Reserved For Wendy Lewis (Business Information Systems)

2010

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Group X 4/24/2010

Nurse Retention

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Table of Contents

Statement of Problem……………………………………………….3-5

Alternatives Considered and Solution Selected……………5-7

The Goals of the New System……………………………………7-8

Details Concerning the Solution………………………………8-10

Implementation……………………………………………………11-13

Cost-Benefits………………………………………………………..13-14

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Over the last few years more and more hospitals are losing quality employees to

larger hospitals and home health care companies. As a hospital employer, the cost of

training alone can be high within the healthcare industry, and the key to success is to

retain superior employees that are already within the organization. Not only the human

resources office, but a collaborative effort of management within a hospital system will

be needed to address the problems and implement the necessary changes to succeed.

Being able to keep and recruit high-quality nurses will increase the overall productivity

of the hospital and will help with all business goals. Identifying the potential reason for

exiting nurses and providing feasible solutions will be discussed.

Specific Problem Facing our Healthcare System

As an employee leaves any position, they are given an exit interview by the

human resources department. On this exit interview a lack of communication is

frequented cited as being a top reason for ending their employment with the hospital.

Many feel that supervisors are not keeping them informed of normal operations around

the hospital and that the communication problems from the supervisors to the staff are

lacking, to say the least. This miscommunication does not allow nurses and doctors to

be prepared for any situation; such as changes in the work schedule or even treatment

plans. The frustration of feeling left in the dark can lead them to seeking work

elsewhere where they feel they are more informed and can make better decisions. The

stress that is caused by communication problems only makes the normal everyday stress

even greater, and is understandable for creating a staff looking for a solution.

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Some of the stress factors that have been listed in the exit interviews are lack of

concern for the patients and the employees that take care of them. When nurses see that

hospitals are treating patients as numbers and not as people, it only makes them feel

that they don’t care about the actions of each nurses or any individual working at the

hospital. The sense of team and family are missing when a hospital is uncaring for

patients and staff. In turn a feeling of hopelessness can reside within the halls of the

hospital, making them feel an attitude of why even bother. Also the stress of not having

enough time to deal with each patient on a personal level sometimes makes the nurses

and doctors feel overwhelmed, and that everything has become a lost cause. The lost

cause effect stems from the fact that there are not enough nurses on call which can mean

that high-quality workers are willing to separate themselves from your organization to

see other employment that values their effort and time.

A lack of good quality nurses can cause many problems, even in the most efficient

hospital. When the staff is short handed it can create long working hours for each nurse

and sometimes causes unwanted schedule changes. Many times nurses are asked to

work well past their normal scheduled time. This causes tension with the staff and

supervisors creating more stress, which leads to overall dissatisfaction with the work

environment. The long hours also lend itself to other areas of concern including poor

decisions that can be made because the staff is tired from working a double shift. When

the problem arises that the hospital does not have enough well trained nurses, the good

nurses will leave to hospitals where they are offered more money, support, and

resources.

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If nurses are tired and worn down they will leave for reasons like better hours

and more compensation for their time. When someone is paid the same amount of

money yet works fewer hours, it feels like they are getting a pay raise and is ideal for

many nurses. Hospitals are then forced to quickly replace that nurse that has moved on.

The reality is that the replacements may not be as skilled as the one that left, which

causes the cycle to repeat itself again. Our hospital in particular has lost first-rate nurses

to the other hospitals in the area based on working hours, pay, and bonuses. The other

hospitals are well staffed, and offer a steadier schedule. This creates a less stressful

environment and increases better communications with the supervisors.

Our hospital is losing money because patients are starting to go to other area

hospitals, where they feel that they can get better quality treatment. They feel less like a

number and more like human being. With all the information gathered goals need to be

set in order to fix the key issues with nurses seeking other employment.

