Effective Productivity Management: Tools and Techniques for Managing Your FTEs

Michelle Niermann, Vice President, OperationsPeg Bradke, Director, Heart Center

Bonnie Carpenter, Coordinator, Clinical StaffingSt. Luke’s Hospital – Cedar Rapids

Iowa Health SystemLeadership Symposium

April 19, 2011

Productivity Management at St. Luke’s Hospital

• Early 2000s– Use of Hours per Patient Day (HPPD) as Productivity Measure for

Inpatient Nursing Units– Participation in Iowa Health System’s Lane Benchmarking Effort

• Mid 2000s– Period of Solid Revenue Growth and Solid Operating Margins– Bi-Weekly Productivity Reports Include Focus on Worked FTEs

and Worked Hours per Unit of Service

Productivity Management at St. Luke’s Hospital• 2007

– Softening of Operating Margin; Heightened Attention on Productivity

• Decision Not to Focus on External Benchmarking but Rather Daily Management of Staffing

• Recognition of Staffing as One of a Few “Big Q” Processes

Year Net Revenue FTEs % Change % Change

2005 $210,744 1821

2006 $234,045 1944 11.1% 6.8%

2007 $238,283 2041 1.8% 5.0%

2008 $262,677 2047 10.2% 0.3%

2009 $279,889 1988 6.6% -2.9%

2010 $295,864 2005 5.7% 0.9%

Productivity Management at St. Luke’s Hospital• 2008

– Intensive Focus on In-Quality Staffing– Greater Use of Existing Bi-Weekly Productivity Reporting– Greater Use of Worked Hours per Unit of Service to Develop FTE

Budgets• 2009-2010

– Continued Refinement of In-Quality Staffing– Investment in One Staff as a Productivity Management Tool– Introduction of Productivity Coaches

3.80

4.00

4.20

4.40

4.60

4.80

5.00

Jan-07Mar-07May-07Jul-07Sep-07Nov-07Jan-08Mar-08May-08Jul-08Sep-08Nov-08Jan-09Mar-09May-09Jul-09Sep-09Nov-09Jan-10Mar-10May-10Jul-10Sep-10Nov-10Jan-11

CMI Adj. FTEs/AOB2007-2011

Actual

Budget

Productivity Management: The Visual History

My understanding of the productivity statistic “CMI-Adjusted FTEs per AOB” is:a) Crystal clearb) Fairly solidc) A little hazyd) I’m sorry, what was that you said?

Productivity Pulse Question

Productivity Management: The Visual History

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Biweekly FTE Variances - 2007-2011

FT

Es

Productivity Management: The Visual History

2005 2006 2007 2008 2009 20100.0%

1.0%

2.0%

3.0%

4.0%

5.0%

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7.0%

% OT to Worked Hours % Extra Hours to Worked Hours% Orientation to Worked Hours

Patient Care Division Improvements

Productivity Management at St. Luke’s Hospital

• The Team– Peg Bradke, Director, Heart Center– Bonnie Carpenter, Coordinator, Clinical Staffing– Mary Hagen, Administrative Director, Organizational

Effectiveness– Jenn Eubanks, Senior Decision Support Analyst– Scott Kallemeyn, Director Business Operations, Surgical Services– Leigh Christensen, Administrative Fellow

10

In-Quality StaffingPeg Bradke

Director, Heart Center

Kick off March 4 2008Goal: To adjust staffing and demand

scheduling toward 95% In-Quality Staffing, using Rapid Cycle Testing.

In your environment, what would you rank as the chief factor negatively impacting your productivity?a) Overtimeb) End of Shift Overagec) Volume Fluctuations. d) Inappropriate Matching of Worked Hours to

Volumese) Not Sure

Productivity Pulse Question

St. Luke’s Cedar Rapids Summation

100-Day In-Quality-Staffing“95% In Quality Staffing”

Kick-off: 30-day check-in: May 60-day check-in: Deferred due to flood 90-day check-in: August – Summation Year End

SMJC – IQS 0307-13 © 2005 Chip Caldwell & Associates, LLC. All Rights Reserved.

