Improvement in Resource Utilization
Norwich University
Executive Summary
This paper describes the problem of resource utilization in the Veteran Health Administration two campuses that are, the West Roxbury and Jamaica Plain Campuses. The two campuses of the Veterans Health Administration deals in different nature of surgeries; for instance, the Jamaica Plain campus deals in outpatient surgeries which requires a small amount of surgical time; whereas, the West Roxbury campus deals in the complex operations that require extended surgical time and long call hours. The different nature of operations in the two campuses creates under-utilization of the nurses within the Jamaica Plain campus as the remuneration is uniform for nurses working in both campuses. Thus, the Veteran Health Administration has recommended a cross-training program that would enable the nurses from both campuses to work interchangeably in the two campuses to improve the utilization of time, and financial resources. The significance of the cross-training program is that it would assist the nurses from both the campuses to be efficient in performing operations in both the campuses. Particularly, the cross-training program will provide the Jamaica Plain campus nurses with the skills to perform complex surgical operations. The training will provide the West Roxbury nurses with the skills to conduct outpatient surgical procedures in the Jamaica Plain campus. This strategy would assist the Veteran Health Administration to attain the goal of improving the utilization of resources of surgical nurses. Moreover, the action plan for the accomplishment of the recommended strategy include tracking time and approximating level of input of every nurse, identification of the bottleneck resources, computation of the availability for the surgical work, establish thresholds for bottleneck resources and project teams and plan at 80%, control at 80% to attain 100% of planned work accomplished.
Improvement In Resource Utilization
The issue in the Veteran Health Administration is the under-utilization of resources, especially, the time, nurses, and financial resources in the Jamaica Plain Campus; and over-utilization at West Roxbury campus. Thus, the proposed project aimed at the improvement in the resource utilization at the two campuses, the West Roxbury and Jamaica Plain. The cross-training program will involve the training of the nurses in both the campuses to be competent to practice and assist on all surgical procedures performed at both campuses. The staffing can share in all duties such as on-call at the West Roxbury campus without any issue regarding the discharging of duties since the remuneration in both the campuses is uniform. The move will help in the efficient utilization of both the time and human resources within the two campuses. The context of the project is the improvement in resource utilization in the perioperative setting at VHA Boston.
Background
The issue becomes noticeable when the nurses working in the West Roxbury campus showed interest in transferring to the Jamaica Plain campus the moment there is a vacancy (Popejoy et al., 2015). The West Roxbury nurses had the notion that they are being exploited because of the complex nature of surgical procedures and long working hours; while the remuneration in the same with their counterparts in the Jamaica Plain campus who are working for fewer hours with simple surgical operations. The training of human resource is efficient in the provision of quality health care and enhancing the utilization of the resources. The proposed project is significant as it will improve the profitability and quality of health care within the two campuses. Particularly, once the cross-training is completed, nurses are provided with the opportunity to work in either of the campuses. This integration of staffing will hopefully improve morale at West Roxbury and Jamaica Plain as they will be working in each of the campuses on a rotational basis. Therefore, the moment the nurses interchange duties or tasks within the two campuses and the rate of remuneration remains constant in both campuses, the nurses of West Roxbury will be motivated to work for the Veteran Health Administration; thereby enhancing their retention.
Problem Statement
The main problem within the Veteran Health Administration is the inefficient utilization of nurses, time, and financial resources (Lachaine et al., 2011). The Veteran Health Administration financial manager is overpaying and underpaying the nurses working in the Jamaica Plain campus and West Roxbury campus respectively; this is because the duration of the tasks and nature of medical operations in the two campuses are different therefore they do not warrant uniform payment. Naturally, the nurses who are working in the West Roxbury campus should earn more salary than their counterparts in the Jamaica Plain campus (Behrns, 2012). The nurses working in the West Roxbury campus are subjected to long working hours and complex operation, therefore paying them a similar salary with the ones working in the Jamaica Plain campus is a form of underpayment to workers. The situation results in dissatisfaction among the nurses working in the West Roxbury. For instance, the potential problem that can exist among the nurses in the West Roxbury is the low performance due to poor attitude towards the tasks.
