In most markets today, patients have a choice in healthcare. As the industry shifts towards an accountable-care model, success metrics are tied to satisfied patients. Technology has made it easier than ever before for patients to evaluate their hospitals in advance. As their financial responsibility grows, so does their desire to find the best care for their hard-earned dollar.
It’s not just consumers that are taking this trend to heart. Medicare shares similar values and has actually implemented value-based purchasing bonuses or penalties that can equal as much as 1.5% of a hospital’s Medicare reimbursement. Medicare determines 30% of these metrics through patient satisfaction surveys called Hospital Consumer Assessment of Healthcare Providers and Systems, or HCAHPS[i].
One metric that has an impact on patient satisfaction is overtime. Overtime is expensive. Not just in dollars, but also in human costs. It has been well documented that nurses who work excessive overtime are at greater risk for error[ii],[iii]. Extreme cases can be harmful or even deadly to patients, but a more common scenario manifests itself in patient satisfaction. Nurses spend almost half of their time on direct patient care. The longer they work (in hours and shifts), the more dissatisfied they, and patients become[iv].
Compared to nurses who work 8-9 hour shifts, nurses who regularly work shifts of more than 13 hours are:
- 2.7 times more likely to burn out
- 2.4 times more likely to be dissatisfied with their jobs
- 2.6 times more likely to quit their current job within the next year[v]
Burn out and dissatisfaction are felt by patients too, as evidenced through HCAHPS reports that point to a decline in satisfaction rates when nurses are reported to work more than 13 hours in a single shift. In hospitals where nurses work longer hours, patients tend to give lower satisfaction ratings through HCAHPS surveys[vi]. Patients who provide a 7 or lower score on the survey have a 38% likelihood of returning to that hospital in the future. When the score is higher than 8, the return rate jumps to 80%[vii].
The connection between patient satisfaction and length of a nursing shift is something that we must begin to pay closer attention to. This is especially true in today’s market, where financial metrics are closely tied to patient satisfaction rates. As healthcare leaders, we must be doing everything possible to not only ensure their continued health and well-being, but also their overall satisfaction with the hospital experience.
For more information about the impact overtime can have on the patient experience, check out the white paper, “Unveiling Overtime’s Total Costs: How OT May Be Harming Your Business and Your Patients.”
[i]Kaiser Health News. “Methodology: How Value-Based Purchasing Payments are Calculated.” Accessed December 22, 2014. http://kaiserhealthnews.org/news/value-based-purchasing-medicare-methodology/
[ii]Rogers, Ann, et al. The Working Hours Of Hospital Staff Nurses And Patient Safety. Health Affairs, 23, no.4 (2004):202-212.
[iii]Bae, Sung-Heui. Presence of Nurse Mandatory Overtime Regulations and Nurse And Patient Outcomes. Nursing Economics. March/April 2013; 31, no. 2: 59-89.
[iv]Stimpfel, Amy, et al. The Longer The Shifts For Hospital Nurses, The Higher The Levels Of Burnout And Patient Dissatisfaction. Health Affairs, 31, no. 11 (2012): 2501-2509.
[vii]JD Power and Associates cited in Sisneros, Dorothy M. Employee Focus in a Time of Change, Thunderbird Leadership Consulting and Leebov Golde Group, May 12, 2012. http://www.lonestarhfma.org/files/file/Presentations/2012_05_Sisneros_Dorothy_CreatingAnEngagedWorkforce.pdf
In most hospitals, overtime is often the rule and not the exception. Industry-wide, more than 50% of full-time nurses work an additional 7 hours per week on averagei. For part-time nurses, 15% work an average of 5.4 additional hours per weekii. While overtime is pervasive, how much is too much? And, are healthcare executives considering the impact overtime can have on factors beyond labor costs? As the industry shifts, it’s becoming increasingly important to understand all of the consequences of overtime, many of which have been largely overlooked until now.
One such consequence is turnover. Studies have shown powerful indicators linking overtime and turnover among nurses. Specifically, nurses who work more than 40 hours in a week are prone to increased turnover and job dissatisfaction, and nurses who work shifts longer than 13 hours are 2.5 times more likely to quit within a yeariii. No one likes to lose a good employee. Not only is it disruptive, but also the cost to fill a vacancy left by a departed employee can be expensive.
In healthcare, particularly with respect to nurses, turnover is extremely costly. On average it can cost $82,000 just to replace a single nurseiv. If you consider that industry-wide nurse turnover averages around 14%, the average expense to manage these vacancies in a 300-bed hospital can equal as much as $4.4 million in a single yearvvi.
Keeping costs under control is a major initiative for any healthcare organization seeking long-term sustainability. When patient care quality and safety are of the greatest priority, factors such as overtime and nurse burnout/turnover must be brought under control. Proactive efforts to understand and manage overtime provide important opportunities to reduce turnover and yield positive financial returns.For a closer look at the cascading effect of overtime, check out the white paper, “Unveiling Overtime’s Total Costs: How OT May Be Harming Your Business and Your Patients.”
i Bae, Sung Heui. “Nursing Overtime: Why, How Much and Under What Conditions?” Nursing Economics, 30, no 2 (March/April 2012): 60-71.
ii Health Resources and Services Administration. “The Registered Nurse Population. September 2010.” Accessed July 28, 2014. http://bhpr.hrsa.gov/healthworkforce/rnsurveys/rnsurveyfinal.pdf
iii Stimpfel, Amy, et al. The Longer The Shifts For Hospital Nurses, The Higher The Levels Of Burnout And Patient Dissatisfaction. Health Affairs, 31, no.11 (2012):2501-2509.
iv Jones, CB. Revisiting Nurse Turnover Costs: Adjusting for Inflation. Journal of Nursing Administration, 38, no 1 (2008): 11-18.
v KPMG. “KPMG’s 2011 U.S. Hospital Nursing Labor Costs Study”. Accessed July 2, 2014. http://natho.org/pdfs/KPMG_2011_Nursing_LaborCostStudy.pdf
vi Sage Growth Partners Analysis