reining in labor costs with predictive analytics march 2, 2016 · 2017-07-20 · reining in labor...

Reining in Labor Costs with Predictive Analytics

March 2, 2016 Tamira Harris, PhD, MBA, MSN

Business Advisor

McKesson Capacity Management

Conflict of Interest Tamira Harris, PhD, MBA, MSN Has no real or apparent conflicts of interest to report.

Agenda • Who We Are • Creating a Data-Driven Culture • Predictive Analytics for Capacity Planning • Outcomes-Based Scorecard • Achievements to Date

Learning Objectives • Evaluate the impact of data-driven decision-making on daily

operations • Demonstrate the value of reliably accurate demand forecasts for

strategic, budgetary and near-term planning • Assess how data transparency can help your organization achieve

sustainable cost reductions and other desired outcomes • Illustrate how demand forecasts can be used to actively engage the

medical staff

http://www.himss.org/ValueSuite

Benefits Realization

• Patient and Staff Satisfaction – Anticipated arrivals, reduced wait times – Predictable schedules

• Treatment/Clinical – Optimal resource allocation – Engaged physician leadership – Decreased care silos

• Electronic Secure Data – Proactive, data-driven behavior – Data leveraged across planning horizons

• Savings – Right-sized capacity – Reduced labor costs – Increased efficiency & productivity

Size and Scale • 4 hospital system with $1.8B in

revenue • Efficient contracts with largest areas

health insurance plans • Alignment strategies with key

physician groups • Non-union

Quality and Specialized Services • Gagnon Cardiovascular Institute • Carol G. Simon Cancer Centers • Goryeb Children’s Hospital • Atlantic Neuroscience Institute • UHC data base participant

Market Leader • Leading market share position, more

than double next nearest competitor • Excellent socio-demographic

characteristics • Currently overseeing 2 ACO‘s

At a Glance • 12,114 employees • 3,168 physicians • 280 medical residents • 1,339 licensed beds • 72,892 admissions • 7,191 births • 19,033 inpatient surgeries • 28,658 same day surgeries • 205,898 emergency visits • 697,416 outpatient visits,833

hospice days

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Atlantic Health System

Atlantic Health System

Vision Empowering our communities to be the healthiest in the nation

Mission • Deliver high quality, safe, affordable

patient care within a healing culture • Educate, in an exemplary manner,

present and future health care professionals

• Innovate through leadership

Shared Values Professionalism, Respect, Involvement, Dignity, Excellence

• Reduce Costs

• Spend less capital on hospital bricks and mortar

• Tightly manage labor costs

• Increase Revenue

• Increase ambulatory presence

• Reduce leakage

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Goal: Cut $70M in Costs Over 3 Years

Overlook Medical Center

• 24,478 admissions

• 5,917 inpatient surgeries

• 9,279 same day surgeries

• 96,612 ED visits

• Fortune 100 Best Place to Work

9

4

U.S. News and World Report

• Best Regional Hospital for Neurology, Neurosurgery, Gastroenterology, GI Surgery, Geriatrics, Gynecology, Nephrology, Pulmonology and Urology

• Neuroscience Institute - Hub for New Jersey Stroke network - treat 40% of state stroke patients

Overlook Strategic Goals Desired End State

Desired Competencies

Proactive/real-time decision-making Improved patient placement Ability to address and monitor

• Service line profitability • Labor analytics

• Improve patient throughput, initially ED

• Match nurse staffing to patient demand

Primary Goals

Organizational Transparency

Enabling Technology

• Self-serve analytics

The Need for Timely, Data-Driven Decisions

Strategic

Budgetary

Scheduling

Operational

3-5 years 1-2 years 1-4 months >30 days - Today What do we need to look like under value-based purchasing?

Where can we find more savings without drastic cuts?

How do we staff for unknown peaks and valleys?

What do we need to do to get these 7 patients out by noon?

What is the next best use for this capacity?

…and without hurting care quality, patient satisfaction or staff satisfaction?

What is the down-stream impact of this OR schedule?

What can we do today to prepare for tomorrow?

How do we optimally deploy our capital and people resources?

Capacity Planning in Healthcare Process by which hospitals can effectively determine the resources (beds and staff) required to meet the forecast patient demand over a given time period.

Review &

Analyze Historical Trends

Forecast Patient

Demand

Schedule Resources

To Meet Demand

Monitor & Measure

Against Plan

Adjust& Refine Plans

Aligning Resources with Predicted Patient Demand • Identify patterns and trends • History based on last 4 years patient

demand, last 2 years staffing • Apply assumptions based on seasonal

changes • Fine-tune timing of demand what

initiatives did we put in place

Demand Forecast

Historical Data

Planning Groups

Statistical Algorithms

Staffing

Productivity Measures / LOS

Manual Adjustments

Executive Hospital Overview

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Proactive Planning & Performance Tracking

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Levers Objective Initiative Measures (KPI's) - Objective Related Baseline 2014 YTD-SEPT- 2015 3 QRT(JAS) Target

Point Person for Initiative Source Report

Increase Inpatient Discharges by 12 pm

14% 0% 0% 14% Directors, Nurse Managers,

Daily Dashboard, Projection Report,

Medicine/ Surgery 4.0 4.0 3.8 4.0Neuro 4.8 4.2 4.0 4.8

Critical Care 5.5 5.2 4.8 5.5

Accelerate inpatient discharge time to facilitate quicker admission from the ED and reduce late afternoon "hold" bottleneck

