OHA ANNUAL MEETING JUNE 9, 2014 Staffing FTE MGMT. Productivity HILTON COLUMBUS AT EASTON
THOUGTHS & ASSUMPTIONS ABOUT FTES & STAFFING Every hospital is designed and managed to produce exactly the results that it is producing: including with staffing & productivity. In most hospital departments a case can be made to add additional staffing; however, the opposite is also true. Managing productivity is a daily, ongoing department management function. Executive leadership s job is to set goals, coach, teach, motivate, monitor, analyze, report, and take action to hold managers accountable for performance and results. Benchmarking doesn t tell you what to do: it helps point you in a direction for further inquiry, analysis and possible action. FTE management is fundamental to good leadership and organizational performance. Don t take your eye off the ball! Constant vigilance of budget / goal variances in staffing and productivity is mandatory on executive leadership. Watch out for FTE creep it is insidious. It is prudent to routinely staff the hospital at a minimum baseline staffing level (not at a level that is hoped for). Set processes in place to flexup with volume as needed. Increasing the number of part time and PRN employees can help increase staffing flexibility and the hospitals ability to flexup. Although there can be circumstances that are unforeseen or totally out of anyone s control, most of the time a hospital Reduction in Force (RIF) is a failure of executive leadership. Operating a senior leadership staffing control committee to review and make decisions about new or replacement positions can work; however, FTE control works the most efficiently with one senior leader having overall responsibility. Tight control is imperative. Playing the FTE shell game by using independent contractors and outsourcing in lieu of employees is fool s gold. More staff doesn t automatically translate to better quality care and service. Incidental overtime (OT) addsup to a big expense: get rid of it! 1
Identify clinical staff working in nonclinical departments / functions that can assist during All hands on deck periods. Develop a policy on using clinical staff assigned to nonclinical departments / functions in clinical areas when warranted. Every newly vacant position is an opportunity to reduce FTEs. Take advantage through attrition. Listen to and act upon all good ideas to improve workflow & process efficiency for staff: give them all the tools you can to be productive. Foster ongoing communication about external forces and their impact on hospital staffing and productivity to promote understanding, acceptance and support. Think and plan ahead for your next several FTE moves always have a contingency plan. HIGH LEVEL STAFFING / FTE ANALYSIS Five highlevel staffing / FTE benchmarking comparisons with hospitals of similar size and scope of services: 1) Total Hospital FTEs: (Less Physician Practices) 2) Total Net Operating Revenue per Hospital FTE: Total Net Hospital Operating Revenue Total Hospital FTEs 3) Total Salaries/Wages/Benefits (S/W/B) per Hospital FTE: Total S/W/B Total Hospital FTEs 4) Total S/W/B per Total Hospital Operating Expenses: Total S/W/B Total Hospital Operating Expenses 5) Total S/W/B per Net Hospital Operating Revenue: Total S/W/B Total Hospital Net Operating Revenue 2
