Introduction and Personal Background

Hi, thanks for joining me. My name is Jason Goodwin and I'm here to talk to you about how you can get C Suite support for your succession plan by using predictive analytics.

Hopefully I meet the needs of this presentation by giving you everything that you ever wanted to know about how to get your C suite to give you support for this.

A little bit about me before we get going.

My name is Jason Goodwin.

I have a consulting firm, healthcare and legal consulting firm called Innovative Cultures.

My professional background I started in 2002 as a staff RN.

It's kind of gone full circle for me, but my first duty station was with the Navy at Naval Hospital Camp Pendleton and I deployed with the Marine Corps in 2003 in a Charlie surgical team, which ended up taking care of wounded service members and enemy prisoners of war, coming back on the forward edge of battle in Iraq and sending them for surgical treatment, being part of the surgical team there.

Perfect Surgery Preparation

And so from that point on I came back, worked in the OR in pacu.

I worked in charge, did a little bit of teaching in the off time, became a manager of an OR and pacu, nursing director of perioperative services and finally an assistant administrator of procedural services for a hospital system.

And now I'm back to the bedside working as an RN and an educator and doing a little bit of this kind of stuff.

So it's great to be back here.

I have about 20 years experience overseeing these types of services and, you know, banging my head up against the wall with these types of problems.

So we're going to try to solve that today.

Okay? So I want you to sit back, you're here with me.

Let's talk about what we could do, right?

Let's talk about the perfect surgery preparation.

I want you to imagine that you have a surgical case where the clinic, the patient is happy and grateful in the clinic.

Case scheduling in the clinic is done without incident.

The surgery plan is clear and the procedure is easy to select.

The OR booking the schedulers are able to be helpful with the case and the case request is clear.

The current and accurate preference cards are attached.

History and physical is thorough.

The consent is neat and correct and ready for verification.

And then the OR preps the case.

They the vendors supplies, they tweak the preference cards finally for accuracy and they save the changes for your next procedure so that your next case is good, your pre op nurse is kind and competent while starting the universal protocol verification and IVs and verifying the patient's ready case picking has all the trays, instruments and carts accurately picked and ready outside the room.

And then you get there and your staff is proficient and diligent.

The surgeon is comfortable and in good spirits.

The OR is set up in the room and on time.

The timeout, when it's time, is brief.

The team is confident and prepared and as a result the patient is reassured and calm.

Now, what I've just described takes over 60 steps to get into the operating room, but it sounds good, doesn't it?

But it also explains why there's so many opportunities for us to have conflict and why this job is a hard and important job.

And that explains a little bit of why it's so difficult to keep and train people in our profession.

So I'm going to talk a little bit about a loosely based case study on some experiences, some different experiences I've had.

Case Study: Level One Trauma Facility

So this is a case study of a level one trauma facility, 600 beds, three surgical venues, including a multi specialty or 300 perioperative staff, 24 hours in the main or with 22 rooms, a trauma room and a hybrid or over 20,000 cases a year, 24, seven hours a day.

Assain Bay Surgery center, which takes the outpatient stuff for 4 ors and 4300 cases a year.

And Monday through Friday 7 to 1800 is their operating hours and then a children's surgery center, 5 or is 247 call evening and weekend in house staff.

Now, in our last slide we talked about the staff being proficient, the surgeon being comfortable, setup being perfect, the team's confident and prepared, right?

These are the goals that all of us have as managers or anybody that's managed resources in this room.

But unfortunately we waste time, we waste trust, political capital and ultimately patient quality because we can't get the supplies, the resources, the information that we need at the time.

We need it so that we can manage our environment well.

So we talked a little bit about this case study.

So some of the things that we had going on in this specific or we had a main OR that had scheduled urgent and emergent cases as well as add on cases and they were completely full from 7 to 3 o'clock every day.

There was no immediate fix.

Expansion was three years away.

Clinical waiting lists were up to six months in some services.

And this is something that we would hear about from the patients.

Efficiency. Some of our opportunities for efficiency, our only opportunities were going to be after 3pm and there was no interest for any surgeries in general after 9pm for the surgeons.

So we had 3 to 9pm that was a possibility.

And we were working on Trying to expand our services to meet that need.

We would also have challenges after three, not only in our existing staff, but when we had hired new staff for the afternoon staff to have the type of proficiency that the day shift has because of the exposure that they get and things like that.

So this is a large picture of our block schedule at that time.

This block schedule just being shown to show that it's quite a, quite a large system, very complicated, right.