The inefficient utilization of the financial resource in the Jamaica Plain campus due to high compensation for the simple surgery tasks and short working hours can result in a loss to the Veteran Health Administration. The efficient utilization of the resources requires that the cost of production should not exceed the revenue. However, in the case of the Jamaica Plain Campus, the nurses are paid a large sum of money for performing simple surgical operations. The increment of the salary for the nurses working in the West Roxbury campus and leaving the salary for the nurses working in the Jamaica Plain campus intact cannot solve the problem of inefficient financial utilization, since the increment in the salary has the potential of increasing the cost of production, thus limiting the profitability. Thus, the financial resource utilization at the Veteran Health Administration campuses needs to be optimized to enhance the performance of the nurses in the West Roxbury who feels that they are the victims of inefficient utilization of the financial resources.
The nursing resource in the Jamaica Plain is under-utilized. The under-utilization of the staff resources in Jamaica Plain campus is demonstrated by the desire of the nurses working in the West Roxbury to get transferred to the Jamaica Plain campus (Vest, 2017). The incitation of the West Roxbury nurses by the nurses working in the Jamaica Plain campus, that their salary is uniform while the condition of the work is different, promotes the desire by the West Roxbury nurses to get the chance to work in the Jamaica Plain campus. The situation creates a lack of enough nurses to perform the complex operations on the West Roxbury campus. Moreover, the short working hours for the nurses working on the Jamaica Plain campus provide them with the opportunity to engage in the contract with the other health facilities. The nurses working on the Jamaica Plain campus can sign a part-time basis contract with the other health facilities to enable them toto earn more. The move if adopted by the Jamaica Plain campus nurses their concentration in the tasks at the Veteran Health Administration will diminish, thereby resulting in the poor quality of the health care. Therefore, the poor remuneration to the nurses working in the West Roxbury campus and short working hours for the nurses on Jamaica Plain Campus creates the problem of poor health care on both campuses. Thus, this demonstrates that the nursing resource on both campuses is not performing their task efficiently.
The lack of motivation on the part of the West Roxbury nurses can create job attrition. The nurses working in the West Roxbury can opt to quit employment because of the complex operations, and long working hours. Additionally, the incitement the nurses in the West Roxbury campus can receive from the Jamaica Plain nurses may result in the protest, go-slows, and boycott of duties by the nurses in the West Roxbury as an expression of their dissatisfaction with the amount of remuneration.
Purpose and Objectives
The purpose of the project, is to cross-trainnurses on both campus to improve the utilization of resources. The resources that need to be utilized efficiently in the Veteran Health Administration include finance, nurses, and time (Vest, 2017). The proper utilization of the time assigned to various task reduces the backlog of the OR scheduling. Moreover, the efficient utilization of human resource increases the performance, reputation, and profitability of the Veteran Health Administration. The purpose of the cross-training is to improve the utilization of the financial resources. The cross-training can reveal to the financial managers the potential and performance of the team of the nurses working in the two campuses. For instance, during the cross-training duration, the financial managers can record the level of profitability and compare it with the profitability before the cross-training project. The difference in the profitability before and during the cross-training is recorded in both campuses about the number of nurses who have been interchanged in the two campuses. Thus, the moment the profitability recorded in Jamaica Plain campus during the training exceeds the profitability before the training of the nurses; it implies that the nurses of West Roxbury are efficient in performing the simple surgical operations. Also, the increase in the profitability of the Jamaica Plain Campus during the training period implies that the nurses from West Roxbury are motivated to work in the Jamaica Plain Campus.
On the other hand, the moment the profitability of the West Roxbury declines during the period of cross-training implies that the nurses from the Jamaica Plain campus are not motivated to work in the West Roxbury. Therefore, the trend is enough to indicate to the financial managers that the nurses who are working in the Jamaica Plain campus are fond of simple surgical operations, and when subjected to long working hours and complex operation their performance declines. This sentence have been mentioned several times earlier. Additionally, the purpose of the cross-training exercise in the two campuses is to improve the utilization of the human resource. The training of the nurses working in the Jamaica Plain to perform the tasks in the West Roxbury provides them with an additional skill and competencies to work at both campuses.
