Methodology FAQs
Overview
Implementation
Measurement/Analysis
Monitoring
Data Analysis
About GRASP
Q. Is GRASP just for nursing?
A. No. GRASP is not just for nursing. In fact, the system has been used in
almost every department or area in healthcare facilities. These include pharmacy,
all the therapies, social work, laboratory, radiology, housekeeping, dietary (nutritional
services), and chaplain services, to name just a few.
Q. What's unique about The GRASP System?
A. Its flexibility. It's also simple and easy to use by both staff and managers.
Through continued feedback from our customers, we continue to work with our clients
to enhance our products to better suit their unique facility workload requirements.
Q. How is the GRASP data collected?
A. GRASP Systems employs an automated, PC-based method to collect data. Data
can also be collected through a facility's automated documentation system. Of course,
data can also be collected manually, though this is not recommended.
Q. How is the GRASP System implemented?
A. GRASP consultants are all former nurses and professional healthcare staff
members who understand your challenges. As the implementation project progresses,
your consultant guides you and your staff through each stage using templates and
definitions to streamline the process - using a detailed project plan.
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Implementation
Q. I've just signed a contract for GRASP. How do I start
collecting information for indirect care? Should I get that started before the consultant
arrives?
A. There is no need to start this process yet. GRASP Systems will provide
you tools to help with this process, including a comprehensive prompter list. Your
consultant will review this process with you during the implementation phase.
Q. Can I use my documentation system to collect GRASP
data?
A. This is a qualified yes. It depends on the documentation system you currently
employ and your current goals. It is key that the documentation system must be capable
of embedding a numeric value behind each intervention and that those values be added
together. Some systems place prospective data in the Care Planning, Acuity or Order
Set areas. If you collect data in the actual documentation, your values will be
retrospective since staff documentation occurs after the fact. Your GRASP consultant
can offer specific recommendations for your individual system.
Q. We just changed to a new care delivery model. It's
a non-traditional way of delivering care. Will GRASP work for us?
A. GRASP works regardless of the care delivery model and setting. GRASP works
for clinical and non-clinical departments, as well.
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Measurement/Analysis
Q. Do we have to do time studies? I've heard Work Sampling
is the only method for a truly valid system.
A. Time studies are not required because GRASP Systems has an extensive normal
time and frequency database updated annually. Many facilities successfully use GRASP
without time studies; they start with our model instruments, then test and modify
them using a consensus approach. GRASP recognizes that Work Sampling is considered
the gold standard; while we can accommodate it, we don't recommend it because it
is unnecessarily cost prohibitive and tedious.
Q. If different units have different instruments, how
can I ever compare them?
A. Different units generally have different patient populations. Typically
the type of care varies between units. The key is to translate the patient requirements
into a comparable measure - that measure is time. GRASP translates patient requirements
into hours of care. There is simply no better way to make these comparisons. Of
course if practice is the same throughout your facility, then many of the interventions
will be the same between units/wards.
Q. The other systems I've seen are all level systems.
Why doesn't GRASP use levels?
A. Level systems rely on an even distribution within levels so that all patients
aren't one extreme or the other within any given level. Levels have ranges of time.
If patients in any given level skew exclusively toward the high or low end, it can
easily result in under- or over-staffing. We refer to this as
"Acuity Creep"
. GRASP eliminates this issue. Staffing is based on the hours of care that are
required by each individual patient, not an aggregate level. GRASP data can be customized
into levels although it's rarely necessary once the hours of care approach is engaged.
Q. Must I use GRASP on every patient every day?
A. GRASP's flexibility makes it easy to choose the assessment that best fits
your needs. You can assess your patients as often as you feel necessary if you're
not trying to meet a governmental mandate that requires daily assessment. If you're
staffing based on daily changes in your patients, you may wish to assess your patients
once a day and/or as their status changes. If you're using GRASP data strictly to
establish a matrix and for budgetary purposes, assessing patients once a quarter
may be sufficient.
Q. Are GRASP instruments prospective or retrospective?
A. They can be either, except in obvious cases, such as Emergency Department
and Obstetrics, where prospective is impossible. We offer the only solution to allow
you both options. Whether an instrument is prospective or retrospective will be
a philosophical decision you'll make based on how the information will be used within
your organization. When you make that decision, keep in mind your governmental requirements
and your organization's future directions.
