Friday, May 5, 2023

The Zen of Time Management for Hospital Executives, Providers, Managers, Charge RNs and Supervisors

Part I of IV

Zen Mindfulness/

Zen Management

Forget Mastery, It's A Practice

Time management is a time-honored practice. But time can't actually be managed. It's a fixed resource, portioned out in exact and specific amounts to each individual at exactly the same pace. You can't speed it up or slow it down, or add to or take away from it. No one can give you theirs. 

Why Do I Need To Manage My Time Better? 

It's when you run out of time, that you may think "Hm, maybe I can manage it better?" 

Or when you are exhausted you may think, "This shouldn't have taken so much effort and time."

Or when you are waiting in delay, or finding you must do the same task repeatedly; looking for the same orders or checking for test results multiple times until they show up; have the same conversation multiple times with the same or a host of different people who each must be tracked down and hounded; redo the same work again, often with the same people. And  you may think, "This isn't a good use of my time."

Or maybe you resign yourself to : "Welcome to Emergency Medicine."

Or when your subordinates or colleagues let you know things in your area aren't ideal, you may ask yourself, "Why is it that things seem so smooth for me up here but not so smooth for everyone else who reports to me?"

Or when, with staffing turnover and shortages, you see that the lack of experience is creating more problems, problems that had been fixed long ago and now the team needs to be rebuilt...And you realize in a flash, "that's on the leader. That's on me.... That isn't on the director or manager below. It isn't on the system President above...It's on me" at whatever level you are at.

And you may conclude: "Where will I find the time?..."

"There Must Be A Better Way to do this. What Am I Missing?"

When the Student is Ready, the Teacher Appears

OK, you're now ready to learn more about executive time management.

Time management is a misnomer, but a good practice, because you are mastering the art of managing your own activities within identified time allotments. That includes a strategy you build to reach specific objective goals you list: aligned to the organization, our patients, the community and the economics of care. 

You are a Grain of Sand on the Beach of Patient Care

Time management starts with the grudging acceptance that you can only control your own behavior, and that behavior may have had mixed outcomes. It is an acknowledgement that you are just a part of a larger system and that system controls much of your day.

From understanding and Balance flows Efficient and Effective Action

The journey to better time management begins with the desire and possibility that maybe there is something different you can do within your available time, something more, that you are not doing today which, tomorrow, will save you multiples of time and produce better outcomes.

Don't Just Stand There. Do Nothing.

And you may realize there are some things that you automatically do, reflexively do, thinking you are taking charge, but actually don't need to do, and by doing you are actually burdening the flow of care.

Your own activity might just be getting in the way. 

By not doing those things, or just not quite so much, and just watching and encouraging, seeing what others are doing and encouraging that,  more will get done.

The more aware you are, the more control you can have. The more reactive, unconscious and emotional you are, the less awareness and control you can have.

Time tracking is  Management Mindfulness:  observing what you actually do in the moment, the reaction among others, the environment, and objectively recording it...It's Time Management Zen

You may think that much of your day may require responding to unplanned events and demands, leaving you no available time.

 But as you observe yourself dispassionately in the moment, and record honestly, you will find...

A. "Some of these things could have been avoided had I done X earlier."

B . "Wow, I'm waiting. Patient isn't ready yet, exec is late....I can do something with this delay: Review my tasks for today; see how the patient's family is doing with home placement; confirm availability with the nurse for my next patient."

C. "Hm. The hour I planned got interrupted but I still have 30 minutes to do part of what I had planned!"

D. "She is actually waiting for me, she is another partner in this, another potential pair of hands, waiting. I'm wasting her time in trying to do this other thing and not communicating, educating and aligning her participation right now...And with that, now we could have two pair of hands, four pair of hands, six pair of hands working on this right now. Instead of just my pair of hands working on something else that can wait, and no one working on the care that is waiting."

You learn to appreciate the half-full glass and take a drink.

Zen See  / Zen Do

This is why a scientific approach, first and foremost, to observing and tracking your time usage dispassionately and honestly, is the first step to growing awareness. Analyzing that, you may find where you can actually try something different. And that idea may just pop into your head as you are observing and recording.

