ArcNews Online

The Healthy Model for Nursing Workforce Management and Planning

Stanford University Medical Center Estimates a $22.5 Million Potential Cost Savings Over Two Years

For many years, health care administrators and hospital human resources (HR) departments in particular have had difficulty finding solid business intelligence for workforce planning. Hospitals acknowledge a heavy reliance on their nursing workforces, as well as on a direct relationship between the strength of those workforces and patient care outcomes. Hence, the development of workforce planning methods and tools is crucial to helping hospitals not only solve the puzzle of successfully recruiting and retaining top-caliber teams of nurses but also be prepared to successfully provide staff and operate during regional emergencies (e.g., earthquakes, fires, pandemics). An additional factor has been recent media coverage of potential nurse shortages, which has increased pressure to detect and plan for any such lack of availability.

The entire San Francisco Bay Area external registered nurse population with hospital points buffered at two, four, and six miles up and down the San Francisco Peninsula, showing the ease with which nurses can establish their careers by leapfrogging from one hospital to another.

Stanford University Medical Center, located in Palo Alto, California, on the Stanford University campus, comprises three main components: the Stanford School of Medicine, Stanford Hospital and Clinics, and Lucile Packard Children's Hospital. With 885 licensed beds, the Stanford University Medical Center also serves as the primary teaching environment for the Stanford School of Medicine and provides a clinical backdrop for world-class research. The nursing staff occupies the largest clinical workforce category, with approximately 2,700 registered nurses. Long-range workforce planning for maintaining an adequate nursing staff is therefore an essential administrative challenge.

"By drawing the analogy to epidemiology and emergency planning," says David Schutt, principal planning analyst, HR Programs, Stanford University Medical Center, "I was able to convince hospital leadership that GIS would be ideal for workforce planning because it introduces a geographic approach and provides visual, map-based results. In actual practice, we discovered that, while a GIS has the ability to access, manipulate, and analyze internal and external data on any type of workforce, it has an almost uncanny hand-and-glove fit with health care, especially relative to hospitals."

Schutt explains that this is because just about every external clinical professional at any hospital, especially nurses, must be state licensed and registered, making their geographic location easy to map. ArcGIS Desktop, which was selected at Schutt's recommendation, enabled HR to analyze and map this external data combined with internal HR workforce data, providing an overview of the hospitals' nursing supply and demand, as well as information about employee commute patterns and distances traveled to work.

With internal and external data for nurse populations mapped, ArcGIS, with its buffering functionality, and the ArcGIS Spatial Analyst extension help answer just about any question as it relates to workforce planning. Queries have included

• If the nursing population living within a six-mile radius of our hospitals is projected to retire in 10 years, but the average home price in the area has become far too expensive for just about any clinical professional, how will we be able to attract new entrants to our workforce to this location?
• What if we experience an earthquake in the middle of the night, and the majority of our nurses live on the other side of a major bridge affected by the quake?
• Many hospitals around the rest of the country are or will be experiencing a nurse shortage. Do we or will we have a shortage in our metro area?

"We have been able to ask and answer all these questions and many more," says Tony Redmond, director, Nursing and Allied Health Talent Acquisition Programs, Stanford University Medical Center. "Our HR and hospital leadership is no longer experiencing a business intelligence deficiency as it relates to the development of actionable workforce plans." Answers to these kinds of questions also help workforce planning for the medical school staff and allied health professional workforces, such as pharmacists, clinical lab professionals, and physical therapists.

Schutt says, "While recruiters have had hunches for decades about what may or may not be attractive recruitment features for nurses—such as pay, shift, and location—GIS analysis has, once and for all, laid the location controversy to rest. The nurse comfort zone for Stanford University Medical Center is about a 12-mile radius. Looked at another way, this is also a retention factor. When close proximity to the hospitals is coupled with nurses surpassing the milestone of three to five years of service, they are more likely to stay on board until they retire."

Real Savings and Better Coordination

While long-term planning must always be a work in progress, large returns on investment are already being realized. The recruitment advertising budget has been reduced by at least 50 percent, a monumental amount considering the San Francisco Bay Area is one of the most expensive advertising regions in the United States.

"GIS enables the hospitals to identify places where there are too few nurses or too much competition and to stop wasteful advertising in those areas," says Schutt.

GIS also allows the hospitals to precisely target candidates and use direct mail to reach them. In addition, mapping and analysis of workforce retention data provide insight into why nurses leave the medical center to work elsewhere. For example, when Schutt compared the medical center location to latitude-longitude points of all other hospitals on the San Francisco Peninsula, applying a buffer at two, four, and six miles and comparing it to other internal retention data, it became visually obvious that nurses just starting their careers could actually leapfrog from one hospital to another, up and down the peninsula, until they were able to locate the right pay and the right shift, as most of these other locations are potentially within their comfort zone.

This knowledge helps hospitals anticipate and mitigate potential interruptions to continuity of care and avoid the astronomical costs associated with hiring and retraining replacements. Schutt estimates that this knowledge could free up approximately $22.5 million over the next two years that would otherwise be spent on replacement/retraining costs.

In the Works

The Stanford University Medical Center HR department has established ongoing dialogs with other medical center departments; the Stanford School of Medicine; and Stanford University GIS labs, libraries, and administrative offices, all of which are also using ArcGIS and ArcGIS Server. Plans are in the works to develop and support coordinated efforts relative to both people and places throughout the campus community, including potential disaster preparedness planning.

More Information

For more information, contact David Schutt, principal planning analyst, HR Programs, Stanford University Medical Center (e-mail: dschutt@stanfordmed.org).