Latest / Nurse Leadership Dumpster Fire / Efficiency Metrics: The Sheild!
Transcript
- speaker-0: In this video, we're continuing our journey talking about metrics for nurse managers and why they matter and how to use them to equip your army. In the last video, we talked about quality and how that is your sword or your weapon to get what you need for your resources. In this video, we're gonna be talking about efficiency and how that is your shield to protect what you have. speaker-1: So efficiency is how hospitals decide how to manage the budget. In our last video, we talked about our quality metrics, and quality metrics are the way that we get our reimbursement. Our efficiency metrics are what we use to decide how to spend that money. Efficiency gets a bad rap because frontline managers often interpret this as the facility and or the C suite wanting to be stingy and not give out the money or pay for the things that they want to. So it kind of appears to staff as though we're saving money and we're cheap and or stingy and won't give the money out. speaker-0: The reality is high efficiency means less waste, which means there's more money left over for staffing, supplies, and the things that you need to have a safe and effective unit. Low efficiency means high waste, and that means there's less money in the budget and maybe even panic budget cuts, which is really alarming and scary to have happen to you as a nurse community. speaker-1: So we're gonna go over a brief history on how we got here. Before World War Two, what we had was a cash-based system, right? You would have your provider that would just come to your house, give you a service, or take care of you, you would pay him and he would leave. speaker-0: Care was that cash based system in our entire history all the way up until the 1940s when World War II happened? And because that war was so expensive in our country, our government started making wage caps. But employers still needed employees to come to work because they had things that needed to get done. This is where the development of private health insurance came from. And employers started offering health insurance to employees. As another type of incentive because they weren't allowed to pay them any more money. speaker-1: I don't think I realized that was happening. That's so cool to know. speaker-0: Yes, I don't think we often think about when did healthcare start and why did it start, but that's exactly what happened. So that's how healthcare started, but there were really no checks and balances at the time. A facility could charge whatever they wanted for a service, and then they would bill the insurance company, and the insurance company would pay that no matter how much it was, or whether it seemed like it was worth that amount of money or not. speaker-1: Yikes then in 1965, the Medicare boom happens. That's where CMS or Centers for Medicaid and Medicare step in to make sure that the poor and elderly have access to medical care. So you just heard me say the word access. This is the step where access started to be talked about. What happened is healthcare spending skyrockets. speaker-0: Yes, because the insurance companies were already getting billed a whole bunch of money and they were paying it. And now you compound that with the Centers for Medicare and Medicaid. So now the facilities are just making a cash cow out of the whole thing because they can just charge whatever they want and they're getting paid back both through insurance company and through CMS now. So fast forward to nineteen eighty three and this is when efficiency first starts to show up when we have the payout cap. So the government after They've had Medicare and Medicaid going around for a few years now, all of a sudden realizes that they're gonna run out of money. With healthcare costing so much money, they don't have the ability to continue to pay those bills long term. So Medicare adjusts the way that they're doing reimbursement at this time, and that's where they start setting flat rates. So now it doesn't matter what the facility charges, CMS says, I'm going to pay this much money, and you can either use it or not use it. So if I go into the hospital and I've broken my arm, CMS is gonna say, okay, broken arm, we pay $800 for that. And if the facility uses that $800, so be it. If they overspend because they accidentally gave me an infection when they were wrapping up my bone and it was sticking out and it cost them more money, it doesn't matter. CMS is still only gonna give you $800. So you could lose money that way. But also if you cut corners, and you just wrapped it up with gauze and didn't use the rest of the supplies that you needed, they could actually make a a bonus from that. speaker-1: Yikes, that's a that's a sticky situation. Also, I don't know if you guys noticed, that was a twenty year gap where we're paying and paying and paying anything. yeah. That was quite pricey time for our healthcare system. So then when we get into the nineteen nineties, we have what we call the clamp down, where insurance companies kind of follow suit with how Medicaid and Medicare are handling things. But they went way too far the other way. They start denying claims. They start saying, that's a pre existing condition. We don't have to pay for it. And that creates an access problem all