Post on 17-Dec-2015
Effective Productivity Management: Tools and Techniques for Managing Your FTEs
Michelle Niermann, Vice President, OperationsPeg Bradke, Director, Heart Center
Bonnie Carpenter, Coordinator, Clinical StaffingSt. Luke’s Hospital – Cedar Rapids
Iowa Health SystemLeadership Symposium
April 19, 2011
Productivity Management at St. Luke’s Hospital
• Early 2000s– Use of Hours per Patient Day (HPPD) as Productivity Measure for
Inpatient Nursing Units– Participation in Iowa Health System’s Lane Benchmarking Effort
• Mid 2000s– Period of Solid Revenue Growth and Solid Operating Margins– Bi-Weekly Productivity Reports Include Focus on Worked FTEs
and Worked Hours per Unit of Service
Productivity Management at St. Luke’s Hospital• 2007
– Softening of Operating Margin; Heightened Attention on Productivity
• Decision Not to Focus on External Benchmarking but Rather Daily Management of Staffing
• Recognition of Staffing as One of a Few “Big Q” Processes
Year Net Revenue FTEs % Change % Change
2005 $210,744 1821
2006 $234,045 1944 11.1% 6.8%
2007 $238,283 2041 1.8% 5.0%
2008 $262,677 2047 10.2% 0.3%
2009 $279,889 1988 6.6% -2.9%
2010 $295,864 2005 5.7% 0.9%
Productivity Management at St. Luke’s Hospital• 2008
– Intensive Focus on In-Quality Staffing– Greater Use of Existing Bi-Weekly Productivity Reporting– Greater Use of Worked Hours per Unit of Service to Develop FTE
Budgets• 2009-2010
– Continued Refinement of In-Quality Staffing– Investment in One Staff as a Productivity Management Tool– Introduction of Productivity Coaches
3.80
4.00
4.20
4.40
4.60
4.80
5.00
Jan-07Mar-07May-07Jul-07Sep-07Nov-07Jan-08Mar-08May-08Jul-08Sep-08Nov-08Jan-09Mar-09May-09Jul-09Sep-09Nov-09Jan-10Mar-10May-10Jul-10Sep-10Nov-10Jan-11
CMI Adj. FTEs/AOB2007-2011
Actual
Budget
Productivity Management: The Visual History
My understanding of the productivity statistic “CMI-Adjusted FTEs per AOB” is:a) Crystal clearb) Fairly solidc) A little hazyd) I’m sorry, what was that you said?
Productivity Pulse Question
Productivity Management: The Visual History
2007
2007
2007
2007
2007
2007
2007
2007
2007
2008
2008
2008
2008
2008
2008
2008
2008
2009
2009
2009
2009
2009
2009
2009
2009
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2010
2010
2010
2010
2010
2010
2010
2010
2010
2011
(150)
(100)
(50)
-
50
100
150
200
250
Biweekly FTE Variances - 2007-2011
FT
Es
Productivity Management: The Visual History
2005 2006 2007 2008 2009 20100.0%
1.0%
2.0%
3.0%
4.0%
5.0%
6.0%
7.0%
% OT to Worked Hours % Extra Hours to Worked Hours% Orientation to Worked Hours
Patient Care Division Improvements
Productivity Management at St. Luke’s Hospital
• The Team– Peg Bradke, Director, Heart Center– Bonnie Carpenter, Coordinator, Clinical Staffing– Mary Hagen, Administrative Director, Organizational
Effectiveness– Jenn Eubanks, Senior Decision Support Analyst– Scott Kallemeyn, Director Business Operations, Surgical Services– Leigh Christensen, Administrative Fellow
10
In-Quality StaffingPeg Bradke
Director, Heart Center
Kick off March 4 2008Goal: To adjust staffing and demand
scheduling toward 95% In-Quality Staffing, using Rapid Cycle Testing.
In your environment, what would you rank as the chief factor negatively impacting your productivity?a) Overtimeb) End of Shift Overagec) Volume Fluctuations. d) Inappropriate Matching of Worked Hours to
Volumese) Not Sure
Productivity Pulse Question
St. Luke’s Cedar Rapids Summation
100-Day In-Quality-Staffing“95% In Quality Staffing”
Kick-off: 30-day check-in: May 60-day check-in: Deferred due to flood 90-day check-in: August – Summation Year End
SMJC – IQS 0307-13 © 2005 Chip Caldwell & Associates, LLC. All Rights Reserved.
