Like many a healthcare enterprise, Children’s Healthcare of Atlanta (CHOA) was grappling with the challenges of meeting clinical needs with inadequate staffing and scheduling processes. Widely considered to be among the best pediatric healthcare systems in the country, the three hospitals and 17 ancillary care locations of CHOA also make it one of the largest. The healthcare enterprise’s staff of 7,400 serves more than 500,000 Georgia patients annually.
The largest Medicaid provider in the state, CHOA’s ongoing mission has been to transform pediatric healthcare in Atlanta to better serve its patients across the entire enterprise.
The challenge
In late 2009, the healthcare enterprise’s transformational mission took the form of a proactive administrative and enterprise leadership endeavor known as “Vision Possible.” A major committee within this multifaceted approach was known as Staffing Effectiveness. At the time, CHOA was using a combination of paper-based scheduling processes and a complex computer-based scheduling system. Both were proving to be highly ineffective at managing clinical staff resources.
The committee’s mandate was to unify staff scheduling across the enterprise via a single automated staff-scheduling system. This would allow CHOA to easily match clinical staffing to patient needs across all three hospitals. The system would need to allow department nurse managers and schedulers to simply and effectively put staff where they were needed based on volume, acuity and sick calls.
Additionally, the system would need to facilitate reduction of overtime, transition the premium-pay incentive model to a bidding process and reduce the use of agency nursing pools. The scheduling system would ultimately need to move beyond the inpatient world to totally maximize staffing efficiency. This meant being able to integrate, monitor and streamline scheduling across all departments and hospitals.
Making the choice
The Staffing Effectiveness committee began the system selection process by distributing a survey to nurse managers and schedulers across departments and hospitals to identify system needs. This was used as an evaluation tool for potential vendors.
The final selection process involved more than 30 nursing managers and schedulers from various departments. Of the four vendor solutions reviewed for possible selection, the group chose ShiftSelect, a Web-based software-as-a-service (SaaS) staffing and scheduling system from API Healthcare.
ShiftSelect was uniquely designed to facilitate enterprise-wide visibility and integration of staff scheduling while simultaneously empowering the staff with flexibility and a level playing field. This combination of attributes would allow CHOA to effectively fill staffing needs regardless of staff and patient fluctuations. In addition to its ability to address all present and future needs, the selection group cited ShiftSelect’s simplicity of use as well as its short implementation and training cycle.
Implementation and rollout
In January 2010, a senior operations team was presented with the recommendation plan that included projected goal achievements and ROI of the new automated scheduling system. This plan took into account the simultaneous evaluation and multi-year implementation of a separate time and attendance system, which would ultimately be integrated with the workforce-management solution.
API Healthcare’s client services executive (CSE) made three trips to CHOA to facilitate the implementation and rollout of the automated system. In the first visit, the CSE worked with CHOA’s application administrator to customize the staffing system departmental profiles. This was accomplished with crucial input from nurse managers and schedulers. It was in this session that skill sets were developed for each department/unit.
It was determined that a four-phase rollout divided into six-week intervals would prove to be the most efficient model. Phase one included Respiratory, Radiology, Emergency Services, Trauma Services, Immediate Care and the Call Center. Phase two included Surgical, Nursing and Rehabilitative Services, Cath Lab, Transport, Transfer Center and ECMO. Phase three included Laboratory Services, Occupational Health, Patient Access and Patient Accounting. Phase four included satellites and clinics.
Shifting the staffing culture
The vendor-deployed trainer joined the project manager for the two remaining visits, which were geared to staff training based out of CHOA’s two largest hospital campuses. The weeklong schedules were comprised of three-hour sessions. Each session was devoted to the staff of a particular service line (Inpatient Nursing, Emergency Services, etc.) across all three hospitals.
The initial staff training was facilitated with just the use of a tip sheet (later updated to computer-based training) due to the Web-based systems simplicity and intuitive nature. In contrast, the legacy computer-based staffing system had taken two eight-hour days per group for training sessions.
Each staff nurse creates a profile containing his or her personal information and competencies via a customized template within the Web-based system. After manager review and approval, nurses can then request any open shift for which they are qualified by securely logging into the system from any computer with Internet access. Once minimum scheduling commitments have been fulfilled by each nurse, they are free to request any shift within the enterprise that matches their qualifications.
The training was structured to produce standardized scheduling practices so that every department across all campuses used the system in the same way. Primary phase implementation involved 2,000 employees, with to-date use of the automated staffing solution at 3,000, or approximately 48 percent of the entire hourly staff.
A primary challenge of the rollout involved the differing levels of computer knowledge across departments. Those departments that were transitioning from a paper-based system were slow to fully adopt the system and routinely reverted to posting paper schedules in the early days of the automated system’s use.
API Healthcare’s strategic consulting assisted CHOA leaders with the rollout of effective change management strategies to ensure user adoption. While changing the culture took some time, everyone is now comfortable with the system’s functionality. The vendor has been instrumental in making regular system updates (based on staff input) a simple and efficient process.
Assessing the results
One of the main goals set forth in 2010 was to save $1 million dollars on labor-associated costs, which CHOA dramatically exceeded by saving more than $2 million dollars between October 2009 and October 2011. This figure included contract labor, overtime, incentive pay and the discontinuation of the use of an agency nursing pool.
The breakdown included a 31 percent decrease in premium pay per patient day, 7.6 percent decrease in overtime per patient day and a 47 percent decrease in total incentive expenditures. Between pre-implementation in 2009 through October 2011, CHOA achieved a 31 percent decrease in premium pay (equivalent to $2.5 million dollars), reduced overtime by 33 percent and achieved a total ROI of 800 percent.
In the year since the system has been in place, the most obvious gains have been through monetary and time savings. In the past, CHOA nurse managers made hundreds of phone calls to complete the scheduling process. The Web-based system has significantly reduced that number via its bidding process and automated confirmation capability. The automated staffing system has also significantly increased cross-campus and intra-departmental staff floating. A committed hours report generated by the system now allows managers to follow up and resolve all minimum commitments with each nurse.
Moving forward
After initial implementation, CHOA now provides refresher sessions to accommodate the system’s frequent upgrades. A primary future goal is to work with API Healthcare to implement a cross-system interface to fully integrate the new time and attendance system.
Ultimately, every automated system in a hospital must serve its users efficiently and simply to be effective. To ensure these most basic of tenets, hospitals must look at each department’s individual needs when evaluating and choosing an automated scheduling system. The right system will acknowledge and accommodate individual departmental processes while still facilitating enterprise uniformity. Accomplishing both will enable significant monetary, time, efficiency and clinical gains.
About the author
Joyce Ramsey-Coleman is chief nurse executive at Children’s Healthcare of Atlanta. For more on API Healthcare, click here.