That 'something different' that you can control will be a small thing, a tiny change, a new idea, an outreach to a colleague, a question that can be answered right now from the people you are with. No prep required. No waste. 

Spontaneous behavior from a prepared mind, seeing opportunity and having objectives already in mind, has no other prep time, no waste, no planning or scheduling required. It is the most efficient use of time, the highest level of vigilance. Spontaneous, balanced response rather than thoughtless reaction, is more efficient than good planned and scheduled work. However, it generally happens as a significant byproduct of good planned and scheduled work. 

That small change could just be remembering to stop and look at where you are and what is happening and record that. Or your new change could be to stop and look at what you are trying to do, your to-do list,  when you find you can't do anything else. All of these prepare you to see and move on the opportunity for behavior change. The less re-active you are, the more responsive  you will be. 

Now interruptions, delays, questions and complaints aren't sources of frustration and anger. They are sources of observation, information,  creativity, and instant improvement in service.

Building The Plan / Understanding Reality Better

When you understand reality better, as a good observant scientist, you see both constraints and opportunity.

Zen Thought - Zen Plan

Thinking about what you see and understand, a plan emerges naturally as next steps. 

Putting a plan together  with the limited wiggle space you have, given the duties and tasks you are obliged to fulfill on demand is a creative process. That includes having the time to put the plan together, making sure the plan aligns with your  goals and mission, and that of your colleagues, superiors and organization. You will see that this becomes a stream-of-consciousness activity, and the plan emerges of itself as you consider what is and what it can and should be.

It's Not Going To Get Done Today

The Zen of No Time

If you find you aren't getting everything done you want to, that is the Zen of No Time. That's where you always want to be, to have a vision of what needs doing, and then the reality that is always more complicated. This is where prioritization comes in, so that you get something done.

Zen Prioritization...It May Not Happen

There is no point in prioritization as long as you are operating under the illusion that everything will get done.

Much more than your list is already getting done, and not everything on your list will get done. 

If it really is a list of what really needs to happen, not everything you envision for today will happen.  You aren't the only one with a list. It's a balance among a lot of people, some visible and some you may not know, often with a fulcrum outside your point of view.

If you find you are getting everything done on your list, it's too short. You left something important out. But that's OK, it'll come to you as you give a little time to think of your list now and then. Doing more is not actually the point. Doing the right things is.

The Zen of Life is Always Full

If you assiduously attempt to keep your list short and limited to what only you can do, to avoid being overwhelmed; if you attempt to fill a ten pound bag of time with only five pounds of activity, that isn't Zen. You will constrain your connection, influence and responsibility, and create a silo that will burden others who must now make up the gap, or worse, patient delay that is used to make up the gap. All ten pounds will actually be filled. But if you can prioritize what to expect today, and keep that real, knowing what you can't plan for, then that's progress. Then you use the time, whether planned or unplanned, in a better balance.   

Zen Pebble / Zen Pond

Why more on your list than you can do? You are staying connected to all the things on your mind, connected to all the people, patients, colleagues your thoughts are connected with, knowing that, like a swim in the pool, you won't cover every cubic inch of the water, but you may create the waves and ripples that, gently,  do. Your list is your reflection, of you, of your place, in action, in your environment.  That's always going to be larger than any given moment of time. 

Others may get done the things on  your list. As you review and update your list through the day and days ahead you will realize that your list is more than you, a living snapshot of something that is fluid, alive, and involves many more people.

You are always part of something larger than yourself. You are a member of something larger. You are here to help others by doing and through doing. Your activity is part of a collaboration with others. Your To-Do list should reflect this, if it is realistic. In healthcare, this is simply reality.

Zen Now Zen Nature 

Zen Nature Zen Plan

Just as you observed your actions dispassionately, as a scientist, observe your own thinking as you plan, and when frustrations arise, recalling past failed efforts to change things, note that with equal dispassion. It is just one more passing thought. 

The right plan will emerge in time and that experience will be part of it. The plan might not fit into today, or tomorrow. But if you can keep that focus, it will become in its time. Let it come through you and your colleagues as discretionary, not demand. 

