Business and financial education at Bristol Hospital began with a game, called “Friday Night at the ER.” Hospital leaders and board members were presented with a hypothetical dilemma: A diminishing number of nurses are struggling to keep up with a steady onslaught of ED patients. And the number of available hospital beds is limited. How can the hospital avoid turning away patients or hiring expensive agency nurses?
In the interactive team exercise, the Bristol leaders worked together to identify the best solution from a clinical and business point of view. “It was a good first session,” says CNO Rob Rose, RN, MS, NEA-BC. “It was not too intense. Yet it really demonstrated how managers’ decisions impact the entire organization, not just the ED.”
Four years ago, Bristol Hospital had good reason to get their managers thinking about business outcomes--in addition to clinical outcomes. After years of multimillion dollar losses, the hospital was desperate to shore up its fiscal health. Part of CEO Kurt Barwis’ approach has been to empower frontline managers to take on greater fiscal responsibility for their units and departments.
“Our CEO feels that we need to give our managers the tools and knowledge they need to run their areas,” says Rose. “One analogy he uses is, ‘This is your house. Are you turning all the lights off when you leave a room?’”
Bristol Hospital received grant funding from Capital workforce partners, which provided the dollars needed to bring in an outside consultant to put on the Friday Night at the ER session.
Since then, however, most of the business education at Bristol has been staff generated. For instance, CFO Peter Freytag provides regular workshops on business and finance topics, such as reading a balance sheet and performance-based flexible budgeting.
“Our CFO really takes the time to break down complex topics and keep it simple,” says Rose. “He usually starts off with a general explanation of a topic and then applies it to our hospital.”
Nurse managers at Bristol also receive additional one-on-one mentoring on their budgets and staffing plans from Mary Smith RN, MS, director of clinical operations, med/surg/psych. “She goes over staffing plans, hours per patient day, position control, and those kinds of things,” says Rose. “She begins with didactic education and then mentors each manager through the process.”
Rose describes Bristol’s efforts as a work in progress. Yet the hospital has already achieved significant improvement, including a reduction in labor costs of about 5 percent. The hospital has cut overtime in half and no longer use travelers.
Nurses are also pleased: Nursing staff satisfaction with nursing leadership has risen.
When asked for lessons learned, Rose stresses the importance of teaching staff about the hospital’s overall strategic plan, including what clinical areas are targeted for growth. Nurse managers naturally tend to think about their own units or departments, he says. If they understand the organization is focused on growing certain areas, then they’ll understand why one unit is being rebuilt while others get denied a new paint job.
Interviewed for this case study: Rob Rose, RN, MS, NEA-BC, is CNO and senior vice president, patient care services, Bristol Hospital, Bristol, Conn. (rrose@bristolhospital.org).