Gap Analysis Helps Nurses Become Better Leaders
Last year, Candace Smith, MPA, RN, was struggling with how to help all of her nurse managers and directors sort through and prioritize all of their leadership responsibilities. “I wanted to give our nurse leaders a tool that allowed them to be more successful in their positions,” says Smith, vice president of nursing/patient care services at Unity Health System, Rochester, NY. “I think we often have leaders running in multiple directions, and how do we support them? How do we get them on a journey that is really thoughtful, consistent, and standardized?”
Smith’s solution: A leadership gap analysis tool that spells out all the processes and documentation needed to run a successful patient care unit or department-from employee orientation and staffing guidelines to capital planning and budget reviews. (View an excerpt of the Gap Analysis Tool)
Optimizing Unit Performance
Over the July 4th holiday break, Smith stayed home and typed up a list of everything she felt was essential to a well--performing patient care unit. “That’s the true story behind this. I literally began to just think about how can we reduce leader variation and become more standardized in our approach.”
Like many experienced nurse leaders, Smith learned a lot about hospital management in the trenches. “I started out at the lowest level of leadership, and I moved my way up to a vice president. Over the last 15 years, I’ve learned what nurse leaders need to do so their units or departments perform well.”
The resulting gap analysis is a six-page Microsoft Word® outline that is divided into three main sections: clinical assessment, operational assessment, and financial assessment. Each section lists specific measures of success--or processes and documentation that successful unit and department managers should have in place. Examples include:
- Does the unit have a charge nurse orientation?
- How is training tracked to ensure that all staff completes the education and competencies?
- Does the unit have a written document that describes scheduling policies and procedures?
- What is the length of stay (LOS)--and does the unit have a written plan that describes efforts to improve LOS and overall care coordination?
Building Better Managers--and Performance
After creating the gap analysis, Smith introduced the tool to a test group of nurse managers and directors at Unity Health System, and worked with each leader to create an action plan (with next steps and deadlines) for any “gaps” that were identified.
Amy Fletcher, RN, BSN, director of the Walk–In Care Center at Unity was one of the early adopters of the gap analysis tool. “Prior to the tool, we didn’t have a thoughtful, thorough, step–by–step plan for managing a department,” says Fletcher. “We had many of the pieces in place. However, as the name suggests, the gap analysis helped us identify what we didn’t have--or where the gaps were that we needed to work on to ensure quality, safety, and financial outcomes.”
Getting a Handle on Staffing
One management tool that Fletcher created as a result of the gap analysis (and one that she now uses daily) is a position control spreadsheet. This tool is embedded with staffing formulas and serves as a guide for managing full–time employees and making hiring decisions. The spreadsheet details staff members and shifts, percentage of voluntary turnover, and vacancies by job code.
“It’s a very important tool to ensure that we have the proper number of full– and part–time staff per shift, as well as good mix of part–time and per diem staff to help cover vacations and sick calls. It also helps us identify the number of vacant positions that are available but may not have been posted through human resources, so we can hire new staff if needed,” says Fletcher.
Over time, using a position control spreadsheet can help managers reduce labor costs, says Fletcher. Last year, she decreased overtime by 10 percent. She also cut her vacancy rate by 8 percent and eliminated the use of expensive agency nurses at the Walk-in Care Center.
Fletcher’s department has kept turnover down, but if turnover does exceed her benchmark, she’ll know from data in the position control spreadsheet. “If that ever happens, I’ll know it’s time to refocus on retention initiatives,” says Fletcher.
Another simple item that Fletcher created as a result of the gap analysis was a staff disciplinary/performance improvement spreadsheet. This tool lists all staff members, including the center’s 20 RNs and LPNs--and allows the manager to monitor if an employee has received a verbal warning, written warning, or other disciplinary action.
A Rich Resource for New Managers
The documentation, history, and trends that arise from a gap analysis process can be especially valuable for new managers. For example, one measure of success on the gap analysis tool is a document for analyzing labor and supply variances. “We work with a flexible budget, and when we compare what we budgeted for labor and supplies with what we actually spend each month, we can identify if we are over budget and what we can do to turn that around,” says Fletcher. “For example, if I go over on medical supplies that month, I need to ask several questions as a manager: Are we overstocking supplies? Are we ordering too much? Can we work with purchasing to see if there is a more cost-efficient option for us?”
Another example is staffing and determining what is an acceptable variance, says Fletcher. “If your LPN line is over--budget, it may be because you have new staff on orientation, which is an acceptable variance. On the other hand, you may have people who are working incremental overtime--a half hour here and there--when they shouldn’t. So a manager may need to hire more per diems to cover vacations or make other changes.”
Although completing a gap analysis can seem time–consuming to many managers, the benefits are worth it, says Fletcher. “Once you’ve completed a gap analysis for your department, it is simply a matter of keeping the processes in place and updating them every six months. Your department will run so much more efficiently.”
View an excerpt of the Gap Analysis Tool
This article originally appeared in The Business of Caring, a newsletter dedicated to helping nurse managers develop business and leadership skills. Learn more.