In Quality Staffing Analysis
4
9
14
19
24
29
UOS
& St
affin
g
2.5
2.7
2.9
3.1
3.3
3.5
3.7
3.9
4.1
UOS/
FTE/
Hr
Out of Quality
Out of Quality
95% In Quality Range
14
30 Day Goals of Report Out
1. Describing rapid cycle test(s) related to staffing you had completed pre-flood and how you're doing holding any successes you had
2. Describing rapid cycle test(s) related to staffing you still plan to pursue
3. Describing any staffing innovations you tried out of necessity during the flood that you may look to continue
4. Describing your 1-2 best waste / cost reduction ideas implemented or planned
1. Describe your departmental IQS staffing results from the latest collection period (Nov. 9-22) and plans for sustaining or improving In-Quality staffing levels into 2009. Report 5-7 minutes.
2. Address any sustained results from your earlier staffing adjustments made either prior to or during the flood, or due to previous rapid cycle tests
3. Repeated Hourly data collection for departments with greater than 20 FTE
100 Day Report Out IQS Objectives
17
3 West – May 2008
3 West - December 2008
In Quality Staffing My Department
0
5
10
15
20
25
30
7-8 8-9 9-10 10-11 11-N N-1 1-2 2-3 3-4 4-5 5-6 6-7 7-8 8-9 9-10 10-11 11-M M-1 1-2 2-3 3-4 4-5 5-6 6-7
Sta
ff/V
olum
e
0.0
1.0
2.0
3.0
4.0
5.0
6.0
7.0
Pts.
Per
Sta
ff
Wtd Pts Staff ADT Volume Pts/Staff/Hr U-IQS Range Lower IQS Range
2008 Themes and Next Steps
• Themes– Reducing Overtime– Reducing End of shift overage– Reducing Extra Hour Incentive– Monitor Non productive time
• Next Steps– Carry forward improved performance results in 2009 Budget
Development– Repeat Hourly monitor for pp2 2009– Emphasis on daily entries in Kronos
January 2009 Report out Results• Developed a new tool for daily monitoring• Set up system to assure correct time schedules were
in Kronos so OT and worked hours would be calculated appropriately
January 2009 Report out ResultsNew Tool for Daily Monitoring
Daily In-Quality Worksheet Calculator
Pay PeriodUnit
Units of Service (e.g. # visits, procedures, contact
hours, OR minutes)Worked Hours
Wkd Hrs/Unit of Service Met Target Y/N
Sunday #DIV/0!Monday #DIV/0!Tuesday #DIV/0!
Wednesday #DIV/0!Thursday #DIV/0!Friday #DIV/0!
Saturday #DIV/0!Sunday #DIV/0!
Monday #DIV/0!Tuesday #DIV/0!
Wednesday #DIV/0!Thursday #DIV/0!Friday #DIV/0!
Saturday #DIV/0!Totals 0 0 #DIV/0!
Units of Service Works Hours Wkd Hrs / UOSYTD ACTUAL 2009
BUDGET 2009YTD 2008YTD 2007YTD 2006
Orientation Hrs. Educ. Hrs. Mtg Hrs. Call Hrs. OT Hrs. % OT/wk hrs Ex Hr. % Ex. Hrs./wk hrs. PL Hrs.
2009200820072006
Comments
2009 Themes and Next Steps
• Themes– Introduces new actions plans related to bedside
report and cross training. – Using PA to address OT issues
• Results / Next Steps– Year ended strong– Start of 2010 started out poor– Set up March 2010 report out
2010 Report Outs
• March- New form, using One Staff to assist • August - Set new plan to concentrate and
report outs from departments running less than 95% productivity.
• November – Started coaching for departments at less that 95% productivity
3C2010 Budgeted HPPD: 11.1
753612.2
1811.713.7
1506411.5
9853
1678112.412
HPPD OT Hrs Extra Incentive HrsPay Period 22Pay Period 23Pay Period 24Pay Period 25
YTD
Comment on your 2010 productivity performance and any action you took to improve that performance:Orientation is running 1 FTE higher than budgeted due to vacancy and orientation to the new aquaphoresis technology. This all happened in the 2nd quarter and 3C has not been able to balance that out. If that out of the ordinary orientation is taken out 3C would be at 11.8 for the year.
PP 24 was seeing improvements. PP 25 43% of the time 3C was at a census of 14 or below. At that level for safe census and coverage of telemetry monitors the unit cannot be within productivity levels and this negatively impacted the pp.
