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Johns Hopkins All Children’s Hospital

Strengthening the workforce – finance and nursing come together with objective data

Financial departments and nursing leadership at St. Petersburg, Florida-based Johns Hopkins All Children's Hospital (JHACH) are on the same page, using data to improve communications and the workforce experience. The health system implemented Cerner's workforce management solution in late 2017. Using objective data from Clairvia®, the financial department supported the nursing department's business case to expand the workforce by more than 80 positions.

"When meaningful and reliable data is available to drive decisions, senior leadership can easily support the case," said Christopher Whitby, chief financial officer. "The Clairvia tool provided that data, and leadership made the additional workforce a top priority." 

Nurse leaders manage the largest part of a hospital's labor budget, the nursing workforce. In a hospital setting, nursing and finance can sometimes speak different languages when it comes to managing full-time employees. They share common goals of financial performance and adherence to budget with the right skills and competencies to support quality and safety.

The nursing team's desire to deliver the highest standard of care to their patients had already led them to begin developing their own acuity tools when nurse executives approached the team with the opportunity to digitize this process with Cerner. The predictive models with Clairvia provide both nursing and finance a tool to manage workload, productivity and assignment equity.

"Engagement from the senior leadership team is key," said Aruna Jagdeo, MBA, BSN, RN, NE-BC, RN-BC, chief nursing informatics officer. "The chief nursing officer was the executive sponsor on this project and was involved with the project and could speak about vision with staff and in front of her peers. We educated major stakeholders to understand Clairvia so we all speak the same language."

After implementation, nursing had objective, reliable data to quantify staffing needs based on patient care requirements for finance. In addition, finance and nursing departments finally had data they could agree on.

"With precise data that factored acuity into the staffing model, nursing leadership and finance partnered to identify the gap and develop a fiscally responsible patient care hiring plan to improve nursing workload and satisfaction, as well as provide better patient care," said Whitby.

With Cerner's workforce solutions, patient demand is clear, quantifiable and unbiased. Both nursing and finance teams can measure staffing and workload needs, connect them and create transparency with mutual understanding of workload data. Four months after using Clairvia data, senior leadership approved 85 new positions: 51 nurses and 34 patient care technicians.1

"We strive to make evidence-based decisions at JHACH and Clairvia gave our nursing workforce an objective way to do that," said Melissa Macogay, MBA, BSN, RN, CCRN-K, NE-BC, chief nursing officer. "Today, patient demand measurement is objective, transparent and quantifiable. It has been very validating for our nurses to see a measurement tied to their interventions and the intensity of the care they are delivering," she said.

Using the data moved debates away from staffing allocation, manual entry of patients, staff numbers and census, and moved the debate toward justifying staffing needs to match patient demand. Clairvia identifies the number of caregivers required for patient demand and workload. The near real-time target/schedule dashboard, which provides transparency of supply and demand in huddles, justifies staff reallocation. This allows for better patient care by ensuring, not only that the right number of caregivers are assigned to each floor, but that the right caregiver is assigned to each patient.

Staff at Johns Hopkins All Children's Hospital can now consider the needs of the entire hospital, not just the patients on their own unit. Now, nursing leaders often volunteer to float staff when they see another floor is short-staffed.

"You have to let folks know that staffing does not get fixed overnight," said Jagdeo. "You have to plan and get to where you want to be. We are confident we can get there."

1Decision based on 75th percentile calculation

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Client outcomes were achieved in respective settings and are not representative of benefits realized by all clients due to many variables, including solution scope, client capabilities and business and implementation models.