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Streamlined Staffing: Taking the Guesswork Out of Labor Allocation

January 27, 2015
by John DeGaspari
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In an industry where staffing is crucial to patient care, better agency management and automated scheduling provide the best match
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At a time of continual change in the healthcare industry driven by an evolution in regulations, care delivery, and payment models amid rising demand for healthcare services, human resources professionals will be expected to do more with less.

That’s one conclusion of a survey on healthcare HR initiatives released last year by the American Society for Healthcare Human Resources Administration and HealthcareSource, a talent management solutions vendor. According to that survey, which polled over 500 HR professionals at healthcare organizations across the U.S., nearly three-quarters of respondents named streamlining HR processes as their top initiative for reducing costs. Furthermore, inefficient systems and inadequate technology were cited as among biggest barriers to achieving their HR goals.

Almost by definition, automating HR processes can help relieve some of these pain points. Implementing technology can make a difference not just in the bottom line, but also in standardizing processes within a provider organization, increasing efficiencies and providing transparency for employees. To be sure, those changes can’t be expected to happen overnight, and sometimes require difficult cultural changes.

Is the effort worth it? What follows is the experience of two major health systems—one to standardize its dealings with contingency staffing agencies, and the other that is in the early implementation scheduling software, with the ability to predict staffing requirements. 

Bon Secours Simplifies Contingency Staffing

Bon Secours Hampton Roads operates three acute-care hospitals, two long-term care facilities and two assisted living facilities in Virginia. It is part of the $3.3 billion Bon Secours Health System that encompasses facilities in six states. Overall, the Bon Secours Health System makes use of more than 50 staffing agencies to fill both per diem and long-term shifts, including both clinical and non-clinical positions.

Several years ago, Bon Secours Health System decided to address concerns of its local health systems around contingency staffing and working with outside agencies.  In 2008, it decided to implement a vendor management system (supplied by ShiftWise, Portland, Ore.), and piloted the program at the Hampton Roads health system.

Helen Anderson, administrative director of HR at Bon Secours Hampton Roads, explains that, at the time, chief nurse executives struggled to track agency hours, and often were not certain which agencies the hospital had contracts with. “It was not a well-oiled machine. It was dysfunctional, paper-intensive and time-intensive. We were frustrated, the agencies were frustrated, and it was not a feel-good for anyone,” she says.

Initially, the solution was implemented for the contingency nursing staff, which accounted for 77 percent of the labor job type usage, according to Anderson, who coordinated the rollout there. Since its initial rollout, the vendor management system has been expanded to other areas, including allied clinical areas such as radiology.

Anderson says that using an automated vendor management system has streamlined the organization’s dealing with agencies by standardizing its processes and providing transparency for both the hospitals and the agencies.

For example, Anderson’s team identified an orientation packet that it uploaded into the vendor management system, which outlined the organization’s code of conduct, expectations and requirements. These so-called prerequisites, as well as a background check, are taken care of before the agency person is approved, Anderson says. She adds that the agency is aware of hospital’s expectations and takes the responsibility of ensuring that the person meets those expectations before being placed on a shift.

She notes that this gives a level of comfort to the nursing executives, as well as human resources executives, that the contingency person hired has met the same expectations as regular hospital employees. It has also streamlined the auditing process when the hospital is visited by regulatory agencies. Pulling the profile on a contingency employee is simple and can be done in minutes on the computer, she says.

One of the most significant advantages of the vendor management system is that contracting has been standardized, Anderson says. The hospital now hires contingency labor only through contracted agencies that are entered into the system.

Three Migrations Of Vendor Management

According to Anderson, implementing the vendor management system has been an iterative process. She explains that the Hampton Roads health system has gone through three “migrations,” by which it has streamlined its process of working with agencies. During the first phase, it uploaded 14 agencies into the system, all of which had signed contracts. “We tried to minimize the number of agencies we worked with to have better relationships and build better rapport with them and vice-versa,” she says. This put the agencies on a level playing field: all had to meet the same expectations to place an employee.

In the next migration, it identified the three top agencies that gave Hampton Roads the most personnel and met certain quality measures, such as fill rates, time to fill and staff performance. Those three agencies were designated “first tier” agencies, and were offered a deal that they would be given first preference to fill a position, at a slightly reduced hourly rate, which would be made up for in volume. “That was beneficial, because they continued to give us quality people, the relationships with those folks increased, and we knew the types of people we were getting. It was a great win-win,” Anderson says.