Similarly, the training of the nurses from the West Roxbury to conduct simple surgical operations will provide them with the opportunity to work on both campuses. Therefore, such scenario improves the utilization of the nursing resource in that the moment one nurse in one of the campus is sick or unable to discharge his or her duty normally, the management will select any nurse who is on leave or holiday to take over for the sick nurse, rather than to hire an external workforce. The cross-training ensures that the veteran health administration uses its nurses in both the campuses to the fullest of their abilities. Hence, the purpose of the cross-training project is to promote efficient utilization of the human resource in both the campuses.
Furthermore, the purpose of the cross-training is to ensure that the time is efficiently spent by the nurses in both the campuses. For instance, the cross-training will provide the nurses in the West Roxbury to work for short hours when assigned duty in the Jamaica Plain campus (Popejoy et al., 2015). Similarly, the cross-training will also provide the Jamaica Plain nurses with the opportunity to work for long hours when assigned duties in the West Roxbury. The exposure of the nurses to the working conditions in both the campuses, will enable them to gain the skill of time management. Effective time management in the context of health can improve the quality of health care. Also, efficient management of the time can minimize the deterioration rate of the patients in both the campuses. The deterioration of the patients is majorly caused by the poor response time by the health professionals to attend the health demand of the patient.
Nevertheless, the cross-training will ensure that nurses are well acquainted with the amount of time required to accomplish various surgicalprocedures. The knowledge of the time required for various surgical procedures will improve the utilization of the time resource.
The objective of the project is ensuring that the nurses working in both the campuses interact to improve the utilization of the resources through cross-training. The cross-training will intensify the culture of teamwork on both ampuses. The nurses who are selected as the facilitators in the cross-training program will have the opportunity to lead the team effectively. For instance, the Jamaica Plain nurse who will have the privilege to train the nurses from the West Roxbury will gain knowledge of the complex surgical operations as a result of knowledge sharing. Similarly, the West Roxbury nurses who will have the privilege of working with the Jamaica Plain nurses during the cross-training period will gain knowledge of simple surgical operations. Therefore, the specific objective of the cross-training project is to ensure nurses can perform both the simple and complex surgical procedures, enhancing the nurse’s potential.
Literature Review and Synthesis of the Evidence
Strengths
The Veteran Health Administration has employed competent nurses in both Campuses. The selection of the qualified and competent nurses provides the Veteran Health Administration with the strength of implementing cross-training program as competent nurses can adapt to changes faster. Naturally, incompetent nurses will require a lot of resource and time to cross-train to master the nature of operations in both the campuses. The research conducted Martin (2014) reveals that cross training competent workforce it is easy and takes a shorter period than cross training those are not competent to begin with. Therefore, the Veterans Health Administration enjoys the strength of having a workforce, which is easily trainable and can adapt to a different working environment. The qualitative research accomplished by Salmond and Echevarria (2017) on the performance of the nurses when faced with strange a working environment and different amount of work reveals that they tend to attain their best in working with the new team members.
Moreover, the nurses in both the Veterans Health Administration campuses knew nursing resource utilization in the campuses was not efficient, especially in the Jamaica Plain campus. The knowledge among the nurses in the Jamaica Plain that time and human resources are not efficiently utilized provide the Veterans Health Administration with the strength; because the agents of change and the nurses who have the vision and objectives of the Veterans Health Administration at their heart will find it easy to mobilize the other nurses towards the project of cross-training aimed at improving the resource utilization. The research by Salmond and Echevarria (2017) further reveals that nurses comprehend the factors driving change, responsibilities for practice change and the competencies (knowledge, skills, and attitude) that will be needed for the nurses and organization-wide success.
Also, the desire by the nurses working in the West Roxbury Campus to work in the Jamaica Plain Campus provided the strength for the success of the proposed project of cross-training the nurses to enhance the utilization of the resources. The zeal of the nurses working in the West Roxbury to work in the Jamaica Plain campus is evident by the fact that they apply for any vacancy or opportunity in the Jamaica Plain campus. The research conducted by Lomero et al., (2018) demonstrates that nurses tend to like the nature of surgical operations which are simple and takes a shorter time to complex surgical operations which take long hours.
