Identify your Gap to Goal - Advisory...executives. While we have provided PowerPoint and Excel...

Image Credit: iStock.

International

Global Centre for Nursing Executives

Identify your Gap

to Goal Tools to Conduct a Nurse Manager Time Audit and

Performance Gap Assessment

©2014 The Advisory Board Company advisory.com 2

LEGAL CAVEAT

The Advisory Board Company has made efforts to

verify the accuracy of the information it provides to

members. This report relies on data obtained from

many sources, however, and The Advisory Board

Company cannot guarantee the accuracy of the

information provided or any analysis based

thereon. In addition, The Advisory Board Company

is not in the business of giving legal, medical,

accounting, or other professional advice, and its

reports should not be construed as professional

advice. In particular, members should not rely on

any legal commentary in this report as a basis for

action, or assume that any tactics described herein

would be permitted by applicable law or

appropriate for a given member’s situation.

Members are advised to consult with appropriate

professionals concerning legal, medical, tax, or

accounting issues, before implementing any of

these tactics. Neither The Advisory Board

Company nor its officers, directors, trustees,

employees and agents shall be liable for any

claims, liabilities, or expenses relating to (a) any

errors or omissions in this report, whether caused

by The Advisory Board Company or any of its

employees or agents, or sources or other third

parties, (b) any recommendation or graded ranking

by The Advisory Board Company, or (c) failure of

member and its employees and agents to abide by

the terms set forth herein.

The Advisory Board is a registered trademark of

The Advisory Board Company in the United States

and other countries. Members are not permitted to

use this trademark, or any other Advisory Board

trademark, product name, service name, trade

name, and logo, without the prior written consent

of The Advisory Board Company. All other

trademarks, product names, service names, trade

names, and logos used within these pages are the

property of their respective holders. Use of other

company trademarks, product names, service

names, trade names and logos or images of the

same does not necessarily constitute (a) an

endorsement by such company of The Advisory

Board Company and its products and services, or

(b) an endorsement of the company or its products

or services by The Advisory Board Company. The

Advisory Board Company is not affiliated with any

such company.

IMPORTANT: Please read the following.

The Advisory Board Company has prepared this

report for the exclusive use of its members. Each

member acknowledges and agrees that this report

and the information contained herein (collectively,

the “Report”) are confidential and proprietary to

The Advisory Board Company. By accepting

delivery of this Report, each member agrees to

abide by the terms as stated herein, including the

following:

1. The Advisory Board Company owns all right,

title and interest in and to this Report. Except

as stated herein, no right, license, permission

or interest of any kind in this Report is intended

to be given, transferred to or acquired by a

member. Each member is authorized to use

this Report only to the extent expressly

authorized herein.

2. Each member shall not sell, license, or

republish this Report. Each member shall not

disseminate or permit the use of, and shall

take reasonable precautions to prevent such

dissemination or use of, this Report by (a) any

of its employees and agents (except as stated

below), or (b) any third party.

3. Each member may make this Report available

solely to those of its employees and agents

who (a) are registered for the workshop or

membership program of which this Report is a

part, (b) require access to this Report in order

to learn from the information described herein,

and (c) agree not to disclose this Report to

other employees or agents or any third party.

Each member shall use, and shall ensure that

its employees and agents use, this Report for

its internal use only. Each member may make a

limited number of copies, solely as adequate for

use by its employees and agents in

accordance with the terms herein.

4. Each member shall not remove from this

Report any confidential markings, copyright

notices, and other similar indicia herein.

5. Each member is responsible for any breach of

its obligations as stated herein by any of its

employees or agents.

6. If a member is unwilling to abide by any of the

foregoing obligations, then such member shall

promptly return this Report and all copies

thereof to The Advisory Board Company.

Global Centre for Nursing Executives

Project Director

Contributing Consultants

Managing Director

Marguerite Lucea, RN, MPH, PhD

Vanessa Orco, MPP

Patricia Wynn, MBA


Tools to Conduct a Nurse Unit Manager

Time Audit and Performance Gap Assessment

Identify your Gap to Goal

Nurse managers all over the world tell us they’re feeling overwhelmed. They’re currently juggling multiple

competing demands and struggling to prioritise.

