The Challenges

The literature documenting research on the relationship between staffing levels and, more notably clinical professional mix in general, calls for increases in professional staffing. This research is based on a comparison of simple care hours per patient day to the occurrence of adverse events aggregated over a long period (several months) of time. In a busy clinical unit, patient arrivals and changes in condition happen continuously. It is not surprising that, as more staff are present, outcomes improve, however this must be set against the overall cost of healthcare. The United States spends the most in the world on health care – about $2 trillion annually . Yet  the U.S. ranks 37th in world in terms of the quality and fairness of its health care, according to the World Health Organization (WHO).

Companies that compare labor cost metrics between healthcare providers document significant ranges. The difference between the lowest and highest staffing levels can be 50%, meaning some institution provide 7.5 med/surg hours per patient day while others provide over 11 hours per patient day. Furthermore, healthcare providers have received accolades for quality while operating on the lower cost side of these comparisons.

Given these disparities in understanding the relationship between cost and quality, it is necessary to both improve the measurement of clinical demand and to study the relationship between staffing levels and adverse events in much shorter time frames. This calls for the integration of clinical information systems with workforce management systems, and improved systems for the allocation of staffing resources.

The real challenge is to develop systems that respond appropriately to the needs of the patient and allow the caring professional to manage each patient’s progress though the encounter. Furthermore, the caring professional should also be coordinating the care team in order to maximize the utilization of each caregiver.