right-sizing your access calculator

Right-sizing your Access team using the NAHAM FTE

CalculatorAdrienne Stimson, MPH, CHAM, CHAA, CCRC

Clinic Manager, UVA Health

Presenter: Adrienne Stimson does not have personal or professional financial relationships with a commercial entity producing healthcare goods and/or services.

Disclosure

Learning objective 1:

• Gain an understanding of UVA Health, an academic medical center in central Virginia.

Learning Objectives

Learning objective 2:

• Define right-sizing for your Access Team

Learning Objectives

Learning objective 3:

• Understand the process and tools used for right-sizing the Access team at UVA Health

Learning Objectives

Learning objective 4:

• Use the lessons learned at UVA Health to mitigate right-sizing your Access team

Learning Objectives

This session is designed to assist the learner with the process of right-sizing their Access team using the NAHAM FTE Calculator and other tools.

This right-sizing approach includes:

• Determining your FTE current state • Determining your FTE needs based on the NAHAM FTE Calculator • Gap Analysis • Developing your FTE request/staffing plan• Gaining approval for your FTE request and staffing plan• Implementing, monitoring, and continuously improving your plan

Overview

An Academic Medical CenterMedical Center: 612 licensed beds, Level 1 Trauma Center,

Children’s Hospital with level IV NICU, Adult & Pediatric Transplant Center

More than 1 million outpatient encounters

Providers: 1,044 Attending Physicians 195 UVA Physicians “Best Doctors in America”

2018 812 Residents/Fellows 283 Advanced Practice Providers

$465M Hospital Expansion: Emergency Department capacity increase (59 to

83) Interventional suite expansion (7 new rooms) 84 new private rooms on floors 3, 4, 5 to decant

current semi-private rooms (brings entire hospital from 57% to 75% private rooms)

Floors 6, 7, 8 shelled for future growth

School of Medicine: 21 Clinical and 8 Basic Science Departments 1,078 Total Faculty 156 Medical Students per Class 11 Degree Programs $226M FY19 extramural awards

StructureBoard of Visitors

JJ DavisEVP & Chief

Operating OfficerLiz Magill EVP & Provost

Dr. Craig Kent

EVP of Health Affairs

Wendy Horton

Chief Executive Officer

James RyanPresident

Mission

TO PROVIDE EXCELLENCE, INNOVATION, AND SUPERLATIVE QUALITY IN THE

WITHIN A CULTURE THAT PROMOTES EQUITY, DIVERSITY, AND INCLUSIVENESS.

CARE OFPATIENTS

TRAINING OF HEALTH

PROFESSIONALS

CREATION AND SHARING OF

HEALTH KNOWLEDGE

1

Rankings

Nationally ranked Specialties

High-Performing Hospital Specialties

Nationally ranked Children’s Hospital Specialties

Best Medical Schools:Research, Primary Care

3

68

2016 2017 2018 2019

Patient at the Center

Scheduling/Registration

OutpatientVisit

Diagnostics

Procedure/Therapies

InpatientCare

Surgery

Post-AcuteCare

HomeCare

PATIENT

Education

Research

Corporateservices

Library

Goals

Become the safest place to receive care

Generate biomedical discovery that betters the

human condition

Be the healthiest work environment

Provide exceptional clinical care

Train healthcare providers of the future to work in

multi-disciplinary teams

Ensure value-driven and efficient stewardship

of resources

1

2

3

4

5

6

PATIENT

Values

A S P I R EAccountability Stewardship Professionalism Integrity Respect Excellence

AT UVA HEALTH, WE PUT THE PATIENT AT THE CENTER OF EVERYTHING WE DO. WE ASPIRE TO CREATE A CULTURE OF

TRUST, RESPECT, AND ENGAGEMENT THROUGH OUR VALUES

Components : MEDICAL CENTER

MedicalCenter

School of Medicine

UniversityPhysicians

Group

Claude Moore Health

Sciences Library

School of Nursing

Pod Structure

Staffing Model Project Problem Statement:

Ambulatory Optimization efforts identified a lack of standardization in staffing levels and structure across the ambulatory clinics. This results in an inconsistent clinic experience for patients and team members as well as:

• Decreased patient satisfaction • Decreased team member engagement• Increased voluntary turnover