Even more concerning, when asked how they spend their time, nurse managers reported they were

frequently getting absorbed by time-consuming tasks such as scheduling, managing patient flow, and

budgeting. This kept them from partaking in the leadership activities their executives wanted them to

prioritise.

The Global Centre for Nursing Executives believes that organisations need to re-evaluate the role and ensure

it is fit for purpose for the new health care reality.

To restructure the role, executives should start by assessing exactly how managers currently spend their

time.

A time audit is a good place to start. Using this information, executives can then partner with managers to

understand which activities can be delegated and what support is necessary to thrive in the role.

At the Global Centre, we think that this is a worthy exercise not only to identify areas of need and gaps

between your priorities and your managers’ priorities, but also to facilitate a conversation between managers

and leaders about the priorities. You can then involve managers in the process of role re-design.

To support you in this process, we have created a set of PowerPoint and Excel tools designed for both nurse

managers and executives to complete.


Table of Contents

Diagnose the Need for Conducting a Time Audit.........................................................................................

Assessing Where You Stand.......................................................................................................................

Orientation to the Nurse Unit Manager Time Audit and Performance Gap Analysis................................

Overview and Directions..............................................................................................................................

Diagnostic Tools: Nurse Unit Manager Time Audit and Gap Analysis.......................................................

Instructions for Worksheet #1..................................……….........................................................................

Explanation of Activity Categories...........................………..........................................................................

Worksheet #1: Daily Time Audit..................................……….....................................................................

Instructions for Worksheet #2..................................………........................................................................

Worksheet #2: Summary Page for Unit Managers.....................................................................................


Worksheet #3: Nurse Unit Manager Summary...........................................................................................

Determine Gap to Goal.....................................................................................................................................


Worksheet #4: Aggregate Nurse Unit Manager Report...............................................................................


Worksheet #5: Nurse Executive Assessment of Unit Manager Time Audit Allocation................................

Instructions for Worksheet #6...................................………........................................................................

Worksheet #6: Executive Summary..............................................................................................................

5

6

7

8

9

11

12

13

14

15

16

17

18

19

20

21

22

23

24


Diagnose the Need for

Conducting a Time Audit

Section 1


Assessing Where You Stand

Level of Executive Understanding No Yes

1. Are you very familiar with how unit managers spend their time on a day-to-day

basis?

2. Do you know where bottlenecks typically occur in the unit manager’s job at

your institution?

Nurse Unit Manager Ability to Prioritise

3. Do unit managers focus on areas that you consider top priorities?

4. Are unit managers clear as to what their primary responsibilities and desired

outcomes are?

5. Do unit managers generally know where they spend their time and, for the

most part, feel that they have accomplished something each day?

6. Do you feel that there is little or no disparity in the unit manager understanding

about senior leaders’ priorities?

Interpreting Self-Results

General Applicability Direct Indicators

Primary benefit of time audit is identifying gaps

between nurse executive and nurse unit

manager understanding of unit manager

priorities. A majority of “No” answers indicates

a potential “fit” for time audit at your institution

Members responding “No” to

questions #1 and #3 should

strongly consider conducting a

time audit

Nurse Executive Self-Test

We acknowledge that time audits are time intensive, so we created this self-assessment to help you roughly

evaluate if this would be a useful exercise for your organisation.

If you feel like you have a good sense of where your challenge areas are, a time audit may not be worth the

effort. But even if you have a good sense of the workload of managers, the results can help facilitate a dialogue

about effective prioritisation between executives and managers.


Orientation to the Nurse Unit Manager

Time Audit and Performance Gap Analysis

Section 1


Overview

This tool is intended to quantify how nurse unit managers spend their time and to identify differences

between nurse executive and unit manager perspectives on appropriate manager time allocation and

organisation.

With limited time to meet their many accountabilities, nurse unit managers must decide how best to allocate

their time. In many cases, these managers do not allocate their time to activities considered the highest

priority by senior nursing leaders or the executive team. The resulting gap in shared vision can lead to a

misplaced focus or misaligned priorities. This exercise aims to reduce those gaps and help nurse unit

managers and nurse executives align their priorities.

Intended Audience

Section 2 of this tool should be completed by nurse unit managers. Section 3 should be completed by nurse

executives. While we have provided PowerPoint and Excel versions of the tool, the Global Centre

recommends members use the Excel tool, because it has been designed to automate calculations.