Challenges and Opportunities for Efficiency

And it's not something that is easily patched into a and matched with a staffing plan.

So this is something that we're always trying to do patchwork together to figure out how to get the right people and train them to be in the right places at the right times.

So as leaders, what we were concerned with, we already knew that the life of an operating room nurse is difficult, right?

You have block utilization and these things, operations affect morale, right?

You have block utilization.

The late block release causes variation, schedule changes, last minute scurrying and heroics, right, from the nursing staff trying to make things work.

There's not really any many times any true incentive for utilization in a traditional block schedule.

So there's some gamesmanship that can be played.

Things like when you have short surgeries, it has a higher denominator and so it's easier to get your turnover times lower.

But if you have a long surgery and you have a bad turnover, then that can really affect your averages.

And so this, the game is not always played on the uneven field in that regard.

There's non block add ons, right?

And so in this case, most of their add ons are Medicare.

It's about 20% of their overall volume and about one in five of those requests are rolled to the next day.

So you have a situation where these cases are getting rolled to the next day and they're the people that have the most disparate access to this care.

So we wanted to make sure that we were trying to take care of that.

And the average of the request for one of these add on, non block add ons, it was the request to cut was 270 minutes.

So our patients that were often most in need didn't get prioritized by our system.

Our scheduling accuracy, we had a case estimate range that was low to high.

So essentially one surgeon might say that it takes them less time to do the work, and other surgeons might say that it takes more and both are off what the true north is. Right.

So excuse me.

All right. And then, you know, some of the other things that we dealt with, technology and missing supplies. Right.

Staffing and Schedule Management

Pick list, glitches, location changes, back orders, preference cards outdated. Right.

Staff call. And all of this stuff creates a situation where people start getting testy with each other, they start losing their patience, they're stressed.

And all of this affects morale. Right.

Staff get into conflicts, there's hoarding because of the system's not working, there's incivility, scarcity of resources.

The land, not to mention working in a health system, means that you're working in the land of 1000 initiatives. Right?

And so, and then any other unnamed surprise that come up comes up whenever you could be surprised.

So it's not an easy job. Right.

And it's no secret why we have some of the concerns that we have.

So our team, as a leadership team, we were concerned.

We know that staff retention and efficiency and quality, when they're up, then the cost goes down.

And when the cost is going down, you get a lot of support for everything else. Right?

So how do we make sure that we have patients that are being taken care of safely?

How do we get our C suite to know what we're going through and try to convey how difficult some of these scenarios are?

How do we convey our problems with surgical access and motivate our senior leadership to help us navigate through some new innovative ideas?

How do we do this with surgical capacity?

How do we increase our competency in different shifts and different case classes?

So essentially what we decided is we did some work in previous projects and we were able to take some data and put that together in a way to where we were able to understand what our needs were.

We were able to put that into a document or a format that our leaders would be able to see and what could create some action around it.

And so we did that.

And I'll talk a little bit about what we did because we needed these resources to be ready.

We were able to start with the short term, which is improving our proficiency and our ability to get our existing staff hired and into the right places for their proficiency.

The long term strategy, which we'll talk about in a moment, is the succession planning aspect.

And in some ways, this win that I'm about to talk about briefly with the data translated into how we decided to tackle the succession plan long term strategy.

Okay, so what we decided we were going to do with our original project is that we said, okay, we want real time data, we want to be able to use it in real time, and we don't want to be gutting any decisions.

There's no more of this, like doing the best we can with what we have. We're not.

We acknowledge that that doesn't work.

And then next we were talking about attrition and succession planning and staffing and competency management.

So we talked a little bit about staffing case variation.

We wanted to put together surgeon teams, we wanted to improve our competency 24 7, wanted to reduce things like manipulation and favoritism and handoffs.

All of this was going to be around improving culture.

And then finally we talked about attrition and succession planning.

What are we going to do once we get these first two ideas out and we get data we can use and we get staff and a system that the staff can use to be competent?

Predictive Analytics in Staffing

How are we going to use attrition and succession planning to improve our culture as well over long term and prevent things like leadership turnover, understand at least terminations, vacations and retirements and address that succession planning and C suite awareness?

Particularly once we get those pieces together, how are we going to make sure our leaders know what we know?

And then most importantly, how are we going to make sure it's embedded in our daily work so that we do not have to fight this battle again?

So as I was talking about before, we, our long term staffing and our daily staffing were part of the, part A of this project where we took data and we were able to come up with some predictive analytics to use in real time to charge our staff members and our leaders to make decisions based on data in real time.

