Cutting Down on Temporary Staff
Health Data Management Magazine, April 1, 2009
During the summer of 2007, Memorial Health System in Colorado was using up to 100 nurses, therapists, administrative support personnel and other health professionals from outside staffing agencies at any given time. After deploying scheduling software, the three hospitals and about a dozen ancillary facilities of the Colorado Springs-based delivery system are using just four to six outside workers at a time.
Memorial Health in April 2008 went live with scheduling and time and attendance software in its central staffing office to manage its staffing agency needs, replacing a manual, spreadsheet-based process for filling open job slots. The software also enables the identification of qualified staff in certain units who want to pick up shifts in other units.
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The central staffing office is using software from Portland, Ore.-based ShiftWise. Managers in various departments and units continue using scheduling software from API Software Inc., Hartford, Wis. But the ShiftWise software enables the central staffing office to enter job orders and match workers to the orders.
Previously, a department that needed more nurses for a particular shift would request a contracted nurse from the central staffing office. The office would enter the request in the spreadsheet, search the sheet for appropriate people and call them or their agency.
"But many departments only called us at the last minute because they couldn't fill the positions themselves," says Jonathan Liepe, who serves as director of staffing services at Memorial Health.
Now, a department manager fills out the schedule on the API Software system, then logs into ShiftWise and fills out any necessary job orders to fill open shifts. The ShiftWise system matches people to orders, enabling the five users in the central staffing office to quickly identify appropriate employees at Memorial Health or agencies to fill open slots. The agencies access the Web-based system to exchange messages with the delivery system.
ShiftWise, Liepe says, acts like an information technology help desk in how it manages the receipt, working and resolution of requests for assistance.
Something for Everyone
Memorial Health uses the Web-based ShiftWise software on a pay-as-you-use basis. Consequently, the delivery system did not incur upfront costs for the application. Memorial Health raised its pay rate for contracted workers by 5% to stay competitive with rates in the area and attract the best possible nurses.
For instance, a year ago Memorial Health paid $52 an hour for a specialty nurse. Now, it pays $55, ShiftWise keeps $1.65 and the agencies, which slightly changed their procedures to accommodate Memorial Health, get a little more than they used to.
Although the central staffing office now fills most slots internally rather than through agencies, it hasn't had to increase employees in the office.
"Cost savings come from having good, accurate data and methods to understand our staffing needs and utilize less contracted agency staff," Liepe says. "The biggest advantage is to more effectively grow a sizable and dynamic resource pool with minimal headcount to manage the staffing process."
Before selecting a vendor, the central staffing office surveyed nearly 80 staffing agencies about their impressions of scheduling software vendors. Responding agencies convinced Liepe and his four staff members that ShiftWise gave better support and its software was easier to use. "Their input was vital," Liepe recalls. "Without the input from the agencies, we would likely have selected another vendor after having seen presentations from several."
Once vendor selection was complete, the next task was to load Memorial Health's paper-based rules for getting contracted help into a rules engine in the ShiftWise software.
Various departments in the hospital have different scheduling rules. A department may need a medical-surgical nurse who has a current drug screening test and list of immunizations on file. So, rules had to be built for these needs, along with billing rates and start dates. "The challenge is making rules work within the application," Liepe says.
Building the rules into the software took the central staffing office and a handful of others familiar with staffing processes about two months. A hospital or delivery system without a central staffing office might consider doubling the time it expects is needed to build the rules, he advises.
To make sure the software matched policies required mapping out all decision points in various workflows. Then, the software had to be tested to make sure it met the needs of department using it. "We probably could have engaged other resources, but getting time from these other units can be a challenge," Liepe adds.
20-20 Hindsight
If he could do it again, Liepe would have gotten more input from various departments in listing their various jobs in the software's "picking" menu used to select particular job assignments. "We should have said, 'Here are your choices in the menu,' and had them sign off on the jobs and specialties," he notes. "We built some job types we thought they would need, and they said, 'Well, we don't really call it that.'"
For instance, the ShiftWise system didn't support "birth center" in the menu. So that had to be interpreted as "labor and delivery" or "labor, delivery and post partum."
With a do-over, Liepe also would have started by testing the software in only a few departments that frequently use contract workers to work out bugs. They could, for instance, create dummy accounts and try to "break" their processes to find mistakes before go-live.
Once the hospital went live with the software, ShiftWise started training staffing agencies on how to use it to communicate with Memorial Health. But the vendor gave a generalized lesson, while agencies needed to know how Memorial Health wanted the software used. So after a couple of months, the delivery system started doing the training.
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