over again speaker-0: Then in 2010, the Affordable Care Act happens with the new administration. And with that, CMS actually comes up with a new better way to incentivize and award or deincentivize poor performers by holding back some of their reimbursement. If you want to know more about how CMS works, watch our other video on quality where we really go in depth on how that actually happens. speaker-1: Now back to our current place, 2025, 2026, the transparency wave. In the transparency wave, what happens is the government drops a directive that says that we have to share and publicize what the cost of healthcare is. speaker-0: Healthcare facilities used to be able to give very vague estimations of how much they were charging for different services. Now they actually have to itemize it and talk about specifically how they're charging for each service. So if you go to a hospital and you're in the hospital for a week, they have to publicize every single part of that to the public. So now the public can see what you're actually charging them for. Exactly. And that actually puts pressure on the facilities to kind of clean up their act a little bit because they feel kind of stupid if it looks like they're charging for something that's not even real. Well, and something interesting that's just a little bit of a tangent is that nursing service is actually bundled into your stay. So if you look at an itemized hospital bill, you're gonna see supplies, you're gonna see the cost of your doctor, you're gonna see MRI or CT or whatever the imaging was that you had done. But you're n you're not gonna see a charge for nursing because that is actually included in your room and board. You're not just paying for the product, you're paying for the whole experience and the labor if you were thinking about it like an auto mechanic. speaker-1: When these executive orders started coming out, we all panicked a little. But now we're swinging back and kind of coming to a balance where the transparency is supporting honest business practices and better healthcare outcomes for all. speaker-0: So we're also going to talk about your shield as a little bit of a tool belt. And within that tool belt, you have lots of tools. Some of those things include things like salaries, and that's just your base salary to pay the bills of your staff in your workforce. You have overtime, and that's the emergency. Things didn't work out in your staffing. Now you gotta pay extra to keep the lights on and keep the patients taken care of. We have unproductive time and unproductive time. Well, I don't like love the way that word sounds, but it actually just means you're not taking care of a patient in front of you. So all of that time that nurses spend orienting and doing training or professional practice advancement, anything that doesn't involve touching a patient, that gets categorized under unproductive time. We have sick leave, and that is our every nurse manager's nightmare because that's when everything falls apart. And often when you have high sick leave, you also have high overtime. And then the one that's been really the hot topic recently is census and occupancy rate. And that is actually how many beds do you have and how many bodies are actually in each bed. speaker-1: So in the beginning, when we started, we never considered these metrics at all. Like even as a bedside nurse, you don't really fully understand them, but even as new managers, we didn't. We paid attention to sick leave because obviously that impacted our staff and our immediate needs. and we paid attention to overtime, but we didn't pay attention to overtime because we knew we should. We paid attention to overtime because our director pointed out that that was something we needed to speaker-0: And I we knew that we were supposed to be fiscally responsible. That was a word that I feel like was talked about a lot when we were new managers. But the way that I always thought about it was that it meant that I was supposed to float my staff if my census was low or call people off. That was what how I interpreted it. I never brought it back to my census of my beds and and how many patients were on the floor and what that actually meant for the bigger picture and the organization. But since that happened, We have been paying way more attention to things like this. And now in my position, I actually have to report my census and occupancy rate on the units that I'm over up to my executive leadership team. And they're asking me things like if the patients aren't in your bed, where are they? Are they offloading into a department that doesn't have the facility and the capacity to do it? Are they in the community? Is somebody else picking up the load? Or Is there something else that we should be doing with these beds? If they're if we aren't using these beds, should we repurpose those beds for something else? We actually have to be more responsible than ever because with the transparency, it means that we all have to do our due diligence to make sure that we're doing the most with what we have. And then when we ask for resources, we need to be making sure we're asking for resources when we really need it. Because staffing doesn't always fix the problems. Staffing is necessary and your ratios are important, but it's not the whole picture. And sometimes when