Directions on Using Nurse Unit Manager Time Audit and Performance Gap Analysis

Section 2: Nurse unit managers use Worksheets #1 through #3 to capture data concerning time allocation

and priorities:

• Worksheet #1 Daily Time Audit: Nurse unit manager uses time audit tool to track time across 7

categories for five consecutive days

• Worksheet #2 Summary Page for Unit Managers: Nurse unit manager stores data and performs

calculations

• Worksheet #3 Nurse Manager Summary: Nurse unit manager provides aggregate data for use by nurse

executive

Section 3: Nurse executives use Worksheets #4 through #6 to record their desired time allocation and to

enter and analyse data captured by nurse unit managers:

• Worksheet #4 Aggregate Nurse Manager Report: Nurse executive compares data from all managers and

calculates institutional averages

• Worksheet #5 Nurse Executive Assessment of Manager Time Allocation: Nurse executive provides own

estimate of both actual and ideal nurse manager actual time allocation at own institution

• Worksheet #6 Executive Summary: Nurse executive uses both own estimates of manager time allocation

and manager actual allocation to identify and analyse gaps

How to Use This Tool

Nurse Unit Manager Time Audit

and Performance Gap Analysis


Nurse Unit Manager Tools:

Time Audit and Gap Analysis

Section 2

10 ©2014 The Advisory Board Company • advisory.com

Instructions for Worksheet #1


Overview

The purpose of this tool is to capture concrete, detailed data about how unit managers allot their time across

multiple responsibilities on a daily basis. Tracking activities across several days in real time and in small

increments is the best way to provide an accurate account of actual time allocation.

Intended Audience

This tool is intended for unit managers.

Instructions

1. Managers should first familiarise themselves with the 7 categories on the time audit by reading through

the Explanation of Activity Categories. This analysis represents a concerted effort to accurately

represent the variety of nurse manager duties, while trying to limit the number of categories. Though

what is included in the categories may not, in every instance, reflect a particular manager’s situation,

managers are encouraged to use this listing so that there is a consistency of responses within the

manager group at each institution.

2. Best practice is to complete the time audit for five consecutive days, using one copy of the audit tool

each day. This provides at least a full week’s worth of data for analysis. The most effective way to use

the worksheets is to stop at several points during the day to note how time was spent in the past 2 to 3

hours. Time should be recorded in minutes. This means that there can be entries in multiple categories

within any given half-hour block. Approximations about time spent on a given activity are better than

omitting any activities. Time spent in meetings should be allocated to the category that most closely

resembles the topic covered at the meeting. If multiple topics were discussed, the time can be allocated

across several categories.

3. Personal time and meals should not be counted in any category. For example, a manager who takes

lunch from 12 until 12:30 should leave that row blank.

4. At the end of each day, total the minutes at the bottom of each column and transfer these numbers to the

appropriate cell in Worksheet #2.

Notes

The Global Centre has created both a PowerPoint and an Excel version of this tool. The Excel version is

available here.

https://www.advisory.com/~/media/ABI/Research/GCNE/Tools/2015/Identify-Your-Gap-to-Goal/Time-Audit-Tool-for-Nurse-Managers.xls


Explanation of Activity Categories

Functions Tasks

Patient Care Services Provide direct patient care (either by being included in staffing count or carrying out

other activities, e.g., vital signs, giving meds, IV therapy, responding to a code, etc.)

Ensure effective delivery of patient education

Attend ward/unit rounds with members of the multidisciplinary team

Lead discussions with doctors, nurses/midwives and allied health staff regarding

clinical care delivery

Establish a feedback process for patients and carers

Review patient feedback, identify trends, and share with staff

Manage patient satisfaction issues/complaints in a timely manner

Develop processes that ensure all patients receive adequate nutrition and hydration

Conduct patient satisfaction rounds

Establish a standardised approach to clinical handover

Support clinical decision making and patient care delivery with evidence

Facilitate critical thinking at the bedside

Ensure patients are aware of and receive their patient rights

Daily Unit Operations Monitor or coordinate patient admissions, transfer, and discharge on ward/unit

