Health care organizations are complex systems that require a multitude of moving parts to work smoothly. The background operations that keep health systems running are key to enabling frontline doctors and nurses to deliver quality care. As a registered nurse and health care administrator for 45 years, I have a unique perspective on the challenges facing health care organizations today.
Earlier this year, I attended the Healthcare Operations Summit in Park City, Utah. There, I joined health care leaders from 26 organizations across 32 states in a discussion of the state of health care operations in America and the urgent challenges facing the industry, including financial pressure, burnout and workforce shortages, compliance adherence, and safety issues. Though we all came from different backgrounds in the health care space, discussions overwhelming circled back to patient care: how can we, as nurses, physicians, health care administrators, strategic partners, and industry stakeholders work together to improve care quality and access through optimizing the non-clinical operations that keep hospitals and health systems running day in and day out? I believe that convening the right players and championing enterprise-wide data are the first steps to improving health care operations and creating a health care system that better serves us all.
The clinical and financial impact of chief nursing officer math
Drawing connections between clinical work, operational challenges, and data is a key part of the role of a chief nursing officer (CNO)—a concept I like to call CNO math. To illustrate what this means to me and how it can impact you and your local communities, I’ll share an anecdote from my own career. In one of my roles as a CNO, we looked at productivity in our pediatric unit. We had calculated the number of nurses we needed on the unit based on the number of patients and hours of care per patient per day. We should have been adequately staffed, but we were consistently coming up short-staffed, leading to issues meeting patient care needs and higher costs in staff overtime and supplementary staff. We eventually found the reason: roughly two-thirds of the nurses on the unit had 30 or more years of service, and they were eligible for extra paid vacation, a factor that hadn’t been considered. The math no longer worked.
While veteran nurses were bringing significant value to the unit, this discovery led to our decision to hire seven new junior nurses to fill those gaps in staffing, approximately $370,000 a year of added staffing costs a year based on national averages. That’s where data connectivity and CNO math are key. Until we connected the data across departments, we couldn’t find the reason why we were short-staffed. The same applies in other areas, including quality and safety: Why are we seeing infections going up? Where are spikes occurring, and why? Why are we experiencing resource shortages? The answers to these questions can often be found when systems and data are connected across the enterprise.
To solve the data connectivity problem and make CNO math easier, we need to have a collaborative structure where nurse managers can consistently sit down with the chief supply chain officer, chief medical officer, or chief technology officer to talk about the data that’s driving their departments and identify where we can work together and do better. At the moment, these structures don’t really exist—the C-suite and the medical staff are largely siloed from each other, with everyone only looking at their own data. I believe that connecting data between workforce management, credentialing, quality, and supply chain must be a top priority in order for hospitals and health systems to thrive, not just survive. We need to convene the workforce in a way where we are operationally effective, high quality, and truly safe for those that we are serving.
Optimize vendor relationships and make AI your copilot.
It’s not uncommon for health care organizations to have 50+ different operating platforms for different purposes such as human resources, clinical care, or workforce management. Health systems are constantly implementing shiny new technology, but after the big hubbub around rollout they move onto the next big shiny thing. To truly improve health care operations, we need to take these siloed platforms and solutions and integrate them. We need to invest in and implement more training and purchase technologies that can leverage the existing infrastructure. Additionally, we need to hold partners accountable for troubleshooting and optimizing technology after implementation to ensure that the solution is delivering on its promise, whether that’s producing cost savings, reducing overtime, or identifying areas that need immediate attention.
One of the recent shiny technologies garnering attention in the health care space is artificial intelligence (AI). While health care organizations should be careful to make a few strategic investments rather than over-investing in disparate technologies, I do believe that AI is going to be our copilot in the coming years to drive data connectivity and low-cost, effective care. AI will never be a replacement for the talented frontline workers who provide patient care, but it can be leveraged to augment care, streamline processes, and relieve some of the administrative burden on clinical and administrative staff. Smart health systems will have thoughtful planning discussions on how technology and innovation can improve ROI.
Drive progress toward a better health care system for all.
Improving health care operations is a big undertaking, and health systems are strapped for time and resources. Leveraging data connectivity, CNO math, and automation requires making smart investments and incremental improvements that will pay off down the line.
I’d urge health systems to act now because the risk of inaction is too high. Health care operations are a critical underpinning that can prevent or set off a catastrophic chain of events. When health care operations and technology aren’t optimized and clinicians are overly burdened by technology rather than empowered by it, there is a risk of medical errors, morbidity and even patient mortality.
Taking action to improve health care operations requires a game-plan and actionable steps. I recently joined other health care leaders and signed a pledge to commit to five actions that health systems must take to bring health care operations to a higher standard. Other top health care leaders across the country have signed the “Pledge to Advance Healthcare Operations” to improve the following key aspects of health care operations, which will give organizations the ability to deliver exceptional patient care:
1. Empower decisions. Unify and standardize health care operations tools, reporting, and analytics for decision-making — ensuring we are getting close to real-time valuable data-based insights
2. Prioritize user experience. Champion user-oriented technology that supports and strengthens an exhausted health care workforce
3. Advocate for better data. Unite around one dynamic and reliable source of truth for provider data as well as other related health care operational data.
4. Expand access, build loyalty. Exceed the expectations of today’s transient health care consumer with patient access and loyalty ecosystems that rival those found in other industries.
5. Facilitate the advancement of care. Embrace proven innovation and automation to streamline care and operational efficiency, raising expectations for how our industry delivers care.
In addition to focusing on these key areas, I believe that we need federal legislation and financial assistance on our side. History shows that with meaningful legislation, real change is accelerated: in 2009, legislation requiring health systems to adopt electronic health records (EHRs) revolutionized health care by creating a mandate for digitization and data connectivity. As clinician shortages and low margins continue to plague health systems and affect their ability to provide quality care to patients, it’s imperative to be bold and build on that initiative.
Linda Knodel is a health care executive.
