WHITE PAPER Remedy Your Scheduling Pains and Meet Financial, Clinical, and Operational Goals
Despite healthcare s embrace of cutting-edge clinical technology, it s not uncommon today to find hospital managers drafting work schedules on paper before transferring them to simple spreadsheets or stand-alone scheduling systems. In building a manual schedule, somehow the manager must keep track of its many elements: average daily patient census, mandated nurse-patient ratios, employee skill mix, union and regulatory requirements, the hospital s own labor policies, and the department s budget. In addition, the needs of individual employees must be taken into consideration. As managers create the schedule, they must balance employee skills, seniority, and shift preferences. Then there are the constant adjustments to accommodate vacancies and requests for time off, vacations, and leave. By this time, managers have devoted hours to creating the schedule only to see it disrupted the day it goes into effect. Think about it. On a typical day, a manager might be confronted with myriad unexpected situations. Two employees call in sick a few hours before their shifts start. The census and acuity report that day shows that the outbreak of flu is more severe than expected. Labor and Delivery is having an extremely busy day. And an email warning that a nurse s certification has expired has just arrived. Managers working with a manual or partially automated staffing process face a nearly impossible task of quickly responding with the right number of skilled workers to match continually changing workload volumes. And it doesn t stop there. Scheduling and staffing demand managers constant attention as they field requests for time off for the next scheduling period while working on today s staffing needs. The processes are perpetual managers make the plans and execute them and are done concurrently. Workforce management solutions with integrated advanced staffing and scheduling capabilities make these tasks easier for managers by providing instant visibility to budget, census, and workload data; employee skills and preferences; and labor costs. Given the right real-time information, managers can react quickly to the unpredictable situations that put a workforce schedule in flux. Leveraging the right solutions to automate and streamline scheduling and staffing practices can also help hospitals meet financial, clinical, and operational objectives: Deliver quality care. A growing body of research shows that nursing workforce characteristics have a considerable impact on patient outcomes. A higher number of RN hours per patient day, an optimal skill mix, and greater nurse experience have been linked to decreased patient mortality rates, fewer adverse events, and lower hospital costs. And patient outcomes are already directly affecting hospital revenues. The Centers for Medicare & Medicaid Services is awarding bonuses to hospitals that deliver stellar care and is denying payment for preventable hospital-acquired conditions. Ensuring that patients are tended by the correct number of staff nurses with the proper skills is essential to providing quality care. Control labor costs. With labor comprising 60 percent of a hospital s overall expenses, it s imperative that those dollars be maximized. An advanced scheduling solution assigns the most cost-effective and qualified employees to specific shifts, reducing overtime and costly agency workers. With predictable shifts and more equitable distribution of overtime, employee turnover is reduced. Automated staffing and scheduling also captures actual time worked and accurately applies complex work and pay rules to reduce errors and pay inflation. Managers who have access to realtime labor cost information can take corrective action before extraneous payroll costs are incurred. Minimize compliance risk. Failing to comply with shifting labor regulations can have significant financial and operational implications. Yet it is all but impossible to apply and enforce all labor policies across the hospital consistently and fairly with manual scheduling systems. Advanced staffing and scheduling automatically applies the necessary rules, regulations, and hospital policies to all staffing decisions and helps managers schedule only employees whose certifications and licensures are up to date. Consistent enforcement translates into reduced employee grievances and claims and fewer lawsuits, fines, and sanctions.
Increase workforce productivity. Stable work environments and good work/life balance retain employees. Advanced staffing and scheduling minimize the employee stress associated with under- or overstaffing. Employees can also participate in managing their own schedules and have more control over their work experience. Less time is spent building and staffing schedules, so managers and employees can be more productive and, in the case of nurses, do the work they enjoy at the bedside. Tailoring a Workforce Scheduling Solution to Fit Hospital departments will vary in their practices and processes for scheduling and staffing. Nursing, surgical services, radiology, pharmacy, and hospitalists have complex staffing requirements, necessitating a schedule that can accommodate patient-flow turbulence and varied employee skills. But even physicians offices and hospital departments such as environmental services and security, which are less sensitive to inpatient volume, can benefit from advanced scheduling solutions and improved processes. For example, allowing employees to sign up online for open shifts contributes to employee satisfaction, as does a schedule that fairly rotates tasks among employees and automatically gives preference to their desired work schedules. The ability to effectively manage the entire workforce is a critical factor in optimizing employee performance. The steps are the same no matter how complex or simple the staffing needs. Consequently, healthcare providers should leverage an enterprise-wide scheduling solution one that s flexible enough to meet the needs of all departments. Selecting the Right Tools Before adopting a scheduling solution, appoint a crossfunctional team to thoroughly evaluate staffing and scheduling processes and needs, investigate the best-fit solution, and communicate and champion its deployment. A cultural shift in scheduling practices may be required to create more balanced staffing. Perks, incidental overtime, and favoritism need to be replaced with visibility, transparency, and accountability. Forecast modeling Automated scheduling tools can mine a hospital s unique historical patient census, acuity data, and other workload/volume measurements such as cases, procedures, or visits. Admissions, discharges, and transfers (ADT) information can predict future daily patient-flow turbulence and is a much more accurate approach to building an effective schedule plan than basing it on a manager s intuition. The new plan can then utilize flexible shift offerings during those hours when patient-flow activities occur irregularly. With forecasting capabilities, data rather than hypotheses drive scheduling and staffing decisions. This insight allows the managers to respond with more accuracy to variations in the original staffing plan. Empowering employees Hospitals that pursue Magnet status a hallmark of nursing excellence must prove that they have creative and flexible staffing models that support a safe and healthy work environment, and that staffing is equitable. Automating scheduling and staffing processes can help fulfill those criteria for any hospital focused on retaining satisfied employees. With advanced scheduling, employees can access a work schedule online and sign up for open shifts, swap shifts, request time off, and provide scheduling preferences and availability. Employees who participate in the scheduling process report higher job satisfaction and are more likely to remain on the job. And managers are happier when they don t have to deal with numerous verbal and written requests from employees to adjust the schedule. Advanced staffing and scheduling solutions can also be configured to alert managers automatically if a schedule deviates from a safe-practice policy of sufficient rest periods between shifts. Equally important, the rules governing the schedule are transparent to employees as they request shifts online, leading to a greater appreciation that the department s policies are being fairly and consistently applied.
