The Business of Caring

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Dear Colleagues, Today s healthcare leaders understand the linkages among nurse staffing patient outcomes and high value. health care The relationship between nursing care and patient outcomes in particular is now widely. accepted Nevertheless it is often difficult to achieve an evidence based allocation of nursing resources. that is understood and accepted by all, Recognizing the potential value added by optimizing nurse staffing and the downside risks of failing to. do so our nursing and finance organizations have teamed up to chart a path forward This report. explores the evolution from conventional quasi adversarial nursing finance working relationships to the. patients first interprofessional collaboration that is a reality for nursing and finance leaders at some health. care organizations and aspirational for others The report also sets forth an action plan for improving. allocation of nursing resources that includes pioneering creative approaches conducting broad based. technology assessments working toward joint accountability agreeing on shared principles and. promoting interprofessional collaboration, We believe that collaboration between those who deliver care and those who ensure the financial viability. of care delivery is the key to success in developing outcomes based nurse staffing models and improving the. value of care that patients receive It is our hope that this report will be a catalyst for achieving these shared. goals Thank you for your interest and your commitment to high value health care. Robyn Begley DNP RN NEA BC Loressa Cole DNP MBA RN Joseph J Fifer FHFMA CPA. FACHE NEA BC,CEO American Organization for President and CEO. Nursing Leadership ANA Enterprise CEO,Healthcare Financial.
Chief Nursing Officer Management Association,American Hospital Association. hfma org The Business of Caring Promoting Optimal Allocation of Nursing Resources. Executive summary 1,Introduction 2,The conventional CFO CNO relationship 3. Assessing the value added by appropriate nurse staffing levels 4. Reaching a shared understanding of value 6, Building interprofessional nursing finance teams 6. Understanding financial and operational stressors on nurses 7. Understanding financial and regulatory stressors on finance leaders 8. Engaging patients as a shared goal 9, Action steps for improving allocation of nursing resources 10. Pioneer creative nurse staffing approaches 10,Assess new technology Panacea or pain point 11.
Work toward joint accountability 12,Agree on shared principles 13. Promote interprofessional collaboration 14,The collaborative CFO CNO relationship 15. Conclusion 16,Appendix Shared vocabulary 17,Footnotes 19. Exhibit 1 What is safe staffing 2,Exhibit 2 Conventional CFO CNO conversation 3. Exhibit 3 Commonly used hospital performance metrics 4. Exhibit 4 Impact of appropriate nurse staffing on outcomes 5. Exhibit 5 Care unit specific factors that impact care delivery 5. Exhibit 6 Building interprofessional teams focused on achieving value 6. Exhibit 7 A systematic approach to improving allocation of nursing resources 10. Exhibit 8 Systemic stressors and corresponding principles for allocation of nursing resources 13. Exhibit 9 Organizational strategies for promoting interprofessional collaboration 14. Exhibit 10 A collaborative CFO CNO conversation 15. hfma org The Business of Caring Promoting Optimal Allocation of Nursing Resources. Executive summary, In an era of escalating pressure on health care organizations to nursing and finance developing a shared vocabulary leading.
streamline operations and reduce the total cost of care the nurs with quality and building trust with consistency Amid efforts to. ing budget which is a significant proportion of labor costs is a improve collaboration between nursing and finance the impor. perennial target for scrutiny Although the relationship between tance of the patient experience should always be front and center. nursing care and patient outcomes is widely accepted today it is. Implementing strategies for improvement Attempts to. often difficult to achieve an evidence based allocation of nursing. align staffing with acuity systems for budget purposes have been. resources that is understood and accepted by all Cutting nursing. largely unsuccessful leading hospitals to rely on their own internal. staff can actually work against efforts to improve care and reduce. data rather than evidence based approaches To remedy this. costs Delivering higher quality of care at a lower price is a key. situation the authors call on health care leaders to take the follow. goal of health care organizations today Investing in appropriate. ing steps to improve allocation of nursing resources Although. nurse staffing offers a clear glide path to achieving outcomes that. many of the specifics in this report are tailored to acute care. support this goal, hospitals the following steps are applicable to all types of health. Gaining insight The chief nursing officer CNO and chief care organizations. finance officer CFO are the dyad that interprets and advocates Pioneer creative nurse staffing approaches Optimize staffing. for designated resources They may face challenges in working using evidence based approaches to help organizations. together effectively because finance and nursing professionals make informed decisions enhance workforce utilization. tend to view value through different lenses In general nurses and improve outcomes. perceive value in achieving desired patient outcomes preventing Assess the impacts of new technology on all phases of care. complications and supporting professional and ethical practice before during and after implementation In some cases. Historically finance leaders have equated value with return on improvements in certain outcomes may come at the expense. investment and achieving desired regulatory outcomes that opti of other elements of the care episode. mize payment Ideally these should be viewed as complementary Work toward joint accountability Addressing long term. rather than mutually exclusive challenges requires fierce collaboration starting in the. C suite and diffusing throughout the organization, Bridging the gap To reach a shared understanding of value. Agree on shared principles Workplace stresses on nurses. interprofessional team building is a key success factor and gain. and finance professionals have ripple effects on the entire health. ing insight into the workplace stressors that nursing and finance. care organization These systemic stresses translate to principles. professionals confront on a daily basis is a prerequisite Several. for allocating appropriate nursing resources for patient care. stressors are unique to those in nursing roles including staff. Promote interprofessional collaboration They key to delivering. nurses nurse managers and