So after getting some data out of epic, creating some spreadsheets and some assessment tools to figure out where their proficiency was based on data, where they thought it was based on their experience, and then matching that with their employee schedule versus the block schedule, crossing that all together, we were able to create a tool that tells us where someone should be whenever there's a decision that needs to be made.

So the staff nurse or the charge nurse, when making an assignment, will use our staff assignment analysis tool.

And if I'm looking for circulating nurse Jason, I want to know where that person has been over the last 90 days.

With a click of a button, I can figure out where he has been spending his time.

And so you can tell what my reps have been in certain procedures, specifically in, you know, different services.

You could go by service by surgeon, you could go even at the level of procedure and you could start to get an idea for where those reps are being applied.

The power in doing that is that, you know, whether I need to be in that case or whether I need to be in a different case and someone else needs to focus their energy on that repetition, right?

So we were able to do that and it made a lot of difference for us.

Our staff saw that and there were great results based on the fact that we paired the service and the staff scheduling, right, with staff availability.

And then we had real time data in order to make those decisions.

And when those decisions were made and the staff or our surgeons didn't agree with that or they had questions, we were able to show that data in real time.

And the wake up call that we got is that when we showed them some of that data and we said, hey, this is why we did it, this is what we're getting it from and this is what the plan is, there was something magical that happened with the surgeons and even with our staff to where they started to see what we saw.

And I think when people, you know, when, when the perception of what you're doing as a leader is different from the perception of the person that understands what you're doing or thinks they understands, that creates a problem.

But if they, and I always said this, if I have no concern about somebody worrying about my decision making, if they knew all the information I knew at the time, right?

So for instance, if somebody knows exactly what went into my decision, I was confident that they would come out with the same decision as well, or at least they would understand my point and that would create better relationships and culture between whomever was participating in it.

Leadership and Succession Planning

So based on this outcome, we completed a lot of our goals in managing all of this stuff in real time.

What we didn't have left was the attrition and succession planning portion of it, right?

We talked about all of these things.

Leadership, turnover, prevention, install succession planning and a development system, proactively maintain readiness for terminations, vacations and retirements, and embed the training and succession planning in daily work.

Those things hadn't been accomplished yet.

So what we said was, hey, we know the situation that we're in, right?

Why don't we use this data and try to see what we can predict based on what we know is coming?

And we can't, we know that we have problems coming.

We've done everything we can do with the staff that's on board now.

And we know we have things like growth, we have access problems, we have attrition, we have training that needs to be argued for and budgetary concerns.

And we're not able to argue for that the way that we want because we know we're not conveying it the way it feels like we're dealing with it daily.

So how do we do that?

Well, we started talking about it and we know, as we talked about before, burnout and attrition for the reasons that we talked earlier about, it's a, you know, it's a problem.

And it's a problem in all of nursing.

And that has to do with lots of things come, you know, that we are all aware of related to the baby boomer population.

People that are going into nursing at one point was increasing every year.

But there's always been a little bit of a deficit in what the needs of nurses were.

And you know, then Covid happened and there were nursing.

Enrollments in nursing schools went down.

Many people even left the profession because of that.

It also takes a long time to hire and find someone in any organization.

And then when you're looking for or nurses that are not as readily available, and when there aren't as many or training programs, oftentimes you end up spending up to as many as 120 days looking for different candidates.

And when you need lots of people, you can't afford to do that.

So we started looking at it.

What do we know?

We know our broken systems, the high stakes of our job, life and death, the expectations of perfection.

Those values, when they're conflicted, they create this feeling of unfed altruism, right?

The conflict, the patient's supposed to come first, right.

And so if we can't achieve that over amount of time, it starts to really grind on you.

And so people, you know, they start realizing that they, they're hopeless.

And that's why as a leader, you have to be able to do the best that you can to keep that state out of where people start to feel hopeless.

So we knew that staying ahead of the curve was critical for hiring.

And we know that if you can't prove it, you're not going to get it. Right.

Addressing Attrition and Nursing Shortage

And so we started looking at how we could do that.

So this program actually had an OR training program that was going for many years.

And in this, this case, we had about, over the last 10 years, an attrition, sorry, A retention rate that was pretty high, 89%.

And that was after it was increased from 20 weeks to 24 weeks.

And so we had a program that was long standing.

We were very proud of it, good results.

But it was expensive, right.

And it required a commitment from our C suite for early funding.

And we didn't always have an exact way to quantify what the results were.

Besides goodwill, we knew we were in a Critical time because I could feel that we had budgetary tough times ahead.

