In this article
I have sufficient time to provide the best care/service for our customers/clients/patients.
Survey Domain: Employee
Survey Theme: Quality/Customer Focus
Understanding the Issue: The first step is to understand the issues behind the survey performance scores. Unless you are absolutely sure that you understand the issues related to a particular survey item, the best place to start is identifying them, and the section Understanding Issues can help you do so. The activities described in Understanding Issues can be used for any of the survey items. Make sure you know what is behind your low score before you begin acting.
Studies have shown that employees' perceptions of staffing adequacy are also linked to their perceptions of quality care and service. When designing work staffing and schedules, consider the types and competency levels of care providers needed. Keep in mind that one inexperienced nurse is not equal to one competent, experienced RN, so competency levels should be a factor in workload calculations. The work plan also needs to be flexible enough to meet changing conditions. In patient care areas, this includes providing adequate time to comfort and communicate with patients and their families. In nursing units, the available nursing staff, workloads, number of beds, availability of support services and supplies, process effectiveness (e.g., admission, discharge, etc.), patient technology, physical layout, and the education and experience levels of staff influence employees' perceptions of having sufficient time to provide good care and service.
Improvement ideas:
Lead a multi-disciplinary care team in a discussion of what contributes or takes away from employees; ability to provide best care and service across all resource streams. Initiate improvement activities to resolve.
Factor time for communications into workload calculations. When there is little or no time to provide comfort and build relations with patients and their families, care providers feel they are not doing their jobs.
Ensure that equipment and supplies are in working order and adequate to support daily needs.
Areas where there is high turnover, or where filling vacancies takes longer, may require consistent, qualified supplementary staff.
Ensure that orientation and training activities for new employees are not overly burdensome to critical core team members, especially during high-volume times.
Establish productivity measures with thresholds at a novice level and then introduce higher production measures one step at a time, based on demonstrated competency.
Provide stress management training to help care providers cope with serious patient conditions and chaotic environments. Fluctuations in patient volume and staffing levels create unpredictability in care providers' workloads, leading to prolonged stress.
Evaluate "patient day" workload measures that are based on midnight censuses. The timing might underestimate true workloads. Admission, discharge and transfer rates may have wide swings in volume across different units.
Ensure that RNs and other care team members are not forced to work in specialty units or areas of care without having first received sufficient training and orientation. Recognize that coercion creates ill will, and the lack of skill places additional burdens on core staff already in place.
(MI 640)