How to make the staff-scheduling nurse a welcome addition to the cost-management team

Caught between rising costs and reduced reimbursement, long-term care facilities must continually find creative ways to reduce costs and increase efficiency. More than half the cost of running a long-term care facility is labor, which is by far the largest controllable cost for institutionally based organizations. Most organizations have mastered the obvious by controlling the costs of food and laundry. Many facilities, however, have not yet mastered the science of labor management.

Healthcare facilities must maintain proper staffing levels 24 hours a day, seven days a week. They must meet federal and state requirements, as well as internal standards for quality of care. Staffing ratios and per-patient-day (PPD) staffing levels, if required, must be continually recalculated. Facilities’ staffing FTE reports, as defined in the Federal Register, must be posted and available to all concerned.

Yet all of this must be accomplished in an environment that is constantly in flux. The realities of nursing shortages, last-minute call-offs, personal time-off requests, vacation schedules, personality conflicts, and more must be considered to create schedules that work for both facilities and employees.

And, as if that weren’t enough, it is vital for facilities to create the least costly schedule that takes all of these variables into consideration.

This seemingly overwhelming task is undertaken in most facilities by a staffing coordinator. Armed with little more than handwritten notes and an Excel spreadsheet, this overtasked, underpaid individual is charged with controlling the largest cost in the organization. Given the monumental challenge he or she faces, this staffing gladiator can be expected to produce a wide range of results—results that are often more closely related to the staffing coordinator’s particular capabilities than to the science of labor management. For many facilities, the bottom-line result is the loss of thousands of dollars monthly.

The question at hand is this: How can labor-management principles and staff-scheduling practices be standardized to facilitate consistent results and maximum savings?

Peeling back the layers of labor management, facilities must focus on several factors. The first step is to remove the facility from a perpetual state of crisis management. Most organizations make their staff-management decisions in retrospect, based on payroll and time-clock reports. Facilities are, all too often, responding to last-minute call-offs and unscheduled leaves, without getting at the root causes of these actions and planning for the future. The money is spent before appropriate staffing decisions can be made. Overtime and the use of temp agencies often substitute for proper position control and hiring practices. Overtime can occur on one unit, while overstaffing occurs on another. Similarly, more costly employees are sometimes used in lieu of less costly ones.

Web-Based Solution

Leading-edge facilities are using new Web-based staff-scheduling tools to standardize labor-management practices and minimize costs. Some of their benefits include standardized staff-scheduling criteria, as well as centralized enterprise-wide reporting and labor-management reporting, enabling prospective management of the key factors that otherwise lead to cost overruns.

The best Web-based products turn the average staffing coordinator into a manager, continually comparing staffing decisions with the budget to avoid cost overruns. PPDs and staffing ratios are instantly recalculated as the schedule is modified moment to moment, day to day. Filling empty slots is expedited with pop-up screens that provide lists of available employees, sorted from least costly to most costly, employees least likely to cause overtime, or other criteria for decision making.

Time and attendance data are recorded as part of the process, providing information that helps avoid continual crisis management. Position-control reports, detailing open employee slots without consideration of vacation and holiday time, are created so that managers can see hiring needs well into the future.

The Web is a perfect medium for this new breed of intelligent cost-cutting application. The Web is cost-effective, offering centralized control on one server across a wide area network, with no need for costly third-party products (such as Citrix) to run more traditional PC applications across the network.

Managers can work from home, viewing up-to-the-minute staffing information at the touch of a button. All that are needed for this are access to the Web, a user ID, and a password.

What to Look for

In Web-based staff-scheduling systems, look for enterprise-wide reporting capabilities with a central database. A central database is essential for reporting across the larger networks often used by multifacility environments. Multiple databases, if used, require merging of decentralized files into one central database for centralized reporting—which means that any network interruption in the middle of the file merge can lead to corrupted, unreliable data.

Other capabilities offered by these companies include fully integrated time and attendance reporting, time-clock interface, use of palm/fingerprint time-reader devices (biometric devices that scan palms or read fingerprints to avoid the problems of lost or forgotten time cards or employees fraudulently punching in for their friends), and a potential interface to payroll accounting. Be aware that many companies will integrate only with their proprietary time-clock solutions; others will allow you to keep existing time clocks, offering significant cost savings in the process. Some organizations offer the added plus of labor-management consulting to help the facility revise policies and procedures relevant to the product.

Costs

Products offered in today’s marketplace vary greatly in capability and cost, with prices ranging from $500 to $30,000. Less expensive solutions generally offer enhanced spreadsheet and basic scheduling capabilities without the benefit of the management reporting necessary to affect the cost savings outlined in this article. Entry level into a system sophisticated enough to create these savings is about $6,000 per facility, plus training and setup. More expensive solutions, starting at $20,000, do not necessarily bring more functionality.

In the end, the slightly more expensive but more sophisticated products are well worth the investment. With significant reductions in payroll, most organizations can recoup their investment within six months to a year. For example, according to Zalman Drew, licensed nursing home administrator of Ocean Healthcare in Lakewood, New Jersey, his organization saved hundreds of overtime hours per pay period within six weeks of installing a particular Web-based system, Intellicost Enterprise Staff Scheduling, in one of its seven facilities. This new system is now being implemented in the organization's remaining homes.

[ Also Available on www.nursinghomesmagazine.com ]