Weaknesses
The veteran health administration is not privy about the nature of resistance to change that may take place among the nurses in the Jamaica Plain campus. The nurses in the operation rooms in the Jamaica Plain campus encounters flexible working conditions, that is, short working hours and the accomplishment of simple operations. It is a challenging situation to subject the nurses who were used to working for short hours to begin working for long hours without salary increment; because they will perceive the change as a form of exploitation. Naturally, the workers are fond of rejecting any nature of change that is aimed at increasing the amount of workload while leaving the amount of salary intact. Moreover, the research conducted by McPhee, Dahinten and Havaei (2017) among the 472 nurses from British Colombia, Canada, to examine the impact of the heavy perceived nurse workloads on patient and nurses. The results revealed that job-level perception of heavy workloads and task-level interruptions have a tangible direct impact on patient and nurse outcomes (MacPhee, Dahinten, & Havae, 2017).
The Veterans Health Administration lack the knowledge that some of the nurses working in the Jamaica Plain campus can have a working contract with other external health facilities; therefore, subjecting them to cross-training program may result in their resignation. The resignation of the Jamaica Plain nurses who have the contract with the other health facilities can come as a result of the long working hours and complex operations in the West Roxbury that willprevent them from working at their second job.
Gaps
There exists a knowledge gap between the nurses working in the Jamaica Plain campus and West Roxbury. The nurses working in the West Roxbury are knowledgeable in complex surgical operations. On the other hand, the Jamaica Plain campus nurses are knowledgeable of simple surgical operations. Therefore, the knowledge gap provides the opportunity for cross-training to ensure equilibrium in the knowledge of the nurses in both the campuses of the Veterans Health Administration. The knowledge gap among the nurses working in the two operating rooms of the Veterans Health Administration can be demonstrated by the nature of surgical operations; for instance, it is evident that the nurses working in the West Roxbury operating rooms are more advanced in the surgical operation knowledge than the ones working in the Jamaica Plain campus. Complex surgical operation requires a more complex knowledge of surgery, unlike simple surgical operations.
The research conducted by Martin (2014) demonstrates that knowledge gap among the nurses working in the operation room can create the best avenue of improving the knowledge of the nurses who have little knowledge of some of the surgical operations. For instance, since the nurses in the Jamaica Plain are inclined to the simple surgical operations, they can advance their knowledge through the cross-training project. However, the nurses of the West Roxbury can become reluctant in working in the Jamaica Plain campus because due to their experience and the knowledge of the complex operations, they will find simple surgical operations easy to handle. Moreover, the knowledge gap can create a poor attitude among the nurses in the two operation rooms towards the cross-training project aimed at the improvement in the utilization of resources. For instance, the West Roxbury nurses may perceive working in the Jamaica Plain operating rooms as a demotion of their ability and knowledge; hence they may become over-confident in discharging their duties in the Jamaica Plain operating rooms. Therefore, the attitude may hinder their ability to gain from the cross-training project. On the other hand, the nurses working in the Jamaica Plain campus operation rooms will develop a good attitude towards learning the processes involved in the complex surgical operations as they perceive it as advancement in their nursing knowledge. It is evident from the investigation conducted by Bilik (2017) that nurses are always excited to improve the knowledge and skills to attain promotion within the health facilities.
Limitations
The time the nurses may find in discharging their duties to the patients may be limited during the process of the cross-training project; since most of the nurses will be conducting the training to their colleagues. Notably, the nurses at the West Roxbury campus operation rooms will be offering training to the nurses from the Jamaica Plain . Similarly, the nurses in the Jamaica Plain will be training the nurses from the West Roxbury. Therefore, during the process of cross-training project, the time that the nurses will be found with the patients will be limited.
