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Streamlining Position Management Strategies SBAR
Voiceover
Presenter(s)
Stephen Pennington
Abstract or Description
Situation: Hospital X modified its organizational process to request new and refill vacant positions. As a result, the organization implemented an online and face-to-face process for position management.
Background: Historically, Hospital X has automatically approved service chiefs' requests to fill vacant positions or when requesting new ones. As a result, Hospital X spends 83% of their annual budget on personnel costs and has 247 positions over a supportable full-time equivalent employee (FTEE). Hospital X identified risks to fiscal solvency with previous position management practices.
Assessment: Stakeholders included the executive leadership team (ELT), human resources (HR), the facility’s finance team, service chiefs, supervisors, and front-line staff.
Plan for Change. Services are no longer approved to refill vacancies or hire new positions without a committee’s approval. Requests will be submitted electronically with objective data on the position’s need, the service’s streamlined processes, and the organizational results of not approving the request. The service chief will present their case at the committee’s face-to-face meeting. Committee members and process champions, including the ELT, HR, and fiscal, will use a standardized rubric to grade the request. If the request meets the required score, approval will be granted. If not, the request is denied, resulting in vacant positions abolished from the facility’s organizational chart.
Phase One. HR communicated with and educated the service chiefs on the process change. HR also served as a point of contact between services and the committee regarding final decisions, typically occurring within three days. Service chiefs were encouraged to speak to their ELT members about meeting decisions and the effects on services.
Phase Two. The implementation date occurred at the beginning of the month, two weeks after the education sessions were completed. HR reviewed the initial requests for completeness and returned them to the service if additional information was needed. Before the meeting, committee members were provided copies of the requests to discuss process concerns with HR.
Phase Three. Service chiefs, supervisors, and committee members provided feedback two months after implementation, including evaluating for strategic intent. Due to perceived bias, the grading rubric was changed, and supervisors were provided with updates at town hall meetings after three months.
Expected Outcome. As a result of the change, the facility is expected to decrease onboard FTEEs to meet an organizational budget of no greater than 70% spent on personnel costs.
Organizational Culture. Service chiefs and supervisors, or change critics, were frustrated by the change, which they perceived as a barrier to daily operations. The change process was unfamiliar, and service chiefs resisted adapting due to time requirements. Front-line staff feared losing their jobs and doing more with less staff, which resulted from limited communication between supervisors and this group.
Recommendations: While the process was standardized and communication with service chiefs was praised, the limited communication with front-line staff increased tension within the facility. In future implementations, it would be recommended to increase communication with front-line staff on the change, provide examples of successful submissions to service chiefs, and facilitate meetings between ELT members and service chiefs on improving efficiencies with fewer staff.
Theory Application. Equity theory is applied to Service Chiefs in this situation. A perception of outcomes, or perceived inequality, when another service receives approval for new positions can result in tension and a potential decrease in productivity. Similarly, Maslow’s hierarchy of needs theory can be applied. When service chiefs have perceived safety and security concerns for not refilling positions, they cannot achieve self-actualization or make decisions in the organization's best interest.
Comments
Erin Phillips10 months ago
Hi Stephen! Thank you for your interesting review. Our unit went through something very similar in what you are describing. When our manager wanted to create a position such as FT/PT/PD the original process was very easy. When we switched organizations, the process changed to a very similar process as you just described. She was no longer able to create a role or change a status without justification. The process became very scary for some as they also thought they may lose their job. Perhaps as you mentioned a simpler form of communication is key along with clear roles. Maybe even the use of AI could assist in making the process smoother. Maslow's Hierarchy of Needs definitely plays a role in this situation with staff and even management worried for safety in keeping a role. Thank you again for sharing, your poster is very eye appealing as well.
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Ashley Juste10 months ago
Stephen, that change in process is definitely more financially responsible and is smart for hospital X to implement. The idea that leaders need to support their request for personnel allows leaders to truly contemplate what is the reason to fill the position and if it is still relevant. In my organization we have a similar structure and it works well for the most part. The only issue I see is what is the process for urgent needs. For instance in my clinic when positions have been abruptly vacated the staff who remain are often over worked and discouraged knowing that support may not arrive for months based on the committee process. We recently implanted a rapid pass through process for urgent open positions. Great poster and thank you for sharing.
