Cleveland Clinic Nursing Creates Centralized Staffing Operations

By Meg Duffy, MS, BSN, RN

From standardizing processes to improving workforce optimization and more, Cleveland Clinic’s precedent-setting centralized 24/7 health system nurse staffing office is quickly becoming a best practice throughout the U.S.

Driven by the leadership of Executive Chief Nursing Officer, K. Kelly Hancock, DNP, RN, NE-BC, the 24/7 staffing office, known as Centralized Staffing Operations (CSO), was created by relocating all Cleveland Clinic Stanley Shalom Zielony Institute for Nursing Excellence staffing and timekeeping operations. They came from each of the health system’s nine regional hospitals and vast 165-acre main campus to one free-standing location.

The CSO is housed at Cleveland Clinic’s Nursing Administration location in Independence, Ohio. The office’s operational structure includes a dedicated nurse manager who oversees 24/7 operations, a shift work leader and staffing associates who are responsible for staffing Cleveland Clinic hospitals every four hours. Additionally, Cleveland Clinic’s enterprise PRN registered nurse (RN) float pool, medical assistant (MA) float pool, patient care nursing assistant (PCNA)/student nurse float pool, and full-time RN night shift float pool are operated and managed from the CSO by a float pool nurse manager.

A significant undertaking with significant results

After many years of discussions, the innovative, one-of-a-kind concept came to fruition in October 2016. Working closely with a Nursing Institute project manager, preparation and planning for the consolidation began with the regional hospitals and concluded with main campus.

To date, the system-wide centralized staffing model has delivered numerous benefits and positive results:

1) First and foremost, it standardized staffing processes across the health system and improved workforce optimization in several important areas of focus such as call-off times, identification of overtime and nurse floating.

2) It significantly enhanced staffing projections and reporting. Each week, Cleveland Clinic nurse managers across the enterprise now receive standardized staffing reports, inclusive of detailed staffing projections. The projections provide an opportunity to balance and optimize staffing based on census trends.

3) It has provided a sharp and wide lens view to ensure allocation and optimization of enterprise float pool resources. It offers strategic opportunities to develop float pools with the skillsets needed across the Cleveland Clinic enterprise, creating a variety of flexible enterprise float pools – from RNs to PCNAs and MAs.

One Cleveland Clinic Staffing Resources (CCSR) Enterprise Float Nurse recently sent a thank you note to a member of the CSO leader team stating, “I just want to take a moment to thank you for the opportunity to work for CCSR. I’ve learned so much in the few months I’ve been in this position. In addition, the ability to schedule around my kids’ activities has been life changing! It’s a beautiful thing to be able to continue to do what I love, and have a work/life balance too.”

4) In addition to addressing current staffing needs, the concept of centralized staffing provides a new outlook on future hiring. For example, shifting from facility-based hiring to centralized hiring allows for identification of new hire opportunities – such as adding full-time night MST registered nurses who are assigned to a facility and unit based on staffing calculations.

Making it happen

To successfully transition from individual hospital nurse staffing to system-wide collective staffing, Cleveland Clinic required several key components, including:

• Guidance and direction from the Nursing Institute Staffing, Scheduling and Timekeeping Committee, which includes nurse leader representatives from throughout the health system. Committee members participated in the review, evaluation and optimization of current and newly recommended staffing and timekeeping practices, further solidifying and enhancing the ongoing standardization of practices across the Nursing Institute – including 82 process enhancements and clarifications thus far. By maintaining connectivity with each Cleveland Clinic hospital, this expert group aims to ensure collaborative, participatory decision-making. Shared Governance groups are involved to review opportunities and obtain feedback from fellow nursing caregivers.
• Installation of an advanced phone recording system, which provides around-the-clock recordings of incoming and outgoing phone calls (with a disclosure that calls are being recorded) and enhances staffing services, provides additional education, and identifies quality opportunities.
• Ensuring continuous improvement. This drove many changes in the CSO office – including collaborative work to improve timekeeping efficiencies. For example, the Office of Nursing Education and Professional Development and timekeeping staff developed streamlined processes and standardized forms to manage high-volume classes.
• Frequent and detailed communication with nursing leadership and other nursing caregivers. The transition to the CSO model required a true culture change to a new way of conducting staffing; therefore, ongoing communication as well as timely responsiveness to facility leadership and staff has been pivotal to gaining buy-in, trust and support while ensuring successful operations. As standardization and optimization continued, especially in 2018, staffers and timekeepers were able to further increase opportunities to support, educate and collaborate with nursing leadership and nursing caregivers – who have been and continue to be actively involved in all phases of the transition.

Centralized staffing: trending now

As healthcare organizations continue to grow and expand, centralized staffing models are almost certain to be the future of healthcare staffing. From having an enterprise-wide view of staffing needs to helping achieve care quality and safety goals, improving caregiver engagement and retention, and creating more positive work environments, centralized staffing answers a variety of strategic staffing and hiring needs.

Meg Duffy is the Senior Director of Staffing and University Outreach for the Cleveland Clinic health system.