Our Take: Top of License Practice and Highest and Best Use of Clinical Staff

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May 12, 2014  |  Delia Caldwell

Recently a lot of articles and educational sessions have focused on using staff to their highest and best use, but any staff planning needs to incorporate flexibility.

Ideally, there is always the right person available to complete a necessary task when that person is needed, and any capacity and process analysis can determine the ideal mix and number of staff. It’s a worthy pursuit, indeed.

Unfortunately, most departments are hampered by budget constraints, position vacancies, or sick calls; many experience all of these all the time, at least to some degree.

In these cases, there needs to be flexible staffing plan that allows a little breathing room and offers benefit to our most important assets:  our patients.

For example, in an emergency department, expediting a patient’s care is of utmost importance. So when the tech is out of the department delivering another patient to an inpatient unit, does that mean that a blood draw or a room cleaning waits for the tech to return? It shouldn’t.

Even if these tasks are not part of a nurse’s highest and best use, there are other priorities that take precedence, like making a bed available for another patient, or getting lab results on a potentially critical patient.

Even in the example of a primary care practice, where usually there is not a life and death situation present, other priorities besides optimizing staff remain, such as patient satisfaction.

Any employee ought to be able to do whatever is needed to make a patient visit go smoothly, answer patient questions (within reason if clinical), and get a patient where he needs to go.

Of course, this kind of flexibility only works when staff are aware of their operation at any given time and are in regular and instant communication with coworkers. At FreemanWhite, while we conduct analysis to determine an ideal staffing pattern, we also look at how a physical space can facilitate communication amongst staff, and ensure processes and systems incorporate flexibility for who can do what, together or separate, and when.

That’s a complex effort often requiring a detailed analysis tool such as computer simulation modeling, but one that cannot be overlooked–we include it in just about every operational analysis we do.

We haven’t yet found the clinical department running the ideal staffing pattern in which doctors and nurses and techs and other employees all have their specific tasks and carry those out exactly when needed. And we aren’t likely to.

 ABOUT THE AUTHOR     Delia Caldwell MBAoutcome_swarming_Delia Caldwell
Delia Caldwell works with clinical staff to put the systems and processes in place they need to improve care and save lives. Through simulation modeling, process mapping, and dashboard tools she helps departments reduce LOS, improve patient outcomes, and streamline operations. A skilled facilitator, Delia guides organizations through change, using data to demonstrate that her recommendations will improve productivity and efficiency. With more than 85 operational studies completed, her efforts have redefined the way that providers deliver care. Read more from Delia.

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