Build rosters for ward/unit care delivery

Ensure staffing levels and skill mix match patient demands/needs

Strategically anticipate long term workforce needs

Ensure appropriate equipment is available and functional on ward/unit

Fill out supply and medication orders

Manage processes for supply and medication procurement

Facilitate routine staff meetings

Business and

Financial Operations

Develop annual ward/unit budget

Collect data regarding ward/unit financial performance against allocated budget

Prepare monthly budget and productivity variance reports

Present on ward/unit financial performance against allocated budget

Draw correlations between performance key clinical indicators and financial impact

Monitor timesheets and do payroll

Service External to

Unit

Assist with hospital-level program development

Implement organisational change initiatives

Participate in activities, committees, or task force meetings outside the ward/unit

Attend hospital-wide nurse manager training sessions

Attend meetings with senior executives, nursing leadership team, department heads

The Global Centre has broken down all nurse manager functions into seven broad categories. This analysis

represents a concerted effort to accurately represent the variety of nurse manager duties, while trying to

limit the number of categories. Though what is included in the categories may not, in every instance, reflect

a particular manager’s situation, managers are encouraged to use this listing so that there is a consistency

of responses within the manager group at each institution.

Before filling out Worksheet 1, managers should familiarise themselves with this list and determine in which

category each of their responsibilities may fall.

NOTE: MANAGERS OFTEN ATTEND MEETINGS THAT HAVE MULTIPLE PURPOSES. PLEASE DO

YOUR BEST TO ALLOT TIME SPENT IN MEETINGS TO THE MOST APPROPRIATE CATEGORY; DO

NOT ACCOUNT FOR TIME TWICE.


Explanation of Activity Categories

Functions Tasks

Staff Management and

Development

Create a vision and culture for the ward/unit that engages staff in goals

Communicate organisational and ward/unit priorities to staff

Ensure staff are aware of and utilise current policies and procedures

Ensure novice clinicians are supervised and supported as they develop their

competence

Establish processes that ensure all staff participate in mandatory trainings

Ensure all nursing/midwifery staff have current registration

Ensure that all staff are practicing within the scope of practice

Conduct audit for 100% compliance with mandatory nurse/midwife training

requirements

Develop a process for succession planning on the ward/unit

Conduct interviews and assess for candidate fit

Train and orient new hires

Deliver annual staff evaluations

Prepare and deliver disciplinary actions

Resolve staff conflicts

Mentor charge nurses or other ward/unit leaders

Coach staff as they deliver patient care

Oversee and follow up on ward/unit staff educational needs

Establish practices that enable giving and receiving feedback

Establish practices that facilitate mentoring

Quality Improvement Analyse and report on ward/unit performance

Monitor and track incidents on the ward/unit

Identify key performance improvement opportunities

Develop quality improvement (QI) projects

Write action plans related to unit-level QI projects

Obtain interprofessional buy-in for execution of QI projects

Implement QI projects

Ensure hand hygiene procedures are followed

Embed evidence-based protocols to advance key indicators

Establish checks and audits to ensure ward/unit performance is up to quality

standards

Administrative and Non-

Managerial Tasks

Develop job descriptions for vacant positions

Review resumes and set up interviews with qualified candidates

Collect data on ward/unit performance indicators

Coordinate hiring process (including obtaining work visas, needed)

Review schedule daily to assess census, call in extra staff, and deal with staffing

