Time to Punch-in

April 1, 2009

An expanding children’s hospital system puts an automated scheduling system on the clock and sees improved productivity.

Scheduling employees in today’s healthcare setting can be a daunting challenge. Managers and schedulers must ensure that a myriad of factors line up correctly including staff qualifications and licensure, patient acuity and census, and regulatory compliance. In addition, increased budget tightening by many healthcare organizations makes it more important than ever to ensure that labor resources are being utilized as efficiently as possible and that employees remain satisfied.

An expanding children’s hospital system puts an automated scheduling system on the clock and sees improved productivity.

Scheduling employees in today’s healthcare setting can be a daunting challenge. Managers and schedulers must ensure that a myriad of factors line up correctly including staff qualifications and licensure, patient acuity and census, and regulatory compliance. In addition, increased budget tightening by many healthcare organizations makes it more important than ever to ensure that labor resources are being utilized as efficiently as possible and that employees remain satisfied.

In 2007, as a follow-up to the successful implementation of an enterprisewide automated time and attendance system, Children’s Hospital and Health System decided to implement a more effective way to manage its staffing and scheduling processes. With more than 2,400 full-time equivalent employees in the health system’s flagship, Children’s Hospital of Wisconsin in Milwaukee, the 236-bed hospital needed a solution that would not only manage staffing and scheduling facility-wide, but also help managers improve workflow and control overtime costs as it expands to a 294-bed facility in April 2009. The hospital was also looking for a system that could generate real-time reports so executive leadership could proactively measure productivity.

Additionally, since staffing at Children’s Hospital is largely handled by individual departments within the hospital, it was important that the system accommodate a decentralized staffing environment.

Problem

Although we were already using software to automate basic staffing and scheduling processes, the system had limitations that prevented certain departments from utilizing it. For example, the software only accommodated three-digit activity codes and the hospital needed the capability for longer activity codes in the surgical services area since that department operates 24/7 and includes a number of staggered shifts. We felt that a system with more flexibility would enable us to meet the diverse staffing and scheduling needs of the hospital while also helping us better manage workflow within each department.

Because supervisors are able to access real-time data, they can respond quickly to changes in patient care needs or employee absenteeism.

We also realized the importance of choosing a solution that would integrate with our time and attendance and HR systems. Implementing a system that could seamlessly share information with our existing labor resource applications would eliminate duplicate data entry, resulting in increased staff productivity and fewer opportunities for errors.

Finally, we were seeking a system that was designed to manage the complex rules and regulations specific to healthcare. Since we operate around the clock, the system had to be able to accommodate all of our scheduling and staffing rules, such as holiday, weekend or called-off policies, and apply them consistently throughout the organization.

Solution

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With these goals in mind, we put together a cross-functional team to determine system requirements and then initiated a formal RFI process. After inviting selected vendors to demonstrate their systems, the team made reference calls to the vendors’ customers and conducted site visits to see the systems in use. We believed that in addition to providing the desired functionality, it was key that the selected vendor offered strong customer support and had good relationships with its customers.

At the conclusion of a thorough evaluation process, we selected the ActiveStaffer staffing and scheduling system from API Healthcare Inc.

We selected the system for several reasons: Since we had successfully deployed this vendor’s time and attendance system in 2005, our employees were already familiar with the look and feel of the user interface, which would mean a reduced learning curve when training employees on the new system. Also, because the solutions integrate with each other, we would be able to leverage the IT infrastructure already being used to run our time and attendance system, resulting in reduced hardware costs.

The ability to share data between the two systems was also an important factor in our decision. For example, paid personal leave information that had been previously entered in the time and attendance system would be available in the staffing and scheduling system — eliminating the need to re-enter information. In addition, we liked the fact that the system included self-scheduling functionality.

Implementation

We launched the pilot for our staffing and scheduling system in February 2007. We knew it was important that diverse areas of the hospital be represented in the pilot group, including the Pediatric Intensive Care Unit, which is comprised of more than 180 employees and has complex scheduling requirements. A representative acute nursing unit, the internal float pool and two ancillary areas — Respiratory Care Services and Radiology — rounded out the pilot group.

Pilot group leaders were provided multiple days of vendor led training and workshops. Our Educational Services Department participated and transferred knowledge into the development of a home grown online course and custom job aids. Pilot members agreed to champion the system and became coaches for subsequent rollouts.

When we began the system rollout, we used a phased-in approach to simplify our effort and ensure that any potential issues were detected and resolved early in the process. Although the project was completed on time and on budget, we realized that we would have been better prepared if we had taken factors such as holiday time into account when scheduling the implementation.

Implementing a system that could seamlessly share information with our existing labor resource applications would eliminate duplicate data entry, resulting in increased staff productivity and fewer opportunities for errors.

We also recognized the value of having dedicated staff resources allocated to the implementation, which helped ensure that the project stayed on track. The rollout was completed in fall 2008 and the system is now being used in 29 areas throughout the hospital. Other areas, such as our Telephone Operators Call Center, also plan to use the system.

Results

Since implementing the ActiveStaffer system, we have realized a number of benefits. The system’s ability to identify employees who are at risk of overtime and then suggest alternate employees for available shifts results in more efficient utilization of resources and better control of labor costs. Although we haven’t yet collected any quantitative data, we believe the system helps us to reduce discretionary overtime.

We also benefit from enhanced reporting capabilities. Because supervisors are able to access real-time data, they can respond quickly to changes in patient care needs or employee absenteeism. In addition, managers and supervisors are able to review online historical scheduling information, and patient care leaders can access productivity data to see how much time caregivers are spending at the bedside versus performing administrative tasks.

To date, six units within the hospital have deployed the system’s self-scheduling functionality for all staff members, while five units selectively use self-scheduling for specific job positions. Self-scheduling enables employees to view upcoming work schedules, submit shift requests via the Internet and electronically inform management when they are unavailable.

Although the project was completed on time and on budget, we realized that we would have been better prepared if we had taken factors such as holiday time into account when scheduling the implementation.

The system’s ability to share data with the time and attendance system has also resulted in unexpected benefits. For example, employees now use a computer or badge reader to indicate when they are moving from one task to another, enabling managers to better manage workflow and make more accurate staffing assignments.

In the future, we may integrate our in-house acuity system with the staffing and scheduling system. Information from the acuity system could then be forwarded to the scheduling application to make sure that shift assignments take into consideration both patient census and the severity of patient conditions.

Overall, we are pleased with the productivity improvements that we have experienced as a result of implementing the automated staffing and scheduling solution. It has helped us to streamline administrative processes and improve workflow throughout the organization. In addition, the system’s ability to integrate with our time and attendance system, as well as enhanced reporting capabilities and access to real-time resource utilization information, have helped us provide more accurate scheduling and utilize our resources more effectively.

Eugene Kleinberg is manager, IS Applications, and Mary Lou Weden is manager, Clinical Informatics at Children’s Hospital and Health System in Milwaukee, Wis. They can be reached at [email protected]  and [email protected] .

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