Zen Plan / Zen Strategy

All plans are strategic if they are made with a larger awareness of the organization's objectives, and align patient, community and hospital.

Zen Flow No Force

Plans don't become reality by force but by flow.  Where there is force, flow is impeded. 

No Blame No Credit No Distractions

In this environment where all are focused on their patients, their own behavior, objectives and plan, working together, this fills our attention.

Zen Flow: 


No thought 

In Physical Medicine Outpatient work, for example, out of an eight hour day, there are usually one or more patient cancellations, no shows or reschedules that open up some time for discretionary work you can do on a project, or reaching out to a colleague to ask for information or propose a new idea. Ah the beauty of instant messenger, email and your portable tablet, laptop or phone!

Having today's list of things you would like to do simply prepares your brain to bring up those those things when time becomes available. 

Zen Moment in the Now, in the Center With Patients,

And with Colleagues, in the Defined Moment and Place

Having your own clearly detailed priorities for discretionary time,  you may choose to schedule other colleague requests for non-patient activity and discussion appropriately around those priorities. 

You begin to prioritize what actually needs to happen now from what can be scheduled for later. Both activities benefit from doing so.

Zen Moment Zen  Plan

Demand Time and Discretionary Time

Work activities come in many flavors, and two of these are demand vs discretionary. Demand activities must be completed now or by the deadline they are schedule for. Discretionary activities are those that don't need to be done now. They may need doing soon. They don't need to interrupt the flow of care demand. They can be scheduled for a later  time today or this week.

Zen Flow, Zen Ripples

No Interruptions

When you are interrupted you must stop, put down what you were doing, alter thinking, listen, process and respond, prepare, deliver service, digest, then pick up where you left off.

Work that is driven by interruption is often half as efficient. That means it requires at least twice as much of your time to complete the same task as if it were scheduled and planned.

Interruptions take you out of the care Zen moment, distract your attention, and reduce vigilance. And those interruptions add delay to all the patients you are going to see today. A five minute delay adds five minutes to all 5 patients waiting for you, or 25 minutes of delay total. But what you don't see is the effect on your functioning after the interruption ends. You must remember, pick up the pieces, reset your mind and activity, and ramp your pace back up again. What was a 5 minute interruption becomes a net loss of 10 minutes of functional performance, and possibly vigilance of short term memory lost and unrecoverable. What you don't remember you can do nothing about.

Therefore that 10 minutes now translates to 50 minutes added to your 5 waiting patients total, plus whatever you forgot that goes undone. But as it is only 5 minutes of your perceived time, your view becomes a separate perspective from the situation of your patients. 

You may prioritize that 5 minutes as reasonable. But had you known you were adding 50 minutes total delay and  a short list of forgotten activities, you might have seen things differently.

Once you reacted blindly as if each request for your time were an immediate patient demand, even when it interrupted waiting patients. But now you see it differently.

Feng Shui Your House of Time

Putting activities In their proper priority and placement

If it isn't patient flow work, the key question is: "Do you need this right now, or can we schedule time for later? I'll be better able to give you more time, and to prepare a better answer also.... What looks good for you this afternoon? Tomorrow Afternoon...In two days...? "

Be a Satori moment of balance and understanding in the flow of action

Be willing to actually schedule time on your phone calendar instantly, in that moment with your colleague. Yes, take 2 minutes instead of 5. Save 3, and eliminate 30 minutes of functional service delay to your patients. 

Perfect Immediate Action Flows from Balance and Creates Balanced Patient Flow

By scheduling immediately, you are giving your colleague  something far more important. They won't have to worry about when their question will be answered. It's scheduled. You are making that moment work in the flow, rather than break your flow. You are teaching them. And now they can stop and think,  plan and prepare to meet you at the agreed and trusted time later. And you can do the same. That will help you both make better use of time. You are teaching them about discretionary work as a very important thing, worthy of scheduled time and preparation, but a lesser priority to patient demand work. Doing this, you perform both with less interruption, greater efficiency.

