LTACHs: The Power To Solve YourStaffingWoesIsAlreadyWithinReach

WilliamReauandNeerajIsaac,Principals,HallmarkHealthcare

Thebusinessmodelofmostlong-termacutecarehospitalsshouldeasestaffing–yet many LTACHs continue to struggle with turnover, employee engagement,overtime, agency use, and more. Only the right modern staffing strategy andfunctionalitycanenablethemtomaximizetheirmarketadvantage.Here’show.

Long-TermAcuteCareHospitals(LTACHs)have a notable (though tightening)advantageovermosthealthcarefacilities.ThetypicalLTACHbusinessmodelshould,underoptimalcircumstances,makeitasnaptomatchstaffing needs to demand and, consequently,increaseprofitability andprovidebetter servicebyensuringtherightworkersareavailableattherighttime.Saythatareferralhospitalcallsandsays,“Ihaveapatientwhoneedsyourservices;canyouadmitthem?” The LTACH can then determine if thepatientisagoodfit.That means LTACHs have foresight into theirfuture patient volume, often days in advance,thatotherhealthcareproviders(likeshort-termacutehospitals)canonlydreamof.Further,ifyourorganizationcanexercisecontrolover admissions times andpatient volume, youalso generally control discharges; altogether,LTACHs should be enjoying near-total controloveryourworkforceneeds.Yetthisrarelyseemstohappen.

In fact,LTACHsoftenfacestaffing issues justasserious as those afflicting other providers andsufferthesamefamiliarconsequences:turnover,overtime,expensiveagencyuse,andmore.Specifically,consequencescanbehighworkforceattrition,lossofconsumerconfidenceandqualityratings, liability issues, costs due to on-jobinjuries and patient accidents caused byoverworked, inappropriate, or poorly trainedstaff. It canalsomeanhigheroperating costs ifschedulingagencynursesorcontractworkersareusedmore,or ifovertime isusedexcessivelytosupplementnormalfull-timestaff.Allofthatcanbeavoidedwithstaffingprotocolsandtechnologythatofferstherightfunctionality;as theAmericanHospitalAssociationsays,“Youcan combine flexible technology with engagedemployees and create thework of the future.”This is one way, according to their “Workforce2015:StrategyTrumpsShortage”report,todealwith tight and problematic staffing. ManualprocessesandExcelspreadsheetscan’tsolvethisproblem.Thispaperwilltellyouwhatcan.

Automate: If LTACHs did nothing other than automatetheirstaffing,they’dstillreapimmediatebenefits.LTACHs don’t have thousands of employees orbeds–asmallersizeisusuallyadefiningfeature–buttheyhavemanydifferenttypesofworkers,including nurses, nursing assistants, therapists,and more; perhaps working across multiplelocations.Allofthoseworkersmakesschedulingcomplex,andtheimmediateandmostimpactfulresultofautomation is reduced time spent preparingmanualschedules.This ispartlywhyclinicalmanagersspendupto70%of their timecopingwith commonstaffingproblems,accordingtoBeckersHospitalReview.Automating that activity has been found togenerate “a time savings of 7-15 hours permanagerperpayperiod.”i

The gains are so dramatic because modernstaffing platforms (unlike Excel or, worse, pen-and-paperschedules)cantrackand intelligentlyincorporate scheduling rules and requirementsnomatterhowextensiveorlabyrinthine.

For example: you might want a nurse with aspecific skill set required by a patient on thatshift, but only if patient acuity matches a pre-determined value, and if that nurse has notworked overtime in the past two weeks.Schedulingrulescanbecomequitecomplex,butan automated staffing platform can tell youexactly who qualifies in just seconds and thenoffersingle-clickadjustmentandapproval.From there, automation underpins anotherpowerfulcapability:predictiveforecasting.With automated schedules that incorporatefuturepatientcensus,youcanaccuratelypredictstaffing needs before you end up paying apremium. For example, if you know next weekyou’re getting 3more patients, then you knowyou’re going to need another staff member inadvance.Sophisticated predictive staffing forecasts havebeen found to be at least 20% more effectivethanjustusinghistoricalaveragesalone.ii

Figure1.Predictiveforecasting--thefuturelaidoutataglance.

Share: Create a common pool of workers that can beeasilysharedbetweenlocationsandfacilities.

Figure2.Thetypicalapproachtostaffinglimitscontroloverovertimeandagencyusage,whilefailingtoguaranteethattherightstaffwillbescheduledattherighttime.

