Front-line ordering clinicians: Matching workforce to workload

Authors

  • Evan S. Fieldston MD, MBA, MS,

    Corresponding author
    1. Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania and The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
    • Address for correspondence and reprint requests: Evan Fieldston, MD, Children's Hospital of Philadelphia, 3535 Market Street, 15th Floor, Philadelphia, PA 19104; Telephone: 267-426-2903; Fax: 267-426-0380; E-mail: fieldston@email.chop.edu

    Search for more papers by this author
  • Lisa B. Zaoutis MD,

    1. Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania and The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
    Search for more papers by this author
  • Patricia J. Hicks MD,

    1. Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania and The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
    Search for more papers by this author
  • Susan Kolb MSN, CRNP,

    1. Department of Nursing, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
    Search for more papers by this author
  • Erin Sladek,

    1. Office of Patient Safety and Quality, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
    Search for more papers by this author
  • Debra Geiger MHS, SSBG,

    1. Office of Patient Safety and Quality, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
    Search for more papers by this author
  • Paula M. Agosto MHA, RN, CCRN,

    1. Department of Nursing, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
    Search for more papers by this author
  • Jan P. Boswinkel MD,

    1. Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania and The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
    Search for more papers by this author
  • Louis M. Bell MD

    1. Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania and The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
    Search for more papers by this author

Abstract

BACKGROUND

Matching workforce to workload is particularly important in healthcare delivery, where an excess of workload for the available workforce may negatively impact processes and outcomes of patient care and resident learning. Hospitals currently lack a means to measure and match dynamic workload and workforce factors.

OBJECTIVES

This article describes our work to develop and obtain consensus for use of an objective tool to dynamically match the front-line ordering clinician (FLOC) workforce to clinical workload in a variety of inpatient settings.

METHODS

We undertook development of a tool to represent hospital workload and workforce based on literature reviews, discussions with clinical leadership, and repeated validation sessions. We met with physicians and nurses from every clinical care area of our large, urban children's hospital at least twice.

RESULTS

We successfully created a tool in a matrix format that is objective and flexible and can be applied to a variety of settings. We presented the tool in 14 hospital divisions and received widespread acceptance among physician, nursing, and administrative leadership. The hospital uses the tool to identify gaps in FLOC coverage and guide staffing decisions.

DISCUSSION

Hospitals can better match workload to workforce if they can define and measure these elements. The Care Model Matrix is a flexible, objective tool that quantifies the multidimensional aspects of workload and workforce. The tool, which uses multiple variables that are easily modifiable, can be adapted to a variety of settings. Journal of Hospital Medicine 2014;9:457–462. © 2014 Society of Hospital Medicine

Ancillary