CIOs, CEOs, and other senior executives in hospital organizations are pursuing a number of approaches to leverage clinical and other key data in order to analyze staffing needs, and are working to optimize staffing, as they address the single biggest operating cost for most hospitals: labor.
On the surface, it should seem obvious: since labor costs are the largest single operating expense for the vast majority of U.S. hospitals, and the complexities of scheduling are so often daunting, leveraging IT to optimize staffing should seem like a no-brainer choice, right? Perhaps, but, as in other areas of hospital and health system management, it's only been in recent years that CIOs have gotten heavily involved in helping chief nursing officers, HR professionals, and others to optimize staffing levels, as costs for such groups as agency nurses have gone through the roof.
In fact, CIOs, CEOs, and other C-suite executives are moving increasingly to analyze their constantly fluctuating staffing needs, and to be able to staff up-or down-with a far greater level of precision in the past. And that's actually where the journey begins with many organizations-just getting a handle on staffing levels to begin with.
That certainly was the case for Michael Poore, president and CEO at MedWest Health System, a three-hospital system based in Clyde, N.C. that includes 189-bed Haywood Regional Medical Center, 86-bed Harris Regional Hospital, and a 25-bed critical access hospital, Swain County Hospital. “Our FTEs per adjusted occupied bed were pretty high as a system, but we didn't have a lot of idea of where we were overstaffed or not,” Poore says. “And we had no internal resources with which to do a productivity study within our hospital. In his organization's case, what made sense was to turn to the combined IT solution and consulting services of the Charlotte-based Premier, the nationwide hospital alliance.
“They helped us implement the Operations Advisor tool, so we could develop the benchmarks to help us decide where to flex our staffing or look at our levels,” Poore says. “I never ask a manager to do something unless I can give them the tools to do it. And I recognized that our managers didn't have the tools to manage our productivity; we didn't even know what our productivity was.” All staffing areas were involved, both clinical and non-clinical, from environmental services to engineering, to nursing, he notes, adding that, “We were able to benchmark ourselves against similar hospitals with similar patient volumes.”
OUR FULL-TIME EMPLOYEES PER ADJUSTED OCCUPIED BED WERE PRETTY HIGH AS A SYSTEM, BUT WE DIDN'T HAVE A LOT OF IDEA OF WHERE WE WERE OVERSTAFFED OR NOT.-MICHAEL POORE
What was learned? “We found out that we were overstaffed in a lot of areas, and that the way our processes were set up didn't allow us to manage that on a real-time basis,” Poore says. For example, he and his colleagues discovered that the number of FTEs in the flagship hospital's emergency department was very high in relation to the number of patients being seen on a daily basis, but that Heywood didn't have the mechanisms in place to adjust staffing precisely enough on a daily basis. So Poore and his colleagues went to work in a number of areas, including the ED, to get truly granular and use data to pinpoint staffing needs, in order to avert cycles of hiring and layoffs that so commonly afflict hospital organizations, as well as to avert the classic situation in which nursing goes through periods of understaffing, putting undue burdens on floor nurses and leading to stress and burnout.
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
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