Balancing the Care

Asbury Communities is the nation’s 15^th largest not-for-profit system of continuing care retirement centers, with seven communities in four states. Each community has its own skilled nursing and rehabilitation services center serving over 3,800 residents, and staffed by approximately 2,000 associates. The development of the NHPPD Dashboard is the collaborative work of Asbury Communities and The Asbury Group Integrated Technologies, with the goal of enabling more proactive management to create balance for staff and management.

The NHPPD Dashboard utilizes as its framework the Centers for Medicare & Medicaid Services’ (CMS) nurse-to-patient ratio in health facilities, which is meant to ensure a quality standard of care. Beyond playing a critical role in accounting for appropriate staffing levels, the NHPPD solution is also aimed at enabling effective management to a facility’s budget. The NHPPD incorporates three main components (staffing, census and budget) to help answer two prevailing questions required by nearly all healthcare facilities:

1. Is the facility adequately staffed in relation to patient census?
2. Is the facility operating within budget?

Being able to now view patient census information along with staffing levels within an automated system on a real-time basis allows management to strategically plan and prepare shifts, while also looking at the bigger financial picture. This effectively keeps Asbury within the framework of an established facility budget. The NHPPD Dashboard also gives each facility a proactive edge in managing their workforce to meet staffing levels in advance of the Quarterly Payroll Based Journal submission.

Calculating NHPPD is done by accounting for the number of hours worked by direct care nursing staff (based on information from the payroll based journal rules) added together for a 24-hour period. The total number of hours worked by applicable staff in that period are then divided by the total patient census for each day, resulting in an NHPPD percentage. The NHPPD system automatically pulls and blends information from two main sources, Vision (the patient census system) and Kronos (workforce management system). By effectively combining and analyzing the data, what was a paper and pencil manual process requiring calculations by staff has transformed into an automated and effective method of allowing managers to schedule staffing models and keep/forecast facility budgets.

Ultimately, each healthcare facility is responsible for keeping thorough records to show that the needs of residents are being met by adequate levels of staffing. Using the payroll based journal, adequate staffing is achieved by establishing a specific minimum Patient Per Day ratio. The visibility through the dashboard ensures that this number reflects a state-by-state mandate, with the goal of most facilities being to stay well above the minimum. This standard of care model, in addition to the budgetary aspect of the NHPPD Dashboard, allows Asbury organizations to maintain a well-staffed and financially secure healthcare facility. The NHPPD reporting solution is now able to be treated as benchmark data that tracks changes in both patient and worker census in real-time, ensuring quality of care, productivity, and detailing fundamental operating efficiencies/deficiencies in a user-friendly dashboard.