Zen Calendar, Satori Calendar

Now you offer to schedule discussion time later today or tomorrow, or the next day, so that you can make progress on your own priorities and plan to add greater value to the scheduled discussion.  You use your calendar actively. Your calendar reflects your values, including time for preparation. It is a whole, a Satori moment. 

You are in control, or more precisely, you are responding functionally to reality and not reacting to it, no longer pushed to perform under unnecessary pressure that can affect  your judgement and what you deliver.

"Lack of Planning On Your Part Should Not Be An Emergency On My Part"

-Handwritten sign on the door of a Radiology Manager

Then, you also can prepare for the requested discussion and improve the use of that time. Maybe there is something you also need from that person? Now you can prepare your thoughts. And prepare to supply a broader, more robust answer that can be more helpful and reduce call-backs and questions.

The paradox here is that planning the discussion just a little later and preparing for it produces a better outcome that saves elapsed time by reducing churn. Patient Length of Stay is shorter when meetings are planned, thoughtful and productive.

While instant messaging is very helpful, its primary purpose should be saved for patient-flow real-time demand work. It's a powerful tool to save time and reduce waste for that purpose only.

 Scheduling off-line discussion for discretionary work also helps you stay focused on the actual line work and its timely delivery.

Zen Change Happens

Just doing the above changes the way care is delivered and the way caregivers and management work together. It is itself a more efficient process of doing and management. And that leads to new insights and better processes.

Zen Gaps > Zen Learning 

Once you realize what can be done, it is natural to ask yourself, "Do I have the skills?" and if not, then fill the gap by scheduling time to learn. Make the road smoother for everyone through your own ongoing education and training. 

Zen See > Zen Learn 

You may also be aware now of the skills your colleagues are applying every day.  This happens when  you are not entirely absorbed in trying to do the smallest things, or being divided and distracted by endless interruptions. 

Observing and recording, being in an observer role, you can see what you didn't see before, the quality of service your colleagues are delivering. 

Understanding their skills, observing and seeing their work objectively now, you can also learn some of it from them. It happens naturally. 

Zen Leadership / Zen Teams..Becoming One

And as a manager, director or executive, you can facilitate knowledge transfer just by acknowledging the specific behaviors you see and buddying people up so they can learn from their peers.

This is why every level of management needs to walk the floor and watch the work every week.  

Zen of Leadership:

If not now, when?

If not you, who else?

In times of higher staff turnover, early retirement, consolidation and change, this is doubly necessary. 

At exactly the time senior executives would rather hole up in an executive cave making executive decisions and delegating all responsibility for operational management to subordinates, they must force themselves to do something in addition: rounding at least weekly on the front line, observing, acknowledging high performance as it happens, engaging, listening, responding and facilitating. This is the core of team-building.  This is the sewing that weaves all the layers together.

Zen Do is Zen Belief

What The C-Suite Physically, Visibly Attends To Becomes the Value of the Hospital and Health System, Not What the C-Suite Says (unless they also, personally attend to that)

This is  also the  demand work of management, even senior management. Just as is a board meeting, a meeting to negotiate mergers and alliances, a press conference, a meeting with local employers, or a meeting with Physician leaders to work on their contract.

 The primary demand work of the C-Suite is rounding on the floor of the front-line worker: purposeful, transparent rounding and engagement, each executive by themselves. 

These are basic requirements to function error-free in times of change; to accelerate recovery, capacity, growth, engagement, excellence, patient experience and revenue.

Zen Leader Zen Student 

When you go, know what you are looking for, and know how to respond when you see it. And if you don't, just go observe with an open mind. If you don't understand what you are looking at, ask. And if you think you do understand, take a step back and ask anyway. This is one function of every member of management that cannot be delegated to anyone else.

Zen Seed Zen Forest

Daily observation, acknowledgement, response and facilitation by the senior executives and all levels of management rounding at the front line immediately improves the efficiency and effectiveness of everyone else, and sustains that performance.

It's not a matter of "Now they are watching, I better pay closer attention".

It is a matter of "They clearly value this work. This executive really loves to watch great care being given,  and that validates my devotion to the work also."