Alternatives Considered and Solution Selected

Fortunately there is a couple of IT solutions for nurse retention. The first and

probably the most important one is having benchmarking and metrics established. The

most important benchmark has been identified as a lack of communication from the

nursing stand point. It seems like during the exit interview process the nurses state

concerns about the lack of communication, which they feel is needed to do their job

effectively. They also feel more recognition is needed when they have gone above and

beyond in their job duties. Some metrics from the communication benchmark would be

1) was there adequate communication between the doctor’s expectations and the nurse’s

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results of patient care. 2) Was there adequate communication between the hospital and

the nurses? 3) Did the nurses feel comfortable in passing information back up the chain

of command? 4) Quality of the communication in recognition for outstanding job

accomplishments, or for that matter any accomplishments whether be related to job,

school, or public awards. Identifying and solving the problems through the benchmark

and metric system will help in retaining qualified and quality nurses.

The second IT solution, e-collaboration, is a relatively new solution to keep

employees throughout the corporation in touch with each other. An example of e-

collaboration would be where employees meet via a teleconferencing session. This can

be accomplished through either just a phone connection from various points where one

set of employees call others for a phone conference, or there could be a video

conference, if each location is equipped with a video camera. These are especially helpful

if the management wants to communicate to each of the different corporate locations, or

if a supervisor were in one location and have employees scattered throughout the

country or world. Examples of this teleconferencing where there is a distance between

upper management and the nursing staff, the employee may feel unappreciated, which

leads them to look for other employment.

Another solution to these kinds of problems is better lines of communication

such as teleconferencing. In video teleconferencing all can meet in a virtual location and

actually see each other to gain the advantage of reading not only the verbal responses,

also seeing the body language. In this way negative feelings can be averted and respect

and appreciation for each person can be gained. Appreciation and recognition are two of

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the best tools for employee retention. Companies should have a corporate wide

employee recognition program that high lights the good suggestions of its employees

and those employees who go out of their way to help a patient at the health care facility,

or finds better more efficient ways of improving the way the health care does business,

and all these things can be done via the IT solution of E-collaboration.

The Goals of the New System

Our new system will help to ease the issues of nurse retention: why nurses are

leaving hospitals, how to retain nurses, and maximize communication between nurses

and other employees to ensure the problems are addressed in a timely manner. Our IT

solutions for each of these problems include databases, expert systems, and E-

collaboration to solve each of these nursing concerns.

Our plan consists of utilizing databases to store information such as exit

interviews and the trends in employment, no matter the time in position, the pay of

competitors, and personality studies conducted at the interview. Having this database

with the above information will allow the facility to run reports or queries to understand

why nurses leave and what they can do to keep qualified nurses longer, which will in

turn provide necessary information to obtain our goal of preserving our qualified

nursing staff.

In order to try to hold on to our nurses longer, we would use an expert system to

help with day-to-day activities. Using an expert system would minimize repeating

assessments, treatments, tests, and reduce errors. Having this expert system could help

nurses determine diagnosis based upon the patients symptoms, and the nurses will feel

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that they are making better decisions for their patients. The expert system could also

help in reducing paperwork and facilitate time management and be efficient in

completing our goal of less workload for nurses, and in turn keeping them happy with

our organization. An expert system will help to reduce employee stress, lessen the

workload, and enable them to spend more time on direct patient care, which will

address the information found to cause nurses to seek other employment.

E-collaboration, such as an updated hospital intranet, will help to solve the

problem of lack of communication between the nurses and other employees. Nurses can

leave work very frustrated and feel as if their complaints are being unheard and/or they

are not able to communicate with the other employees properly. It makes it hard to

communicate properly when there are varying shifts of employees. Having e-

collaboration they would have a way to see what other employees said about a topic and

be able to reply with their opinions. This would prevent having employees left out of

topics that could affect them or giving them the opportunity to add valuable

information. With a company intranet in place, each patient could have a file with all

their information listed and any nurse could see and review the information to help with

workload issues. Then the nurse can add his/her comments as necessary to keep it up to

date.

Being able to reach each of these goals will greatly help the hospitals, and

healthcare clinics in keeping nurses longer, hearing nurses complaints and understand

why nurses may choose to work at certain hospitals verses another.

