last 12 months.
Nursing directors and ward managers know when they are
understaffed, but often seem to lack the hard evidence to do
anything about it. A culture has developed in the NHS over recent
years where the focus has moved away from patient care to improving
working lives. As a result, shifts are often arranged to suit
individuals’ requirements, rather than the ward or department as a
whole. Addressing this situation upsets staff, and managers often
shy away from the confrontation.
A catalyst for change
Automated workforce management systems can help managers take
control of shifts and bring back some element of standardisation to
the hours that staff work, while highlighting staff shortages, as
they happen in real time. These same systems have links to the
Electronic Staff Record (ESR), which can be a significant help in
avoiding payroll errors and fraud.
If a manager can see exactly who is working — when and where —
and if there is currently a potentially dangerous shortage of staff
in a certain area, they can do something to rectify the situation.
Such systems not only empower the manager, but they provide an audit
trail of staffing levels, skills mixes, nurse/patient acuity levels,
permanent/agency staffing ratios, and unplanned absence.
Transparency improves staff utilisation
Geoff Smith, project manager of nurse staffing and electronic
rostering at Pennine Acute Hospitals NHS Trust said: “The SMART
solution from Kronos has had a significant impact across implemented
wards, enabling increased levels of transparency for all staff and
providing real time management information that enables improved
utilisation of staffing resources within our organisation.”
Brendan McGrath, Assistant Director of Nursing at the Western
Health and Social Care Trust stated: “Our aim is to ensure that we
meet our care and staffing key performance indicators. The workforce
management system helps us to do this and provides benefits to staff
on several levels. Nurses see the fairness and equity of the system
when shifts are allocated. Ward sisters particularly like the
monitoring of contract hours used, and the prioritisation facilities
within the system, allowing staff to take more responsibility for
Return on investment
Automated workforce management systems provide other less obvious
benefits beyond simply ensuring that the right staff is in the right
place at the right time (although that in itself is a huge step
forward for many healthcare organisations).
By having the correct levels of staffing across all departments,
a healthcare organisation can ensure that regulatory requirements
are met, such as the Care Quality Commission registration, and NHS
Litigation Authority (NHSLA) standards, as well as Working Time
regulations. Reducing risks of harm, avoiding fines and reducing
membership premiums (for example to the NHSLA) can provide a
compelling return on investment.
An automated workforce management system can help healthcare
organisations of all sizes control labour costs, minimise compliance
risk, and improve workforce productivity and, most importantly,
deliver quality care.
Visibility of staff helps deliver quality patient care
In addition to helping healthcare organisations meet the QIPP
(Quality, Innovation, Productivity, Prevention) agenda, innovative,
next generation workforce management systems provide critical labour
data to management. These systems help meet the requirements set by
regulators, commissioners, and the professions, as well as deliver
efficiencies and cost savings called for by the Government. There is
no excuse for Trusts, the systems to help them are out there, and if
they were in use by the Trusts mentioned in the BBC report, some of
the situations putting patents at risk could have been averted.
Tristan Spencer, director, SMART, a Kronos solution