Moreover, the cross-training project will limit the nurses in both the operation rooms from specialization. The specialization in the health sector is the process where a nurse concentrates in a given field of the operation; for instance, if it is a simple surgical operation, the nurse specializes in all types of the simple surgical operation. However, the cross-training diverts the attention of the nurses to one field of operation as they are exposed to different categories of surgical operations. The research by Bell (2018) among the participants of the sports games reveals that specialization in one sporting activity improves the performance of the participants rather than engaging in more than one sporting activity. For instance, the moment an individual specializes in athletics sports, he or she will improve his or her performance in the athlete competitions. However, the moment one tries to balance his or her skills in football and athletics, his or her performance in both the sporting activities will decline due to divided interest and effort. Therefore, in the context of the cross-training project of the nurses working in the simple and complex operation rooms, the performance of the nurses will decline. For instance, the nurse can perform well in the execution of the simple surgical operation, and while faced with the complex operation, he or she declines in performance. Thus, lack of specialization that will be generated by the cross-training project will reduce the quality of health care as specialization has the potential of enhancing the quality of health care. Further research by Bell (2018) demonstrates that specialization of the nurses improves the quality of the health outcomes to the patients. The Veteran Health Administration will enhance the utilization of the nursing resources in the two campuses; however, the quality of the health outcome will be compromised by the lack of specialization among the nurses.
Additionally, the cross-training project can create confusion among the nurses who are used to one type of operations. For instance, the nurses working in the Jamaica Plain campus operation rooms may fix their mind on the simple surgical procedures, thus, when they are exposed to the complex surgical procedures, they may get confused in the process and start recording the operation and issue prescriptions that are meant for simple surgical operations. The News article by the Nation Media (2018) demonstrates how the doctors at the Kenyatta National Hospital in Kenya conducted brain operation on the wrong patient. The article by the Nation Media (2018) further reveals that the patient was meant to undergo a simple surgery; but due to the confusion by the doctor, he conducted brain operation which a very complex and sensitive operation. Therefore, the scenario at the Kenyatta National Hospital (KNH) provides clear evidence that the confusion can arise in the operating rooms. Thus, the Veteran Health Administration cross-training project may generate confusion among the nurses in both the campuses as they will interact with both complex and simple surgical procedures at given intervals on a rotational basis.
Search Strategy for Literature Review
The research question for the Literature was: What are the factors that can ensure efficient cross-training of nurses in operating rooms to improve resource utilization?
The keywords and concepts employed in the search included: Hospital, improve, operation rooms, cross-training, utilization of resources, and nurses. The keyword synonyms applied in the search included: efficiency, healthcare. The keywords were generated from the research question.
The timeframe for the search was from 2011 to 2018. The articles were searched on the CINAHL and PUBMED database using the keywords and concepts like Hospital, efficiency, cross-training, utilization of resources, and nurses within the timeframe 2011-2018. 267 articles were found, but only 15 were applicable for the review. The keywords and concepts that were used in the search were related to Transformation, Training, Healthcare knowledge and workload, ethics, specialization, and efficiency.
Examination of Leadership and Organizational Behavior
The leaders of the Veteran Health Administration need to adopt the initiative of driving the nurses towards the proposed project of cross-training to improve utilization of resources in both the operation rooms. Notably, the nursing leadership needs to take the lead in sensitizing the staff nurses of the necessity of the suggested change and how the cross-training will impact on their skills (Brekke et al., 2014). Therefore, the Nurse Managers will act as the driver to the proposed change.
Resistance to change will be experienced among the nurses in the Jamaica Plain campus (Borokowski, 2016). The nurses working in the Jamaica Plain campus operation room will resist the proposed change as they perceive it as a strategy to increase their workload. Particularly, the cross-training of the nurses in Jamaica Plain campus to work in the West Roxbury campus, where there is complex surgical operation will be perceived as an increase in the workload. On the other hand, the nurses in the West Roxbury campus will accept the proposed change as they will perceive it as a reprieve from complex surgical operations.
Examination of the planned change theory
The Veterans Health Administration can use Kurt Lewin’s theory of planned change to implement the change in the two campuses, Jamaica Plain, and West Roxbury. Kurt Lewin’s change theory consists of three steps; unfreezing, changing, and refreezing (Colville & Camilleri, 2016). The unfreezing stage involves the sensitization of the nurses on how the maintenance of the status quo is impacting on the organization. The changing stage consists of the adoption of the cross-training program. Lastly, the refreezing stage involves the practices that reinforce, stabilize, and solidify the new state following the change.
