Practice Matters

Digital dashboards and staffing

Many healthcare organizations use digital “dashboards” to provide employees with real-time data collected from various sources, helping to guide decisions and improve the quality of care. Increasingly, dashboards also are being used to support effective staffing decisions.

Whether part of a software program or a stand-alone product, a digital dashboard provides a visual way to manage large amounts of data by bringing together and displaying selected data elements related to a specific need. Dashboards organize information in meaningful ways, making the data more useful and promoting better communication and decision making. Various types of displays, such as charts and graphs, make large amounts of data easier to interpret.

Staffing, data, and decision making

Staffing plays an important role in the operational and financial performance of a healthcare organization. Staffing levels can be linked to labor costs, patient safety, quality of care, length of stay, readmissions, throughput, turnover, and staff satisfaction. Thus, staffing decisions can broadly affect an organization’s performance. Yet staffing has become more complex, so dashboards that improve communication and staffing decisions are imperative.

Although most of us understand the implications of staffing decisions, many facilities still use antiquated staff­ing strategies, designs, and operations that are paper-based and driven by opinion and tradition. This situation has inspired many nursing professionals to rethink staffing strategies; create new staffing models based on evidence; revisit staffing practices, policies, and procedures; and redesign technology solutions to better serve the foundational aspects of a successful healthcare organization.

What data are needed?


The data needed to make informed staffing decisions fall into three categories: patients, care team, and organization.

Patient data. Healthcare providers obviously need to understand patients’ care requirements, such as level of care, stability of condition, procedures needed, educational background, level of cooperation, family situation, and related issues (such as language barriers and belief system).

Care-team data. Required information includes staff availability, role, role and skill competencies, hours worked, fatigue level, minimum commitment compliance (for example, per diem commitment), schedule (for continuity and fatigue considerations), and costs (which may include base salary, overtime implications, incentive use, and impact on budget).

Organizational data. Required information includes admissions, discharges, policies and procedures, legislation (such as staffing ratios, which are defined by law in California), and labor contract requirements.

Making data available

Making data available is perhaps the single greatest challenge. The types of data identified above may reside in the information systems of various departments, such as finance, human resources, payroll, and admission/
discharge/transfer, as well as in various acuity or patient classification
systems or clinical documentation systems. These systems may be electronic, paper-based, or a combination. Few of them share data easily; even when they do, the timing of data entry and availability and consistency of the data may be problematic. For instance, if the data needed to make daily staffing decisions are available only weekly or monthly, they aren’t terribly useful. Challenges also may stem from inconsistent or poorly understood data definitions, which can raise doubts about data validity and make it difficult to effectively analyze and compare data sets. (See Using a digital staffing dashboard by clicking on the pdf icon above.)

Dashboard design and usability

Dashboards provide access to the disparate data sources needed to support excellent staffing practices. Whether you develop your own dashboard, work with a company that specializes in developing them, or use a dashboard provided by your current staffing system pro­vider, be aware of the design considerations that can yield maximum benefit. For instance, choosing which data to display can be challenging. Remember—the more complicated the dashboard, the less usable it becomes.

Stay focused on the specific needs the dashboard is meant to address. Gaining a deep understanding of the situation the dashboard is supporting will help reveal the most critical data elements.

Use of color and display options, such as charts and graphs, can increase a dashboard’s usability. Ideally, these elements should be user-configurable, as people differ in how they like to view information. To see the range of personalization options in a popular web-based application, visit www.iGoogle.com. This page allows you to create your own customized homepage from a menu of options in about 30 seconds.

When designed well, dashboards simplify complex data, making them more useful. Dashboard designs that emphasize simplicity and usability while supporting user configurability are more likely to be used successfully. User-centered design and design flexibility are crucial.

Getting there

Getting the data required for effective, evidence-driven staffing poses challenges—and in some cases, it might even be easier to avoid using critical data when making staffing decisions. But the era of making these decisions based on tradition or budgets alone must give way to a process grounded in an evidence-based model based on meaningful use of data.

If dashboards are to be all they can be, organizations must demand that vendors cooperate and collaborate in defining and using data, as well as in transferring data from one system to another to meet organizational requirements. Organizations also need to find ways to make data more consistent—not just for their own employees but to support national benchmarking efforts and identify best practices.

Selected references

Ciesielski S, Daily B, Levine WC. Patient Safety and Quality Healthcare. A dashboard for the PACU. September/October 2008. www.psqh.com/sepoct08/pacu.html. Accessed March 24, 2010.

Douglas K, Kerfoot K. Applying a systems thinking model for effective staffing. Nurse Leader. 2008;6(5):52-55.

Hughes NJ. Clinical dashboards and open kimonos. BMJ. 2008;337:a787.
Hyun S, Bakken S, Douglas K, Stone P. Evidence-based staffing: potential roles for informatics. Nurs Econ. 2008;26(3):151-158, 173.

Srinivasan A, Abellera JP, Danos S, McNabb S. Improving awareness in message exchanging platform—a knowledge driven approach. AMIA Annu Symp Proc. 2007 Oct 11:1122.

St. Joseph Mercy Hospital to install LiveData OR-Dashboard. Business Wire. June 26, 2007.

Wolpin S. An exploratory study of an intranet dashboard in a multi-state healthcare system. Stud Health Technol Inform. 2006;122:75-79.

Kathy Douglas is president of the Institute for Staffing Excellence and Innovation in Sedona, Arizona and former chief nursing officer at Concerro, Inc. in San Diego, California, a firm that specializes in scheduling and shift-management systems.

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