We were looking at budget cuts and I think we were feeling like we were losing C suite support for the funding of this training program.

So we finally decided that we were in trouble enough to for hiring.

We didn't know what to do.

So we started talking to our leaders and saying, what can we do that we haven't done?

And figuring out how to hire and how to get better data than just our hiring, our position control report, Right.

And so we started talking and we decided that we would go to HR and try to find some information. We found.

We went to HR and we said, hey, we want to know the number of the years of service for every one of our employees.

And they said, no, we can't give you that.

They said, well, why not?

And they said, well, because that's private information.

And we said, well, no, that's not private information.

That's years of service.

That should be okay.

You know, is there a different way that we can get it?

They said, let me talk to our boss.

They came back and they said, okay, we can give you that information, but it's de identified.

And we said, that's fine, we don't care about that.

So we took that information, we put it into a chart, right?

And so we have the years of service by roll in this chart, right?

And so we started to break down, well, how many years have our staff been here and how many people do we have in the area that we think they're getting towards retirement?

How many people are brand new so we can understand where we are?

So then after we did that, we took that data and we put it in to groups.

So we said, okay, well, we have 39 people with at least 30 years of service by role.

Let's put those into a group so that we know who they are or in general know what roles they are and what we're going to have to be ready for?

So we had three technicians in CPU.

We had three in the OR.

We had five or nurses.

We had seven or managers or charge nurses.

And then we had another six.

Data-Driven Decision Making

Well, actually we had another 10 managers in other areas.

So we realized that we had a lot of those people are senior level, upper, you know, junior manager or above.

So that was one of the first things we learned about it.

We also learned that we had a fairly large contingency of RNs that were part of that.

At that time. We had 25 positions posted and seven filled and 18 open.

So we were looking at critical shortages in CVOR children's surgery and in our team, lead nurses, the CN3s.

So we're starting to get an idea where our problems are.

And then we took that information and we went back to HR and we said, okay, now we want, we have the years of service.

We want the age of the employee.

Can you give us that? And they said, absolutely not. We said, why not?

Well, that's protected information for sure.

We said, okay, but is there a way for us to get that information the same as we got before with just the ages, no names, no identifiable information?

And they said, hang on, we'll talk to our boss and get back to you.

Well, we were able to work it out.

And finally we got that information.

And so we took that information and we cross referenced it with the years of service.

We created a scatter plot.

And so what we started saying is that we think that we have X many people that are within 10 years or sooner of retiring. Right?

And so what we found out when we did that is that 60% of our RNs were in one of those three zones of retiring.

We put them into within 10 years is green, within five years is yellow, and within three years is red.

And so 60% of our RNs were In that section.

And 15%, which ended up being 32 FTEs, was, we're going to be retiring within three years.

So we knew that that number was coming up.

We were already 18 in the hole.

We knew that this is a situation that we needed to be able to communicate.

So what was the pitch?

What we did is we decided that what we were seeing is we have a training or training program that's in trouble, but we're in greater trouble without continuing it based on what our needs are. Right?

So we started trying to show that in a graphical term.

So the or training program we listed out here and for two people for one training cycle, and then on the next training cycle, we had six.

And so we added those as plus six. Right?

And then we started putting in what our attrition rates were and our liabilities. Right?

It's kind of like a balance sheet.

And so we had some temp fills that were trying to keep us afloat, but we knew that in a year, our ongoing attrition rate, we'd lose 20 FTS in the next three years.

So we calculated that as a negative 7.

We also had a 3 to 7 expansion program that was coming. Right?

So we knew that we were going to need to have even more RNs than we currently have based on what the needs of the department and the hospital were going to be at that time.

So we made sure that we accounted for that expansion as an upcoming need as well.

And then we calculated what our existing surgical staffing requirements were and what the hiring aspects would give us.

And that was two years away.

It would take us two years to get to zero in our current market.

Our ongoing attrition rate due to loss of people in retirement, then our OR two staffing requirements for new supply, that would be coming.

Another expansion would leave us by the end of a year from the time when we were projecting.

It would leave us with -10 FTEs.

And our COO is wasn't a fool.

He knew that the or is it was important for us to be effective and efficient in order to keep the bottom line running.

We were 80 of the revenue at that point, and he knew that our readiness would be critical to also some upcoming projects that were important to him as well.

So we just, we wanted to be able to use this format to argue our needs in a way that could visualize the concern and could propel action from our coo.

So we took this and we continued to extrapolate it out.

And so as you see the bottom here, we extended that out another two years and we collected the tallies over here. Right?