Describe your productivity action plan for 2011:Will continue working with Director re: coaching on productivity. Meeting with Peg Bradke 12/16 for increased productivity education. Education done with unit Secretary on importance of early morning payroll input for monitoring with OneStaff. Work with staff 1:1 with end of shift outliers & early punch ins. Use adaptive design observations for end of shift monitoring. Encourage alternatives to 1:1 if an option
St. Luke’s CR—OnestaffBonnie Carpenter
Coordinator, Clinical Staffing
How we are using Onestaff to Monitor Productivity
How frequently does your department receive productivity reports/ data?a) Greater than once/ dayb) Dailyc) Weeklyd) Every payperiode) Monthly
Productivity Pulse Question
Ramping it up in 2010
Creating a Culture Change—Moving toward Prospective Productivity Reporting
Using our IHS affiliation to look for Best Practices—and borrowing shamelessly…
• Use OneStaff to create a Productivity Report for every shift.
• Generate a weekly Productivity Report every Monday to give Managers an idea of how they are doing midway through the payperiod.
• Provide coaching to those who need it.
What is OneStaff?
• It’s owned and operating at every IHS affiliate hospital
• Employee Database• Scheduling• Daily Staffing• Reporting• Productivity
Kronos
InfiniumCare Cast
At the Core---
The Interfaces
OneStaff---how it works…..
• The Department’s budgets and schedules are entered into Onestaff.
• OneStaff interfaces with CareCast to bring in the census.
• Based on the census and the staffing data that comes from the unit’s schedule, OneStaff can predict if staffing will be within budget on a given shift.
• Interfaces with Kronos to bring in the actual hours worked.
Set up For Productivity Reports
Elements required:– Budgeted FTE’s– Orientation FTE’s– Nonproductive Factor– Account for Other Nonproductive hours– Budgeted Units of Service
Diagnosing the Problems—the 5C Story
• Off to a bad start—87% productivity in week one.
• Coaching• Using OneStaff to
diagnose staffing issues• Creating a correction
plan
5 Center Productivity 2011
50%
55%
60%
65%
70%
75%
80%
85%
90%
95%
100%
105%
110%
115%
1 2 3 4 5 6 7 8
Goal
Productivity
Attending to the little things—the 4W Story
4 West Productivity 2011
70.0%
75.0%
80.0%
85.0%
90.0%
95.0%
100.0%
105.0%
1 3 5 7 9 11 13 15 17 19 21 23 25
Goal
Productivity to Target OS
What is happening in Respiratory Therapy????
Resp Therapy Productivity
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%
110.0%
1 3 5 7 9 11 13 15 17 19 21 23 25
ProductivityGoal
Productivity toTarget OS
Accounting for all their activity….
• Pulmonary Function Lab—52hrs/wk• Crit Care and NICU Competencies• Unit’s Education, i.e. STEPPS• ICU and NICU Multidisciplinary Rounds—24
hours/ week
• These activities had to be built into the 2011 budget—3.6 FTE’s
Future Goals
• More departments will monitor productivity in OneStaff
• Implement Web Reporting in 2011• EPIC interfaces will bring in workload data for
both nursing and ancillaries.• Affiliates will continue to cooperate,
standardize Units of Service, and potentially benchmark against each other
Key Themes – For Departments
• Monitor staffing real time and calculate HPPD or Worked Hours per Unit of Service on a daily basis. Develop action plan for flexing staff concurrently if volumes rapidly decline.
• The schedule should match the budget • Differentiate your schedule from your day to day staffing • Engage staff in the discussion of productivity targets• Address general overtime utilization and end of shift overtime • Revise Orientation/Learning methods • Look for ways to utilize cross training • Assure schedule options in Kronos are appropriate for the clock in and
clock out times. • Share best practices and compare interventions across departments
Key Themes – For Organizations
• Strengthen the Core Team / Administrative Focus• Ongoing Use of In-Quality Staffing Report-Outs• Increasing Use of One Staff as a Productivity Management
Tool• Productivity Coaches• Frequent Reporting
– One Staff Daily, Weekly and Bi-Weekly Productivity Reports– Bi-Weekly Productivity Report Produced by Finance– Inpatient Nursing Unit Trend Report, also now Produced by
Finance– Monthly CMI-Adjusted FTEs per AOB
• Top-Down FTE Budgeting / Tie to Daily Staffing
Next Steps for Productivity Management at St. Luke’s Hospital
• Continued use of the In-Quality Staffing approach and of productivity coaches
• More fully deployed use of master staffing plans and grids for all unit-of-service-driven departments
• Broader use of One Staff within St. Luke’s and, with Iowa Health System support, expanded capabilities of the One Staff system– Web Reporting– Epic Interface
• Productivity benchmarking in select departments, preferably starting within the Iowa Health System, facilitated by standard unit of service definitions (Finance Departments) and expectations for dialogue at the affinity group level (Chief Operating Officers)