Staffing Model Project Proposed Solution:

Develop a Staffing Model and Organization Structure that will:• Provide operational consistency • Flexible enough to be customized to meet the needs of a

specialty area• Actively elevates and recognizes the value of our Access

workforce

Staffing Model Project Expected Outcomes:

• More uniform clinic experience for patients and team members

• Increased patient satisfaction• Increased team member engagement• Decreased voluntary turnover• Stabilization of the Access workforce

Access Workforce Development Program

Pre-Work Recruiting On-boarding Performance Management

Coaching and Learning

Succession Planning

Program Plan

Baseline Metrics

Data Collection

Position Descriptions

Pipeline for qualified

applicants

IntentionalHiring

“Back to Basics” program

Program to reduce turnover

Cohorts to develop peer

networks

Competencies Measured and

Evaluated

Quality Control Program

Team Lead position

Certification through NAHAM

Local NAHAM affiliate

Recognition Program

Continuing Education Program

Career Ladder

Toolkit for Leaders

Float Pool

Staffing Model Project

Our approach:

• Research based • Test of change based on Oncology• Utilize the legacy staffing model • Utilize the National Association for Healthcare Access Management

(NAHAM) FTE Calculator • Compare the predicted FTEs from each model

Staffing Model Project

FTE current state:

• More challenging than anticipatedo Reporting structure o Role delineationo Location of team memberso Organization specific complications

Pod Manager

Supervisor

Location

Clinic/Team

SENIOR

AA

OR

Location

Clinic/Team

Senior

Senior

Senior

Location

Clinic/Team

Senior

AA

Location

Clinic/Team

Senior

Senior

Senior

AA

Supervisor

Location

Clinic/Team

Senior

Senior

Senior

AA

Location

Clinic/Team

Senior

Senior

AA

Supervisor

Location

Clinic/Team

Senior

AA

Location

Clinic/Team

Senior

Location

Clinic/Team

Senior

Senior

Location

Clinic/Team

Senior

Other

Other

Location

Clinic/Team

Senior

AA

Clinic/Team

Senior

Senior

Senior

AA

Location

Supervisor

Clinic/Team

AA

AA

AA

AA

AA

AA

AA

AA

AA

Clinic/Team

Senior

Senior

Senior

Senior

Senior

Senior

Senior

Senior

Supervisor

Clinic/Team

Senior

Senior

Senior

Senior

Senior

Senior

Senior

Senior

Clinic/Team

Senior

Senior

Senior

Senior

Senior

AA

Clinic/Team

Senior

Senior

Senior

OR

Vacancy

ORG CHART

NAHAM FTE Calculator

Live demonstration

https://www.naham.org/mpage/FTE__Calculator

Staffing Model Project

Gap analysis:

• Possible outcomes: o Current staffing = optimal staffing (no action needed)o Current staffing < optimal staffing (create plan to fill the gap such as hiring

additional FTEs)o Current staffing > optimal staffing (create plan to reallocate extra FTEs to

other areas)• Implement targeted plan to meet predicted staffing needs.

Staffing Model Project

Gap analysis:

Location

Completed Visit Volume

FYXX

NAHAM Recommended

FTEs

Current Staffing

FTEsDifference in

FTEsFTEs

requested

Location 1 XXXX 2.85 3 -0.15 0

Location 2 XXXXX 5.03 3 2.03 1

Location 3 XXXXX 8.7 3 5.70 1

Location 4 XXXX 2.35 5 -2.65 0

Location 5 XXXXX 5.26 5 0.26 0

Location 6 XXXXX 6.4 3 4.66 1

Staffing Model Project

Developing your FTE request/staffing plan:

• Project brief format: o Issue/problem statemento Proposed solutiono Expected outcomeso Current state Organizational Structureo Proposed Future State Organizational Structureo Gap Analysis

Staffing Model Project

Gaining approval for your FTE request/staffing plan:

• Must have the trust of senior leaders• Must do the detailed work• Must use the data to tell the story• Must be objective and consistent

Staffing Model Project

Implementing, monitoring and continuously improving your staffing plan:

• Start with an area where the need is great• Allow time for hiring/on-boarding new FTEs• Check in on areas with new FTEs

o What is working well?o Concerns?

