May 17, 2023
Surging healthcare labor costs are the primary cause for spending growth in hospital patient care. In their annual Cost of Caring report, the American Hospital Association notes, "Hospitals' labor expenses... are up 20.8% from 2019 to 2022.... largely due to a greater reliance on contract staffing agencies to address workforce challenges, resulting in a staggering 258% increase in hospitals' contract labor expenses in 2022 compared to pre-pandemic levels." The report goes on to indicate that healthcare staffing agencies increased their rates to record-high levels, exacerbating an already significant expense. Given the negative perception of healthcare staffing agencies and their associated costs, healthcare executives have made reducing their dependence on contract labor and staffing agencies a top priority.
However, workforce shortages are here to stay (at least for now), and COVID-19 surges coupled with increased patient volumes from those individuals who deferred care during the pandemic are forcing healthcare administrators to find innovative solutions to maintain access to high-quality care for their patient populations with their limited workforce.
While health worker float pools have been around for decades, restructuring their conventional model to meet the current demands across the healthcare continuum can help address several of the challenges facing hospitals and health systems today, including patient care.
This blog post will focus on how a thoughtfully constructed and well-managed clinical float pool can support positive patient outcomes, safety, and satisfaction.
In our last post, we discussed how float pools help reduce clinical burnout by ensuring safe nurse-to-patient ratios, citing Penn Nursing CHOPR team's study that found each additional patient per nurse [beyond the recommended 1:4 nurse-to-patient ratio] was associated with a 23% increase in the odds of nurse burnout and a 15% increase in the odds of nurse job dissatisfaction."
Beyond the negative impact on the clinical staff's well-being, patient overload directly impacts patient outcomes. Data published in BMJ Open found a 16% increase in the mortality rate and a 5% increase in the odds of a patient staying an extra day in the hospital for each additional patient a nurse is responsible for beyond the 1:4 baseline. In addition to increased mortality rates and length of stay, the U.S. Government Accountability Office found that low nurse staffing can lead to potentially preventable hospital readmissions, which cost Medicare over $5 Billion in 2018.
Float pools can help maintain adequate nurse-to-patient ratios by supplementing core care units with qualified, competent clinicians familiar with the hospital and patient needs in times of increased demand and unexpected clinician shortages. When built to the specific needs of the patient population, float pool clinicians with the appropriate certifications and training in specialties with the highest patient volumes can be deployed for optimal care delivery.
One of the risks of traditional float pool models is that the clinician sent to work on another care unit may be unfamiliar with that team's policies, procedures, protocols, and dynamics, leading to uncoordinated care, medical errors, and adverse medical events. New approaches to float pool development address the risk and support the growth and expansion of critical skill sets across the organization.
Today's models recommend building a dedicated float pool containing clinicians who opt to circulate across different hospital departments and care units rather than mandating that care providers move to unfamiliar settings when needed. Establishing a group of clinicians hired exclusively to support a variety of clinical specialties can help hospitals deliver quality care and outcomes in the departments where additional clinical support is needed most. Experienced personnel that prefers to work solely in a float pool often have more diverse experience, training, and certifications. More entry-level clinicians that opt for a float pool assignment may enjoy exposure to new types of patients and care settings and the opportunity to obtain additional licenses and certifications, expand their professional network, and discover their passions.
It should be noted that building a robust cross-training program for floating health workers is essential to ensure they meet the organizational and unit-specific standards of care. When adequately supported and prepared, dedicated float pool clinicians obtain a robust set of skills that can be leveraged across the organization to not only maintain care quality and outcomes, but improve them.
Unlike expensive travel labor and external staffing agencies, float pools typically source local clinicians that know the unique needs of the patient population and are a part of the community. The clinician's proximity to the care setting improves patient access to care in several ways. For example, local floating clinicians can more easily access the facility to maintain adequate staffing levels when unexpected shortages or increased patient volumes arise. Additionally, a local-first float pool reduces the costs of travel labor (i.e., expenses such as commutes, accommodations, and meal stipends) and cuts agency fees. Hospital administrators can invest these savings in healthcare services and interventions that reduce inpatient volumes and keep beds open to patients most in need.
Last, utilizing an on-demand roster of local clinicians helps foster a positive relationship between the floating staff, the core clinical teams, and the patients. A recent study conducted by McKinsey & Co. found "...the most important factors keeping [clinicians] in their direct-patient-care roles included doing meaningful work, a positive and engaging work environment, and feeling healthy and safe". Considering this data, hospitals can better engage floating clinicians directly connected to the community they serve. They will be able to better connect with the patients to:
Leveraging a well-built and managed internal resource pool is essential to achieving positive patient outcomes, safety, and satisfaction while maintaining labor costs. Float pools provide access to a wide range of qualified healthcare professionals in the hospital's backyard and support patient services across the organization. When properly deployed, floating care providers help hospitals increase access to care and address health disparities, maintain appropriate patient acuity levels, and increase the expertise of the entire.
In our mission to disrupt healthcare workforce management for the better, DirectShifts has developed a tech-enabled float pool management solution to help provider organizations realize the benefits discussed here. To learn how DirectShifts' Float Pool Management Solution addresses the shortcomings of traditional float pools to support the goals of today's healthcare system, join us on July 12th for our live webinar.