Motivators and Controls

Understanding and Managing Fiscal Motivators, Regulatory Compliance, and Professional Standards

In Healthcare regulation and compliance is a fact of life. A solid understanding of the intent of these initiatives is important in setting and defending the workforce management strategies of your organization. Three types of external organizations influence site based workforce management strategies. Payers, Regulators, and Professional Standards Organizations

The first group is the payers, CMS ( the Center for Medicare and Medicaid Services) is one such entity that effects staffing based on what they will pay for, it is important to remember that payer policies are based on insurance type actuarial studies of long term aggregate data, and staffing systems need to deal with short term patient needs. Payer systems don’t normally address the patient variable of status and dependency. Although an organization must maintain fiscal viability, too much focus on payer methods can affect a staffing systems ability to flex to the needs of the current patient population.

Regulators come in the form of State and Federal statutes which affect staffing requirements, and of course The Joint Commission on the Accreditation of Healthcare Organizations ( JCAHO ) and Amerian Nurses Credentialing Committee (ANCC) Magnet Recognition Program that sets voluntary accreditation standards for Hospitals to use as a guide for policy and strategy. These agencies tend to cover issues of safety, quality, and privacy.

Professional Organizations tend to focus on a focused slice of the healthcare system, and exist to provide information and advocacy to specific clinical or administrative groups. Some of these groups publish detail staffing standards for the specialty they represent, and can be excellent evidence based guidelines that can be used to compare to the payer stance. The Emergency Nurses Association and the American Academy of Pediatrics publish detailed event based staffing standards.

The partial list in the right column is organizations of which a workforce planning professional should be aware.

A useful exercise in understanding the current climate and opinions regarding clinical staffing issues in the US is to compare the US Senate bill 54 introduced by Senator Inouye to the US Senate bill 1031 introduce by Senator Boxer. SB 1031, like it’s counterpart in the House of Representatves, HR 2273 is similar to the California Ratio bill. S 54 calls for involvement from non-management clinicians and staffing based on individual patient need, like the State Legislation enacted in Ohio, Illinois, Oregon, Washington, and Texas. The American Nurses Association (ANA) is also supporting the development of Federal Policy.