This form of executive time management, making other's time more efficient and effective by attending to their work, acknowledging their performance,  may require new skills and a learning curve, which generally requires more effort, patience and willingness to make course corrections along the way. This is an investment that yields tremendous returns. 

But it isn't just the Senior Executive that can take a moment to see and acknowledge good work. Everyone can and should do this. If you can observe yourself, try taking a look at your colleague.

When the leader does it, when that is their routine, everyone else begins to follow that model without ever having to be asked.

Questions? Reach out to Dirk or Spence


Next Section, Part II, Time Mgmt Tools and Analysis on the way...

Monday, April 10, 2023

This Dinosaur Must Die

Hospital care and diagnostic work is still, classically, woefully, wasteful and inefficient

One of the most prevalent and greatest sources of inefficiency in hospitals is the unsynchronized and unmanaged execution of various care and diagnostic activities. It's gone on for so long it's become invisible to care givers, managers and executives. 

The persistent inefficiency glaring to any hospital patient and their family members, has become non-existent to the very people who must work to fix it. But there it is. 

Less than half of a hospital caregiver's time is spent with patients...and there are 4 other employees, who don't work directly with  patients, "supporting" them.

It is common to see less than half of a therapist, lab scientist,  technologist, nurse and physician's time with their patients during peak day hours, and that is often their highest percentage of direct patient care time throughout their day. 

Elvis Has Left The Building

The effect is substantial delay for patients and a demand for large numbers of highly trained professionals who, today,  are just not there. And who will manage these crew? Experienced management have left the building. 

The result, growing gaps in care

Despite a large constituency of Performance Improvement departments, executives and consultants who have worked on efficiency year in and year out, little lasting or real improvement has been made. Or, more precisely, improvements that often are incredible and have substantial impact on bottom line, quality and morale are allowed to fall apart without leadership commitment to conjoint professional accountabilities: Leadership to continue the effort, because, indeed, sustained higher performance is a sustained effort. 

With good leadership, the effort is a point of pride. Without leadership, the ones still making the effort are targeted for ridicule.

Humpty Dumpty is just a broken shell of his former self 

Once these painstakingly built and implemented solutions fall apart, it is a monumental task to rebuild them: The task facing Hospital management and executive leadership today. 

Most Care and Diagnostic Work is compressed into one-third of the available time

Roughly 75% of all patient care and diagnostic work is ordered between the hours of 6 am and 2 pm on weekdays. That's 75% of the work ordered during only 24% of the total hours every week. Or only 36% of the total patient waking hours during the week. 

That's compressing 75% of the Diagnostic and Care work into  one-third of the available patient care hours.  It is done so everyone can work something like a "normal" schedule: come in at a reasonable time and leave on time. However, without solid work synchronization,  adding work compression on top of clinical order batching leads to derailed care:  Patient admissions, transfers and discharges are all held up, each passed off to the next shift, doubling or tripling handoff work, delay and risk.

Work compression, work batching,  unsynchronized and uncoordinated activity, error, waste, rework, delay and rescheduling have plagued hospitals for all the decades of hospital history. 

The Dinosaur practices still roam the earth, though now they have EMR road signals and saddles. But they are still Dinosaurs. 


There was a day when highly skilled people managed patient care with complex subtlety as one

The lost arts of collaboration in real time are known in places.  The superpowers of nearly telepathic teamwork and a much broader range of professional  responsiveness. These required highly trained, situationally aware and skilled individuals who connect immediately to their patients and each other. 

While the new Dinosaur practices have multiplied, with the help of technology,  to replace the old, the newer crew in settings without good veteran supervisors and mentors, know nothing of that.  They go forth unaware, assured that following the orders of their AI-generated worklist represents the bulk of their professional duty and assume this to be best practice. It is all they know. 

Are there alternatives? Yes, and they have been implemented here and there successfully in some of the nations' best hospitals years ago. They produce better margins and stable crew over time. But they are long-term investments in crew deeply imbedded into the very fabric and history of the hospital.

