During the past year, hospitals across the United States have felt the crunch of the recession, with executives being forced to trim budgets wherever possible.

One area that has been hit particularly hard is the administrative department. In a poll by the American Hospital Association asking what actions CEOs planned to take in order to maintain fiscal viability, 80 percent said they would cut administrative costs and 48 percent said they would reduce staff.

Why administrative? “There are high overhead costs that can be eliminated,” says Kerry Kerlin, executive vice president of Stoltenberg Consulting (Bethel Park, Pa.), costs that can result in significant savings.

A number of organizations are tackling these costs by implementing automated systems that house schedules in a central location, giving managers a birds-eye view that enables them to more effectively allocate resources across the enterprise.

The big(ger) picture

For Midland Memorial Hospital (Midland, Texas), the source of overhead costs was obvious; the administrative department was forking over big money for overtime and agency staffing. The solution, says Bob Dent, R.N., chief nursing officer at the 320-bed hospital, was to create a more centralized system. “We wanted to move away from paper assignments to a system where we can see the scheduling from any location.” That way, he says, managers could make adjustments across the board without having to go from one system to another to view staff schedules.

In 2007, Midland went live with the ClairVia Demand and Staff Manager systems from Durham, N.C.-based AtStaff. Within a year, the hospital was able to eliminate agency staffing, which had cost anywhere from $4.5 to $6 million per year, he says.

MidMichigan Health, a four-hospital system based in Midland, was dealing with a situation where staff members at one facility were being sent home due to low volume, while other locations were so busy that agency nurses were brought in. So, the organization's leaders began looking for ways to more effectively distribute the workload.

In the fall of 2008, MidMichigan began rolling out MyTimeSelect, a Web-based staffing tool from San Diego-based Concerro that enables nurses who are short on hours to fill empty shifts in other facilities. “With the interaffiliate floating capability, now we can get properly trained clinical staff to go between organizations, which we couldn't do before,” says Harlan Goodrich, vice president and CIO. The solution is now live in the nursing units at all four hospitals and is being implemented in several ancillary departments.

While visibility is certainly a critical component, another benefit of automated scheduling is standardization, according to Kerlin.

“When you roll it out across the organization,” Kerlin says, “you ensure that everyone is following the same rules. And usually, you can create better, neater reporting to use for management oversight.” What happens, he says, is that individual departments often adapt different sets of standards for overtime. For instance, emergency department managers might grant overtime for nurses who work a shift of more than eight hours, while the rest of the organization may only grant overtime for staffers who have exceeded 40 hours in a week. “If you do it in an automated system, the computer is going to apply the same rules to everybody,” he says.

The staffing system at MidMichigan has been instrumental in helping managers navigate the nuances of the different compensation systems within the organization. “We're very complex in the fact that we have not only union and nonunion environments, but we also have several different unions within the four facilities,” says Sue Haley, director of inpatient services at MidMichigan. “This has really helped us to manage the differences within the system.”

The final piece of the puzzle, for some organizations, is being able to not just centralize and standardize schedules, but also leverage the data for trending purposes.

At Midland Memorial, the business intelligence tools found in the ClairVia Demand Manager are being leveraged to forecast staffing needs based on historical data. “Our managers can make real-time decisions about staffing and not have to rely on lag indicators, where data can be two weeks or even a month old,” says Dent. “I wanted to make them more accountable to daily staffing patterns and hold them to those productivity standards.”

With the most current data at their fingertips, managers are able to correct scheduling inconsistencies much faster, and without turning to outside help. As a result, Midland has decreased overtime charges from 7 percent to less than 4 percent of its overall labor costs.

Says Kerlin, “It's very good for trending, and it's very good for quick response. With older systems, everything happens retrospectively, which can be anywhere between two and four weeks after the event occurs. If you have a good scheduling system that you can report on, it can turn those numbers very quickly.”

Empowering the staff

One component that can't be overlooked is staff satisfaction. By automating staff scheduling systems, hospital leaders can empower nurses and other staff to take a more active role in determining their assignments.

At Meridian Health, a four-hospital system based in Neptune, N.J., the implementation of two solutions from McKesson (Alpharetta, Ga.) has helped boost morale, according to CIO Rebecca Weber. Meridian uses ANSOS OneStaff as its core scheduling solution, and eShift as a Web-based tool that enables staff to fill open shifts (see sidebar for more information). Nurses and other employees can access the tool from workstations throughout the health system, as well as from laptops, smartphones or PDAs. The idea, says Weber, is that a nurse can pull up eShift at 2 a.m. from her home computer if she needs to access the system.

“Our requirement was that we wanted a totally Web-based scheduling system,” she says. This way, the staff has more flexibility and control over their hours by using a tool that is simple to navigate, and requires minimal involvement from an IT standpoint. “It really is low maintenance. We have an administrator of the system and it's really not onerous at all for nursing.”

In fact, she adds, “It's become a way of life here. We couldn't imagine not having it at this point. To go without it would be like transferring to a bank that didn't have an ATM.”

At MidMichigan, the Web-based staffing tool has been well received by nurses, thanks in part to an incentive program in which they earn reward points every time they fill an open shift, according to Haley, who led the staffing project. The earlier nurses sign up for shifts, the more points they can collect and redeem for merchandise through an online catalog. “The system really reinforces constant behavior and keeps the staff happy,” says Haley. But it isn't all about the reward points. “It's amazing when you look at this from a change perspective, at the level of dissatisfaction with the way things were. Everyone just hated doing staffing.”

What has made the roll-out successful, she says, is the fact that it benefits not just staff, but the entire organization. “It's actually a win all the way around. It's a win for the organization because of the decrease in agency costs. It's a win for the managers because the bargaining and begging and pleading to get shifts went away, and it freed up time for them so they were able to improve efficiencies,” she says.

Goodrich agrees, adding that it's difficult to pass up a technology that can improve processes while being relatively hands-off from an IT standpoint. “I would say wholeheartedly that it's one of those rare golden nuggets that's right in plain sight,” he says. “It really is a no-brainer.”

Sidebar

Breaking Down Scheduling Systems by Hospital Size

HCI Research Series: Trends in Technologies for Nurses