Sonowyouknow,inadvance,howmanypeoplein what roles you will need before you needthem. Inotherwords,automationfreesLTACHsto find the best staffing resources – the rightnumber, the right people – for their needs inupcomingshifts.Butwhatifyourusualstaffareallonovertime,andyouwanttopay$40anhourratherthan$60,asatraditionalapproach(figure2)mightrequire.Easy:drawworkersfromoneormorenearbyfacilities(figure3).Therightsystemcantracktheresourcesavailableto all facilities within a geographic region. Forexample, anymajormetroarea inUSwill likelyhost three or more sister LTACHs; when one’scensus is high and another is low, the systemshould be able to communicate and distributeworkersfromacommonpool.

Figure3.Asmartschedulingplatformconnectingmultiplelocationsmakesmovingstaffassimpleasdataentry.

Withtherighttechnology,staffingmanagerscanloginandseeotherstaffatotherfacilities–andwhetherornotthey’rebeingusedorgoingidle.Theideaisdeceptivelysimple.Organizationslogintotheirstaffingplatformandpullupalistofallemployeeswhomatch theirpatientcensusandacuity needs for the shift under consideration,instead of just the employees who commonlywork at one location. Simple, but it requiresmanagers to base staffing decisions off of real-timedatastoredinareliable,sharedrepository.

Amobileworkforceprogramthatconnectsalllocationscanoptimizestaffproductivity,standardizebestpractices,drivedownlaborcostsand

improverecruitment/retention.

Usingacommonpoolofworkersacrosslocationsdrivesdownlaborcostsandbettermeetspatientneeds. For one thing, it frees LTACHs fromrelianceoneitherovertimeoragencystaffing;infact,itallowsLTACHstoactastheirownagencyby accessing a large, multi-facility pool ofcontingent workers, making it easier to reduceuse of overtime or supplemental workers –

excessuseofwhichincreasespersonnelcostperpatient per day, according to The Journal ofNursingCareQuality.iiiCreating a central staffing repository has anadded benefit: greater transparency andschedulingflexibility.

Open: Make your workforce scheduling system moreflexibleandtransparent.Turnover in health care is at epidemicproportions:40.6%turnoverratesfordirectcareworkers,versus15.7%averageforallindustries;with the ensuing recruitment costs, which theAmericanNursesAssociationestimatestobe1.1to 1.6 times the annual salary for a registerednurse,whichequatesto$60to$90Kpernurse!ivAccordingtoCareerBuilder,nearlyhalf (43%)ofnewhiresareactuallyattractedbytheabilitytowork flexible schedules, which is something agoodworkforcemanagementplatformwillmakepossible.vThis isagenerational trend,so it’s justgoingtogetstronger:accordingtotheAmericanHospitalAssociation, a significant portion of youngerworkers (37% of those under age 50) identify“flexible scheduling”asavery important factor.Two-thirdsindicatedtheyweren’twillingtoworklongerhours,evenformorepay.viEricGilpin,PresidentofCareerBuilderHealthcarenotes,“Incertainareas…demandforhighqualitycandidates is higher than the available supply,forcing health care employers to rethink howtheyretaintopemployeesalongwithattractingnew,highlyqualifiedworkers.”vii

Enterself-scheduling.This may sound like it would complicatescheduling, but this is actually where the realstaffingmagic happens to create a system thatengages and retains workers who want morecontroloverwhereandwhentheywork.Butno,youcan’tuseExceltodothis.Itrequiresa tool that can bridge the gap betweenadministrators and managers setting staffingneeds and rules and staff browsing availableshiftsfromtheirphoneorcomputer.

Figure 4. Facility-specific and organization-wide views ofavailablestaffwhomeetpre-requisitesfortheshift

Benefit:Maximizeyourschedulingsystemwithaprogramdesignthatincorporatesbestpractices.Thestrategicobjectiveofanyschedulingsystemistoprovideeachpatientwiththebestcarebyallocating staff to the right place, at the righttime,everytime.Yourgoalsforitshouldn’tstopthere,however:theaverageLTACH’sschedulingsystem can – and should – do so much more:decrease communication time with staff,removeemploymentdis-satisfiers,cultivateandretain anoutstanding reputation for thebrand,andsoon.To achieve such value-adds requires a programdesignthatmaximizestheschedulingplatform’spotential.1. Start by establishing compensation, work

agreements, marketing, recruitment andon-boarding programs to support eachlocation in attracting and retaining talent.Theseeffortsmayvaryacrosslocations.

2. Standardizeschedulingpracticestomakeiteasiertoutilizeamobileresourcepool.

3. Standardization should be followed bycentralization. Design and implement acentral staffing office to support everylocationandcentrallymanageresources.

