Choose Your Shift

Aug. 21, 2009

Filling open shifts throughout Garden City Hospital (GCH) in southwest Michigan had become time consuming, costly and inefficient.

GCH wanted a new approach that would ensure cost-effective patient care, demonstrate technology innovation from a competitive standpoint and motivate nurses to become an active part of the hospital’s staffing solution.

Garden City Hospital President and Chief Nursing Officer Debra Williams

As the hospital’s new vice president and chief nursing officer, Debra Williams was challenged to find a creative and reliable solution to ensure the effective use of existing nursing resources in a competitive labor market. Like many hospitals, the process for filling open shifts at GCH was managed manually by posting unit-based lists and making manydaily phone calls to staff. Frequently, GCH was required to rely on costly contract agency staff or overtime to fill vacant nursing shifts.

Williams realized the system needed significant restructuring. “The process was a time-consuming challenge for front-line managers, without any rules, standards or consistency in how the hospital filled open shifts,” she says. “Despite all the effort involved, we were only filling a small number of the hospital’s open shifts with our own staff, and didn’t have the resources needed to meet patient care demands.”

As a result, GCH found itself routinely faxing 12-15 local staffing agencies with open shift requests. “We were often spending over $100,000 a month in agency fees to fill multiple open positions throughout the hospital. It was extremely difficult to manage manually and was a reactive versus proactive approach to the problem,” explains Williams.

Garden City Hospital is a 323-bed teaching hospital with 1,300 full-time staff, including 365 physicians and 500 registered nurses. Surrounded by 15 local hospitals with more than 8,600 beds in a 30-minute radius, the competitive landscape for nurses is intense, and GCH frequently was short-staffed.

Last year, GCH’s human resources department contacted Williams about an open-shift management program developed by Concerro. Vacant shifts could be posted online, and the hospital’s staff could access and view available shifts using the Internet. Staff could search for specific days or units where they were qualified to work, and make an online request to work the shift.

The program would ensure transparency into all open shifts available at the hospital and help reduce reliance on expensive contract agency personnel to fill the shifts. Staff would have the choice and flexibility to work when and where they wanted beyond their core schedules.

Rewards Help Reduce Costs

In the past few years, online staffing programs have been used with increasing frequency to give employees freedom to choose when they work extra shifts, making the process of filling open shifts more efficient and reducing labor costs for hospitals. Now, merchandise rewards are being incorporated into these programs to motivate staff with new incentives to help fill vacant shifts. For Garden City Hospital, launching a rewards-based work force management system provided a return on investment by reducing labor costs, empowering the existing work force and promoting a culture of collaboration.

As a next step, Williams signed up for a Concerro webinar to learn more about the capability. A feature that captured William’s interest was an incentive-management component of the program called ShiftRewards. Similar to airline frequent-flyer programs, points are accumulated for filling open shifts, which staff redeem through a merchandise catalog for a variety of items, such as iPods, sports equipment, jewelry or gift certificates.

“ShiftRewards was a big selling point for me,” says Williams. “I saw the program as a way to show staff appreciation by putting them in the driver’s seat to decide when and where they wanted to work extra shifts to help GCH meet its staffing needs.”

Williams formed a committee with representatives from nursing, IT, finance and human resources to further review the technology solution. Although GCH did not use an official RFP process, staff interviewed two vendors in the open-shift management market.

The committee decided Concerro’s point-based rewards program was a differentiating way to motivate staff to fill open shifts and increase nursing job satisfaction. Committee participants said a system based on rewards would carry a higher perceived value over cash incentives offered in the past, and motivate staff to participate in the program, particularly if employees could choose their own rewards based on personal interests.

Once Williams and the committee agreed on Concerro, the next step was to ensure internal support and executive sponsorship up front by educating and developing buy-in among all key stakeholders.

Buy-in Not Automatic

There was skepticism among some of the nursing staff when the program was first introduced. Some of the staff felt it was just another program that would never take hold, like many of the other cash and bonus incentive programs GCH had previously implemented.

To ensure an effective launch, Williams pursued a number of communication strategies, starting with an educational campaign where information flyers and leaflets were sent each week to all users. In addition, information about the program was described in the employee newsletter, and posted on signage throughout the hospital.

To encourage buy-in and ownership, Williams asked nursing staff to submit ideas for an internal brand and slogan for the program. In addition, Michelle Fullen, manager of the nursing office, was appointed as the internal program director and attended many of the unit staff meetings to educate the nurses on various shifts.

Town hall meetings were also held to allow staff to discuss the program and its benefits. Meetings were staggered across a number of days and time frames in order to accommodate all nursing staff across all shifts. Super users of the system were made available to answer staff questions.

“Debby Williams did an outstanding job in moving the program forward by continually communicating program benefits and letting employees know she was behind the capability 100 percent,” says Michael Malecki, director of critical care services. “Her support and that of our entire administration was key to the success of the implementation.”

Although the program was launched across all nursing units, many nursing directors did not enroll their staff at first. With additional understanding about how the system worked, however, nurses began modifying their actions to maximize points.

According to Malecki, the program provided a level of buy-in that GCH had never seen before. “Staff really got involved, and our largest nursing unit earned more than 12 million point rewards.”

The program was provided via a software-as-a-service (SaaS) model, where Concerro managed the system and staff accessed it remotely via the Internet. No upfront investment in hardware was required, or software maintenance necessary.

The training phase involved inviting managers and nursing staff to a computer lab to instruct them on how to log on, create individual profiles and request available shifts. Employees were shown how the system automatically tracked point reward totals for each employee and displayed the points needed to redeem various rewards.

Williams and Fullen continued the communication effort with detailed flyers and e-mails about the Concerro program and its benefits. “The technology was extremely easy to use and intuitive,” Williams says. “Its simple interface, including a familiar calendar view, gave staff personalized views on available shifts that they were qualified to work.”

After the system went live, with the first shifts awarded on the same day, GCH was able to reduce the use of contract agency staff and improve productivity. The hospital began seeing a reduction in monthly external agency use, reducing agency spending from approximately $108,000 a month in March 2008 prior to implementation, to just $6,700 a month in March 2009 – a 94 percent reduction. As of June, GCH completely eliminated agency spending.

To ensure an effective launch, Williams pursued a number of communication strategies, starting with an educational campaign where information flyers and leafletswere sent each week to all users.

The point-based open-shift management program provided an internal fill rate for open shifts of 68 percent by the third month of implementation. After a full year of use, the hospital increased its fill rate to about 71 percent. According to Williams, more than 580 nurses and nursing support personnel have signed up to use the program and have filled more than 7,800 shifts.

The program also brought a greater sense of control and satisfaction to nursing staff, according to Williams. The program built trust with employees, she says, as it provided complete visibility into open shifts equally for all staff, and a consistent approach to open-shift fulfillment across the enterprise. In addition, she says the technology enhanced the productivity of nursing managers by automating the filling of open shifts, allowing them to focus more on patient care-related activities.

According to Williams, the program has helped break down silos and provide a collaborative approach to staffing across the hospital. Nurses are volunteering to work in other nursing units within the hospital, and 21 percent of all shifts are now being awarded to staff outside their assigned nursing unit.

“When employees can go online 24/7 and see all the shifts they are qualified to work, they are much more inclined to find and fill a shift and try working on a different unit,” says Williams.

The program also attracts nurses. “Concerro has proven to be an excellent staff recruitment tool that has given us a competitive edge in the local market and supports our efforts to be one of the best places to work in the state,” offers Malecki.

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