A combination of centralized scheduling, customized nursing grids, a well-trained float pool and the creation of a 13-bed “flex” unit that opens or closes based on volume has enabled University of Utah Health Care to reduce labor costs by $2.4 million while boosting patient satisfaction and quality outcomes during the past 1½ years.

The 613-bed, two-hospital system in Salt Lake City has earned the Spirit of Excellence Award in the new category of Process Improvement for these innovations; the honor comes after other recognition last year, including Top Improver, according to Press Ganey patient-satisfaction surveys, and No. 1 for quality among academic medical centers, according to the University HealthSystem Consortium.

“They kind of sat down and actually had to rethink the way they looked at their per-diem support float pool,” says category judge Christina Ryan. “They looked at hard-core staffing and getting the most productivity out of the staff while providing the support they needed.”

During a strategic planning process a few years back, University of Utah officials realized they did not have a good mechanism to look at patient census and know how to allocate staffing most efficiently, says Margaret Pearce, chief nursing officer.

“Some departments were overstaffed and trying to send somebody home,” she says, “and then another unit was hiring an agency nurse or asking someone to work expensive overtime because they were short.”

So the hospital system put together a central staffing office that looks at the big picture, finds the right nurse-to-patient ratio based on acuity, and moves staff around as needed. The cross-trained float pool—which Pearce refers to as the “SWAT team”—fills staffing holes.

“We did some financial work around, ‘What is the best possible volume for each unit, so the nurses are fully engaged, she's the most productive she can be, she's not stretched too thin,' ” she says. “We determined what that was for every unit, sent it out to centralized staffing, and said, ‘We want you to fill each unit to capacity.' ”

The SWAT team runs the flex unit and has taken passionate ownership of it, Pearce says. “They consider that to be their personal unit. They work real hard on it,” she says. “That resource staff is totally engaged in patient satisfaction.”

Different nurses and nursing units adjusted to this new scenario at different rates of acceptance, Pearce says. “How quickly and rapidly my nurses absorb changes depends significantly if not totally on the attitudes of their manager,” she says. “Some said, ‘This will be great'; others weren't so sure.”

But acceptance has grown as savings have added up, Pearce says. “At the end of the day, everybody is really excited,” she says. “They can see the difference it's made. They're getting a lot of positive feedback. It was more of a systems problem, getting people to realize they needed to switch gears … from each unit taking care of themselves to looking at the global picture.”