North Shore LIJ, a 16-hospital system based in Manhasset, NY, has undergone rapid growth in the last several years. With nearly 50,000 employees, including 9,400 nurses and 10,000 physicians system-wide, managing the labor allocation with an eye on efficiency and the bottom line has been a challenge, according to Jim Bosco, vice president of human resources.
To manage its labor more efficiently, North Shore LIJ has implemented a time and attendance software solution (supplied by Kronos Inc., Chelmsford, Mass.), in an effort to gradually move away from a paper-based system. The hospital system is now in its third year with the product, and Bosco says that about 80 percent of its labor force is now on the system.
By automating its labor allocation, the hospital system has been able to better control its labor costs, as well as identify trends in how it is allocating its labor resources, he says. About 12 percent of the hospital system’s labor force across the board is per diem, with a significant percentage of it being the nursing staff. “By using real-time data, we are starting to look at trends and how we are using our workforce,” he says.
Among its initiatives, the hospital system has started to introduce self-scheduling for its nursing staff, having completed implementation in a portion of the hospitals and is conducting ongoing implementation with the rest. “We have technology in place where people can remotely log in from anywhere, to be able to schedule themselves,” he says. “They can log in at any time of the day to see what is available when the schedules get posted, and the nursing leadership is able to approve or do whatever they need to do online.”
According to Bosco, the night nurse manager in the emergency department at LIJ Medical Center maintains that the self-scheduling feature has given him back 75 percent of his time that used to be spent on scheduling, because the use of data in the system has allowed streamlining the process of balancing the schedule. RNs are separated and organized by skill-set.
Bosco says the scheduling software will allow the hospital to use its per diem employees more efficiently. While the hospital system has not increased the number of its per diem employees, he says, “We aren’t using our per diems efficiently enough, because they aren’t in the office and they don’t have access to a lot of their shifts. Unless they get called, they tend to get left out.” Bosco says that the scheduling solution will allow the hospital system to control costs and drive efficiencies more effectively around this issue.
As part of its strategy to make more efficient use of its own workforce, North Shore LIJ now makes better use of its census data with the various departments, Bosco says. “We automated the census so that the census data comes to the departments two hours before the start of a shift,” he says. That allows better planning based on the volume of patients, and has minimized over-staffing, helping control costs, he says. “By updating the census two hours before the shifts start, we are able to see what’s coming, who is in the ER, what volume is coming into the hospital, so we can do a better job.”
The patient census data is used to establish the number of RNs required for each shift and the skill mix is predetermined by the manager and automated in the system. When this particular number of RNs with specific skills is reached, the shift will no longer be available as an option for employees who are self-scheduling, in effect creating a “self-balancing” schedule.
Bosco says that automating labor allocation has also allowed North Shore LIJ to react to staff shortages more quickly than before. The hospital system is currently pilot testing the elimination of the traditional call list to reach out to nurses one by one, replacing this with text messages that are sent to the nursing staff. “It is done electronically and they respond back electronically,” he says, adding that the system is being implemented in selected sites.