An Integrated Delivery Network (IDN) that includes two hospitals and multiple physicians offices improved employee satisfaction and reduced turnover when it switched from a paper-based schedule to an automated one. Employees valued the online convenience of accessing their schedules and requesting shifts and time off, and the organization was able to reduce its overtime and agency hours saving it nearly $1.5 million in one year. The advanced scheduling, integrated with time and attendance capabilities, alerts managers when employees work schedules will result in overtime as well as when employees are working too few hours to receive benefits. On-demand staffing Admissions, discharges, and transfers can put the most meticulously built workforce schedule in a constant state of flux the day that it goes into effect. Streamlining processes and leveraging automated staffing tools allow managers to react to real-time information to generate optimal staffing. As patient census and acuity reports become available during the day, an automated solution not only calculates the appropriate employee coverage for the day s workload but also produces a list of the most competent and cost-effective employees to fill any gaps in coverage. Access to real-time data reduces communication errors and increases response time to fill an open shift, allowing the manager to meet fiscal responsibilities and deliver quality patient care. And if census should decrease in one department, an automated scheduler can identify employees who have the skills to float to other departments. The Next Generation of Workforce Management: An Unrivaled User Experience While workforce management systems can effectively capture and catalog vital labor information, it s up to the manager to figure out which data to access and how to apply it to scheduling and staffing decisions. The new generation of workforce management solutions not only creates an early warning of potential problems but also automatically applies an organization s business rules and pay practices, which narrows down hundreds of possible solutions to the most appropriate course of action. These guided decisions save managers valuable time and help them make choices that best serve the needs of the hospital. When a large healthcare provider with a 750-bed hospital and 80 clinics was scheduling its 2,000 nurses on paper, supervisors couldn t detect underlying staffing trends, such as a need to hire additional full-time nurses or changes in the way staff were being deployed. It wasn t until the nursing department switched to an advanced scheduling system with integrated time and attendance capabilities that they discovered how often an internal supplemental nursing pool was being used to fill holes in a poorly balanced basic schedule. Now the nursing pool is functioning as it was intended to accommodate the flex in nursing workload and call-ins. And the organization was able to decrease the cost of its supplemental labor by 13 percent, reduce overtime hours from 3.5 percent to 2.5 percent of total direct care hours, and stop using expensive traveling nurses a savings of millions of dollars. New advanced scheduling and staffing tools also have more intuitive and adaptable applications that are easier to learn and use, and they offer interactive communication between employees and managers using mobile technology. Managers can now push out coverage requests to all eligible employees using text, intelligent voice response, and email. Employees accept or decline the shifts in a single message using the same technology. Each department determines how shifts will be filled: on a first-come basis or with the most senior employee to respond within a specific time frame. The process of assigning available shifts is fair and transparent, which can be especially important in unionized work environments. With mobile technology, the time it takes to fill most open shifts with a qualified staff member is typically less than five minutes. Just imagine
how convenient and effective mobile technology would be in deploying staff during natural disasters such as a hurricane or flood, or in responding to a pandemic outbreak such as H1N1. A large university medical center relies on an automated scheduling system to enforce its own rule about not scheduling too many novice nurses during a shift. As managers build schedules, the software automatically populates shifts with the correct mix of experienced and novice nurses a step that has positively affected nurse recruitment and retention. Researchers are studying this facility s staffing model because it has such a good record of retaining nurses. The organization s ability to appropriately schedule nurses based on their skills and experience will also likely be a key factor in helping it be redesignated as a Magnet facility. Summary Adopting advanced scheduling and staffing tools can benefit any hospital, long-term-care provider, or physician s office, no matter how complex or simple the staffing needs. Look for an integrated workforce management solution that can meet your enterprisewide needs yet still accommodate department-specific processes. Forecast modeling, employee self-service, and on-demand staffing capabilities will ensure adoption of the tool, deliver accelerated results, and increase workforce productivity. Employees are happier, regulatory and contractual requirements are met, and managers spend a fraction of the time they formerly did on scheduling and staffing processes. Moreover, the software ensures that staffing decisions are made fairly, appropriately, and cost effectively. And providers that adopt an enterprisewide approach to their scheduling and staffing practices and leverage automated tools can expect to substantially control labor costs, minimize compliance risks, increase workforce productivity, and deliver quality care throughout the organization. Kronos Incorporated 297 Billerica Road Chelmsford, MA 01824 (800) 225-1561 (978) 250-9800 www.kronos.com 2009, Kronos Incorporated. Kronos, and the Kronos logo are registered trademarks of Kronos Incorporated or a related company. All other product and company names mentioned are used for identification purposes only, and may be the trademarks of their respective owners. All specifications are subject to change. All rights reserved. 25004-84803