Doing less with less in nursing

By Rose O. Sherman, EdD, RN, FAAN

“If you want something new, you have to stop doing something old” Peter Drucker

Over the last five years, we have repeatedly heard in healthcare about the need to do “more with less”. Many nurse leaders today believe that they have reached the peak of what they can reasonably expect relative to staff productivity with current expectations. Peter Drucker, considered the father of modern management theory, frequently talked about the problem that leaders have in making decisions to stop doing things. But as Laurie Gehrt points out in the recent Voice of Nursing Leadership, this is flawed thinking. To move forward with the type of change needed in healthcare and nursing, nurse leaders need to move beyond this mindset and consider ways to do less with less.

Important Questions to Ask in Any Health System

Doing less with less starts by giving yourself permission to consider doing less. Some good questions to brainstorm include the following:

1. If we were part of a brand new system that had the opportunity to design entirely different care delivery, what would we do differently?

2. What are the redundancies that we have in our current processes?

3. Are the emerging technologies that we are using worth the expense?

4. Do all of the services that are provided by professionals require this level of expertise?

5. What parts of our care could we eliminate or reduce and lose very little value to the patient?

6. Are we leveraging our electronic health records to their fullest potential?

7. Do our staffing models still make sense or are they designed for the convenience of our workforce?

8. Are our processes too complicated?

9. Could this care be delivered in a less staff intensive/expensive setting?

10. Do we use the data that we have to make better decisions?

The challenge in doing less with less is a willingness to ask frankly what adds value to the patient experience and what does not. This may mean sacrificing some sacred cows. The current health care environment is challenging the sense of order for many nurses with long professional careers. When we feel fearful, it can be comforting to cling to what we know has worked in the past. A key skill for leaders is to work in the present with an eye toward the future.

Harvard professor Clayton Christensen, an expert in disruptive innovation, describes the phenomenon as something that transforms an existing market by introducing simplicity, convenience, accessibility and affordability where complications and high cost are the status quo. This is a good way to think about ways to change processes and practices. Simpler processes and practices are often the most elegant and reduce everyone’s time. The best solutions may lie with our staff ,particularly our younger staff, who are less tied to traditional ways of practice.

I would challenge you rather than to ask staff “how can we do more with less” – ask “what can we do less of and not significantly impact care?” You may be surprised at some the great ideas that may be generated.

Read to Lead

Gehrt, L.A. (January 2014). Leading health care innovation: What leaders of today need to know about tomorrow. The Voice of Nursing Leadership. 12(1), 6-9.