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Johnathan Clevinger10 months ago
Hi Stephen, I appreciate your presentation, as it resonates with me and my own organization. When I first began working in my current organization in 2010, the culture was very similar in that positions were submitted and processed without much question. We have since integrated a structured approach to position requests and approvals. In the beginning, there were similar frustration and fear responses to the process; however, we have also revisited the process over the years to improve. Our process began as a committee-based approval; however, we ran into barriers with the committee not meeting frequent enough. As the organization grew, the volume of requests also became unsustatinable. In our current state, each department is allocated an FTE allotment as "core staffing," and each year's budget cycle includes a review to determine if adjustments are needed in collaboration with Finance, Human Resources, and Executive Leadership. Within the core staffing targets, each department manager is responsible for submitting replacement positions, and it continues to include justification for the needed position. If the justification does not make sense, or if the department is more than 10% over their core staffing, the request is denied and sent back to the department manager citing the reason for the denial. If there are questions, the department manager may request a meeting with the Business Operations Director to review the request should special circumstances exist. When comparing the original process to the current process, the guardrails and tighter control on position approvals has led to a more equitable and fiscally responsible organizational culture; in addition, department managers are more proactive in workforce awareness and planning. I also appreciated the perspective of the frontline staff, as we heard similar comments, and it highlighted the importance of communication at all levels to ensure all employees are confident that we will maintain a strong and effective workforce.
Thank you for sharing your experience.
Thank you for sharing your experience.
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Jennifer Oliver10 months ago
Hello Stephen and thank you for your presentation on streamlining processes for filling positions. In my personal experience, when justification for a position needs to be brought before a committee, the extra work acts as a deterrent. This is beneficial if there is a flood of requests that are not suitable to the situation, but can also cause managers to avoid the extra work even if there is a validated need. I appreciate your recommendations for the future and recognize that they are all based on communication. Clear and concise communication is extremely important when there are so many different positions that are collaborating. It seems like this change project was a real success and benefited the organization. Thank you for sharing.
-Jennifer Oliver
-Jennifer Oliver
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Zoe Corkill10 months ago
Hi Stephen,
Thank you for sharing your thoughts and critiques on this change processes. I thought it was helpful that you included the critiques thoughts and fears on this process. If this had occurred in my organization, I would initally felt the same fear as a staff nurse and I agree with your assessment that clear communication from leadership would have eased worries associated. As a leader requesting new positions, I would have appreciated an example to aid and prepare me for face-to-face justification. Overall, I feel that this project would definitely financially benefit the organization given the statistics. I do not currently hold a leadership role within my organization, but your project has sparked my interest in how my organization and leadership request new positions.
Thank you,
Zoe
Thank you for sharing your thoughts and critiques on this change processes. I thought it was helpful that you included the critiques thoughts and fears on this process. If this had occurred in my organization, I would initally felt the same fear as a staff nurse and I agree with your assessment that clear communication from leadership would have eased worries associated. As a leader requesting new positions, I would have appreciated an example to aid and prepare me for face-to-face justification. Overall, I feel that this project would definitely financially benefit the organization given the statistics. I do not currently hold a leadership role within my organization, but your project has sparked my interest in how my organization and leadership request new positions.
Thank you,
Zoe
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Kevin Springer10 months ago
Hi Stephen,
I very much appreciate your very detailed verbal description of your organization making a change in the process of declaring new and available positions and requesting permission to have them refilled. It was especially enlightening that you described the organizational culture, such as the service chiefs and supervisors, which you described as change critics who were frustrated by the change that they felt was a barrier to daily operations. Because this new process was unfamiliar, the service chiefs resisted adapting. This scenario is very common throughout several organizations when reacting to sudden changes within the organizational structure. The fact that frontline staff feared losing their jobs appears to be due to insufficient communication between leadership and the workforce. As you recommended, increased communication with frontline staff would likely go a long way in resolving future conflicts. From a nursing standpoint, I very much appreciate you using the equity theory and Maslow's hierarchy of needs as the basic framework of this case study.
I very much appreciate your very detailed verbal description of your organization making a change in the process of declaring new and available positions and requesting permission to have them refilled. It was especially enlightening that you described the organizational culture, such as the service chiefs and supervisors, which you described as change critics who were frustrated by the change that they felt was a barrier to daily operations. Because this new process was unfamiliar, the service chiefs resisted adapting. This scenario is very common throughout several organizations when reacting to sudden changes within the organizational structure. The fact that frontline staff feared losing their jobs appears to be due to insufficient communication between leadership and the workforce. As you recommended, increased communication with frontline staff would likely go a long way in resolving future conflicts. From a nursing standpoint, I very much appreciate you using the equity theory and Maslow's hierarchy of needs as the basic framework of this case study.
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Erica Leal10 months ago
Hello Stephen! Thanks for a great presentation. This method does make sense for organizations, especially since onboarding/orientation takes up much of the budget. Our organization does something similar to this—if a position is vacant, it must be approved before it is pushed through for posting. If a certain amount of time goes by with no applicants, then it gets closed again. Some positions are closed and never reopened unless it is proven that they are needed. At times, it feels very restrictive, but then you look at the bigger picture, and it absolutely makes sense to do this process or something similar. Great work!
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