Abstract
BackgroundHistorically, governmental hospital organisation consisted in a heterogeneous distribution of staff and a fragmented logistical organisation without cross-functionality or sharing of resources between departments. This organisation could not last in a context of an evolving healthcare environment, changing patient profiles and hospital expenditure constraints. Cost-effective workforce regulation for optimal patient quality of care was urgently needed. The purpose of the study was to describe the reorganization that led to resource management no longer based on what has been achieved but based on a daily measured workload.MethodsThis prospective study used nursing intensity indicator, mirroring patient care needs, which was reported daily using VALPAReSO® software. Indirect care activities were recorded in departments of medicine, surgery and obstetrics. Based on data collected in 2012, a new organisation strategy was implemented and evaluated in 2015.ResultsNursing intensity indicator analysis led to a reallocation of workforce per department, and the reinforcement unit (float pool) was managed based on this decision-aid tool for replacement and daily adequate staffing. The healthcare workflow audit resulted in the revision of five working tasks: time spent on handover, working time management, connections between services and the pharmacy, housekeeping, and food management. The reorganization took place at the same time as the transition to the development of very short-term care, resulting in a decrease in the number of full inpatient beds, which were therefore mainly occupied by heavier care profile patients. With the integrated strategy, this transition was achieved with constant staffing, and good overall patient satisfaction and working conditions were maintained.ConclusionThe reorganisation strategy was managed in a context of institutional commitment, coaching leadership built on close manager-employee interaction, a defragmented management between healthcare and all service providers, and a seamlessly dissemination and sharing of indicator information between healthcare managers, nurses and healthcare assistants. The process optimization allowed a better allocation of tasks and enabled nurses to refocus on patient care. Nursing intensity and indirect care indicators, when widely accepted, can be used as decision support tools for daily adequate staffing.
Highlights
Governmental hospital organisation consisted in a heterogeneous distribution of staff and a fragmented logistical organisation without cross-functionality or sharing of resources between departments
Additional tools are necessary to quantitatively and qualitatively assess the daily activities of nurses and healthcare assistants, and to provide decision support system in term of work organization, working condition improvement, and adequate staffing according to patient needs
Several measurement tools of nursing intensity exist like the Projet de recherche en nursing (PRN) in Canada used since the 70s [2], the RAFAELATM system owned by the Association of Finnish Local and Regional Authorities [3], the Safer Nursing Care Tool, a National Institute for Health and Care Excellence (NICE) endorsed tool [4], the Scottish Community Nursing Workload Measurement Tool [5] and the Pendiscan [6], a French system that determines patient dependency profiles
Summary
Governmental hospital organisation consisted in a heterogeneous distribution of staff and a fragmented logistical organisation without cross-functionality or sharing of resources between departments. It was introduced to better describe hospital services and to improve measurement and management of hospital services It provides indicators on medical activities and management costs of different pathologies, but it does not link patient needs with healthcare provider workload. In France, the most widely used method is called SIIPS® [7] It provides a common methodology for measuring the burden of care and for obtaining a model estimating the workload of hospital care through explanatory variables. Nurses and healthcare worker assistants ensure tasks that do not directly affect the patient These tasks correspond mainly to administrative tasks, logistics, phone, training, and management. A specific methodology was designed and validated by the French Ministry of social affairs, health and city in order to standardized the measurement of indirect care in French healthcare institutions [9]
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