Watching the news updates of the Ebola crisis for the past few months, I am reminded of the H5N1 (bird flu) scare. No one was sure at the time if the virus would be contained and a vaccine created, or if we would experience a global pandemic in the form of the Spanish flu of 1918. As it turned out, the WHO got ahead of the situation and disaster was averted for now.
The Ebola virus, of course, is a completely different situation than we heard about from the media five or so years ago, but that we still are quick to question and worry if this will be the next global pandemic.
The CDC has come out with new protocols for hospitals and many organizations, including an AONE communication I received just this morning, are emphasizing what measures need to be taken to protect the hospital staff from infection. What I see in these communications is a significant amount of clinical detail in what to do, including this morning’s instructions around appropriate use of PPE (personal protective equipment). But that doesn’t mean that all measures to be taken are directly clinical in nature.
With my “staffing operations” glasses on, here are three non-clinical actions hospitals should be performing to prepare their staff:
1. Determine the staffing needs for an Ebola patient in advance.
Before you have any Ebola infected patients in your hospital (i.e. now!), determine how your staffing levels and ratios would be affected with an Ebola patient. This is not just a simple measure of acuity. This is a measure of nursing intensity. How much care will this patient need? How much time will that require of the nurses? That may require practicing with non-typical protocols like the PPE and accounting for that in the nursing intensity calculations.
Figuring this out in advance will position you to better staff should it become necessary. However, waiting until you have a patient in your facility to decide what to do puts you at risk of flubbing up the staffing and either negatively impacting your labor budgets unnecessarily by overstaffing or, worse yet, creating a risk scenario for both your patient and your staff by understaffing.
2. Establish your staffing protocols.
Just like there are clinical protocols in dealing with a patient infected with Ebola, you should also prepare staffing protocols for the same scenario. These should include factors like:
· Staff to use for direct patient care (seniority levels, skills, employee types – i.e. “no per diems”)
· Shift lengths – are your standard shifts acceptable or do they need adjusting due to the nursing intensity levels of the patient?
· Shift handoff adjustments – do you need to plan extra time for pre-shift training, debriefing, or other special tasks beyond a standard shift report?
· Duration projections – once you have an Ebola patient, how far out do you create and maintain a special staffing scheduling? Is it one day at a time? A rolling one week period updated every two days?
Again, figuring out these protocols in advance positions your hospital to better react immediately rather than risking a shift or two worth’s of time while you “figure it out.” That’s not to say you won’t make real-time adjustments to the protocols when/if the time comes, but having a framework of protocols to work with provides a reliable starting point.
3. Address training deficiencies.
On October 20, CDC Director Tom Frieden, M.D., held a press briefing on Ebola. An underlying theme of the discussion of protocols was staff training. In talking about materials coming from the CDC, he said “…but really there’s no alternative to hands-on training.”
What does that mean to your hospital? Based on my own experience working in health care and with hospitals, outside of something like HIPAA training, no hospital has a perfect medium for mass hands-on trainings in short periods of time. That make this the time to shore up some of those weaknesses. You should be taking into account at a minimum the following factors:
· Priority order of staff training – the staffing protocols should help you prioritize this
· Medium for mass staff training – beyond the hands-on practice, will you use videos or something else? Waiting for the CDC videos or creating your own custom ones, or both?
· Have you identified a training leader with a corresponding executive champion?
There are many aspects where this sounds like a change management effort to me, so take advantage of the strategies to effectively implement change in order to make sure you have all your bases covered in addressing your training deficiencies.
