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Staffing
Is Your Staff Making the Grade?
Karen Griffin
Publish Date: October 10, 2007   |  Tags:   Staffing

What gets measured gets done, right? If you're looking for a no-nonsense way to measure your staff's performance, here's a simple point system you can use to recognize and reward good deeds - and to give extra help or hands to those who need it.

Target areas
First, identify the areas or services in your facility that you'd like to analyze. Then ask your clinical manager to collect data about staff performance (she may delegate the responsibility to a member of the clinical staff). You should collect data monthly and analyze it quarterly. Here are a few examples of services you could analyze and measures you could evaluate.

  • Patient education. Did the patients receive clear and concise pre-op explanations?
  • Patient safety. Did the OR team perform a timeout before surgery and did the staff check the patient's identification wristband? Are patient consent forms properly completed and witnessed?
  • Infection control. Staff must follow standard infection control precautions, including the use of clippers instead of razors to shave patients, sponge and instrument counts before the surgeon closes and regular maintenance checks of the facility's sterilizing equipment. How many, if any, surgical site infections occurred?
  • Recovery area. Did staff take and record patients' temperatures within 10 minutes of their arrival in PACU? Did staff provide detailed discharge instructions, including wound care protocol and pain medication use to the patient?

These are just examples. You might wish to measure different clinical indicators. Focus on problem areas or issues that you suspect are deficient. Remember, you don't have to reinvent the wheel to find the needed information. Accrediting bodies already mandate that you collect staff performance data, and chances are you've collected for quality reviews you've already performed. It's likely that you'll find most of the information you'll need in patient records or patient satisfaction surveys. You can also collect administrative data on overtime used, vacancy rates, turnover rates and sick-time use.

Point system
After collecting the data, use a point system to measure performance. You can confer with your clinical manager and staff to devise weighted scores for each indicator. The specific numbers you use are relative, just be sure to divide the point system into three categories: poor performance; adequate performance but improvement needed; and performance level you ultimately want to reach.

Create a three-columned scoring sheet, listing the performance criteria, compliance rating and points per compliance. We chose to award points based on the following weighted system:

  • 100 percent compliance: 30 points;
  • between 90 percent and 99 percent compliance: 20 points;
  • between 80 and 90 percent: 10 points;
  • compliance ratings that are less than 80 percent are not awarded points.

For example, PACU nurses who provide complete discharge directions to patients 100 percent of the time earn 30 points per review. The OR team that uses clippers to remove hair at the surgical site pre-operatively nine out of 10 times might earn 20 points.

In addition to assigning compliance scores for individual assessments, create a weighted scoring range to assess performance at the end of the review period. For example, based on our scoring system, we created these weighted total scores for our quarterly review:

  • 301 to 390 points is the performance level we ultimately want to reach.
  • 200 to 300 points is the lowest acceptable target level.
  • 0 to 199 points indicates poor performance.

At the end of the review period, add the scores from each individual performance criteria and see where the total falls. For example, a quarterly review our the OR staff's complete performance totaled 380 points, so they did very well in meeting each standard we set. You can transfer scores to a graph made of concentric circles on which you assign the highest relative value to the outer circle and the lowest to the innermost. I set it up this way to show that those with high scores have achieved excellent perfomance levels in the most clinical areas. Thus, staff closer to the middle know that, while they may have achieved well in one clinical area, they need to improve performance elsewhere to cover more area, as it were. This circle graph offers a quick snapshot of staff's performance. It's a good idea to post it in the staff lounge or on the OR bulletin board.

Data analysis
Focus your review on the results that jump off the chart. Perhaps your facility experienced an increase in surgical site infections. A quick look at your tracking of performance indicators may point to a potential cause.

You can also use the data to measure the effectiveness of your staffing levels. Trending the results and comparing the numbers to staff mix, education, training and workflow lets you tweak your assignments to improve problem areas. Perhaps misguided patient expectations are an indication that pre-op staff are overwhelmed and don't have time to adequately answer patients' questions. And maybe your PACU nurses scored through the roof in providing discharge instructions. Backfilling the pre-op area with PACU nurses might help improve pre-op instruction scores during the next review period. If problems persist, you may need to add a new hire. The data you've collected and charted will justify the addition.

This method for scoring and tracking your staff's compliance is designed to be adaptive. It creates empirical evidence for your current quality initiatives but you should be prepared to look elsewhere when specific issues arise. The quality of your staff's performance is in constant flux and this system will focus your energy on areas that need improvement.

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