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Revision of hospital work organization using nurse and healthcare assistant workload indicators as decision aid tools

BACKGROUND: Historically, governmental hospital organisation consisted in a heterogeneous distribution of staff and a fragmented logistical organisation without cross-functionality or sharing of resources between departments. This organisation could not last in a context of an evolving healthcare en...

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Autores principales: Briatte, Isabelle, Allix-Béguec, Caroline, Garnier, Gérard, Michel, Mercédès
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6686463/
https://www.ncbi.nlm.nih.gov/pubmed/31391052
http://dx.doi.org/10.1186/s12913-019-4376-7
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author Briatte, Isabelle
Allix-Béguec, Caroline
Garnier, Gérard
Michel, Mercédès
author_facet Briatte, Isabelle
Allix-Béguec, Caroline
Garnier, Gérard
Michel, Mercédès
author_sort Briatte, Isabelle
collection PubMed
description BACKGROUND: Historically, governmental hospital organisation consisted in a heterogeneous distribution of staff and a fragmented logistical organisation without cross-functionality or sharing of resources between departments. This organisation could not last in a context of an evolving healthcare environment, changing patient profiles and hospital expenditure constraints. Cost-effective workforce regulation for optimal patient quality of care was urgently needed. The purpose of the study was to describe the reorganization that led to resource management no longer based on what has been achieved but based on a daily measured workload. METHODS: This prospective study used nursing intensity indicator, mirroring patient care needs, which was reported daily using VALPAReSO® software. Indirect care activities were recorded in departments of medicine, surgery and obstetrics. Based on data collected in 2012, a new organisation strategy was implemented and evaluated in 2015. RESULTS: Nursing intensity indicator analysis led to a reallocation of workforce per department, and the reinforcement unit (float pool) was managed based on this decision-aid tool for replacement and daily adequate staffing. The healthcare workflow audit resulted in the revision of five working tasks: time spent on handover, working time management, connections between services and the pharmacy, housekeeping, and food management. The reorganization took place at the same time as the transition to the development of very short-term care, resulting in a decrease in the number of full inpatient beds, which were therefore mainly occupied by heavier care profile patients. With the integrated strategy, this transition was achieved with constant staffing, and good overall patient satisfaction and working conditions were maintained. CONCLUSION: The reorganisation strategy was managed in a context of institutional commitment, coaching leadership built on close manager-employee interaction, a defragmented management between healthcare and all service providers, and a seamlessly dissemination and sharing of indicator information between healthcare managers, nurses and healthcare assistants. The process optimization allowed a better allocation of tasks and enabled nurses to refocus on patient care. Nursing intensity and indirect care indicators, when widely accepted, can be used as decision support tools for daily adequate staffing. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12913-019-4376-7) contains supplementary material, which is available to authorized users.
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spelling pubmed-66864632019-08-12 Revision of hospital work organization using nurse and healthcare assistant workload indicators as decision aid tools Briatte, Isabelle Allix-Béguec, Caroline Garnier, Gérard Michel, Mercédès BMC Health Serv Res Research Article BACKGROUND: Historically, governmental hospital organisation consisted in a heterogeneous distribution of staff and a fragmented logistical organisation without cross-functionality or sharing of resources between departments. This organisation could not last in a context of an evolving healthcare environment, changing patient profiles and hospital expenditure constraints. Cost-effective workforce regulation for optimal patient quality of care was urgently needed. The purpose of the study was to describe the reorganization that led to resource management no longer based on what has been achieved but based on a daily measured workload. METHODS: This prospective study used nursing intensity indicator, mirroring patient care needs, which was reported daily using VALPAReSO® software. Indirect care activities were recorded in departments of medicine, surgery and obstetrics. Based on data collected in 2012, a new organisation strategy was implemented and evaluated in 2015. RESULTS: Nursing intensity indicator analysis led to a reallocation of workforce per department, and the reinforcement unit (float pool) was managed based on this decision-aid tool for replacement and daily adequate staffing. The healthcare workflow audit resulted in the revision of five working tasks: time spent on handover, working time management, connections between services and the pharmacy, housekeeping, and food management. The reorganization took place at the same time as the transition to the development of very short-term care, resulting in a decrease in the number of full inpatient beds, which were therefore mainly occupied by heavier care profile patients. With the integrated strategy, this transition was achieved with constant staffing, and good overall patient satisfaction and working conditions were maintained. CONCLUSION: The reorganisation strategy was managed in a context of institutional commitment, coaching leadership built on close manager-employee interaction, a defragmented management between healthcare and all service providers, and a seamlessly dissemination and sharing of indicator information between healthcare managers, nurses and healthcare assistants. The process optimization allowed a better allocation of tasks and enabled nurses to refocus on patient care. Nursing intensity and indirect care indicators, when widely accepted, can be used as decision support tools for daily adequate staffing. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12913-019-4376-7) contains supplementary material, which is available to authorized users. BioMed Central 2019-08-07 /pmc/articles/PMC6686463/ /pubmed/31391052 http://dx.doi.org/10.1186/s12913-019-4376-7 Text en © The Author(s). 2019 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Briatte, Isabelle
Allix-Béguec, Caroline
Garnier, Gérard
Michel, Mercédès
Revision of hospital work organization using nurse and healthcare assistant workload indicators as decision aid tools
title Revision of hospital work organization using nurse and healthcare assistant workload indicators as decision aid tools
title_full Revision of hospital work organization using nurse and healthcare assistant workload indicators as decision aid tools
title_fullStr Revision of hospital work organization using nurse and healthcare assistant workload indicators as decision aid tools
title_full_unstemmed Revision of hospital work organization using nurse and healthcare assistant workload indicators as decision aid tools
title_short Revision of hospital work organization using nurse and healthcare assistant workload indicators as decision aid tools
title_sort revision of hospital work organization using nurse and healthcare assistant workload indicators as decision aid tools
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6686463/
https://www.ncbi.nlm.nih.gov/pubmed/31391052
http://dx.doi.org/10.1186/s12913-019-4376-7
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