Moving out of the red zone: addressing staff allocation to improve patient satisfaction.
BACKGROUND: Each summer, Hermann Hospital (Houston), like virtually all health care organizations, faces staffing challenges because of employee vacations, increased patient load, and staff turnover. A "zone" system was developed to address staff allocation, which was identified as a factor in deterioration of the hospital's patient satisfaction performance. ZONE SYSTEM: Every day, each unit or department designated the zone most appropriate based on factors identified in root cause analysis--high patient census, high patient acuity, emergent activity, and the number of float, agency, or unfamiliar staff members. A green zone defines conditions where the staff is very comfortable; yellow reflects increased activity; and red indicates that staff members are stressed and overwhelmed with patient needs. ACTION STEPS: Management's action steps included decreasing the nursing vacancy rate to minimize reliance on agency and float staff members and securing longer-term commitments from temporary staff members. Individual units also generated contingency plans, such as identifying a "partner unit" to provide shared staff members, supplies, and other assistance. RESULTS: The percentage of patients rating their overall experience at Hermann Hospital as "good" or "excellent" increased from 83% in August 1997 to 89% in August 1998, despite increases in admissions, patient days, operating room cases, and emergency department visits. DISCUSSION: The zone system provides a rapid way to quantify contributing factors to patient dissatisfaction and respond to them. Hermann Hospital is currently developing a broader zone system to include staff vacancy rates by departments, areas of increased patient census for prolonged periods, and balancing episodic zones with prolonged zones.