The potential strategies; pros and cons of each strategy
The potential strategy to ensure successful implementation of the cross-training project aimed at improving resource utilization is the establishment of different quantities of overtime salary due for the nurses working in different campuses. For example, the nurses working in the West Roxbury campus need to be given more amount of overtime salary than the nurses working in the Jamaica Plain operation rooms. Thus, the strategy will reduce the potential resistance to the proposed change among the Jamaica Plain nurses (Kristensen et al., 2016). The decision to provide the nurses working in the West Roxbury with higher amount of overtime salary than that of nurses working in the Jamaica plain campus is based on the condition and terms of work. Particularly, the West Roxbury nurses are conducting complex surgical operations; and work for long hours that require a higher salary, unlike the nurses in the Jamaica Plain campus. Naturally, long working hours requires payment of the overtime too for the completion of surgical procedures. Therefore, in the health care context payment of the overtime to nurses who conduct complex operations that may take longer than the scheduled working hours also improves the performance of the nurses in the operating rooms. The payment of the overtime to the nurses in operating rooms is necessary because the operations, once initiated, must be completed regardless of the time, to achieve an optimal and safe outcome of the patient.
The advantage of this nature of the strategy is that it will ensure that the operation which takes more time than the recommended working hours are accomplished without any grumble from the nurses in the operation rooms. The moment the nurses are compelled to work extra time without any compensation, their performance will diminish as they perceive the extra working hours as exploitation. Therefore, the strategy of setting a given amount of overtime for the nurses will improve staffing resource utilization.
Moreover, the strategy of paying allowances to the nurses depending on the terms and condition of work will promote efficient utilization of the financial resource. For instance, the moment the nurse works for extra time; it implies an increment in the work input, and naturally, the increase in the operation input increases the output for the Veterans Health Administration. Particularly, when an operating room initiates many complex surgical operations in a day, which requires long hours; the hospital will benefit even if it pays the overtime allowance to the nurses. The output per day of the operation rooms will increase when the payment of the overtime provides for more work input. Therefore, the use of the financial resource in the payment of overtime allowances will promote profitability and the utilization of the human resource.
The disadvantage of the strategy of paying allowances to the nurses working extra time in the operating rooms; is that it will cost the hospital a large amount of money during the initial stages of its implementation. For instance, during the initial stages of implementation of the strategy, the hospital will have to use the financial reserve to pay the difference amount of allowances due to the nurses working in different campuses. Therefore, the hospital will feel the impact of increasing cost of operation in the overtime payment to the nurses working for extra hours.
Another disadvantage of the strategy of paying different amount of allowance to the nurses is that it may promote laxity in some of the nurses working in the operating rooms, especially, when the mode of paying overtime is on an hourly basis. The nurses in the operating rooms may take long hours in the execution of a simple surgical operations that can be accomplished within the working hours to earn a weekly paycheck. Thereby, the nurses can resort in using the opportunity of compensation for extra working hours to exploit the financial resources of the hospital. Thus, exploitation of the financial resources of the hospital may result in insolvency.
Nevertheless, another potential strategy that the veteran health administration can employ to promote the cross-training project aimed at improving resource utilization in the operating rooms is the promotion of teamwork among the nurses on both campuses. The nurses in the campuses will work on a rotational basis. The rotational working basis of the nurses will enhance teamwork among the nurses from both operating rooms as they will concentrate on the achievement of the common goal of the organization. The teamwork will integrate the workforce of the Jamaica Plain and West Roxbury through the rotational working program. The nurses from both the campuses will also perceive the organization as one rather than two separate entities. Thus, it will minimize incitement and grumbles regarding the condition of work among nurses in the two campuses (Killingsworth, 2011).
The advantage of the organization of teamwork in both the campuses is that it promotes social interaction among the nurses working in both the operation rooms. For instance, the nurses in the West Roxbury will freely interact with the nurses in Jamaica Plain campus operation rooms. The interaction of the nurses in both the operation rooms also promotes acceptance and diversity in the Veterans Health Administration. The diversity allows the nurses to recognize the distinct traits of their colleagues without discrimination based on gender.
Another advantage of the organization of teamwork strategy is that it provides the team leader with the opportunity to identify the potential of every nurse in each of the operation rooms. The team leader can use the potential of each member of the team to enhance the performance of the team while working in both the campuses. For instance, the nurses who have the strength in certain surgical procedures, either simple or complex surgical procedures can be mobilized to cross-train the ones with weaknesses in such surgical procedures to improve the utilization of resources.