Transfer admitted ED patients to Inpatient bed

within 1 hour of Disposition1,882 1,092 329 1788

Nursing, Environmental

Services, Patient Access

Average Daily Occupancy, Hourly

Pattern Reports

Utilize McKesson Capacity Planner & McKesson Performance Visibility information to support initiatives to reduce ED Hold time

ED Hold Overlook & Union 61,462 39,093 1,747 58,389 Target for 2015? Terri reports

Nurse managers proactively manage staffing adjustments 72 hours out - evaluate staffing schedules to support peak workload demand

Utilization of Staffing projections

8 Hrs 8 Hrs 36 Hrs 72 Hrs

Staff required vs. actual summary

report; actual versus budget report

Initiative Planning Groups Budget 2014 YTD-SEPT- 2015 3 QRT(JAS) Budget Comments HPPD Chart

Medicine 7.24 7.40 7.48 7.24Surgery 6.90 6.85 6.95 6.90Neuro 7.55 7.45 7.47 7.55Critical Care 16.86 17.55 18.12 16.86Summit ED 2.25 2.13 2.06 2.25Union ED 1.89 1.69 1.62 1.89

Initiative Decrease in Overtime by Planning Groups UTIL 2014 YTD-SEPT- 2015 3 QRT(JAS) Target 2% Less Comments

Medicine $469,226.03 408,381.19$ 351,366.68$ 459,841.51$ Surgery $243,399.53 215,400.07$ 193,399.02$ 238,531.54$ Neuro $175,241.19 151,692.03$ 140,006.81$ 171,736.37$ Critical Care $337,470.87 244,495.33$ 229,539.55$ 330,721.45$ Summit ED $579,553.33 611,613.20$ 551,610.37$ 567,962.26$ Union ED $292,183.24 379,426.66$ 333,536.85$ 286,339.58$

InitiativeDecrease Agency Usage UTIL 2014 YTD-SEPT- 2015 3 QRT(JAS) Target 1% Less Comments

RN FTE's $2,506,458.71 1,179,061.28$ 333,568.26$ 2,481,394.12$ Sitters FTE's $2,651,626.37 1,764,756.03$ 450,269.49$ 2,625,110.11$

Project Scorecard Matrix (QRT 3# JULY, AUGUST, SEPTEMBER)

MA

RG

IN

G

RO

WTH

Q

UA

LITY

Improve patient

throughput

Match Staffing to Demand

Implement robust daily planning & management process including review and enhancement of daily meeting structure and outcomes (Neuro, M/S, CC)

Plus/ Minus 0.3 care hours (ex. Medicine= x HPPD, target x - HPPD) Productivity

Improvement by Planning Group

Decrease Overtime by 2% at each Planning Group

Hours Per Patient Day Chart

Client report on OT trends Productivity

Report per PP

Forecasting center, Resource Planning

Centre weekly agency report PP

Utilization of Planner in ongoing projects to Agency & Sitters(NEURO, CC, M/S, ED)

Utilization of Planner in ongoing projects to decrease LOS (Neuro, CC, M/S)

Case Management, Nursing

Care hours listed is the avg for the planning

groups Allowed to be .30 over budget

Use Baseline 2015

Use Baseline 2015

Historic ALOS Trend Chart

STEPS: Satisfaction

• Staff • Predictable

schedules managed at unit level

• Patients • Arrival and

needs are anticipated

• Patients • Reduced ED

wait times • Hold hours

halved from ~4,800 hours to ~ 2,800 hours per month

“If the staffing is not balanced appropriately, then my staff get pulled to other units, which is always a dissatisfier. Now that we know what type of admissions are arriving and when, we can assign the right staff and prepare for them.”

Anticipating Hourly Admissions and Discharges

Why are we behind on projected discharges? Where are the delays? What can we do?

STEPS: Treatment/Clinical

• Optimal resource allocation

• Standardized staffing model

• Balanced workloads

• Engaged physician leadership

• Decreased care silos

• Cooperation at planning group vs. unit level

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Cooperation at Planning Group Level

Physician Engagement • Monthly Executive Patient

Throughput Team – CMO

– Nurse managers

– Physician over Case Management

– Directors of Neuroscience, Finance, Operations, ED, Special Projects

Capacity Executive Team

STEPS: Electronic Secure Data

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• Proactive, data-driven behavior

• Reliance on single source of truth

• Leveraging data across planning horizons

• “It’s like scarily predictable.” • “I love that all the information

can be gathered in one place.” • “The biggest thing is how

accurate it is and how much you can look at things ahead of time and then make decisions based on that.”

• “It creates transparency … that is the first step in improving processes.”

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Projection Accuracy

Leveraging Data Across Planning Horizons

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STEPS: Savings

• Labor costs • $250,000 in

reduced OT use • Productivity

• .2 day reduction in NHPPD

• Efficiency • .2 day reduction in

LOS (4.4 to 4.2) • Earlier discharges

• Right-sizing capacity • Flexing surgical and

critical care units based on predicted demand @~$3,400 savings/day for $150K+ savings to date

http://www.himss.org/ValueSuite

Benefits Recap • Patient and Staff Satisfaction

– Anticipated arrivals, reduced wait times – Predictable schedules

• Treatment/Clinical – Optimal resource allocation – Engaged physician leadership – Decreased care silos

• Electronic Secure Data – Proactive, data-driven behavior – Data leveraged across planning horizons

• Savings – Right-sized capacity – Reduced labor costs – Increased efficiency & productivity

Questions Tamira Harris, PhD, MBA, MSN Business Advisor McKesson Capacity Management tamira.harris@mckesson.com