“We were using a completely manual process based around sign-up sheets,” says Dave Walczak, CIO of the two-facility, 335-bed system. “You could imagine the different issues we had with a paper-based system. It was really limited as to the number of individuals who were exposed to the available shifts.”
There was no easy way to communicate opportunities about open shifts to clinicians in different departments at Bayhealth's two facilities, Kent General Hospital (Dover) and Milford Memorial Hospital (Milford, Del.). As a result, says Walczak, the hospital was forced to use overtime and pay contract workers.
“It definitely created a financial strain,” he says, explaining that the decision to deploy an electronic system was motivated both by budget concerns and a desire to make the environment more convenient.
Bayhealth's experience is not uncommon. A large number of hospitals have found that adopting Web-based, self-service scheduling systems with interfacing capabilities can result in significant cost and time savings, more effective workflow processes, and increased satisfaction among clinicians.
Facilities are also finding that scheduling solutions can extend beyond the nursing department by integrating with business management and billing applications to create more centralized systems. With this centralization comes a capability for functions like trend reporting and analytics tools that are changing the face of staff planning at Wellmont Health System, a 13-facility network based in Kingsport, Tenn.
Wellmont is in the process of deploying a module-based labor force management system from Chelmsford, Mass.-based Kronos across its enterprise. The system delivers an integrated approach to staffing, scheduling, time and labor that can improve productivity by enabling managers to access employees' certifications, skills, salary and availability without having to go back and forth between systems.
According to CIO Bill Moran, Wellmont is utilizing three modules from the Kronos suite focused on time and attendance, leave and management, and analytics. The former two have already yielded positive results, he says. “We found that people in the OR were spending upwards of 25 to 30 hours building schedules each week. We're talking about reducing that clinician's time down to maybe two to three hours.”The latter module enables Wellmont to run trending reports by using data from patient census, which is imported into the Kronos scheduler every two hours to allow each unit to either increase or decrease staff accordingly, Moran says. Census integrates with the core system, San Francisco-based McKesson's Star, to determine the number of nurses needed in various departments at certain times based on trends and historical data. Using that information, managers can staff to meet fluctuating demands.
“With this system, we're able to run customized reports that allow us to trend things. Because they use a real-time system, we can get data up-to-the-minute and can run daily staffing and productivity reports specific to each unit,” Moran says. This functionality also provides managers and directors with an accurate picture of how staffs are working.
Bayhealth currently utilizes a system in which employees create profiles using their information that are then validated by the nurse managers. However, the IT staff is looking at a more efficient model where managers would be able to download employee information from the human resource management system from St. Paul, Minn.-based Lawson.
According to Bayhealth IT Analyst Rose Williams, “If we can more easily access that demographic information, the managers won't have to manually go through the profiles.”
A solution that is also integrated, rather than just interface-friendly, can clinch the deal for a CIO. That's especially true at a system like Wellmont, which includes 12 facilities and houses more than 200 applications.
“We spend a lot of time building HL7 interfaces back and forth to communicate,” says Moran. “If I can find an application that's integrated in multiple module features in a centralized environment, that's going to make a big difference.”
Expanding beyond nursing
Once a system has demonstrated success in one department, the natural next step is to expand into other areas. At Bayhealth, there are plans to expand the Concerro staffing solution that is currently being used by nurses in the intensive care units and emergency department to patient care rehabilitation and respiratory therapy, which according to Williams, will be the first non-nursing department to go live with the system.
“Eventually we will be able to roll it out to our diagnostic imaging and lab departments,” she says. “It has a lot of capability for integration with other systems.”
Concerro is currently interfaced to work with the Ansos One-Staff management solution from McKesson. After clinicians have bid on and been awarded shifts, the schedule is downloaded from Concerro into One-Staff, the core system, which then imports that information into the timekeeping system from Kronos.“We're doing another interface of putting the core schedules into Concerro,” says Williams. “Right now, employees can see their calendar, but all they can see are their awarded shifts. We're going to give them the extra capability so it makes it easier for them to see both of their schedules at once.” It will also mean that managers who are awarding shifts for a particular week won't be forced to switch back and forth between systems.
