By giving nurses the flexibility to choose their own hours and work locations, Mercy’s nurse staffing increased by 20% in two years, with a 94% fill rate. For nurses, the flexible work options allow them to choose what's most important to them – where they work, when they work and how long.
This new way of working is a component of Mercy’s workforce transformation strategy, intended to enhance workplace culture and ultimately lead to a better patient experience.
The Challenge
Mercy comprises more than 50 hospitals and employs 12,000 nurses across several states. In order to institute a nursing workforce transformation for a system of this size, the health system needed new technology to assist with innovation.
For Betty Jo Rocchio, DNP, CRNA, CENP, Mercy’s senior vice president and chief nurse executive, the main questions were: How do we transform our operating model infrastructure for healthcare personnel? How do we use data and analytics for them? And then what architecture will we need?
“I will tell you, transforming the [nursing] workforce requires a technology component. To try to do it without data to push people in the right direction, it's impossible. Data finetunes and directs the process,” Rocchio said.
The technology is needed to be able to both scale down to the unit level and roll up to the system level for a health system strategy.
A New Idea
When she was thinking about nursing workforce transformation, Rocchio knew that staffing challenges in nursing (and healthcare more broadly) were not going to be solved by doing things the same way. They needed to start looking at not only shifts, but also supply and demand.
“In order to develop this demand-supply concept, I looked at the Uber and Lyft models. As the demand goes up to get the supply of Uber drivers to drive, the rate goes up,” Rocchio said. “If the demand is low on a Saturday morning at 9 o'clock, they're going to get less money for working, but that may be the time they want to work. So that flexibility in offering those Uber drivers to work as many hours as they want, they turn their app on, they turn it off to pick up work, and they pick when they work, how they work, they pick what area they work in.”
In partnership with Trusted Health, Mercy developed a staffing platform called Mercy Works on Demand (MWOD). The app allows nurses to select their desired locations, hours and shifts. Shifts are offered to core (permanent) staff first and, if unfilled, they go to float pool and gig nurses. One primary concern was adding a large amount of technology to people's time and pay structure. Launching a new system would change the way in which staff was paid and how they picked up hours.
"We were concerned that there would be generational differences in the technology from what they were used to,” Rocchio said. “It turned out that the flexibility the technology offered was appealing to nurses of all experience levels.”
Through the use of an app that lists available shifts and corresponding pay rates, nurses can select what works for them in terms of work-life balance. So, if their priority is to have certain hours off for their families, they can select to work the hours that fit. If the priority is to maximize income, they can look for shifts in hard-to-fill areas and at times, such as nights and weekends, when demand is higher and pay is therefore higher. Nurses select the shift and the clinical area.
Creating a Plan
Mercy needed to clarify the needs and demands of a modern nursing workforce before launching the technology. The health system established layers for its nursing workforce: core nurses, flex (local and regional float pools) and gig nurses.
Gig nurses are part-time contract nurses. The only requirement is that they work at least one 12-hour shift per month. Nurses are eligible for this role once they have at least a year of nursing experience at Mercy, and they get a base flat rate, plus an incentive that depends on where and when they work. These positions do not include any health benefits or contributions toward retirement.
“The number one goal for the workforce is that they are happy and healthy. Our goal is not that you have to work when I say you have to work to meet our needs; we've done that. It doesn't seem to work any longer. To make this work transformation, we had to change our thinking from shifts to hours. This way of thinking allows us to offer greater flexibility to our core and contingent staff,” Rocchio said.
By determining the workforce layers, the new technology could then manage a staffing algorithm. The app indicates the hours when nurses are needed, and nurses can select what works for them. A key step, as the pandemic began to wane, was standardizing pay for core, float and gig workers. All nurses – core, float and gig – can use the app to pick up additional hours if desired.
Implementation
With the MWOD platform, Mercy’s labor strategy team can manage the entire nurse staffing system without additional workload for nurse managers.
- The manager and core staff build the schedule through a self-scheduling process and identify understaffed shifts.
- The MWOD app identifies the nurses who have the competency/certification to fill those shifts and sends out the opportunity to work those hours to core staff members.
- Any hours that remain unfilled after being offered to core nursing staff are then offered to the gig employees.
- Artificial intelligence (AI) that is built into the platform calculates the pay rate according to the demand for the available shift/hours. (The staff who are in the gig pool receive no benefits but a higher rate of pay as a result.)
“Because of Mercy Works on Demand, nurse managers no longer get up at 4:30 in the morning to try to fill shifts. If somebody calls in to be off, they call the labor strategy team,” Rocchio said. “They take that person out of the schedule, and it launches the shift immediately and then people pick it up. I have people that are ready and waiting for people to call off, because that launch has the highest incentive rate. It's an immediate demand that we weren't predicting.”
Measures of Success
Mercy conducted a pilot on the platform in one hospital and then went system-wide soon after, because the platform necessitates everybody working on the same structure.
“Here's what it did to our staffing mix. We were 25% agency before, and now we're down to 6% and it keeps dropping,” Rocchio said.
Since launching the platform two years ago, Mercy has:
- Lowered premium labor spend by $52 million
- Decreased the amount spent on staffing and scheduling system-wide by 25%
- Decreased agency costs by 62%
- Increased fill rate to 94%
Lessons Learned
MWOD creates more variation in who is working on the unit. With this implementation, Mercy sought to create standardization; for instance, using the same IV pumps and the same documentation to facilitate nurses working across different units.
Advice to Nurses
“We now have more than just our nursing staff on the platform. It can be a hospital strategy. It came up only in nursing across Mercy, because there was so much to do. Now everybody's on that same platform,” Rocchio said. “Even if you're just paying people premium labor to come in and do extra shifts, you can still benefit from that algorithm in the platform. You're going to save money and you're going to get a higher pickup, which is your goal. That way you can get more hands to the bedside.”
By using this approach, Rocchio said nurses and other team members are more likely to sign up for shifts because they know the staffing is going to be at an adequate level.
“Chronic understaffing and poor work environments lead to high turnover, which leads to further gaps in staffing, a vicious cycle. Using the gig model and the app to improve staffing, we shift to a virtuous cycle where appropriate staffing improves patient care and nurse retention,” Rocchio said. “What's the ultimate goal? That nurses and all [other] team members can spend more time with their patients, doing the work they find fulfilling and ensuring optimal outcomes.”
Additional Resources
- Strategic Staffing: The Synergistic Power of People, Process and Technology
- AACN Acute and Critical Care Staffing Resources
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