• Identify areas that need additional customization

NAHAM FTE Calculator

Inputs

• Based Completed Visits • Identify applicable tasks on NAHAM FTE Calculator • Determine time estimates for applicable tasks (Good, Better, Best provided)• Define productivity assumptions

Erlang Calculator

Additional Factors

Staffing Estimate

• Based on Call volume• Determine call time estimate• Establish Service Level (XX% calls answered in XX seconds)

• Decentralized locations • Supervisors XX% time in Access staffing • Surgery Scheduling adjustments

• NAHAM estimates number of Access FTEs• Erlang Calculator estimates number of Call Center FTEs from the total FTE• Proposed Organization Structure establishes leadership ratios and support

Staffing Model & Organizational Structure

PFA Pod Manager

PFA Pod Supervisor

Access Assoc./Senior

Access Assoc./Senior

Access Assoc./Senior

Team

Access Assoc./Senior

Access Assoc./Senior

Access Assoc./Senior

Team

Access Assoc./Senior

Access Assoc./Senior

Access Assoc./Senior

Team

Access Assoc./Senior

Access Assoc./Senior

Access Assoc./Senior

Team

Access Assoc./Senior

Access Assoc./Senior

Access Assoc./Senior

Team

One Access Associate in each squaddesignated as Epic Super User

Staffing based on:VolumeComplexityNumber of clinic locations

Access Quality Analyst

(Onboarding and Quality)

PFA Referral Coordinator

(ManagesInsurance referrals

for Pod)

• Pod Managers will have a maximum of 5 squads.

• Pods >60 people should include an ProposedAdministrative Assistant

Pod Supervisors will have a target of 15 direct reports.

Dotted line reporting to POD Manager for consistency across service lines

Surgery Schedulers

Organizational Structure

This unit of 5 teams is a squad

Refining FTEs with the Erlang CAverage Handle

TimeTotal time agent is handling call, including talk time, holds, and post call wrap-up time.

Call Center Daily HoursThe Erlang model factors in how many hours a day calls can come in. The calculator we used allowed for calculating either 8- or 10- hour availability. This team is available 9 hours a day, so the best prediction or this team falls somewhere between the 10-hour and 8-hour availability.

• Max FTE: The number of FTEs who should be employed

• Avg FTE: Resulting number of FTEs who will likely be available at any given moment after shrinkage

Target Service LevelStandard industry metric for call centers, utilized extensively in healthcare call centers, which measures the percent of answered calls which are answered within a set number of seconds. For PFA Pods, the benchmark is achieving an 80/20 Service Level, which means "80% of calls that are answered are answered within 20 seconds or less." A stretch goal is to achieve 90% of calls answered within 20 seconds.

Tier 1 Call Support

Staffing Levels Recommended by Erlang Calculator

Average Handle Time

Target Service Level

Call Center Daily Hours

Day of Week (Avg Calls)

Max FTE

Avg FTE

Max FTE

Avg FTEMax FTE

Avg FTEMax FTE

Avg FTE

Monday (657) 14.5 10.8 15.5 12.9 14.5 11 15.5 13.1

Tuesday (601) 13 10.1 14.5 12 13 10.2 14.5 12.3

Wednesday(571) 13 9.7 13 11.5 13 10 14.5 12

Thursday (541) 11.5 9.4 13 11.1 13 9.5 13 11.2

Friday (510) 11.5 8.9 13 10.7 11.5 9 13 10.8

4 Minutes 21 Seconds

80/3080% of calls answered w/in 30 secs

80/2080% of calls answered w/in 20 secs

10 Hrs 8 Hrs 10 Hrs 8 Hrs

Less FTEs More FTEs

More FTEs

Less FTEs

Lessons Learned• Expect resistance • Must have the trust of your senior leaders• Determine a starting point and have the courage to start• Start small then customize as needed• Take time to listen and develop relationships • You can win and woo by showing consistency and

competency over time

What questions do you have?

Thank you to the PFAbulous Implementation Team!

Katie Fellows, PFA DirectorClaire O’Donnell, PFA ManagerKim Burgess, PFA SupervisorJulia Dahl, Project ManagerKatie Pennock, Project ManagerJustina Sutphin, Project Manager Jenn Garfield, Project CoordinatorJessica Rogers, Project CoordinatorPam Trapani, Administrative Specialist