Susan Reese is chief executive nurse at Kronos, a Chelmsford, Mass.-based workforce management solutions and services vendor. She spoke recently with Healthcare Finance News editor Richard Pizzi about the changing relationship between the hospital business office and a hospital’s nursing leadership.
In recent years there has been a significant change in the relations between the CFO and CNO at hospitals and health systems. How do you assess the change in terms of managing the nursing workforce?
In the past there wasn’t a warm relationship between finance and nursing. Finance looked to nursing to get everything done cheaper. The nursing staff was viewed as a cost to the organization and only a cost. What has changed is that finance better understands that nursing has an impact on revenue loss prevention. Quality of care does impact the revenue stream, and nursing leadership has always emphasized quality of care. For instance, under new reimbursement rules, hospitals are not paid for hospital-acquired conditions. This potential revenue loss has opened the eyes of the finance team, and they better understand that good quality care makes a difference in cost control.
Do hospital finance leaders rely on nursing leadership to help determine what workforce management tools are important?
Deciding on the “right cost” for the right tools for your health system or hospital is an individual decision. It differs across health systems. External benchmarks are good, of course, but it’s more important to look inward and improve your own performance. These internal benchmarks are determined in conversations between finance and nursing. Nurses sometimes struggle in conveying to the finance team what they do above and beyond the individual task. Nursing is all about critical thinking and assessment of patients, but it has been hard to convey that statistically.
Good analytics tools measure performance and provide metrics. They bring finance and nursing leaders together in determining what to measure and report to assess the nursing workforce. The most common metric reported by such tools is inpatient days. But nursing leaders might let finance know that things are not that simple. Nurses might take care of outpatients in observation, and not just inpatients. If you don’t measure that, you don’t get the entire picture. You ultimately have to weigh tasks differently to accurately determine what requires the most work.
What are some other key drivers for nursing-finance relations?
The nursing population is a big issue. The nursing shortage we experienced a few years ago awakened hospital CFOs to the importance of keeping staffing vacancies filled. Conditions are better now, but there is another nursing shortage looming. Part of being prepared for these shortages is having the right tools in place. For example, our analytics tool includes an HR component. It allows you to drill down and identify why nurses are joining and/or leaving your organization. Such information improves staff retention.
Strong communication between the finance team and nursing leaders will help you choose the metrics your workforce tools should provide. Different managers within a hospital need access to different information. At the unit level, you want information on absenteeism, or you want to know the exact employee who is using the most overtime. But at the executive level, you want to know trends in overtime across the enterprise. Your tools should provide you with all of that information.
I guess it’s a truism to say that technology is critical to modern workforce management at hospitals.
Yes, but technology should not be “cookie-cutter” across hospitals. Hospitals may want to automate their processes, but a bad process should not be automated without making substantial changes to the process itself. Certainly, hospitals should put workforce management programs in place that are supported by technology. Yes, technology is a critical piece, but technology alone is not enough.
