Getting workforce planning right
Workforce planning and budgeting is a complex task that often seems like staff utilisation and workload measurements are misrepresented throughout the process.
In the context of hospital services, the workforce comprises 70-80 per cent of revenue, and nursing staff often comprise 40-50 per cent of the overall workforce. There is significant imperative to get nursing workforce planning right.
The evolution of State and Territory based enterprise agreements over the past decade to include specified minimum staffing requirements is aimed at providing surety on the staffing levels and can provide a basis for setting staffing levels in the budget development of new inpatient capacity. But the comparison to actual staffing levels is not well known or reported.
To get a handle on this we have analysed data from Western Australian public hospitals over the past 4 years to understand the actual staffing level compared with the EA requirement, and the overall trend in the staffing levels over time.
Western Australia adopted the Nursing Hour per Patient Day (NHPPD) methodology in the public-sector enterprise agreement in the early 2000’s, in conjunction with the development of a classification system for wards. The classification system is aimed at recognising the varied nursing acuity across ward and hospital types and adjusting the level of nursing care accordingly.
Results:
This analysis has provided three key results:
108 of the 164 wards in the data set (66%) in 2017 were categorised according to the EA categories, the remaining 34% have “combined” classifications, with a ‘bespoke’ NHPPD target established. The proportion of wards with a combined classification has decreased from 41 per cent to 34 per cent over the 4 years.
85 per cent of classified wards have staffing levels above the EA level, with NHPPD levels on average more than 25 per cent higher than the minimum level specified in the EA.
There is a wide variation within categories. For example the figure below illustrates that the Category C wards (target of 5.75 NHPPD), have a range between 4.9-7.5 NHPPD and the median value of 6.08 NHPPD compared to the EA target of 5.75 NHPPD.
So how do we use this in practice?
While Western Australia has some differences to the rest of Australia (ie lots of sharks), the results are likely to be generalisable to other jurisdictions and provides some key learnings:
Budgeting based on the EA level is likely to underestimate the required staffing levels and operational budget, and this could have a significant impact.
With over one-third of wards unable to be classified into the categories listed in the EA, is it timely to consider whether the classification system needs revision?