AREAS FOR INQUIRY & ASSESSMENT Skill mix (RN s / LPNs / Aides) o Matching skill mix competencies skills, knowledge & abilities required for job performance o Nursing Acuity System for Staffing Overtime policies, procedures and practices Weekend differential Shift differential Part time pool and packages PRN pool and packages Working supervisors Clinical vs. nonclinical FTEs Administrative FTEs Authorization process for open positions Monitoring & reporting of FTEs ongoing Average hourly rates for selected key positions (Hospital Association wage & salary survey) Salaries, wages & benefits as a % of net revenue Accountability practices for meeting ongoing staffing budgets 3
Department STAFFING, PRODUCTIVITY & FTE MANAGEMENT ANALYSIS Hospital A Hospital B Hospital C Hospital D Hospital E Total Beds 25 25 25 25 25 25 25 Group Average* Difference County Hospital 2012 1.0 Cardiac Rehab 0.57 0.57 1.68 1.11 H 2.10 0.42 1.53 1.1 Cardio Pulmonary 1.05 1.05 (1.05) (1.05) 1.3 Cardio EKG 1.00 0.73 0.97 0.90 (0.90) (0.90) 1.4 Cardio 1.80 1.80 (1.80) (1.80) 2.0 Occupational Therapy 3.00 6.43 2.40 3.94 (3.94) (3.94) 2.1 Speech Therapy 0.10 2.17 0.81 1.03 (1.03) (1.03) 2.2 Physical Therapy 5.50 13.47 9.49 4.43 (5.06) 5.28 4.40 (4.21) 3.0 Accounting 3.5 3.15 3.37 3.34 4.13 0.79 H 4.52 0.39 1.18 3.1 Administration 5.80 10.81 10.42 10.17 3.06 8.05 5.09 (2.96) 5.10 0.01 (2.95) 3.2 Patient Access/(Registration) 9.90 9.35 9.73 9.66 13.79 4.13 H 13.51 (0.28) 3.85 3.3 Human Resources 2.90 3.21 3.35 3.15 3.04 (0.11) 2.76 (0.28) (0.39) 3.4 Marketing 2.00 1.90 1.95 1.00 (0.95) 1.00 (0.95) 3.5 Medical Education Physician Relations 0.49 0.49 (0.49) 4.0 Patient Financial Accts./Bus. Office 13.60 24.91 11.87 4.92 15.74 14.21 10.28 (3.93) 11.06 0.78 (3.15) 4.1 Physician Billing 5.34 5.34 5.85 0.51 5.85 5.0 Food Services/(Dietary) 11.80 19.60 12.25 12.31 11.63 13.52 13.84 0.32 H 13.51 (0.33) (0.01) 6.0 Infection Control 0.60 0.61 1.00 0.74 (0.74) 1.13 1.13 0.39 6.1 Infection Control/Education 0.97 0.97 0.94 0.94 6.2 Education 0.87 0.96 0.97 0.93 (0.93) (0.93) 7.0 Lab 13.70 23.95 16.11 14.05 15.82 16.73 16.58 (0.15) 15.75 (0.83) (0.98) 7.1 Sleep Lab/EEG 0.52 3.06 7.10 3.56 2.49 (1.07) 2.18 (0.31) (1.38) 8.0 Housekeeping/(Environmental Srvs.) 11.20 22.72 17.04 13.75 13.12 15.57 16.9 1.33 H 14.69 (2.21) (0.88) 8.1 Laundry/(Linens) 3.33 3.43 1.99 1.23 2.50 1.08 (1.42) 1.06 (0.02) (1.44) 9.0 ICU 8.42 4.88 6.65 5.15 (1.50) 5.17 0.02 (1.48) 9.1 Medical/Surgical 20.20 32.74 31.81 22.96 41.70 29.88 21.43 (8.45) 18.01 (3.42) (11.87) 9.20 Nursing Administration* 0.60 7.03 2.58 13.74 0.76 4.94 7.15 2.21 H 6.28 (0.87) 1.34 9.30 Emergency Room 17.30 16.60 15.93 15.84 16.42 20.51 4.09 H 18.36 (2.15) 1.94 9.4 Labor/Delivery 8.84 9.40 10.97 9.74 21.25 11.51 H 18.97 (2.28) 9.23 9.50 Respiratory 2.00 13.47 10.97 18.12 11.14 6.26 (4.88) 6.03 (0.23) (5.11) 9.60 Recovery 1.00 0.66 7.42 3.03 (3.03) (3.03) 9.7 Surgery 5.20 20.24 8.45 13.15 20.21 13.45 18.74 5.29 H 14.89 (3.85) 1.44 10.0 Imaging Services 10.30 20.89 14.00 14.30 11.78 14.25 22.77 8.52 H 20.75 (2.02) 6.50 10.1 CT Scan 1.04 1.04 (1.04) (1.04) 10.2 Mammography 1.03 1.03 (1.03) (1.03) 10.3 MRI 1.75 1.75 (1.75) (1.75) 10.4 Nuclear Medicine 0.90 1.01 0.96 (0.96) (0.96) 10.5 Ultrasound 0.60 2.86 1.73 (1.73) (1.73) 