right-sizing your access calculator
TRANSCRIPT
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
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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
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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