The third migration occurred in July of last year, when the decision was made to expand the vendor management system in a coordinated way to other local hospitals with in the Bon Secours Health System. With that expansion, the vendor management system is also being expanded beyond nursing to other employment categories—allied clinical as well as clerical and financial positions. “Basically, any position that we had used an agency for in the past, we included across Bon Secours,” she says. “Our agency numbers that we have loaded in ShiftWise and the agencies we have agreements with have dramatically increased.”  (Hampton Roads remains the only local system, so far, that maintains the first tier designation for top agencies, however.)

According to Anderson, automating its vendor management process has saved costs for the organization. It has seen gains in time and efficiencies by eliminating reliance on phone use to fill slots with contingency employees, as well as by standardizing contracts with all agencies. Standardizing the contracts across the board for all agencies has also allowed the hospital system to focus more on quality measures and performance in conversations with the agencies, she says. She adds that the vendor has taken on a significant role in re-negotiating vendor contracts, and that the agreed-upon rates were market rates.

Anderson says vendor management system offers the data and transparency that has allowed the hospital system to manage its labor supply more efficiently. “We are able to get daily, by shift, however you want to slice it, reports as to where our agency is being utilized, where it is being utilized, and the type of agency we are utilizing,” she says. That gives the hospital more information to have a dialog with department managers about their labor needs and the best ways to fill them, she says.

Staff Scheduling As Cultural Shift

Inpatient nursing units are some of the top cost centers at the University of Vermont Medical Center in Burlington, according to Jan Carroll, administrative director of nursing. That represents a possible $2 to 3 million opportunity for potential savings, she says.

That was one of the reasons behind its decision to make staffing and scheduling on the inpatient side of nursing more efficient. Carroll’s team brought in scheduling software (supplied by Avantas, Omaha, Neb.), which would improve the hospital’s ability to accommodate last-minute staffing changes, including the ability to flex up or down according to demand. “It’s a tool to minimize variance,” she says. While acknowledging that quality patient care is the top priority, “We wanted to make sure that we are stewards of our resources, especially as we know that the dollars are going to get tighter as the years go on,” Carroll says.

The scheduling software has been applied to all inpatient units in the hospital, from the ED to the ICU and general med-surg floors, according to Carroll, and encompasses full-time, part-time, and per diem nursing staff as well as agency nurses. “We focused on the inpatient nursing units for two reasons: That’s where our biggest labor-saving opportunity is, and we all, for the most part, abide by the same business rules,” she says.

One of the hospital’s goals is to centralize its staff scheduling, so that it can build a pool of nursing professionals that staff that it can apply to areas where there is a need due to staff fluctuations and census, she says. Although the hospital has had a central staffing office, some department managers have been reluctant to use it, because they regard staff scheduling as one of their departmental responsibilities.

The reluctance amounts to a cultural issue, Carroll acknowledges. “In any culture old habits die hard, and especially in patient care, everybody is worried that they are not going to have enough staff to take care of the patient,” she says. “Now this is more of a system responsibility that they are a part of. That is a shift for them.” she says.

The hospital is taking a gradual approach to winning the acceptance of the department managers. “It’s just a matter of education and helping to bring them along in terms of logic and why we need to go this route,” she says. “We are trying to be thoughtful in doing this, and setting it up for success.”

Carroll believes that the gradual approach is worthwhile, and that it will pay off. In the meantime, the hospital system is working with the vendor to improve the predictive accuracy of the solution—which is crucial to winning the support of the department heads. She says that in some departments the model works well, and in others it is being tweaked for more accurate results.

Improving the predictive accuracy of the system is a process that takes some time as more data is incorporated. It was implemented using three years of census data, and the University of Vermont Medical Center, working with the vendor, is fine tuning it with additional data from the Centers for Disease Control and Prevention (CDC), the Google Flu Index, and local variables related to the hospital. “We are in the process of working that out, and we will get there,” she says.

Carroll believes that the scheduling software will have a big impact on workflow improvement. “In the past, managers spent a lot of time working on their schedules and doing staffing, as well as completing time cards to reflect what actually happened, and it was consuming a lot of their day,” she says. “That’s not what they were trained to do; this work does not require a clinical background.” Automated scheduling can enable a move away from the cumbersome process of using spreadsheets, which are prone to scheduling mistakes, she says. The transparency it offers is popular with employees, who can access it via the web to view their schedules, as well as for the staffing office, which can get an overall view of staffing issues throughout the organization at a glance.

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