In Quality Staffing Analysis

4

9

14

19

24

29

UOS

& St

affin

g

2.5

2.7

2.9

3.1

3.3

3.5

3.7

3.9

4.1

UOS/

FTE/

Hr

Out of Quality

Out of Quality

95% In Quality Range

14

30 Day Goals of Report Out

1. Describing rapid cycle test(s) related to staffing you had completed pre-flood and how you're doing holding any successes you had

2. Describing rapid cycle test(s) related to staffing you still plan to pursue

3. Describing any staffing innovations you tried out of necessity during the flood that you may look to continue

4. Describing your 1-2 best waste / cost reduction ideas implemented or planned

1. Describe your departmental IQS staffing results from the latest collection period (Nov. 9-22) and plans for sustaining or improving In-Quality staffing levels into 2009. Report 5-7 minutes.

2. Address any sustained results from your earlier staffing adjustments made either prior to or during the flood, or due to previous rapid cycle tests

3. Repeated Hourly data collection for departments with greater than 20 FTE

100 Day Report Out IQS Objectives

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3 West – May 2008

3 West - December 2008

In Quality Staffing My Department

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5

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7-8 8-9 9-10 10-11 11-N N-1 1-2 2-3 3-4 4-5 5-6 6-7 7-8 8-9 9-10 10-11 11-M M-1 1-2 2-3 3-4 4-5 5-6 6-7

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ff/V

olum

e

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Pts.

Per

Sta

ff

Wtd Pts Staff ADT Volume Pts/Staff/Hr U-IQS Range Lower IQS Range

2008 Themes and Next Steps

• Themes– Reducing Overtime– Reducing End of shift overage– Reducing Extra Hour Incentive– Monitor Non productive time

• Next Steps– Carry forward improved performance results in 2009 Budget

Development– Repeat Hourly monitor for pp2 2009– Emphasis on daily entries in Kronos

January 2009 Report out Results• Developed a new tool for daily monitoring• Set up system to assure correct time schedules were

in Kronos so OT and worked hours would be calculated appropriately

January 2009 Report out ResultsNew Tool for Daily Monitoring

Daily In-Quality Worksheet Calculator

Pay PeriodUnit

Units of Service (e.g. # visits, procedures, contact

hours, OR minutes)Worked Hours

Wkd Hrs/Unit of Service Met Target Y/N

Sunday #DIV/0!Monday #DIV/0!Tuesday #DIV/0!

Wednesday #DIV/0!Thursday #DIV/0!Friday #DIV/0!

Saturday #DIV/0!Sunday #DIV/0!

Monday #DIV/0!Tuesday #DIV/0!

Wednesday #DIV/0!Thursday #DIV/0!Friday #DIV/0!

Saturday #DIV/0!Totals 0 0 #DIV/0!

Units of Service Works Hours Wkd Hrs / UOSYTD ACTUAL 2009

BUDGET 2009YTD 2008YTD 2007YTD 2006

Orientation Hrs. Educ. Hrs. Mtg Hrs. Call Hrs. OT Hrs. % OT/wk hrs Ex Hr. % Ex. Hrs./wk hrs. PL Hrs.

2009200820072006

Comments

2009 Themes and Next Steps

• Themes– Introduces new actions plans related to bedside

report and cross training. – Using PA to address OT issues

• Results / Next Steps– Year ended strong– Start of 2010 started out poor– Set up March 2010 report out

2010 Report Outs

• March- New form, using One Staff to assist • August - Set new plan to concentrate and

report outs from departments running less than 95% productivity.

• November – Started coaching for departments at less that 95% productivity

3C2010 Budgeted HPPD: 11.1

753612.2

1811.713.7

1506411.5

9853

1678112.412

HPPD OT Hrs Extra Incentive HrsPay Period 22Pay Period 23Pay Period 24Pay Period 25

YTD

Comment on your 2010 productivity performance and any action you took to improve that performance:Orientation is running 1 FTE higher than budgeted due to vacancy and orientation to the new aquaphoresis technology. This all happened in the 2nd quarter and 3C has not been able to balance that out. If that out of the ordinary orientation is taken out 3C would be at 11.8 for the year.

PP 24 was seeing improvements. PP 25 43% of the time 3C was at a census of 14 or below. At that level for safe census and coverage of telemetry monitors the unit cannot be within productivity levels and this negatively impacted the pp.