nurse executives These stressors. high value health care is collaboration among clinicians health. include the need to improve quality while reducing costs and. care administrators and finance leaders Interprofessional. provide patient care through the frequent introduction of quality. collaboration is predicated on relationship building When. and safety initiatives all while managing the churn in a dynamic. finance and nursing professionals achieve a shared understand. environment of discharges transfers and admissions In recent. ing of value and build solid working relationships that reflect. years changing payment models regulatory requirements cost. insight into their respective workplace stresses all health care. containment pressures and disruptive competition have emerged. team members the organization and most importantly. as sources of stress for health care finance leaders Several best. patients will reap the benefits, practices are particularly important to building trust between. hfma org The Business of Caring Promoting Optimal Allocation of Nursing Resources 1. Introduction, Clinicians and nonclinical executives alike recognize the understood and accepted by all members of the executive team. importance of keeping patients safe promoting and restoring as well as the staff The chief nursing officer CNO and chief. health and meeting patients and families health care needs finance officer CFO are the dyad that interprets and advocates. throughout the life cycle An abundance of evidence supports for designated resources Their collective opinion carries signifi. the direct contribution that registered nurses RNs make to cant weight with other C suite leaders and decision makers who. achieving these goals 1 determine final allocation of resources. Direct patient care provided by RNs includes both hands on It is important to note that nurses at every level including staff. care and cognitive work that incorporates application of nurses routinely make decisions that can impact the organization s. knowledge from formal education and experience 2 Ensuring financial health For example being aware of the issue of patient. deployment of appropriate nursing resources and creating an supply waste and making an effort to reduce it advances key. optimal work environment is critical to providing adequate levels organizational and systemic waste reduction goals 5 Staff nurses. of both hands on and cognitive care reducing errors and pro are also keenly aware of the need to anticipate and plan for patient. moting safe practices 3 4 In recent years nurse staffing models and family transitions in care that affect hospital length of stay. have emphasized safe staffing which matches RN expertise to post hospital resources and patient education to increase adher. a patient s needs as the key determinant for resource allocation ence to discharge instructions and follow up care all of which. Safe staffing as described in Exhibit 1 is synonymous with can have significant impact on finances Also nursing care is a key. evidence based staffing contributor to the patient experience As such the quality of the. nurse work environment is strongly associated with patient satis. Although the relationship between nursing care and patient. faction as measured by the Hospital Consumer Assessment of. outcomes is widely accepted today it is often difficult to achieve. Hospital Providers and Systems Survey HCAHPS in particular. an evidence based allocation of nursing resources that is. Exhibit 1 What is safe staffing,number of RN,care hours.
Assessing the right skill,patient mix of other,experience care team. Analyzing Analyzing,overall costs of care,productivity. Monitoring, hfma org The Business of Caring Promoting Optimal Allocation of Nursing Resources 2. Introduction continued, with whether patients would definitely recommend the hospital While primarily focused on acute care settings the key takeaways. to others 6 This measure gets considerable attention from organi are applicable to finance and nursing professionals in all types of. zational leaders What is important to note is that the adequacy health care delivery organizations The need for interprofessional. of nurse staffing is one of the most important determinants of collaboration cuts across health care settings. nurses positive assessment of the work environment. The conventional CFO CNO relationship,The goals of this report include the following.
Describe the evolution of the CFO CNO relationship and Not long ago finance and nursing executives were often at odds. the differences in their respective views on value with each other when it came time to establish the annual budget. Identify and describe stressors on clinical and finance leaders They may have believed they shared mutual goals but in reality. to promote mutual understanding and facilitate joint decision the CFOs wanted a guaranteed surplus and the CNOs wanted. making about nurse resource allocation robust nurse staffing At times these goals appeared mutually. Encourage use of shared vocabulary and understanding exclusive The CFOs wanted good staffing to avoid patient. of the vital components of nurse staffing in the context of complaints The CNOs knew the no margin no mission mantra. good financial stewardship that was frequently invoked to reinforce the need for ensuring. Link stressors to principles for facilitating productive working resources for capital expenditures A typical conversation. relationships between nursing and finance professionals between a CFO and CNO in that scenario is shown in Exhibit 2. Outline action steps leaders can take to promote optimal. This scenario has changed for the better Finance and nursing. allocation of nursing resources leaders today share an understanding of the mutual interests that. Exhibit 2 Conventional CFO CNO conversation,CNO Jaimie. What s important is to,look at outcomes We,need the right mix and. CFO Sam CNO,number of staff to keep Length of stay hasn t. Jaimie I ve reviewed patients safe report on budged and costs are We ll try but I worry. your budget submission quality measures and going up so we have to what will happen. and once again you ve keep patient satisfaction cut somewhere Our without adequate. asked for far more scores up If we can labor is 50 of the staffing It leads to. FTEs than we can afford hire more permanent budget mostly in your burnout and turnover. How are you going to staff we can use fewer areas Other depart and omissions in care. The Business of Caring Promoting Optimal Allocation of Nursing Resources Robyn Begley DNP RN NEA BC CEO American Organization for Nursing Leadership Pamela F Cipriano PhD RN NEA BC FAAN Former President American Nurses Association Todd Nelson FHFMA MBA Director Partner Relationships and Chief Partnership Executive Healthcare Financial Management Association

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