The disadvantage of the organization of teamwork strategy is that it can promote social loafing. Social loafing is the concept that an individual is vulnerable to exert less effort on an assignment if they are working in a group than when working individually. Some of the nurses may tend to embrace laxity in the group than when working individually because of the failure of the attributed to the group and not to individual nurses. Social loafing may reduce the performance of the nurses and also promote the inefficient utilization of nursing resources.
Another disadvantage of the strategy of organizing teamwork among the employees during the cross-training project aimed at the improvement of resource utilization is that when the team leader does not have the leadership skills, it may result in poor management of the team members. The poor management of the team members may create internal resistance among the team members in the process of cross-training. For instance, some of the team members who are supporting the change aimed at the improvement of resource utilization may view that change as a hindrance to their freedom; especially the ones who are interested in working in the operation rooms with simple surgical procedures.
Recommended strategy/strategies with justification/ rationale
The recommended strategy is the payment of different overtime allowance to the nurses working in different campuses. The payment of the overtime can be justified by the demand of the nurses working in the West Roxbury campus operation rooms to have more compensation than their counterparts in the Jamaica Plain campus operation rooms. For instance, in three- month duration, West Roxbury nurses overtime was $64, 548.06, and Jamaica Plain was $3, 241.53. The difference in the amount of overtime pay in the two campuses demonstrates that the workload at West Roxbury require more time. Therefore, the improvement in the utilization of the time resource requires the compensation of the extra time worked to the nurses.
The reason why the payment of the overtime is the recommended strategy is that it reduces the dissatisfaction among the nurses working in the West Roxbury operation rooms (Borokowski, 2016). The nurses working in the West Roxbury complains of the uniformity in remuneration, yet they are subjected to long working hours and complex surgical procedures, unlike the Jamaica Plain nurses who are only executing simple surgical operations. Thus, the strategy of paying more overtime to nurses in West Roxbury campus is recommended to improve the satisfaction of the nurses working in the West Roxbury operation rooms.
Also, the reason why the payment of the overtime is recommended strategy is that it improves the performance of the nurses who works extra time in the operation rooms. The lack of compensation for extra time may cause demonstrations, boycott, and go-slows among the nurses in the operating rooms since they perceive the uncompensated overtime work as a form of exploitation by the Veterans Health Administration (Borkowski, 2016). Therefore, the situation may result in higher attrition rate among the nurses as they may opt to search for employment in the health facilities with good compensation and better working terms and conditions. The provision of the overtime allowance is the best- recommended strategy to accomplish the project of cross-training aimed at the improvement of the resource utilization.
The Action Plan to implement the recommended strategy
The Action Plan to adopt the recommended strategy of paying the overtime to the nurses working in the operation rooms includes;
1. Tracking time and approximating the level of input of every nurse
The leadership of the Veterans Health Administration tracks time and approximate the level of input of every nurse to ensure efficient financial and time resource utilization. The tracking of the time is accomplished through examination of the scheduling plan for every surgical operation assigned to the nurses in the operation rooms. For instance, the leadership of the West Roxbury needs to record the start and final time for various operations to ensure that the nurses do not embrace laxity in the execution of surgical procedures in the operation rooms just to earn the overtime. The tracking of the time will ensure that the hospital set a target to the nurses in the operation rooms, and also approximate the nursing hours in the operation rooms. The plan will limit the possibility of the nurses embracing laxity to earn undeserved overtime allowances.
2. Identification of the bottleneck resources
The next action plan is the identification of the bottleneck (constraints) resources. For instance, in the Veterans Health Administration operation rooms, the bottleneck resources include nursing, time, and financial resources. Therefore, the Veterans Health Administration needs to ensure that the time allocation and financial resource allocation is sufficient to enhance the efficient performance of the human resource, in this case, the nurses. The improvement of the resource utilization in the operation rooms is interdependent; that is, the efficient performance of the nurses depends on the provision of enough finance to cater for the planned changes like the cross-training project. Naturally, every project requires a financial resource to become successful; therefore, the Veterans Health Administration need to allow enough feasibility time to accomplish the project. For instance, if the financial resource is enough in the payment of the overtime for the nurses working in the West Roxbury and Jamaica Plain operation rooms. Moreover, the overtime is paid to the nurses who work beyond the normal time scheduled for work in the operation rooms. Thus, the Veterans Health Administration needs to consider providing or soliciting the identified bottleneck resources.
