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 of Kronos.

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 their shifts.”

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