Linear Flow EMR Work Lists are new silos, Baby Dinosaurs


Technology has helped inform, but hurt patient flow.

Now new physicians in the ER insist on seeing test results first before they see their patient. And in many cases never see their patient. They have replaced eyes-on-patient-first with eyes-on-computer-first and sometimes only.

Instead of working in real time, transparently, with their team, now work is stacked in the EMR in lists. 

Managing the list leads to batching, which is very efficient for the one managing their own list, but terrible for care across multiple work lists. 

The EMR thinks your groceries are the meal and so it took away the kitchen

The EMR work list is a seductive temptress: Maybe you don't need as much collaboration or conjoint accountability or real-time participation in decisions anymore?  Maybe you don't need supervisors anymore? The worklist is the hero to an environment where everyone is asking for different, at times conflicting things.  Let's just spend our time in our worklist.  Let's let our worklist tell us what to do. 

People value what they attend to, and by requiring so much attention, behaviorally, the worklist becomes the boss.  

The best-practice process  of diagnostic and care planning and execution is quite different. It uses the EMR, as it uses every available human and technological resource to its best capacity. But it's not elementary school math. It isn't linear one-dimensional work lists. Best practice care is real-time, multi-dimensional, multi-disciplinary, multi-factorial.

 Best practice diagnostic and patient care is medical science, care management, neuroscience, group dynamics, social science, psychology and multivariate analysis in real-time. It isn't data then decision. Sometimes it's impression, sharing, exploration, hypotheses, dialogue, learning through action that alters team understanding and subsequent action.  

Before they met the team they thought they knew some of the data. Together, in discussion with their patient and each other they grow knowledge. While they are together and while they test, examine and care for their patients,  ideas arise organically and flow with new results seen or reported, into becoming new information, agreement and coordinated action. This solution is largely collaborative, participative, and creates lateral accountability and the highest level of vigilance and inspection in real time. 

The old Dinosaur practices are wearing new software clothing... But...

This Dinosaur Must Die

And perhaps now, in the post-Covid economic and human capital environment, it may.

But it won't go down without some effort, and true people-building, team-building, profession-honoring, clinical and quality work engineering.

Friday, March 10, 2023

Is your Hospital Labor Management System Unlovable?

 Are you facing damaging staffing shortages, high-cost travelers, high turnover, and lower retention at your Hospital or Health Center? Are your managers and executives relying on labor and productivity tools that aren’t credible or useful? 

We see this happening all over the country. 

Workforce teamwork, reliability and performance is more crucial than ever, but the tools just aren’t up to it. 

Check out a new system we recently built that does several of the things missing in traditional systems.  Just scroll down and click on the first slide to bring up the slide viewer. 

We didn’t build this alone for managers and executives; we built it with them from the ground up on a portable, scalable and interoperative PowerBI platform.

This is just what hospitals need today:  a very affordable, collaborative suite of workforce productivity and management tools that isn't another bloated software silo: A new approach using the latest technology; a lean, rapidly installed HIPPA compliant and secure system; interoperative to existing systems and back end data; and available with easy-to-use online tools for all registered users. A system that can be installed in weeks and further customized and built out to each managers’ needs:  In the words of our clients, a system “We love...and Trust”. 

Find out more from the slide deck below and learn what's missing from your current system, and what a more robust, user-friendly and useful system looks like: A system to love, and trust.

If you have any questions, or interest to pursue further, reach out to Dirk or I..

We are more than happy to provide a free live webinar to present the deck below to you and your team, some recent case studies, and answer any questions.

We help people build better people systems


Saturday, February 25, 2023

Boarding Patients in Your Emergency Department?

Is your hospital no longer the best place for your sickest patients?
You are not alone.

Check out the recent article from the American Academy of Emergency Physicians here

How did this happen?

1. It happens due to staffing holes exacerbated by poor working conditions;

2. Efforts to manage patients' lives by benchmarks and ratios.

3. Weak staffing pool development needed to cover all shifts with high experienced crew engaged in longer, meaningful career ladders.

