Onus is on ED managers

When ED managers are confronted with a mandate to cut staff, they need to carefully examine the data used to justify the decision, McClay recommends. "You need to go back and look at underlying assumptions of the benchmarking organization that supplies the data, and see if those match your own situation," he emphasizes. "Any time we outsource those functions to third parties that don’t have a vested interest in the quality of care we’re providing, we may be giving away a little too much."

However, in order to refute the data, ED managers need to come armed with their own data. "You need to make it clear there may be problems with the data, but you can’t refute a big notebook full of tables if you have nothing to show for yourself," says McClay.

Analyzing your own ED’s work flow may lead to alternatives to maintain quality. "Find innovative ways to improve the services in your department while still cutting staff," McClay suggests. "Talk to other facilities that are doing it effectively and find out what they’re doing right that you’re not. If you move registration from out front to bedside, you may be able to cut staffing needs. If you analyze work flow, you may find you’re doing redundant work or could be using less skilled personnel."

Having good clinical data is key. "We had to do this by hand because nobody had these data, and yet it should be a key punch away," stresses McClay. "You need a good acuity system. And, keep close tabs on who is doing what in your department. Find out what the real workload is, not one generated by a third party."