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Shifting the Burden

October 1, 2006
by Bruce Springer
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Web-enabled shift scheduling technology may be an easier way to handle a very complex task.

The national focus on the nursing shortage and the resulting competitive labor market for nurses and other clinical professionals is a major concern facing healthcare organizations across the United States.

Hospitals are continually challenged by the daily reality of meeting staffing requirements necessary to deliver safe and quality patient care.

To fill staffing gaps, many hospitals are filling vacant shifts — a complex task — by relying on costly and short-term alternatives such as staff overtime, incentives including sign-on and referral bonuses, intensified recruitment efforts, internal float pools, and the use of costly temporary agency nurses.

But as use of these interim staffing solutions skyrockets and drives up labor costs, many healthcare organizations are using staffing automation, such as online shift scheduling and bidding technology, as a means to communicate shift openings between management and staff.

Web-enabled shift scheduling technology provides the valuable benefit of organization-wide visibility into staffing needs by posting open shifts across care settings on the Internet that employees can review. After examining what's available, they can then request to work specific shifts for a specific wage. Employees log on from anywhere there is Internet access to see which shifts are available that match their skills and experience. For example, a nurse or pharmacy technician who is interested in working extra shifts can look at all shifts they are qualified to work — in any unit in the hospital — or across hospitals in a system.Bruce springer

What's in it for me?

To motivate employees to request open shifts, some systems provide configuration options to support a wide variety of desired incentive pay formats. Many hospitals choose to use variable-rate bidding, while others use self-scheduling at regular pay formats or with predefined incentives.

With variable-rate bidding, shift openings are assigned a dollar or percentage incentive above base pay or a minimum and maximum hourly pay rate. The bidding works like a reverse auction where employees bid down from the last bid rate. The more sophisticated systems provide protections to assure that base pay is never compromised, and nurse managers retain the ability to choose any bidder based on appropriate criteria such as experience, qualifications, seniority or cost.

In addition, some products provide multiple-phase incentive features that allow even greater control over who is able to view open shifts and/or incentives. This is particularly helpful in union environments where the ability to ensure that automation is aligned with work rules for extra shifts is critical.

With self-scheduling, shift openings are posted with set rates, such as a fixed per-hour rate, with bonuses, point reward programs or lump sum incentives. Again, having a wide variety of incentive options allows for improved targeting of employees and better outcomes for most organizations.

Online shift scheduling and bidding software is typically offered through a hosted applications model, where a vendor hosts the software application and customers access it through the Internet, intranet, or a virtual private network. Organizations pay a set monthly fee for access to the service based on hospital size, or less frequently, the number of users. According to industry estimates, the monthly fee for the comprehensive technology and services at a 300-bed hospital ranges between $5,000 and $9,000.

The hosted applications model offers cost-conscious healthcare organizations the ability to deploy the technology rapidly, shifts IT burden and maintenance to the service provider, and provides cost predictability by avoiding the operating costs and labor of supporting an in-house solution.

Hosted applications rely on the Internet to deliver service, which means that access to services depends on a reliable connection. Although many healthcare workers do not have computers at home, nationwide adoption has been consistent across generations of nurses and other healthcare providers. Those without computers often use computer kiosks at the hospital, go to the library or rely on friends and relatives.

Implementation time

The quality and experience of the vendor implementation team is a key determinant of success. Although the capabilities of the system are critical, the process of change management to include aligning incentives, overcoming fears, and choosing the right process for each organization are critical decisions which hospitals often look to vendors to guide. In this realm, experience of the vendor across a variety of healthcare environments is critical.

Chief nursing officers and human resource executives are typically the champions for these systems, as cost savings can be significant. In the initial months of operation, Christus St. Joseph's Hospital in Houston saved $792,000 by decreasing contract agency spending and improving turnover and vacancy rates. Management anticipates projected annual savings in excess of $3 million per year by continued use of the technology. When open shifts are filled internally, everyone benefits — employees, management, physicians, and patients.

Author Information:

Bruce Springer is president and CEO of BidShift, Inc., San Diego.