Describe your productivity action plan for 2011:Will continue working with Director re: coaching on productivity. Meeting with Peg Bradke 12/16 for increased productivity education. Education done with unit Secretary on importance of early morning payroll input for monitoring with OneStaff. Work with staff 1:1 with end of shift outliers & early punch ins. Use adaptive design observations for end of shift monitoring. Encourage alternatives to 1:1 if an option

St. Luke’s CR—OnestaffBonnie Carpenter

Coordinator, Clinical Staffing

How we are using Onestaff to Monitor Productivity

How frequently does your department receive productivity reports/ data?a) Greater than once/ dayb) Dailyc) Weeklyd) Every payperiode) Monthly

Productivity Pulse Question

Ramping it up in 2010

Creating a Culture Change—Moving toward Prospective Productivity Reporting

Using our IHS affiliation to look for Best Practices—and borrowing shamelessly…

• Use OneStaff to create a Productivity Report for every shift.

• Generate a weekly Productivity Report every Monday to give Managers an idea of how they are doing midway through the payperiod.

• Provide coaching to those who need it.

What is OneStaff?

• It’s owned and operating at every IHS affiliate hospital

• Employee Database• Scheduling• Daily Staffing• Reporting• Productivity

Kronos

InfiniumCare Cast

At the Core---

The Interfaces

OneStaff---how it works…..

• The Department’s budgets and schedules are entered into Onestaff.

• OneStaff interfaces with CareCast to bring in the census.

• Based on the census and the staffing data that comes from the unit’s schedule, OneStaff can predict if staffing will be within budget on a given shift.

• Interfaces with Kronos to bring in the actual hours worked.

Set up For Productivity Reports

Elements required:– Budgeted FTE’s– Orientation FTE’s– Nonproductive Factor– Account for Other Nonproductive hours– Budgeted Units of Service

Diagnosing the Problems—the 5C Story

• Off to a bad start—87% productivity in week one.

• Coaching• Using OneStaff to

diagnose staffing issues• Creating a correction

plan

5 Center Productivity 2011

50%

55%

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85%

90%

95%

100%

105%

110%

115%

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Goal

Productivity

Attending to the little things—the 4W Story

4 West Productivity 2011

70.0%

75.0%

80.0%

85.0%

90.0%

95.0%

100.0%

105.0%

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Goal

Productivity to Target OS

What is happening in Respiratory Therapy????

Resp Therapy Productivity

50.0%

60.0%

70.0%

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110.0%

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ProductivityGoal

Productivity toTarget OS

Accounting for all their activity….

• Pulmonary Function Lab—52hrs/wk• Crit Care and NICU Competencies• Unit’s Education, i.e. STEPPS• ICU and NICU Multidisciplinary Rounds—24

hours/ week

• These activities had to be built into the 2011 budget—3.6 FTE’s

Future Goals

• More departments will monitor productivity in OneStaff

• Implement Web Reporting in 2011• EPIC interfaces will bring in workload data for

both nursing and ancillaries.• Affiliates will continue to cooperate,

standardize Units of Service, and potentially benchmark against each other

Key Themes – For Departments

• Monitor staffing real time and calculate HPPD or Worked Hours per Unit of Service on a daily basis. Develop action plan for flexing staff concurrently if volumes rapidly decline.

• The schedule should match the budget • Differentiate your schedule from your day to day staffing • Engage staff in the discussion of productivity targets• Address general overtime utilization and end of shift overtime • Revise Orientation/Learning methods • Look for ways to utilize cross training • Assure schedule options in Kronos are appropriate for the clock in and

clock out times. • Share best practices and compare interventions across departments

Key Themes – For Organizations

• Strengthen the Core Team / Administrative Focus• Ongoing Use of In-Quality Staffing Report-Outs• Increasing Use of One Staff as a Productivity Management

Tool• Productivity Coaches• Frequent Reporting

– One Staff Daily, Weekly and Bi-Weekly Productivity Reports– Bi-Weekly Productivity Report Produced by Finance– Inpatient Nursing Unit Trend Report, also now Produced by

Finance– Monthly CMI-Adjusted FTEs per AOB

• Top-Down FTE Budgeting / Tie to Daily Staffing

Next Steps for Productivity Management at St. Luke’s Hospital

• Continued use of the In-Quality Staffing approach and of productivity coaches

• More fully deployed use of master staffing plans and grids for all unit-of-service-driven departments

• Broader use of One Staff within St. Luke’s and, with Iowa Health System support, expanded capabilities of the One Staff system– Web Reporting– Epic Interface

• Productivity benchmarking in select departments, preferably starting within the Iowa Health System, facilitated by standard unit of service definitions (Finance Departments) and expectations for dialogue at the affinity group level (Chief Operating Officers)