emergencies

Deal with process glitches, interdepartmental or ancillary problems

Perform general office and clerical duties


Worksheet #1: Daily Time Audit

Time of

Day

Patient

Care

Services

Daily Unit

Operations

Staff

Management

and

Development

Quality

Improvement

Business and

Financial

Operations

Service

External

to Unit

Administrative

and Non-

Managerial

Tasks Time of Day

5:30a–6a 5:30a–6a

6a–6:30a 6a–6:30a

6:30a–7a 6:30a–7a

7a–7:30a 7a–7:30a

7:30a–8a 7:30a–8a

8a–8:30a 8a–8:30a

8:30a–9a 8:30a–9a

9a–9:30a 9a–9:30a

9:30a–10a 9:30a–10a

10a–10:30a 10a–10:30a

10:30a–11a 10:30a–11a

11a–11:30a 11a–11:30a

11:30a–12p 11:30a–12p

12p–12:30p 12p–12:30p

12:30p–1p 12:30p–1p

1p–1:30p 1p–1:30p

1:30p–2p 1:30p–2p

2p–2:30p 2p–2:30p

2:30p–3p 2:30p–3p

3p–3:30p 3p–3:30p

3:30p–4p 3:30p–4p

4p–4:30p 4p–4:30p

4:30p–5p 4:30p–5p

5p–5:30p 5p–5:30p

5:30p–6p 5:30p–6p

6p–6:30p 6p–6:30p

6:30p–7p 6:30p–7p

7p–7:30p 7p–7:30p

7:30p–8p 7:30p–8p

8p–5:30a 8p–5:30a

Total

Minutes

Total

Minutes




Overview

The purpose of this tool is to create a summary report of the total amounts and percentages of time spent in

each category during the audit period.

Intended Audience

This tool is intended for unit managers.

Instructions

1. If unit managers have not done so previously, fill in the grid on Worksheet #2 with the end-of-day

category totals from each of the daily time audits.

2. Then, total each row in column F. After column F is filled, sum the column in the last cell of column F to

obtain the total minutes spent working during the time audit period.

3. Finally, calculate the percentage of time spent in each category by dividing each row in column F by the

total number of minutes spent working in the last cell of column F. The percentage should sum to 100

percent.

4. Transfer the data from columns F and G to columns A and B on Worksheet #3.

Notes


available here. The Excel spreadsheets have formulas already written into the calculation boxes. If you

make adjustments to the forms, please double check the formulas in the calculation boxes.



Worksheet #2: Summary Page for Managers

A B C D E F G

Categories Total Minutes per Day

Total Minutes

for Week

(sum columns A

through E)

Current

Percentage

(divide column

by total in

column F) Day #1 Day #2 Day #3 Day #4 Day #5

1 Patient Care

Services 0

2 Daily Unit

Operations 0

3

Business and

Financial

Operations 0

4 Staff Management

and Development 0

5 Quality

Improvement 0

6 Service External

to Unit 0

7

Administrative

and Non-

Managerial Tasks

Total 0 100%




Overview

The purpose of this tool is to create summary of each individual manager’s time audit findings for their nurse

executive. Additionally, Worksheet #3 asks managers to identify their ideal time allocation; this will help

nurse executives understand individual managers’ priorities.

Intended Audience

This tool is intended for nurse unit managers.

Instructions

1. Transfer the minute totals from each category from column F on Worksheet #2 to column A on

Worksheet #3, and the calculated percentages from column G on Worksheet #2 to column B on

Worksheet #3. Again, check to make sure column B sums to 100 percent.

2. The questions at the bottom of the form provide an opportunity to describe any unusual circumstances

about a specific time audit.

3. Managers should use columns C and D to identify areas in which they would like to allocate more or less

time. Do so by placing a check in the appropriate column.

4. Column E asks unit managers to identify their ideal time allocation. In a perfect world, how would time be

allocated across the same 7 categories? If managers prefer not to spend time in one area, answer “0%”.

5. Upon completion of the audit, unit managers should turn in all worksheets to the person leading the time

audit project.

Notes






Worksheet #3: Nurse Manager Summary

A B C D E

Categories

Total Minutes for

Week

(from Worksheet

#2 column H)

Current

Percentage

(from Worksheet

#2 column I)

Allocate More

Time?

Allocate Less

Time?

Ideal

Percentage

1 Patient Care

Services

2 Daily Unit

Operations

3 Business and

Financial

Operations

4 Staff Management

and Development

5 Quality

Improvement

6 Service External

to Unit

7 Administrative and

Non-Managerial

Tasks

Reflection Questions

1. Do you think this is an accurate reflection of how you spend your time? Yes______ No_______

Comments:

_______________________________________________________________________________

_______________________________________________________________________________

2. During the time audit period, were there any circumstances that resulted in an unusual time

allocation? Yes______ No ______

Comments:

_______________________________________________________________________________

_______________________________________________________________________________


Nurse Executives Tools:

Determine Gap to Goal

Section 3




Overview

The purpose of this tool is to calculate the average time allocation among managers at each institution.

Intended Audience

This tool is intended for nurse executives.

Instructions

1. Once managers have completed Worksheets #1-3, use the data from column A of Worksheet #3, to fill in

the total minutes in each category for each manager. There is space for data from only five managers,

so multiple copies of this form may be needed (if this is the case, do not calculate averages on each

page, just the final page).

