Hospice X (Hospice) is a not-for profit hospice organization serving a population of approximately 60,000 in southern Arizona. Since their inception in 1996, they have provided hospice and palliative care to terminally ill patients and their families 24 hours a day, 7 days a week.  Hospice has a reputation for doing whatever it takes to provide comfort to patients and their families; for spending as much time as is needed to ensure patients feel cared for in the final days of their lives.

 

Over the past 6 month, Hospice observed significant ongoing financial losses. Failure to reverse the loss trend would result in Hospice closing its doors within the year.  I volunteered to conduct an analysis of the organization and develop recommendations for improvement. A quick review of the organization’s financials revealed that Hospice needed to assess its staffing and compensation philosophy to ensure it capability to continue providing high quality patient care while maintaining financial sustainability.

 

I evaluated job descriptions and appropriate patient caseload for Hospice’s registered nurses (RNs), hospice aids, social services professionals, and clerical professionals, the organization’s staffing model, on-call and overtime policy, and the existing timekeeping and payroll practices. Analysis of the organization’s performance expectations for RNs revealed that, through its accepted staffing model and culture, the organization held its RNs to underperforming standards compared to national averages, on-call time was not appropriately managed, and self-reporting on timecards allowed opportunity for abuse and mismanagement by staff. The scope of this assessment did not extend to individual productivity, performance management, training, etc.