Leader Q&A forum, Jan. 6, 2023

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EXECUTIVE FOCUS TEAMS

Retention and recruitment

• To engage the workforce, round on every employee at least quarterly.
• Report activities to your one-up and expect it of the leaders who report to you: turnover, termination reasons, rounding and classes.
• Take all leadership classes available.
• Prioritize recruitment, including candidate review and interviews. (Show up to interviews and make sure your teams do too.)

Labor-use management

• Understand all reports – hours productivity (104% target), WEE (101% target), TEE, director summary report (new).
• Classes on managing labor will be offered.
• Pull the levers to impact the metrics, take an active role in department finances.
• Create and promote a culture of safety and speak up.

ALOS, capacity and throughput

• Ensure EDD is in place upon admission.
• Work for timely discharges.
• Identify and remove barriers, especially for complex discharge placements. Make sure to communicate with patients and family.
• Participate in Edgility engagement as they arise.

Enhancing key services

• Teams are looking where demand exceeds capacity: Imaging, surgery, cancer service, APP production, oral oncology.
• So far, net revenues have exceeded the target!
• Prioritize the work of all five teams.
• Take an active role in activities that drive the key services enhancements.
• Drive production at the unit level.

Supply costs and purchased services management

• Be aware of your EPSI drilldown: Look for opportunities to reduce expenses, know where the dollars are going. Chrissy Shepard can help.
• Engage in the new negotiation process for contracts greater than $100,000. Jeff Stein is the contact.
• Review historic spending to identify opportunities to lower costs.

CRISIS STANDARDS OF CARE

• Asante is experiencing an extreme surge of volume, mostly due to the rapid rise of influenza, RSV and COVID-19 cases.
• This is having an enormous strain on our already limited staffing resources and capacity.
• We requested 40 additional contract nurses through Gov. Brown’s executive order and received eight.
• We activated crisis standards for care for the nurse staffing at ARRMC and ATRMC on Dec. 16. (Crisis standards of care are activated when the patient care resources are limited and more patients need care than hospitals can supply.)
• We plan to follow the guidance issued by the Oregon Health Authority and navigate both patient volume and staffing.
• We’re working collaboratively with hospitals across the state as well as county public health officials to discuss resources and capacity constraints.

What this is

• Objective prioritization of care.
• Prioritization of patients.
• Limitations on services.
• What it may mean:
  • Higher nurse-to-patient ratios.
  • Canceled or delayed elective surgeries.
  • Reduced documentation requirements.
  • Nursing care prioritized according to available resources.

What it isn’t

• Asante is not making triage decisions. That is, decisions necessary to provide equitable prioritization of our critical care resources (who gets a ventilator or who gets a critical care bed).
• This is solely about optimizing our nurse staffing.

Mitigation strategies

• Incentive pay for extra shifts.
• Asante- and state-funded travelers.
• Redistributing staff to even out shortages.
• Floating staff from service lines unaffected by inpatient volume surges.
• Implementing a disaster documentation policy.
• NPD page on myAsanteNET has resources available for nursing staff.

“I’m so grateful for our clinical leaders and the commitment they continue to show. It makes us stronger as a team.” — Amanda Kotler, chief nursing officer

VACANCY RATES

• Asante’s overall vacancy rate has declined from a high of over 14% to to 12.6% in December.
  • 16.1% at ARRMC
  • 11.5% at ATRMC
  • 15.2% at AACH
  • 10.5% at APP
  • 2.5% corporate
• Asante currently has 855 open positions — 395 of them in nursing.
• Recruiters are now filling more positions (about 120 per month) than the number of people leaving the organization.

DISASTER PAY PRACTICES

• Asante moved away from all disaster bonuses except emergency and volunteer shift premiums, effective Dec. 27.
• The current disaster bonuses include disaster shift bonus, disaster shift premium, disaster shift bonus (extra shifts) and disaster double time.
• ESP/VSP bonuses on eligible job codes will be offered through March 25. They will be evaluated further if needed.
• Increases for ESP/VSP non-RN jobs took effect on Jan. 1.
• If your department’s jobs are ineligible for ESP/VSP and you’re experiencing critical staffing issues, work with HR and your senior leader on alternatives.

The next leader forum takes place on Feb. 3.