Listen to front-line care solutions for inadequate staffing

Editor's Note: This is the second in a three-part series on leadership and operations that examines the power of front-line staff.

By Thomas H. Dahlborg

Mother Teresa once said, "Do not wait for leaders; do it alone, person to person."

Front-line employees are following this advice, trying to make things better for patients, families and one another.

Consider front-line efforts to combat emergency room overutilization shared in a previous Hospital Impact blog post. Hospital leadership called for investments in brick and mortar, such as building a larger emergency room, constructing hospital-owned urgent care centers closer to where frequent ER users live or establishing primary care practices inside the ER.

However, front-line staff had its own solution and knew how to better address the issue. "I know the people who would utilize the ER. I have developed relationships with these people. When they have a concern, they call me and we talk," a physician assistant (PA) from Northern Maine said. "And when they should come to the ER, they do. And when there are better options, I help them understand those options," she said.

This PA is positively influencing patients, improving their satisfaction and experience, while also saving the hospital and the system money. And she is doing so by developing and leveraging relationships, empathy and trust.

My previous article told of hospital leadership not understanding the staffing needs of a maternity ward. Luckily, a solution arose from the frontlines of that community hospital in Portland, Maine.

Using hospital definitions and American College of Obstetricians and Gynecologists (ACOG) standards, front-line staff determined the difference between minimum standards and actual staffing levels for each day over a given length of time.

The analysis showed 60 percent of the time, the maternity ward was understaffed to the point where patient experience and safety would be impacted, and 20 percent of the time, the ward was so understaffed, it put the hospital at significant risk of a lawsuit.

Front-line staff shared the data with hospital leadership along with the message, "Something is going on, and we are in trouble. Had there been a catastrophe during the time periods when we were significantly understaffed, the hospital would have paid out $10 million to $20 million. How many nurses could we have hired for $20 million?" the interim chair of the department of obstetrics and gynecology said.

Yes, hospital leadership heard the front-line message and approved hiring additional nurses. But in many cases, hospital leadership can't "hear" the problem until it is couched in terms they deal with every day--financial terms.

Overseas, we see similar issues. For example, one doctor was responsible for covering an entire hospital in London; but no matter what staff said, no additional support arrived. So when a nurse's patients with cardiovascular disease would experience an angina attack in the middle of the night, no physician would be available.

"So I did what I thought best--I administered the [glyceryl trinitrate] in an effort to provide the best care possible for my patient. And each time, I knew I could be sacked for doing so. But I couldn't let my patients suffer," the nurse said.

This could be happening at your facility. Your patients and your organizations could be at risk due to inadequate staffing, all because no one is listening to the needs highlighted by those closest to the patients.

Front-line staff has great insight and wisdom to share. It is time for leadership to listen and collaboratively develop solutions to improve care provision, patient experience and safety, staff satisfaction and retention, and the bottom line.