1. Nurse Staffing Optimization Project Reducing CSO Shift Requests 2007 Dec 2008 Jan Feb Mar Apr May June July Aug Sept Oct Nov Dec 2009 Jan Feb Mar Apr June July Aug Sept Oct Overview Progress Since Last Update Key Metrics Issues / Concerns / Roadblocks Linkage to: Best Patient Experience: Coordinate care so that it meets each patient’s unique needs. Best People: Assure a meaningful work experience for each employee. Problem Statement: Current nurse staffing model does not involve coordination of all nursing resources across units. During FY07, 7320 shifts were requested to be filled by the float pool. Of those, 937 shifts remained unfilled, requiring 36.15 FTEs and $391,105 of agency usage. The causes of these unfilled shifts is not clear. Goal/Benefit: Reduce the use of agency staff to 0 for FY09 for unapproved variances. Reduce the number of unfilled shifts to 0 when the schedule is posted beginning June 2008. Reduce the number of unfilled shifts to 0 for FY09. Reduce shifts requests through the CSO by 50% to 3660 for FY09. Increase nursing satisfaction with the overall floating experience from 3.66/5 to 4.3/5 based on the Staff Satisfaction Survey (N=77). Scope: Feinberg and Oncology Inpatient Staff Nurses scheduling process and floating practices. System Capabilities/Deliverables: Revision of Nursing Staffing Policies/Guidelines to ensure optimization of current inpatient Staff Nurses. Standardized process to fill shifts and request staff from the CSO. A process to ensure that nurses who float are more supported and comfortable. Next Steps Collection and analysis of key metrics and process metrics On-going follow up emails to Managers of units non-compliant with workflows and floating tools Rapid design sessions held with staff nurses to find solutions to further reduce amount of unfilled shifts. Checklist created for Clinical Coordinators and Central Staffing Office created to improve compliance with daily schedule workflow process metrics. Nurse floating guidelines retooled based on feedback from rapid design sessions. Nursing post float satisfaction survey link transitioned to NM Connect from central staffing office. DM C Number of unfilled shifts Number of requested shifts Amount of agency hours used Satisfaction of nurses floated Supplemental hours used I Executive Sponsor : Michelle Janney Sponsor: Robert Fortney Process Owners : Cindy Darrah, Alan Pietrowski Improvement Leader: Alan Pietrowski A Completion Revise process as necessary to achieve all project goals Implement new inpatient floating guidelines Transition project to Central Staffing Office

2. Nurse Staffing Optimization Project– Results – Outcome Metrics D M A I C Since implementation of the project in July 2008, it can be determined that we have achieved the goal of decreasing agency usage to zero. While reducing Supplemental hours was not a goal, we have seen a continuous monthly reduction in usage since September.

3. Nurse Staffing Optimization Project– Results – Outcome Metrics 73% 27% Pre-implementationPost-implementation Filled shiftsUnfilled shifts Since implementation in July 2008 we have seen a decrease in the number of average monthly shift requests while also seeing an improvement in the percentage of the shifts requested filled though not a significant increase. 75% 25%

4. Nurse Staffing Optimization Project– Results – Outcome Metrics D M A I C Goal-4.3