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Details Concerning the Solution

After evaluating a variety of different solutions it was determined that a database

is essential in evaluating the cause of low employee retention. The database will be used

as a logical collection of information which will allow our company to pinpoint key areas

to be addressed. Our first step will be to determine what type of information will be

collected. Important information to include will be exit interviews, frequent trends in

employees that quit after a short period, pay of competitor/competitors retention, and

personality studies of current and future employees. Our database will then be utilized

to organize the information in a coherent manner and allow for human resource

employees to extract pertinent information to why we have difficulties hiring and

keeping quality nurses. Next, data mining techniques, such as query and reporting tools,

will be used to create clear reports on the key issues that are causing nurses to leave

after a short period of time. Also a database management system will be used to

simplify storing, modifying, and extracting information from our database. On top of

having a database to evaluate hiring practices we will also include a database for

scheduling purposes. This will show which shifts need more staff so human resources

can offer extra incentives for particular shifts that are undesirable.

Our next solutions will focus on improving the work environment and reducing

stress, because the key to retaining quality employees is through having a work

environment that employees are satisfied with. We are proposing a system that includes

an electronic database for patient records; plus we will integrate an expert system that

will have a multitude of assistive properties including alerts and reminders,

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diagnostic/assessment assistance, therapy critiquing and planning, prescribing decision

support, information retrieval, and identification of contradictions in care. The

computerized database for patient records will house all of the medical records

electronically. Each nurse will be able to easily access the patient records with their

individualized password and they will also be able to input new information in a timely

manner. The expert systems will apply reasoning capabilities to reach a conclusion. For

example each nurse will have a personal digital assistant which houses the expert

system, and it can be brought into the patients’ room while performing the assessment.

The nurse then could instantly document the findings, and it would give immediate

feedback to insure nothing was missed. This comprehensive system would essentially

eliminate the time a nurse would spend behind a desk documenting therefore freeing up

time for patient care. Plus a huge source of stress in the healthcare field can be directly

related incidence of errors, and through the use of this expert system errors could be

significantly reduced. The expert system will contain a knowledge base of rules from

which the decisions can be made, a database of facts specific to the domain of focus, and

an inference engine to solve problems by linking the knowledge base rules with the

database. This will essentially allow a nurse to have instant access to expert assistance.

Finally, employee dissatisfaction can also be directly related to lack of

communication, which is why we chose to utilize e-collaboration amongst fellow

employees and management to facilitate information. By having an integrative

collaboration environment established it would serve as a way to share essential

information between various levels of employees. This method would serve as a source

for networking were employees would be able to post how each shift went, key issues,

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and reports on patients. Finally team meetings could be held in a virtual environment

which could eliminate time constraints of particular employees. This virtual

environment enables all healthcare staff to have continuity of care for patients and

everyone is aware of key issues.

Implementation

Once a solution has been developed, it is time to implement the changes within

the organization. Many feel that implementing the IT solutions will be very easy, yet

within this process there are many elements that need to be done to assure the decisions

made were appropriate. Having a plan and following through will make the

implementation of the new system more effective. As well as having a plan, making sure

the correct number of staff members are in place, and that they have support with this

system is crucial. If all the pieces are in order and the staff is there to support the new

system, one has a great chance of retaining qualified employees.

When trying to maintain the best pool of employees, full cooperation will be

needed from all the managers and the human resource staff within an organization.

When new databases are created, all the information will need to be input into the

system. Most of the past information can be input at time of creating, but future

information will need to be input by the hospital managers and the human resources

department. Once the benchmark is in place, the hiring staff can access the information

to make better decisions when selecting potential new staff members. Current

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managers will be required to use this information stored in the database to address

concerns with their staff, and suggest improvements to upper management. Within the

implementation plan, there needs to be provisions as to what future maintenance will be

needed for the system. Ongoing training programs will be required to keep the staff on

the same page with the requirements of the database. (Birnbaum)

When implementing an artificial intelligence system, or specifically an expert

system, the programs and people need to work together. To introduce the staff to the

new program created to assist in decisions and make the work environment less

stressful, training classes on the actual software will need to be given before it can be

fully rolled out and made the operational standard within the hospital. The system will

need to be updated and tweaked to make sure it is doing its job of helping with decisions

and diagnosing patients, yet this can be done after the initial implementation.

