Culture change is falling short. Don't get me wrong, I'm a big believer and supporter of the culture change movement in long term care. I am an active board member of the Ohio Person Centered Care Coalition which advocates for culture change. Even OnShift’s scheduling software supports aspects of culture change principles such as consistent assignment. As you can see, I am a big supporter of the movement. Now let me explain the problem.
I just returned from the OK Leading Age Conference where I presented scheduling practices to improve care. My audience was filled with Directors of Nursing and other clinicians. During the presentation I asked to see a show of hands of facilities that have implemented culture change. Most of the hands in the room went up. Then I asked for everyone who has implemented consistent assignment to leave their hands up. Most hands remained in the air. Then I asked for everyone who has implemented acuity-based staffing to leave their hands up. One hand remained in the air. This didn't surprise me, but really got me thinking. If culture change is all about building your healthcare practice around the needs and preferences of the residents, how can it be accomplished if you don't know if you have enough staff, or the right staff to meet resident’s needs?
It's true that facilities today have made such great advances in clinical, operational and financial technologies, created great programs such as greenhouse and Eden to better cater to the needs of the resident, but have yet to make significant strides in quantifying staffing requirements to effectively execute on those needs. It’s not that the facility does not know the clinical needs of the residents. The MDS assessment catches every clinical detail on admission and uses it for billing. But, this information is not used in creating the staffing plan. Most facilities today have staffing targets they need to meet in the form of a staffing matrix (number of employees needed based solely on the number of residents), HPPD (number of hours needed based on the number of residents), or even both. But these methods overlook a vast variety of clinical needs and patient-centered care preferences that impact the number of CNAs or CNA hours actually needed. Other than the census increasing, there are typically no per-approved extra hours for things like resident ADL spikes, falls, extra assists, and behavioral problems that require more staff. The DON typically makes those decisions and then must painstakingly justify to management.
This might not apply to all facilities, especially ones that cater to a higher standard by staffing considerably higher than state requirements or are not constrained by budgets. But for the vast majority this should be a big deal for two primary reasons: cost containment and close scrutiny of clinical outcomes in preventing unnecessary hospital readmissions. Incorporating acuity helps to make sure the right number of staff is on hand to provider proper care to your residents. It helps to pinpoint those exact requirements. And, as long as you meet requirements, why staff extra when you current resident population has low ADLs, for example? This can represent critical dollars saved.
The other reason for acuity-based staffing is accountability in proving to partners; especially the hospitals that you are effectively providing the right level of care which will help reduce unnecessary readmissions. Use the data about your process and results to strengthen relationships with hospitals. Acuity based staffing will help you be first in line for the best referrals.
The evidence is compelling. Even a great culture change strategy can end up falling short without a complementary staffing component that takes into account the clinical, functional and social needs of the residents. Staffing to acuity is an important topic and I look forward to more discussion that will help drive real change across our industry.
Be sure to read this OnShift white paper on Staffing to Acuity 5 Reasons To Make It Your Top Priority. It is a great place to start to better understand the importance of acuity in caring for the resident and why it should be considered a critical element in the culture change movement.