4. Further centralize by adopting a smart

scheduling tool – integrated across alllocations – to deploy, share and manageresources.Make sure the tool incorporatesstandardized practices and extends to allemployees,notjustnurses.

5. Finally,customizereportingandanalyticsinthe tool to monitor key performanceindicators, such as labor spend, hours,utilization,openneeds,andfutureresourceplanningacrossallthelocations.

Figure4.Withasmartplatformandtherightprocess,yourschedulingsolutioncangeneratemulti-layeredbenefits.

The Bottom Line: Scheduling health care in the 21stcenturyisallaboutstrategyplustechnology.TheAmericanHospitalAssociationputsitbluntly:“Attempting to make old staffing models workwith fewer staff leads to employee burnout,increasedfrustration,andhighvacancyrates.”Instead, the right staffingplatformandstrategycantransitionyourorganizationfromoldmodelstoanewprotocolthatfreesyoufrommanuallymanagingworkloadandstaffing.Forward-looking tools can give you tomorrow’scapabilitiestoday:automation(toaddfreehoursof time each day); predictive analytics (toproduce more accurate schedules); sharedresources (to reduce or eliminate over-spending); and more flexible scheduling (toattractandretaintoday’sworkers).

AbouttheAuthorsWeareapeople,process,technologyconsultingfirmblendingStrategyandTechnology.Forthepast11yearswehave conductedmore than4000engagements formore than1500 clientsnationwide.Wehelpwithworkforceoptimizationsolutionstoenhanceyourclinicalworkforcestrategyrelatedtorecruitment,deployment,retentionandtechnology.Weunderstandthatamoreengagedandadaptableworkforcetofluctuatewithvolumechanges,theabilitytoautomateyourschedulingprocessandsharingresourcesthroughouttheentiresystemisdesired.Theneed for a larger resource pool, analytic software, real time information and the ability to bettermanage/communicatewithstaffaroundworkforceneedsisparamounttocontinuedsuccess.Hallmarkisheretoassist.Visitwww.hallmarkhealthcareit.com,www.einsteinii.com,oremailinfo@hallmarkhealthcareit.com

WilliamReau,PrincipalandCOO.WilliamistheCOOandPrincipalofthecompany’sLaborProductivityandWorkforceOptimizationpractice.

Neeraj Isaac, Principal and CTO. Neeraj has anextensive background in developing technologysolutionsinbusinessintelligence,analytics,andmore.

PhotobyNECCorporationofAmericawithCreativeCommonslicense

ReferencesiWhite,D.(2015,Jul17).Nurseschedulingproblemssolvedbypredictiveanalytics.BeckersHospitalReview.RetrievedApril2016fromhttp://www.beckershospitalreview.com/workforce-labor-management/nurse-scheduling-problems-solved-by-predictive-analytics.html.iiSchouten,P.(2013,Oct22).“BetterPatientForecastsandScheduleOptimizationImprovePatientCareandCurbStaffingCosts.”BeckersHospitalReview.RetrievedAugust2015fromhttp://www.beckershospitalreview.com/hospital-management-administration/better-patient-forecasts-and-schedule-optimization-improve-patient-care-and-curb-staffing-costs.htmliiiXue,Y.,Chappel,A.R.,Freund,D.A.,Aiken,L.H.&Noyes,K.(2015,Apr-Jun).JournalofNursingCareQuality,30(2):130-137.RetrievedAugust2015fromhttp://journals.lww.com/jncqjournal/pages/articleviewer.aspx?year=2015&issue=04000&article=00007&type=abstract.ivAmericanNursesAssociation.“SafeStaffing.”RetrievedAugust2015fromhttp://www.nursingworld.org/SafeStaffingFactsheet.aspxvLorenz,M.(2015,Jan7).“HigherSalariesAmongHealthCareEmployers’Plansfor2015,AccordingtoCareerBuilder’sNewHealthCareForecast.”CareerBuilder.com.RetrievedAugust2015fromhttp://www.careerbuilder.com/share/aboutus/pressreleasesdetail.aspx?sd=1/7/2015&id=pr861&ed=12/31/2015viAmericanHospitalAssociation.(2010).Workforce2015:Strategytrumpsshortage.RetrievedApril2016fromhttp://www.aha.org/content/00-10/workforce2015report.pdf.viiLorenz,M.(2015,Jan7).“HigherSalariesAmongHealthCareEmployers’Plansfor2015,AccordingtoCareerBuilder’sNewHealthCareForecast.”CareerBuilder.com.RetrievedAugust2015fromhttp://www.careerbuilder.com/share/aboutus/pressreleasesdetail.aspx?sd=1/7/2015&id=pr861&ed=12/31/2015