Healthcare Management Forum

Staff scheduling has historically been embedded within hospital operations, often defined by each new manager of a unit or program, and notably absent from the organization's practice and standards infrastructure and accountabilities of the executive team. Silvestro and Silvestro contend that “there is a need to recognize that hospital performance relies critically on the competence and effectiveness of roster planning activities, and that these activities are therefore of strategic importance.”¹ This article highlights the importance of including staff scheduling — or workforce deployment — in health care organizations' long-term strategic solutions to cope with the deepening workforce shortage (which is likely to hit harder than ever as the economy begins to recover). Viewing workforce deployment as a key organizational competency is a critical success factor for health care in the next decade, and the Workforce Deployment Maturity Model© is discussed as a framework to enable organizations to measure their current capabilities, identify priorities and set goals for increasing organizational competency using a methodical and deliberate approach.

L'établissement des horaires du personnel a toujours été intégré à l'exploitation des hôpitaux, est souvent défini par chaque nouveau gestionnaire d'une unité ou d'un programme et est remarquablement absent de l'infrastructure des pratiques et des normes de l'équipe ainsi que de l'obligation de rendre compte. Silvestro et Silvestro soutiennent la nécessité d'admettre que le rendement d'un hôpital dépend largement de la compétence et de l'efficacité des activités de planification des horaires, qui sont d'une grande portée stratégique.¹ Le présent article fait ressortir l'importance d'inclure l'établissement des horaires du personnel, ou déploiement de la main-d'œuvre, dans les solutions stratégiques à long terme des organisations de santé pour affronter la pénurie grandissante de main-d'œuvre (susceptible de frapper plus fort que jamais lorsque l'économie reprendra). Il est essentiel de percevoir le déploiement de la main-d'œuvre comme une compétence organisationnelle, et c'est un facteur de succès capital pour le milieu de la santé au cours de la prochaine décennie. Par ailleurs, le Workforce Deployment Maturity Model© (modèle de stabilisation de déploiement de la main-d'œuvre) peut constituer un cadre pour permettre aux organisations de mesurer leurs effectifs courants, de déterminer les priorités et d'établir des objectifs pour accroître la compétence organisationnelle au moyen d'une démarche méthodique et délibérée.

Managing multiple priorities and achieving sustainable outcomes is a challenge for leaders across health care organizations. One academic health science centre set about to address this challenge through the development of an innovative annual goal and objectives process that aligned every unit/department around organizational priorities. The results have enabled exceptional outcomes for individuals, teams, patients/families and the organization as a whole.

A results-driven approach to optimizing patient flow, grounded on quality improvement, change management and organizational learning principles, is described. Tactics included collaborative governance, performance management, rapid process improvements and implementation toolkits. Results included an 83.1% decrease in emergent volumes waiting for greater than 24 hours and a 49.1% improvement in emergency department length of stay for admitted patients. There were no adverse outcomes on other key indicators. Sustainability remains the challenge but early results are encouraging.

The current crisis in Canada's health care system calls for transformational change in the way we deliver care. The Collaborative Model of Care is not a new concept, but has not been implemented in Canadian acute care hospitals until recently. Toronto East General Hospital developed and piloted a collaborative care model on three acute units and initial results are promising in terms of improved patient safety, patient satisfaction, job satisfaction and improved use of resources.

The financial costs associated with Adverse Events (AEs) for older patients (≥65 years) in Canadian hospitals are unknown. The objective of this paper is to describe and compare costs between patients who experienced an AE and those who did not during an acute hospital admission to a tertiary care facility Patients with an AE had twice the hospital length of stay (20.2 versus 9.8 days, p < 0.00001), resulting in 1,400 extra days at a cost of approximately $7,500/patient.