Background 

Each summer, Hermann Hospital (Houston), like virtually all health care organizations, faces staffing challenges because of employee vacations, increased patient load, and staff turnover.

A « zone » system was developed to address staff allocation, which was identified as a factor in deterioration of the hospital's patient satisfaction performance.

Zone system : Every day, each unit or department designated the zone most appropriate based on factors identified in root cause analysis-high patient census, high patient acuity, emergent activity, and the number of float, agency, or unfamiliar staff members.

A green zone defines conditions where the staff is very comfortable ; yellow reflects increased activity ; and red indicates that staff members are stressed and overwhelmed with patient needs.

Action steps : Management's action steps included decreasing the nursing vacancy rate to minimize reliance on agency and float staff members and securing longer-term commitments from temporary staff members.

Individual units also generated contingency plans, such as identifying a « partner unit » to provide shared staff members, supplies, and other assistance.

Results 

The percentage of patients rating their overall experience at Hermann Hospital as « good » or « excellent » increased from 83% in August 1997 to 89% in August 1998, despite increases in admissions, patient days, operating room cases, and emergency deparment visits. (...)