2. Once all of the data is entered, calculate the sum of each row in column F. Next, add up column F. This

is the total number of minutes spent by all managers over the course of the audit process.

3. Finally, calculate the average percentage of time spent by managers in each category by dividing the

total minutes for each category in column F by the total number of minutes for all categories in total cell

in column F. Enter the result for each row in column G. Column G should sum to 100 percent.

Notes




https://www.advisory.com/~/media/ABI/Research/GCNE/Tools/2015/Identify-Your-Gap-to-Goal/Time-Audit-Tool-for-Nurse-Executives.xls



Worksheet #4: Aggregate Nurse

Manager Report

A B C D E F G

Categories

Total Minutes per Day Total

Minutes for

Week

Current

Percentage

(must add up

to 100%) Manager

#1

Manager

#2

Manager

#3

Manager

#4

Manager

#5

1 Patient Care

Services

0 0.00%

2 Daily Unit

Operations

0 0.00%

3 Business and

Financial

Operations 0 0.00%

4

Staff

Management

and

Development 0 0.00%

5 Quality

Improvement

0 0.00%

6 Service

External to Unit

0 0.00%

7

Administrative

and Non-

Managerial

Tasks 0 0.00%

Total 0 0.00%

21 ©2014 The Advisory Board Company • advisory.com



Overview

The purpose of this tool is to capture concrete, detailed data about how managers allot their time across

multiple responsibilities on a daily basis. Tracking activities across several days in real time and in small

increments is the best way to provide an accurate account of actual time allocation.

Intended Audience

This tool is intended for nurse executives to complete during the time that nurse managers are conducting

time audit.

Instructions

1. Explanations of each of the 7 time audit categories can be found in the Explanation of Activity

Categories. This analysis represents a concerted effort to accurately represent the variety of nurse

manager duties, while trying to limit the number of categories. Though what is included in the categories

may not, in every instance, reflect a particular hospital’s situation, executives are encouraged to use this

listing so that there is a consistency of responses within each institution.

2. Once familiar with the 7 categories, in column A record how the nurse managers at your institution

actually spend their time.

3. In column B, create your ideal time allocation, considering in which categories you would like managers

to spend more or less time.

4. The percentages in each column should sum to 100 percent. If any of the categories do not apply to a

particular institution’s managers, “0%” may be entered in that category.

Notes






Worksheet #5: Nurse Executive

Assessment of Manager Time Allocation

A B

Categories Current Percentage Ideal Percentage

1 Patient Care

Services

2 Daily Unit

Operations

3

Business and

Financial

Operations

4 Staff Management

and Development

5 Quality

Improvement

6 Service External

to Unit

7

Administrative and

Non-Managerial

Tasks

Total 100% 100%




Overview

The purpose of this tool is to identify gaps between managers’ and nurse executives’ understanding about

manager priorities and time allocation.

Intended Audience

This tool is intended for nurse executives.

Instructions

1. Transfer managers’ data from column G on Worksheet #4 to column A and the executive’s data from

column A on Worksheet #5 to column B.

2. Subtract the columns to identify gaps between the managers’ current allocation and the executive’s

expectations. Gaps greater than 10 percentage points (plus or minus) should be analyzed to discover if

additional support or training could bring managers closer to expectations. This exercise can also be

performed for individual managers using the data from column B of an individual’s Worksheet #3.

Notes






Worksheet #6: Executive Summary

A B C

Categories Manager

Percentage

Executive

Percentage Gap

1 Patient Care

Services

2 Daily Unit

Operations

3

Business and

Financial

Operations

4 Staff Management

and Development

5 Quality

Improvement

6 Service External

To Unit

7

Administrative and

Non-Managerial

Tasks

Third Floor, Melbourne House

46 Aldwych, London WC2B 4LL, UK

P +44 (0)203.100.6800

advisory.com

2445 M Street NW

Washington DC 20037

P +1 202.266.5600

F +1 202.266.5700

Identify your Gap to Goal - Advisory...executives. While we have provided PowerPoint and Excel...

Documents

Transcript of Identify your Gap to Goal - Advisory...executives. While we have provided PowerPoint and Excel...