3. Computation of availability of the surgical work
The leadership of the Veterans Health Administration needs to compute the availability of the surgical work in the operation rooms before embarking on the amount of overtime that is paid to every nurse. For instance, the number of surgical work available in the West Roxbury operation room is determined to ensure that some nurses are allowed to work overtime to reduce the possibility of a backlog of patients in the operation rooms. Similarly, the number of patients who require surgical operations in the Jamaica Plain campus is also determined to ensure that the nurses in such operation room are provided with the opportunity to work extra time to accomplish the task within the shortest time possible. Therefore, in doing so, the veteran health administration will be paying overtime to the nurses who deserve the compensation; thus improving the utilization of the financial and time resource.
The availability of the surgical works in the operation room is what will determine the amount of overtime pay to the nurses in the operation rooms. However, the moment the Veterans Health Administration embarks on the payment of the overtime allowance to the nurses when there is insufficient availability of the surgical works, it will be exploiting the financial resource. This is because some of the nurses may decide to embrace laxity in the performance of the surgical procedure with the intention of earning a paycheck. Therefore, that is why it is important for the Veterans Health Administration leadership to compute the availability of the surgical work in each operation rooms to ensure that the payment of overtime will optimize the utilization of human, time and financial resources.
4. Establish a threshold for bottleneck resources and project teams and plan at 80%, control at 80% to attain 100% of planned work accomplished
The leadership of the Veterans Health Administration needs to establish a threshold for the constraint resources. The constraint resource, in this case, is the availability of finance to mobilize the nurses to work extra time. Thus, the financial threshold needs to be established among the team of nurses working in the West Roxbury operation rooms and the Jamaica Plain campus operation rooms. The financial threshold in each operation room needs to be distinct to ensure that different amount of overtime pay is established for the West Roxbury and Jamaica Plain nurses.
The financial manager of the Veterans Health Administration needs to plan the efficiency in the use of the financial resources at 80 percent, control at 80 percent to ascertain that the 100 percent of the available surgical operation work in the operation room is accomplished. The action plan will improve the utilization of both the financial resource and the human resource in the operation rooms. This is because the pay of the overtime ensures 100% accomplishment of the tasks in the operation rooms.
Conclusion
In conclusion, the issue in the Veteran Health Administration is the under-utilization of resources, especially, the time, nursing staff, and waste of financial resources in the Jamaica Plain Campus. Thus, the proposed project aimed at the improvement in the resource utilization in the two campuses, that is, the West Roxbury and Jamaica Plain is the cross-training program for the nurses working in the two campuses. The time the nurses may find in discharging their duties to the patients may be limited during the process of the cross-training project; since most of the nurses will be conducting the training to their colleagues. Particularly, the nurses in the West Roxbury campus operating rooms will be offering training to the nurses from the Jamaica Plain campus operating rooms. The main problem within the Veteran Health Administration is the inefficient utilization of the nurses, time, and financial resources. The Veteran Health Administration financial manager is overpaying and underpaying the nurses working in the Jamaica Plain campus and West Roxbury campus respectively; this is because the duration of the tasks and nature of surgical operations in the two campuses are different therefore they do not warrant uniform payment. The potential strategy to ensure successful implementation of the cross-training project aimed at improving resource utilization of establishment of quality perioperative nurses working in different operating rooms that are proficient in all surgical procedures. The reason why the payment of the overtime is a recommended strategy is that it improves the performance of the nurses who works extra time in the operating rooms. The lack of compensation for extra time may cause demonstrations, boycott, and go-slows among the nurses in the operation rooms since they perceive the uncompensated overtime work as a form of exploitation by the Veteran Health Administration. Moreover, the action plans for the accomplishment of the recommended strategy include tracking time and approximating level of input of every nurse, identification of the bottleneck resources, computation of the availability for the surgical work, establish thresholds for bottleneck resources and project teams and plan at 80%, control at 80% to attain 100% of planned work accomplished.
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