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Better Scheduling Boosts Productivity
Health Data Management Magazine, July 1, 2008
Using software to simplify staff scheduling sounds simple enough. But those who’ve implemented the latest scheduling software say that taking full advantage of the technology is a complex task that can pay off in much better management of productivity.
“Using scheduling software as a productivity system, our labor supply and patient demands can be blended and optimized for the benefit of all,” says Janet Stifter, R.N., vice president of patient care services at St. Joseph Hospital in Chicago.
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In addition to improving overall staff productivity, hospital executives say the applications help them carry out the terms of union contracts, comply with state regulations regarding nursing staff levels, cope with the nursing shortage while holding down staff costs, and accommodate employee self-scheduling.
While a growing number of hospitals are turning to scheduling software to manage their staffs, some ambulatory care providers are automating appointment scheduling to improve service to their patients (see sidebar, p. 39). Meanwhile, some hospitals are using a different flavor of scheduling software to automate the tasks associated with data warehouse management (see sidebar, p. 40).
With a goal of improving staff productivity, Resurrection Health Care, the delivery system that owns St. Joseph Hospital and seven others in the Chicago area, is phasing in labor management software from Res-Q Healthcare Systems Inc., Calabasas, Calif.
Factoring in Patient Acuity
An essential component of the effort, Stifter says, is pairing improved staff scheduling with more accurate measurement of patient acuity. The delivery system chose the Res-Q software because it enables users to build in custom patient acuity measures for each unit of each hospital to help ensure that enough staff members with appropriate skills are scheduled to work on the unit, she explains. Managers on each unit carefully select the most meaningful acuity indicators, such as frequency of blood draws or need for chemotherapy at the bedside. Once those indicators are updated, the managers use the software for scheduling and specific assignments.
The Res-Q software is interfaced with a time and attendance system from api software Inc., Hartford, Wis., and an admission/discharge/transfer system from McKesson Corp., San Francisco. “These interfaces will allow a manager, on a shift-by-shift basis, to evaluate staffing decisions using real-time data,” Stifter says.
“Day to day, managers work to ensure that nurses with the right skills are available. The managers might have to move a nurse from one shift to another or one unit to another.”
Even smaller community hospitals face the challenge of improving the management of productivity.
The 67-bed Marlborough (Mass.) Hospital, for example, is using scheduling software from McKesson to help it make sound staffing decisions, says Candra Szymanski, R.N., who is COO. “On a weekly basis, by cost center, I now know how many FTEs we are using” and how much time they devoted to patient care vs. other tasks, such as training, she adds.
The hospital sets benchmarks for the amount of care hours it takes to serve various patient census levels and then carefully measures whether those benchmarks were achieved. Szymanski prepares reports to explain why staffing on a particular unit was higher than anticipated, analyzing such factors as vacation time, sick time and time spent in training or other non-clinical tasks.
“Before having the software, I would spend hours trying to figure that out because I couldn’t sort nonproductive from productive time.”
The software, which handles payroll as well as scheduling, also saves other managers considerable time.
“On Friday afternoons and Monday mornings, my management team was not available to me because they were doing payroll manually and trying to build schedules,” she says. “To generate a staffing report, we’d have to put it together manually.”
The automated system also will help the hospital in the event of a disaster, she notes. “If we had a catastrophic event, I could ask the system to give me a report on every nurse who lives within 30 minutes of the hospital and who is certified in advanced cardiac life support,” she says.
Union Contracts
As they use scheduling software to improve productivity, some hospitals are discovering that they also can use the applications to make sure they are complying with all of the terms of union contracts.
For example, managers at 244-bed Evergreen Hospital Medical Center in Kirkland, Wash., use a rules engine in its scheduling software and automated time and attendance system from api software to determine compliance with overtime provisions of union contracts, says Kristine Scholl, systems analyst. “We’ve also designed a lot of custom reports for managers, such as attendance tracking that identifies employees who call in sick frequently.”