4. Misguided efforts to thin support staff, supervisors / Charge RNs and front-line management to curb costs.

5. Focusing disproportionately on low acuity / high margin patients.

6. EHR workflows, bed management tools and task lists sold to help workflow but which segment, section, silo and stack patients. Now people work to their work lists, not with each other.

7. The decision to use median throughput time values in the Emergency Department, erasing boarder patients from the Emergency Length of Stay calculations, erasing accountability: It was never "just" an Emergency department problem. But now it's also not an Inpatient one's problem but the patient.

8. These are all the result of weak Emergency / Inpatient / Support / Clinical Diagnostic consulting by an army of "Subject Matter Experts" blinkered to cut costs within the siloes of each department.

9. Poor or non-existent work engineering.

These have only worsened the Emergency Boarding Patient problem. And an unsolved problem leads to blaming the victims, your patients.

When this happens staff, management and executives begin to burn out, leading to anger and denial, which never solved anything. Then blame and burnout become your culture, with all the power of the status quo behind it. At that stage no solution is supported.

The biggest secret of all? Blame isn't the answer, understanding is. No blame is needed. Ever. It's a Systems Thang: Emergency departments are downstream of the hospital, functionally, not upstream. Patient flow doesn't begin with a new patient at the Emergency Department door or the call from the ambulance team. It begins at the moment the inpatient nurse confirms their patient is likely to be ready for transfer or discharge.

It is not an Emergency Department problem. It's a Hospital and Health System problem.

Stop the old thinking that makes things worse.
Find real solutions here..

And the best consulting support in the nation to help you get there:
And if you need more inspiration that boarding was fixed decades ago in our best Emergency Departments before, during and after a national pandemic, read more than a dozen Emergency and House-wide Patient Flow and Patient Satisfaction case studies here

Become the number one hospital again.

#hospitalmanagement #populationhealthmanagement #emergencymedicine #nurseleaders

Do Nurse Practitioners Really Help Emergency Department Care?  Yes! if Coordinated Well!

Research on the effectiveness of Nurse Practitioners in Hospitals appears mixed.

Some studies indicate improvements in cost, patient care and throughput outcomes...

In Primary Care Settings:

And in the Emergency Department:

This coincides with our experience working with Emergency and Inpatient departments.

We have found that Advanced Practice RNs, in a well-coordinated team approach optimizes their strengths, reduces LWOT, Elopement, Length of Stay, and Readmissions; and raises Patient Satisfaction. Indeed, in the right model, their presence improves Physician outcomes.

However, recent research at Stanford using three years of VNA data indicates worse clinical and throughput outcomes by Advanced Practice RNs who had sole clinical responsibility for patients, compared to Emergency Physicians:

The actual paper can be downloaded here:

And there is some precedent for these findings:

Here is our take on the difference:

The problem can be found in this sentence from the new Stanford study: " In December 2016, the VHA granted full practice authority to NPs, allowing them to practice without physician supervision."

In every high functioning Emergency Department no one works without collaboration and supervision. The Charge RN functionally supervises all the professionals when things work, including the APRN and the MD. The APRN doesn't provide a lesser function but a different one.

The Emergency Physician is often the Clinical Specialist. But often times a more experienced RN better fills the role of the primary Clinician.

Effective Emergency care is a synthesis of talent, a synergy of different skills, and a synchronization of professions who collaborate in real time patient by patient. APRNs actually fill a skill gap that the Emergency Physician Specialist cannot, and in part that is because their practice has changed in Emergency Medicine from initial eyes-on-patient assessment to post-labs assessment. They created a gap in an effort to be efficient. That's OK. Because APRNs are filling it, assuring patient safety. The problem is assuming anyone is above supervision and collaboration.

What is the short course conclusion? If you aren't going to develop the management of your teams, you will need more Physicians, and even there quality is no guarantee. And your staffing will continue to be unreliable.

If you are willing to develop your people, analyze the work, and help them synchronize their collaboration, create systems of accountability and transparency, then skyrocketing patient satisfaction and dramatically improved quality outcomes are yours.

#hospitals #hospitalmanagement #nursingleaders #emergencymedicine #criticalcare