But while navigation among different applications can function fairly well in some facilities, it can create problems in others. At the University of Texas M.D. Anderson Cancer Center in Houston, the scheduling systems must accommodate the needs of 2,700 nurses and administrative personnel, a fact that presented the IT staff with a significant challenge.In order to facilitate coordination among the three systems used at the Cancer Center — human resource software from Redwood Shores, Calif.-based Oracle's PeopleSoft enterprise application, Kronos' time and attendance system, and Ansos One-Staff from McKesson — the IT staff deployed Automate, an integration solution from Network Automation of Los Angeles. Automate works to orchestrate the three systems, keeping them updated and synchronized to ensure optimal staffing levels, working as a “traffic cop” to enable a more efficient workflow.
Although the system is mostly confined to the nursing department at this point, M.D. Anderson CIO Lynn Vogel, M.D., can see the possibility of it expanding.
“This was a solution that met a particular need,” Vogel says of Automate, which was implemented prior to this tenure. However, “Over time, as we evolve as an organization, we begin to look at broader, more enterprise-wide solutions. Organizations like ours become much more integrated and things that two years ago were thought to be self-sufficient, we discover need to be much more integrated with everything else.”
What Vogel has found is individual departments are realizing that connecting and collaborating with other areas is essential, and that, “They have to work in conjunction with the enterprise-wide architecture,” even with solutions like staffing and scheduling.
“I think this application is an excellent example of the fact that, while this may have been a niche application three or four years ago, it was an excellent response to a very well-identified but probably fairly localized need,” he says.
And as many CIOs have found, localized needs are often best solved with centralized solutions. According to Moran, “One thing I noticed from an IT shop is when you do have a centralized system, it allows you to reduce the cost of contract labor and overtime over a period of time.”
Staffing and Scheduling: What CIOs Need to Know
Keeping the wheels on patient throughput
“We highlighted nursing overall in our report because there's a lot going on with very complex nursing workflow. We have a group of professionals who are one of the largest components of one of your largest budget programs — labor. They're in short supply, their workflow is complex, and we know for sure that they're absolutely critical to keeping the wheels on patient throughput and patient quality in hospital settings. We know all that. And we know that IT can do things to help this.
“The first thing you want to do is to understand the satisfaction realities of your current staff. That always starts with having the right staffing. The organization tension is between having plenty of nurses and the budget. The first thing that'll kill you in the budget is if you're using a lot of overtime and a lot of agency nurses that you didn't budget for. So this comes right back to when you want to release the pressure valve, when you want to attend to nursing needs and make their workflow more efficient. The first thing you need to do is have the organization correctly staffed for the way you operate today.”
The role of self-scheduling systems
“These systems are a good way, an important way, and even an essential way of doing that. Your ability to do that and the satisfaction of your nurses can be enabled by self-service scheduling and by the process whereby if you have a shortage, you can go out and canvas people based on their preferences — who might be interested in working, who might be interested in getting overtime or more days, that type of thing.
“It's a modern approach to accommodating the needs for adequate and best staffing and the needs to adhere to a budget. Multiple systems exist that have demonstrated very nice, pretty quick ROI and make people happy. They're part of a strategy that says, ‘We must attend to the opportunities for IT to aid nursing — nursing productivity, nursing retention, nursing satisfaction, nursing quality, and clinical outcomes.’ It's so basic; you have to have the right staff, you have to try to stay within budget, and you want to give your workforce, to the maximum degree you can, the kind of working hours and environments that they prefer.”
“Your success with these applications is not as simple as, ‘We saved some money,’ it's that, ‘We really used it to every degree we can to manage the workforce and make the workforce happy.’ Because oftentimes they find these applications will end up extending past nursing to other professional scheduling.
“You don't want to box yourself into thinking that you're only buying a nursing solution.”