Each time a union employee signs in, the software automatically uses built-in rules to assign the right pay rate for such factors as working on the weekend or starting the day 30 minutes early at the request of a supervisor, Scholl explains. Loading the software with the necessary union contract data and then checking the rules took six months of planning and testing, she says.
“You really have to test everything well before you bring it up live.”
Some hospitals also are discovering that managing productivity with scheduling software helps them when it’s time to prepare annual budgets.
“We’re looking at our budgeting process differently this year because we have data on the amount of nurse hours it takes to care for a patient and the amount of hours nurses devote to other tasks,” says Susan Marino, director of nursing informatics at 867-bed Hartford (Conn.) Hospital.
The hospital rolled out scheduling and automated time and attendance software from Kronos Inc., Chelmsford, Mass., in 2007. “We scrutinize our overtime every single week because we now have the data available at our fingertips,” Marino says. “I can even predict who’s going to hit overtime today two hours into their shift so I can take appropriate action.”
By using special codes to designate the tasks of a nurse during a specific time period, “we know a lot more about how much it costs us to run an orientation program or how much time nurses spend getting training on a new system or attending meetings,” Marino adds.
Another important benefit of deploying scheduling software is improved compliance with state regulations that require hospitals maintain specific nursing staffing levels.
A new Illinois law that went into effect Jan. 1, 2008, requires hospitals to have a mechanism in place to measure patient acuity levels when making nurse scheduling decisions, explains Stifter of St. Joseph Hospital.
Hospitals must form a committee to oversee staffing levels based on patient acuity. In this way, hospitals will assign nurses based on the condition of their patients, rather than just a nurse/patient ratio, Stifter says.
The patient acuity components of the Res-Q software makes it much easier for Resurrection’s committee to do its work, she says.
In Massachusetts, hospitals must report the number of hours direct care providers work relative to their patient census levels to demonstrate adequate staffing, says Szymanski of Marlborough Hospital.
By using the McKesson scheduling software, “I gained the ability to prove our staffing levels without spending hours going through reports manually,” she says.
Implementing scheduling software also has helped many hospitals cope better with the nursing shortage.
For example, the Medical Center of Central Georgia saved more than $1 million in the first year it used scheduling software because it was able to cut back on using temporary nurses hired from agencies, says Barbara Stickel, senior vice president and chief nursing officer.
The 603-bed hospital more efficiently schedules its employed nurses using BidShift software from Concerro Inc., San Diego, through the application service provider computing model.
The software, which costs about $144,000 a year to use, has saved the hospital $1.9 million since August 2006, Stickel says. In addition to saving money by hiring fewer temporary nurses, the hospital has slashed overtime costs and has seen its nursing turnover decline.
Self-scheduling
The key to success, Stickel says, has been using the software to enable nurses to self-schedule.
Nurses call up the application on a Concerro Web site to view shifts that need to be filled. They normally work three 12-hour shifts a week, “but many like to pick up extra shifts now and then,” she says.
Evergreen Hospital Medical Center also is capitalizing on self-scheduling. Nurses know the date and time that schedules are available on the hospital’s intranet, says Scholl, the systems analyst. They use the software from API to select the shifts they want.
“It’s really empowering to the nurse that they can go into the system and sign up for what they want,” Scholl says.
In addition to hospitals, other health care organizations are benefiting from introducing self-scheduling.
For example, Pathology Associates Medical Laboratories, Spokane, Wash., uses an application from Maplewood Software Inc., Spokane, to facilitate self-scheduling for dozens of staffers who work at the reference lab’s 20 patient service centers.
Patients visit these neighborhood centers to have blood drawn or other tests conducted, explains Matt Swanson, manager of the centers.
The software, which uses the ASP computing model, enables workers to view schedules on a Web site, replacing the old, inefficient system of using voice mail, e-mail and faxes to fill shifts. As a result, the lab has reduced staff overtime expenses, and supervisors have cut the amount of time that they devote to scheduling by two-thirds, Swanson says.
“If you have a lot of time and money, you don’t need scheduling software,” Swanson quips. “But if you’re trying to schedule staff more efficiently, the software is essential.”
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