Texas Health Resources Empowers Nurse Leaders with Real-Time Data to Tackle Daily Staffing Challenges

As labor costs continue to rise for hospitals and health systems nationwide, many organizations seek to strike a balance between optimizing care and effectively managing workforce expenses. 

It’s a challenge that leaders at Texas Health Resources (THR) know well. The faith-based, nonprofit health system recently implemented Strata’s Real-Time Labor Performance (RTLP) across its 29 hospitals spanning 16 counties in North Texas. The solution serves as a centralized tool that provides real-time insights to help unit managers, supervisors, and nursing leaders make informed staffing decisions. 

Prior to RTLP, nursing leaders at THR pulled data from a variety of disparate sources and used multiple tools to generate insights into their departments’ daily census, expected discharge transfers, patient acuity, staffing grids, overtime or agency usage, or other factors. 

Health system leaders wanted to develop a streamlined approach that would help reduce high labor costs, especially overtime and use of contract labor. At the same time, they sought to make the best use of resources and allow clinical managers more time to focus on delivering safe, high-quality care. 

“We wanted to give our nursing leaders the right tools to empower them to balance care delivery with efficient staffing,” said Luke Gorman, vice president of financial planning and decision support at THR. “We needed a one-stop shop for frontline users that allows them to see a real-time, comprehensive picture of their current state — one that would allow them to quickly make cost-informed decisions while maintaining focus on delivering care for their patients.” 

One tool to address multiple challenges 

THR sought a tool that could help leaders address multiple issues in a single resource. To start, they wanted to make it easy for nursing leaders to review their staffing needs and current census, filtering through different systems, reports, or data sets to facilitate informed decision-making within minutes. 

Health system leaders also wanted to create more consistency organization wide. At the time, different hospitals across THR had different processes for bed huddles and determining staffing assignments. THR also lacked access to real-time data and insights on staffing performance and productivity. The most current metrics were at least two days old and were not helpful in guiding daily staffing decisions.  

“We didn't have anything close to providing any kind of real-time insights,” Gorman said. 

Lastly, leaders in both nursing and finance requested a way to document decisions or actions taken by nurse leaders during shifts. Such notes would provide frontline insights to help explain variances identified in routine productivity reports.  

Under the prior system, nursing and finance leaders spent a significant amount of time preparing for productivity meetings. Having better metrics and documentation would help expedite meeting preparation. 

“We needed to think differently and explore options that would reengage our operational leaders by using the data that we already have but weren't using in the most effective manner,” Gorman said. “We wanted to improve engagement and accountability by providing managers with the data that would allow them to course-correct in the moment.” 

Collaborating to create the right solution 

As a long-time customer, leaders at THR chose to collaborate with Strata to develop a real-time labor performance solution to meet the health system’s many needs. One major goal was to shift ownership of the productivity process from finance to nursing and operational leadership. 

To help achieve this goal, leaders from both nursing and operations were included on the steering committee that drove most of the project decisions. In addition to Strata experts, the steering committee included two executive sponsors, a chief nursing officer, and leaders from finance, information technology (IT), decision support, and THR’s labor optimization team. Having executive sponsorship helped the committee navigate various roadblocks throughout the project, such as moving process approvals through the health system’s various governance committees. 

Once the solution design was complete, one THR hospital was selected to be an early adopter, said Ryan Rowe, THR’s director of productivity and benchmarking. By limiting the initial rollout to just a few departments, the health system was able to work through any issues with a smaller, more manageable group before doing a wider rollout. 

Leaders from all THR’s hospitals were engaged during the general rollout of RTLP, including nurse executives and finance officers. They helped to keep frontline managers informed so they knew what to expect as the tool was being rolled out. Involving operations leaders was critical because it helped foster greater buy-in among end users as the tool was implemented, Gorman said. 

A one-stop shop to better manage labor decisions 

All THR hospitals now use RTLP in their nursing departments. RTLP ensures that nurse managers and charge nurses across the health system are aligned and getting their information from one centralized source, Rowe said. 

Utilization is especially high at the system’s larger hospitals that can pull from multiple departments when they encounter significant staffing challenges. Rather than having to rely on reviewing outdated data in retrospect, nursing and operational leaders can look at real-time data to inform daily staffing decisions. 

Throughout the implementation, Rowe said they found it was infinitely more effective when managers and huddle leaders were presented with data from their own departments to review. They were more inclined to be engaged and ask questions when they were looking at familiar data.  

The health system offered office hours once a week during the rollout, so that end users could ask questions and get live, one-on-one help. The office hours also offered the implementation team an opportunity to share use cases or recommended best practices, such as checking RTLP once every three or four hours to compare staffing plans with actual staffing levels. Having that information also helps managers pinpoint where they might be short-handed versus where they might have excess staffing capacity, so they can adjust accordingly. 

“The goal is for this to be an operational tool,” Rowe said. “We wanted to give them a place they could look a couple times a day to see trends and make real-time decisions in 60 seconds or less.” 

In the future, THR leaders hope to expand use of RTLP to other hospital departments, such as emergency departments, surgery, or imaging. They also hope to add patient acuity information to the tool to help ensure equitable bed assignments. 

“The best feature is that it allows nursing leaders to look forward in their schedule and to be more proactive rather than everything always being so reactive,” Rowe said. “There is plenty that’s reactive on a nursing floor because you never know what's going to happen with the patients, but anything that they could do to be a little more proactive would help them with the chaotic days especially.”