Q. Are GRASP instruments always 24-hour instruments?
A. No. They can be designed to reflect the work over the time period you
choose. You could choose an eight-hour shift, a 12-hour shift, a different shift
length, or an entire day. The choice is yours based on the goal you have defined
for the data.
Q. Can GRASP Systems give facilities average HPPD's for
surgical patients, outpatients, medical patients, etc.?
A. Yes. Facilities can obtain this information several ways. If your facility
is part of GRASP Systems National Comparative Databases (NCD), you'll receive this
information as part of your quarterly reports. If your facility has a GRASP Systems
Annual Maintenance Contract and is not part of the NCD, this information can be
provided to you on a one-time basis when some unit/ward specific information is
provided. If your facility is not part of GRASP Systems, we can provide this information
by unit/ward for a fee per unit with your facility providing unit specific information.
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Monitoring
Q. How often do I need to review my instrument?
A. This is usually determined by regulatory requirements for updating workload
instruments. Our research has found that changes in the healthcare system make it
wise to update once every 12 to 18 months and more often if you change your practices,
procedures, or policies.
Q. How often should reliability monitoring be performed?
A. This varies by unit type, but may often be 10 percent of your average
daily census per week. Your GRASP consultant will help you identify the best schedule,
which will meet your regulatory requirements, your organizational needs and provide
data credibility.
Q. How often should we perform our "Percent of Care Delivered"
audits?
A. We recommend that you perform "Percent of Care Delivered" audits at 10
percent of your average daily census per month.
Q. How often should we conduct a skill mix review?
A. Skill mix reviews should be conducted when there is an identified need
for making changes in the skill mix. Some facilities conduct skill mix studies annually.
How often you conduct a skill mix review depends on your organization's individual
needs.
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Data Analysis
Q. How do I use my data for program management?
A. Regardless of your organizational design, GRASP data can be bundled appropriately
to meet your needs. Your GRASP consultant will assist you in identifying the best
setup for collecting workload information based on your facility's management methods.
Q. What do the reports mean and which are the important
ones to review?
A. During the implementation process, your reports will be reviewed and your
consultant will show you how to interpret the data. If your facility has a maintenance
agreement, reports may be reviewed again with your consultant during a scheduled
on-site visit. Reports which are usually reviewed on a daily, monthly, or quarterly
basis can be discussed during this educational session. If your facility has no
maintenance agreement, contact us for contract or hourly rate prices.
Q. I need to prove how a change in practice will be cost
effective before I start. How can I accomplish this?
A. Your facility's consultant can show you how to cost the current practice,
identify workload-related activities with the new practice, and cost the change
in practice. You can then annualize these costs to identify potential savings. In
addition, outcomes anticipated by your facility can also be identified and costs
of changes noted.
Q. How do I work out my staffing needs using HPPD's?
A. To determine staffing by HPPD's, multiply the average HPPD's by the average
daily census. Multiply this number by 365 to identify the annual workload requirement.
Divide this requirement by the Full Time Equivalent/Whole Time Equivalent ratio
to obtain the result in FTE/WTE's.
Q. Once the FTE/WTE's are determined, how is this converted
to skill mix requirements?
A. If a skill mix analysis was not included in your initial contract, then
your facility can request an estimate for an add-on contract; the contract is based
on your facility's budget. This add-on contract provides the training and on-site
assistance needed by staff to conduct a skill mix analysis. Additionally, GRASP
Systems can conduct the study at your facility's request.
Q. The number of beds will be increasing on one of our
units. How much staff will we need to cover the increase?
A. GRASP clients have access to the National Comparative Databases for various
patient populations and services. This information can provide you with hard data
to assist with staffing resource requirements.
Q. How do I link workload data with other outcomes measures
that I've implemented in my organization?
A. You can do this manually or automated. If you collect the outcome data
for both patient and staff manually, you can collect and enter it manually in the
quality evaluation section. You can then compare utilization percentages and HPPD's
with the numbers of patient and/or staff outcomes. If you collect the quality data
in an automated environment, GRASP Systems will assist with an interface between
GRASP and the program you use.
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