you have too many staff, you actually can have other negative consequences. When nurses are bored, that's when oftentimes problems actually bump up because they're bored and they create new problems. Because let's be honest, we all got a little drama in us. speaker-1: Stirring the pot. As much as all of this matters, we have to still bring this information back to the front line so they can prepare themselves for the battle. They need to prepare their shields and know when to put them up. speaker-0: Yes, we need to be able to get those teams on board in helping us solve these problems. So for example, recently I was helping manage the occupancy rate in the census of a skilled nursing facility that I'm currently over. And it includes rehab, skilled patients, and hospice. And there's three separate locations for each. We have been pushing to get our senses up on the skilled and rehab really high. And we actually got to a point where that census was so high that we were seeing backlogs of patients on the med surge unit. We weren't able to transfer them into the to the SNF because we were full. But we had open beds in hospice. And traditionally, the hospice unit or the hospice house was reserved for only hospice patients. And so when we started talking about flexing those beds to take maybe some skilled or some memory care patients. The staff were really anxious and upset about it because it was different and they weren't used to it and they didn't understand why this was happening. So I started going to their morning huddles and allowing the staff to ask questions, and I was very open and transparent with them. And I just explained to them the whole thing that we talked about just a minute ago about why this matters and why. If we aren't utilizing our beds appropriately, we could be at risk of actually losing those resources. If my hospice unit is only being staffed at 50%, my executive leadership team could potentially take nurses from me and say you don't need as many nurses as you have because you don't have enough patients to support that. And that's not good for any of us. And once they understood that and that we were trying to do our due diligence to help with the backflow of the inpatient and help with the backflow in other places where the patients were getting pushed out because they couldn't come to our our facility, then they were like, that makes sense. And that's better for patient care. And we can get behind patient care because at the end of the day, we all care about what's happening in that bed with that patient. speaker-1: As a frontline manager, you might think of this as the corporate cage that keeps you from doing the things you want to do, just making your life miserable. The truth is, this is often the most underutilized tools that new managers don't implement. True. But these are some of the sharpest tools you can use to get your needs. speaker-0: So, summarizing what we've talked about today in the last video, your quality metrics are your weapon to ask for the resources that you need, but your efficiency metrics are almost just as important so that you can make sure that you keep the resources that you have and you can keep the way that your unit is functioning. Here's some take-home lessons that you need to know to keep your unit running like a well-oiled machine. speaker-1: Lesson one, own your own data, or the C suite will. What that looks like is if there is a red cell in your Excel spreadsheet, they're gonna make cuts without even knowing why that's like that. You could can take that information and make a decision that turns that cell green and communicate that to the C suite what your plan. speaker-0: Lesson two. Efficiency helps fund your wish list. Do you want new bladder scanners? Do you want more wages for your nurses? You need the efficiency to put the room in the budget so that you actually have the money to buy those things. Prove that you're the manager who doesn't accidentally leak money in overtime unnecessarily so that your executive leadership team doesn't trust to give you the resources that you're speaker-1: Bonus lesson Speak the language of the boardroom. Most managers don't get any business training at all. So when you walk into a meeting talking about your unproductive time and your occupancy rates, the business suite is surprised and you walk in there looking like an executive leader instead of a stressed out clinician. speaker-0: For sure. And if you are on a trajectory to go up the ranks in leadership, this is a really good skill to master because this looks very good to hiring managers in upper positions. speaker-1: In the next and final video on metrics, we're gonna talk about team health and how if you have an army that is high efficiency and high quality, you're gonna have a team that sticks around rather than a an army that is a desserting and speaker-0: And it's hard to have a high functioning team that produces high quality metrics and high efficiency metrics if you don't have a unit with an army to run it. What efficiency metric is your unit struggling with right now? Is it accidental overtime? Is it managing sick leave? Is it fluctuating census? Let us know in the comments below. If you found this video helpful, like and subscribe and send it to another fellow nurse leader who needs to hear this information.