Chapter 6: Statistical Process Control at Valley Memorial Hospital:

Conversation with Lee Jordan:

This assignment involves controlling the number of nursing hours at VMH. You will work with Lee Jordan, Director of Medical/Surgical Nursing. VMH employs over 500 people in nursing, both full and part-time, and has an annual nursing budget of $5,000,000. Nurses must always be present at VMH-three shifts daily, seven days per week, 365 days per year. VMH is seeking a 5% reduction in the nursing FTE (full-time equivalents).

"Good morning. I'm Lee Jordan. I'm pleased that you will be working on this assignment. I look forward to someone like you familiar with statistical process control techniques to help me in controlling the nursing department's operations. The Med/Surgical unit has 38 employees, of which 25 are registered nurses (RNs), while the remaining 13 are nurse assistants or unit secretaries. The 38 employees represent the equivalent of 28 FTEs. Each employee is budgeted for a predetermined number of hours. It is particularly costly when employees budgeted for 80 hours per pay period work additional time because they must be paid overtime wages. Currently, five RNs, two Nurse Assistants, two Unit Secretaries/Nurse Assistants, and one department secretary, are budgeted for 80 hours per pay period. We also have access to an in-house nursing pool (the "Float Pool") for additional staff when needed."

"VMH has budgetary and productivity goals that I must consider when staffing the units. Productivity is measured in nursing hours per patient day (NHPPD). We currently operate at an actual NHPPD of 8.74 hours. The target NHPPD is 8.00. Before I change staffing, I like to discuss changes with the staff. The turnover rate in hospitals is very high to begin with, so I prefer talking with the staff about any proposed staffing changes."

"You can think of the nursing department as a "process" whose performance in terms of nursing hours per patient per day (NHPPD) is subject to variations over time. I have the NHPPD data (select Medical Surgical Dept) for the past three months. I want you to analyze this data and come up with some specific suggestions. Also, since you are applying statistical process control techniques, I want you to help me respond to the queries on quality and process control issues from the staff in other departments. Please look at Will Hartman's Data on Billing Errors (select Billing Office), Doug Jennings' Data on Patient Surveys (select Quality Improvement Teams), and Margot Hamilton's Data on Room Cleaning (select Human Resources) and give me some recommendations."

1. Develop a confidence interval for FTEs within which the Medical/Surgical Unit will be efficient and will maintain quality at least 95 percent of the time (z = 1.96). Please show your work.

2. Examine the data and determine whether Jordan is really in control of nursing hours. If not in control, explain why.