11.0 Quality Assurance 4.44 4.44 (4.44) (4.44) 11.1 Utilization Management 6.03 1.0 3.52 3.13 (0.39) 2.62 (0.51) (0.90) 12.00 Information Technology/(Systems) 4.40 5.73 4.09 8.27 5.62 7.14 1.52 H 7.2 0.06 1.58 12.10 Material Management/(Purchasing) 2.40 1.10 4.74 2.26 1.00 2.30 7.37 5.07 H 6.91 (0.46) 4.61 12.20 Medical Records/Info. Management 7.10 10.63 10.11 9.84 13.70 10.28 12.89 2.61 H 13.68 0.79 3.40 12.30 Oncology 3.80 7.42 3.18 5.03 4.86 (4.86) (4.86) 12.40 Pharmacy 4.10 6.12 5.75 5.63 6.12 5.54 3.59 (1.95) 4.58 0.99 (0.96) 12.50 Plant Services/(Maintenance) 5.20 11.23 4.36 7.48 7.21 7.10 5.59 (1.51) 5.41 (0.18) (1.69) 12.60 Specialty Referral Clinic 3.40 3.40 1.43 (1.97) 1.89 0.46 (1.51) TOTAL FTES PER PEER GROUP HOSPITAL 171.50 278.53 227.59 176.25 271.03 224.98 265.53 40.55 251.19 14.34 26.21 Trend County Hospital 2013** Difference 2012 to 2013 Group Average to County Hospital 2013 * Admin FTE Number includes FTEs' in Admin, CFO, Corp plan & Development together * ER data does not include FTE number of Admin. * Nursing Admin FTE number includes reported house supervisor FTE number. Number of beds reported from Health Financial Systems (HFS) 2012 Worksheet S3. Audited manhour and wage index reports were used to establish total manhours per cost center. 4
Premier 2013 Productivity Benchmarks for Small & Rural Hospitals (<100 Beds) COUNTY HOSPITAL DEPARTMENT NAME VOLUME DESCRIPTION BM 90% BM 75% BM 50% 2011 2012 2013 Executive Office/Administration Adjusted Discharges 0.556 0.701 0.912 1.56 1.48 1.68 Marketing/Public Relations Adjusted Discharges 0.147 0.236 0.293 0.29 0.29 0.33 Ambulance Services Ambulance Trips <300 11.89 12.73 17.445 13.91 12.56 14.3 Urgent Care Free Standing Visits 1.200 1.363 1.731 1.28 1.28 1.44 Emergency Department Visits >3,000 2.101 2.293 2.856 2.69 2.7 2.76 Progressive Care Unit/Intermediate Care Patient Days 8.40 10.10 11.70 24.49 26.11 22.05 Nursing Administration *Total Nursing Paid FTEs 4.177 5.603 6.273 7.37 7.12 6.28 Adjusted Patient Days 0.205 0.241 0.343 0.615 0.579 0.534 Med/Surg Units Patient Days >1,200 7.704 8.497 9.297 16.58 17.91 15.23 Telemetry Nursing Unit Patient Days 9.1 9.7 10.3 28.85 26.11 22.05 Cardiac Rehab Visits <500 0.783 0.951 1.273 1.05 1.06 1.21 Surgery Cases 9.05 10.37 11.011 22.13 30.82 24.64 OB/GYN Nursing Unit Patient Days 8.655 9.052 9.521 34.87 41.91 51.11 Labor & Delivery Deliveries 26.98 30.53 34.728 96.31 120.4 98.64 Mother/Baby Unit (OB, PP, & Nursery) Patient Days 5.815 6.948 7.466 34.87 41.91 51.11 Materials Management Adjusted Discharges 0.786 1.011 1.179 2.22 2.13 2.27 Womens Services Office Visits 1.703 1.64 2.149 Education Services Adjusted Discharges 0.238 0.293 0.441 0.26 0.28 0.31 Food & Nutrition Services Total Meals Served <12,000 per month 0.148 0.189 0.201 0.35 0.34 0.34 Plant Operations/Maintenance *1000 Square Feet Maintained 150,000 300,000 4.221 4.89 5.56 4.62 4.84 4.78 Security *1000 Square Feet Patrolled 0.866 1.24 1.95 3.00 2.90 2.89 Health Information Management/Medical Records Total Registrations 0.227 0.294 0.362 0.525 Utilization Management Review Adjusted Discharges 0.540 0.753 0.923 0.83 0.91 0.86 Case Management Adjusted Patient Days 0.184 0.231 0.287 0.23 0.25 0.22 Adjusted Discharges 0.734 0.946 1.247 0.83 0.91 0.86 Infection Control Adjusted