Can you help to secure the continuity and quality of our care?
The teams of a medium-sized nursing and home care organization in the middle of the country were increasingly hard pressed to fill their duty rota in a responsible manner. That was bad for the health of the organization and its employees. The director wanted to know how he could secure the continuity and quality of care for his customers with his people.
What was the problem? To answer that question, we performed an analysis that started with talking to all the key players in the staff planning process. The general conclusion: everyone was up and about to fill the duty rota at the last minute. The department heads were not happy with the flexitime office. And the flexitime office found that the department heads saddled them with finding too many people for the duty rota. And that they overlooked the fact that understaffing made it impossible for either of them to do their job.
In addition, it had become painfully obvious that none of the different players had ever agreed clear procedures for the staff planning process, what needed to be done by who and when, or how to help each other if things didn’t work. The result: massive frustration, great difficulty in sorting out the pool of flexitime employees, and lots of temporary workers on site to fill the gaps. Nor was it clear to the department heads which standards to apply for staffing and booking personnel. As a result, no vacancies were placed to make up for understaffing. The past year, the organization had a net outflow of employees. Finally, the supply of information to the teams was based mainly on financial data, lacking any translation into specific hours, levels, or duty rotas. So, there was never any real clarity on how much room they had to fill the gaps.
What the organization sought to achieve with this project was to create stability in the team staffing process. So that customers would always get sufficient care and a more regular crew of employees to give them the assistance they needed. In other words: capacity management with the focus on customers.
We started by talking to all the individual MT members to ascertain what they thought about the planning process. It turned out that everyone saw it differently. But to finalize the details at the end of this project, we needed to have all MT members on the same wavelength. How? By getting everyone to see that responsibilities need to be defined before they can be assigned. Because if a team’s responsibilities are not clear, how can a team account for them? For example, if it is not clear that a team may not spend more than 100 hours filling gaps in the staff rota, fat chance of them sticking to that limit.
Together with the flexitime office, team ambassadors, and members of the MT, we dissected the staff planning process and set down who was responsible for what – and what to do if that arrangement fails. Such as if a team does actually know that it can spend 100 hours to fill the gaps, but that it simply cannot manage. Who can employees turn to for help – and when? And if they have been asked to keep a limit on sick leave, when are they allowed to exceed it? If someone is seriously ill? Or even before? And when are they allowed to organize a substitute without having to ask their superior first?
Together with the organization, we established a logical relationship between the demand for care and the number of employees ultimately assigned to that task. This gave us an accepted standard for the deployment of staff. We established a clear standard for the demand for care, based on the organization’s care concept. We also took stock of which tasks the team still needed to perform besides providing care (such as staff planning, placing orders, mentoring students, training sessions, and meetings). Our aim was to incorporate that as much as possible into a fixed duty pattern to bring stability to the indirect tasks. The teams drafted a duty pattern, based on the standards. We used this duty pattern to design a practicable model for the ‘ideal staffing’ per team.
Based on the duty pattern, the teams outlined procedures to lead the staff planning process. These ‘rota guidelines’ are used by the planning staff at the beginning of each planning period. Standards have also been agreed with the flexitime office. Each time, the team consults the flexitime office on the main points so that it knows what to expect. This prevents having to email and call each other back and forth: no more frustration.
The flexitime office has been converted into capacity management with an intermediary role. The staff planning role has been shifted to the teams – with support from capacity management. Each team must take the step to put customers first in planning staff to meet the demand for care. We set to work on that as soon as possible. Based on all the new procedures, we started to train and coach the teams in staff planning.
Thanks to the clearer goals and responsibilities, accepted at all echelons, responsibility for staff planning has become more a process of sharing success and asking for help – and much less a control process. As a result, the organization is well on its way to ‘ideal staffing’.
Thanks to the improved staffing and sound duty pattern, the teams have more to hold on to in staff planning, with advice and support from the capacity manager where necessary. This has created more stability, staff turnover has been reduced, and absence due to sickness is on the decline. And as a result, hardly any temporary workers are needed any more. In addition, employees know much earlier on what is in store for them. And that makes their job much more enjoyable as well.
