How CHEO Used Real-Time Target Tracking to Calibrate Staffing Levels

CHEO’s chief nursing executive created a task force with input from quality improvement, organizational development, and IT to determine which staffing data points needed to be tracked to determine appropriate staffing levels. Using that data, IT developed an Excel tool—now an automated dashboard—to facilitate in-the-moment analysis of staffing targets.

The dashboard, shown on the following page, first calculates targets for the 24-hour day based on census data. Then, at the start of each shift, managers enter their units’ actual patient census and staffing numbers. The tool determines if the unit has met its HPPD targets.

Managers can provide a rationale for missed targets in a section for “contextual factors.” Leaders also use this feature to identify systemic issues that need higher-level attention.

Using the dashboard, care facilitators and managers can intervene immediately when staffing mismatches occur—with data to support their actions.

If the dot on the dashboard is red, managers know that the unit has more nurses than necessary and is therefore over budget. Care facilitators can ask nurses to take time off or float them to other units, or the unit can admit more patients to hit their target.

If the dot on the dashboard turns green, one of two situations may be happening:

1. The unit is hitting its target exactly. While nothing needs to be done, managers will continue to reassess staffing throughout the day.
2. Staffing level on the unit is too low. Managers must assess whether more support is needed and in which roles. However, leaders expect that managers ask staff to work overtime only if they have exhausted every other alternative.

Floating nurses from one unit to another to balance staffing requires strong collaboration among units. At CHEO, these conversations occur during daily organizational bed meetings.

Representatives from all units attend the meeting to discuss staffing, bed allocation, and patient flow. Managers present their reports and decide the actions needed. They strategize discharges and triage admissions.

These meetings give managers a view of staff allocation for the whole organization.

Key components of organizational bed meeting

1. Managers, care facilitators, and charge nurses meet four times a day for 15-30 minutes to discuss patient fluctuations.
2. Managers, care facilitators, and charge nurses help each other hit their staffing targets by discussing which units need nurses and deciding whether to float staff.
3. Care facilitators recommend which patients can be transferred or discharged to meet HPPD targets by evaluating their patient flow and staffing metrics.
4. Having four daily organizational bed meetings provides opportunities for units to make real-time staffing adjustments for midday discharges and admissions.