Patient Days 0.016 0.028 0.0387 0.07 0.079 0.08 Adjusted Discharges 0.079 0.113 0.167 0.26 0.28 0.31 Home Health Services Home Visits <1,000 per month 1.982 2.439 3.047 3.36 3.2 3.33 Human Resources *Total Facility Paid FTEs 0.729 0.85 1.053 3.14 2.99 2.76 Radiology Services (Functional RollUp) Procedures by CPT4 Code 0.968 1.051 1.13 1.51 1.65 1.82 Intensive Care Unit Patient Days 15.3 17.4 19.4 23.61 32.1 27.86 Laboratory (total laboratory) Billable Tests >50,000 0.105 0.119 0.135 0.19 0.21 0.23 Adjusted Discharges 3.618 3.882 4.526 4.89 4.79 5.17 Pharmacy Total Patient Days 0.823 0.975 1.369 1.16 1.27 1.35 Adjusted Patient Days 0.271 0.37 0.453 0.30 0.29 0.324 Physical Therapy Timed Units >5,000 0.39 0.442 0.487 0.77 0.8 0.9 Respiratory Therapy Procedures by CPT4 Code >10,000 0.352 0.41 0.49 0.48 0.6 0.74 Total Patient Days 0.963 1.119 1.305 2.35 2.6 2.53 EEG Procedures by CPT4 Code 100 300 1.034 1.337 2.005 14.88 16.19 19.98 Wound Care Visits 1.175 1.337 1.942 NA 2.67 3.09 Fiscal Accounting Adjusted Discharges 0.737 0.935 1.122 1.22 1.2 1.49 Patient Accounting/Business Office Adjusted Discharges 1.541 2.48 3.200 3.09 2.98 3.63 Information Services Adjusted Discharges 0.994 1.19 1.937 2.17 2.06 2.37 * denotes monthly benchmark 5
CH Compared to BM 50% Difference in FTE's to Reach the BM 50% Volume Description Used 2013 FTE 2013 Productivity Compared to 2012 FTE Impact From Productivity Loss 0.77 (2.324) 6,331 Adjusted Discharges 5.1 0.2 0.6 0.04 (0.108) 6,331 Adjusted Discharges 1 0.04 0.12 (3.15) 1.74 5.22 (0.29) 0.16 0.48 (0.10) 0.06 0.39 10.35 (6.628) 1,332 PCU Patient Days 14.12 4.06 0.01 (5.983) 98.37 Total Paid Nursing FTEs 6.28 0.84 0.19 (2.248) 24,451 Adjusted Patient Days 0.05 5.93 (7.015) 2,460 Med/Surg Patient Days 18.01 2.68 11.75 (9.933) 1,320 Telemetry Patient Days 16.47 4.06 (0.06) 0.15 0.26 13.63 (8.236) 1,257 Total Surgery Cases 14.89 6.18 41.59 (15.441) 771 OB Patient Days 18.97 9.2 3.41 63.91 400 Deliveries 21.77 43.64 1,659 OB & Newborn Patient Days 9.2 3.41 1.09 (3.671) 6,331 Adjusted Discharges 7.26 0.14 0.43 (2.15) (0.13) 0.03 0.09 0.14 #VALUE! 82,703 Total Meals Served 13.67 No Change (0.78) 0.06 0.94 1.070 196,137 Facility Square Footage 3.28 0.01 0.16 (4.246) 54,208 Total Registrations 13.68 No Data No Prior Year Data (0.06) 0.05 (0.07) 0.03 (0.39) 0.05 0.04 (0.364) 25,571 Adjsuted Patient Days 0.84 No Change 0.14 (0.332) 6,331 Adjusted Discharges 0.84 0.03 0.09 Total Home Visits 0.28 (1.513) 6,258 (Should this be monthly #) 10.68 0.13 0.43 1.71 (2.563) 389 Total FTEs 2.76 0.23 0.69 (7.852) 23,741 Total Radiology Procedures 20.75 0.17 1.92 8.46 (1.570) 386 ICU Patient Days 5.17 4.24 0.10 (6.642) 140,323 Totla Lab Tests 15.75 0.02 1.58 0.64 (1.974) 6,331 Adjusted Discharges 0.38 1.17 (0.02) 0.08 0.4 (0.13) 0.03 0.4 0.41 0.01 0.5 0.25 (2.054) 16,879 Total Respiratory Treatments 6.03 0.14 1.16 1.23 (2.359) 5,851 Total Respiratory Patient Days 6.03 0.07 17.98 (1.961) 227 Total EEG 2.18 3.79 1.16 1.15 (0.298) 538 Total Visits 0.8 0.42 0.11 0.37 (1.105) 6,331 Adjusted Discharges 6 4.52 0.29 0.87 0.43 (1.320) 6,331 Adjusted Discharges 11.06 0.65 1.99 0.43 (1.304) 6,331 Adjusted Discharges 7.2 0.31 0.93
Steven B. Reed, FACHE President p/f: 317.713.7951 sbreed@mmgsi.com One American Square Suite 2200 Indianapolis, IN 46282 7