Within our plan to resolve the lack of communication between employees,

we will need to implement new e-collaboration tools. With any position,

communication between co-workers and with management can be limited. Once an

infrastructure system has been created of emails and other vital information being

stored and collaborated throughout the hospital, each staff member can access the vital

information and also comment or adjust the information with specific computer

training. It is very important that management and the staff both need to held

accountable for utilizing the system. It is up to human resources to teach the staff that

hires how to use the infrastructure of the hospital system. (McKnight)

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As with the current staff the nurses should be given training and have at

minimum quarterly training if no changes to the system, and if the system is updated

training at that time. Just introducing the new e-collaboration tools are not enough,

practice will make perfect and the use of the system will increase its effectiveness with

adjustments and this should be implemented within the infrastructure’s training

program. This training would include a class on basic computer skills and how to use the

created collaboration tools by the hospital IT department. The hospital should also

provide a resources center for continued learning and incase a procedure needs to be

researched by the nursing staff.

The implementation process is very important because it gets the hospital staff all

on the same page and a can also create good working teams. With the help of

management and human resources the new database, expert systems, and the use of e-

collaboration business can help retain better employees by lessening the work load and

increasing communication. Implementation of these keys systems is integral in helping

the hospital success by retaining superb nurses. (Richards)

Cost Benefits

Our company had to first decide whether to choose outsourcing, in-house, or

purchase program, to accomplish the goals we are working to obtain. Outsourcing in our

business is too risky; we cannot share our information as readily as other organizations

because of HIPPA laws. Our in-house IT department does not have the experience or

staff to write our own program. After taking all this into account we have decided to

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purchase a program that will satisfy all our needs. This will be the least expensive of

options with programming and implementation.

Time will be one of our biggest costs after the program is purchased and

implemented. For example we will need to spend time on managing the new system,

time understanding the system, and training on the new system. We will have staffing

expenses associated with the new system, such as help desk, but not limited to.

We will have expenses due to cultural challenges, in adopting the new system,

with leader and staff by-in. We will need to find a way of stopping the loss of employees

while the system is being implemented.

The benefits of our Management Information System are as follows:

1. Reduction of advertisement and recruitment costs

2. Ability to react to nurses needs faster

3. Fewer vacancies and reduction in vacancy costs

4. Fewer new hires and reduction in hiring costs

5. Ability to meet and understand the needs of staff

6. Happier employees

7. Better patient care

8. Better overall management

Conclusion

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In our quest to improve our retention of our nursing staff, we identified several

problems that we need to fix. We wanted better nurse retention, more open and

interactive communication, less stress on our nurses, and better patient care. We have

gone through the process in defining a new Management Information System and what

we needed it to accomplish. The MIS is an important component to our overall new

management style and we want a fully integrated system. We do realize that our people

have to be technology-literate knowledge workers. As with any good MIS system we

know that we will be in the maintenance phase for the life of the system, which helps us

monitor and support any changes, for our ever-changing needs.

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Works Cited

Birnbaum, Bill. "Strategy Implementation: Six Supporting Factors." 2009. Birnbaum

Associates, Web. 21 Feb 2010. <http://www.birnbaumassociates.com/strategy-

implementation.htm>.

Management Information Systems: For the Information Age. 7th. New York, New York:

McGraw-Hill Irwin, 2008. Print.

McKnight, Ph.D., Richard. "HR's Role in Strategy Implementation: Leading the Human

Side of Change." Right Management Consultants. 2005. Right Management

Consultants, Inc., Web. 22 Feb 2010.

<http://www.right.com/Documents/Consultant/20050314160045.htm>.

Richard, Daniel. "About.com: Entrepreneurs." Writing a Business Plan -

Implementation Plan. 2010. About.com, Web. 20 Feb 2010.

<http://entrepreneurs.about.com/od/businessplan/a/implementation.htm>.