Getting the Numbers Right

CRITICAL NEEDS ON A SMALLER SCALE

Of course, it's not just larger hospitals and health systems whose leaders face challenges regarding the constant fluctuation in staffing needs in the hospital setting. Smaller organizations face major challenges, too; they just involve fewer overall numbers of people. Stephen M. Stewart, CIO at Henry County Health Center in Mt. Pleasant, Ia., definitely has a story to tell. For one thing, though the core facility of the organization is a 25-bed critical-access hospital, Henry County also owns a 49-bed long-term care unit on campus; a 75-bed long-term care unit located 25 miles away that it manages; and is part-owner of a dialysis company that it manages. As a result, Stewart and his colleagues are faced with the challenge of appropriately staffing 500 FTEs across several different-and very diverse-pieces of the organization and related entities, in seven different locations in its service area.

“From a payroll perspective, we have the kind of diversity that much-larger organizations usually face,” says Stewart. “And you create payroll scenarios to fit the business needs for a particular organization and its staff size. And each entity has a different scenario,” so that the classes of individuals are extremely diverse, and challenging in their complexity. In other words, Stewart and his colleagues must manage a very diverse constellation of small groups of people.

So Stewart and his colleagues, who went live in 2004 with their core EMR product, from the Mobile, Ala.-based CPSI (Computer Programs and Systems Inc.), began using CPSI's scheduling tools in 2006, and have since used the company's scheduling solution to create an Intranet portal solution, “to provide transparency to everyone.”

So, for example, Stewart says, referring to as-needed on-call nurses, “A PRN nurse who only works five days a month, he or she can go online and see their schedule for the month. And we can make scheduling changes on the fly so that everyone can see them. We also run the ambulance service for the county, so that provides a whole host of scheduling demands and needs as well.” The bottom line, he says, is that “we used to have pieces of paper hanging around all over the place; but by getting everything onto the portal, the department director can make a scheduling change, and it's immediately available for everyone to see, and he or she can also trigger an e-mail to all affected staff. And this is a good thing: almost all the entities are under the same benefits company, with the exception of the dialysis company.

“THE THING TO REMEMBER IS THAT YOUR SALARY COSTS FOR NURSING ARE YOUR NO. 1 COST.”-GARY BARNES

ANALYZING ACUITY

Leveraging clinical data from the EMR in order to analyze acuity and thereby optimize staffing levels is an approach a number of hospital organizations are pursuing, among them the 362-bed Medical Center Health System in Odes sa, Texas. CIO Gary Barnes notes that his organization has a rather unusual staffing situation.

“We're in the area of West Texas where the oil boom was very big for a while, and we had a boom in patient census, and not enough nurses,” Barnes reports. “In fact, what happened was that a lot of nurses had husbands in the oil business, so they quit working during the boom, because their husbands were making a lot of money. The boom has diminished somewhat, and some have come back” since then, he says. But one of the lessons learned from that situation was the need to carefully assess fluctuating acuity levels in the hospital in order to understand more comprehensively how many nurses might be needed at any particular time.

Barnes and his colleagues have leveraged the ANSOS One-Staff solution from the Alpharetta, Ga.-based McKesson Corp., linking the data analysis capabilities of that solution with the hospital's EMR, also from McKesson. The most immediate goal? “To help us reduce overtime, and the use of agency nurses, by looking at and analyzing fluctuating acuity levels.”

As a result, Medical Center Health System has been able to reduce its use of agency nurses significantly. “The thing to remember,” Barnes says, “is that your salary costs for nursing are your No. 1 cost in your organization. So you need to take your time and evaluate the solutions, and find something that will save you money and improve staff satisfaction.”

Healthcare Informatics 2011 February;28(2):32-35