Comment: Give nursing managers the teeth to do the job!

Several stories reported recently in the media have addressed the issue of NHS hospitals failing to operate with safe staffing levels, including the now notorious case of Stafford Hospital. Roy Lilley, NHS commentator from NHSManagers.net, responded to the reports by claiming that nurse directors must have known that the trusts concerned were operating with dangerously low staff levels. A Nursing Times survey has also revealed that 75% of nurses polled had witnessed situations they considered ‘poor’ care over the last 12 months. In this article, TRISTAN SPENCER, director of SMART, a Kronos solution, looks at how 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 in the future

The Royal College of Nursing has been warning us for several years that some areas in some trusts are understaffed and nursing directors and ward managers know about this, 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 as individual’s requirements, rather than the ward or department as a whole

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 as individual’s 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 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.

A need for transparency

Geoff Smith, project manager of nurse staffing and electronic rostering at Pennine Acute Hospitals NHS Trust, which has implemented the SMART workforce management solution, said: “The SMART solution 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.”

Addressing this situation upsets staff, and managers often shy away from the confrontation

Brendan McGrath, assistant director of nursing at the Western Health and Social Care Trust, added: “Our aim is to ensure that we meet our care and staffing Key Performance Indicators. The SMART 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

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 reports, some of the situations putting patents at risk could have been averted

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 NHS Litigation Authority, can provide a compelling return on investment.

Additionally, 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 reports, some of the situations putting patents at risk could have been averted.