• Staffing and Scheduling: Easing the Management Burden

    Jackie Larson and Rhonda Kowalowski Jan 31, 2013

    As a New York hospital learned, reducing the amount of time that unit/department managers spend on staffing and scheduling frees these experienced caregivers to engage staff and interact with patients.


    Unit/department managers at Champlain Valley Physicians Hospital (CVPH) in Plattsburgh, N.Y., used to spend an inordinate amount of time dealing with scheduling and staffing issues. This is a common and frustrating problem for hospital managers. In fact, staffing tasks—such as developing schedules, struggling with paper processes like paid time off (PTO), tracking licensure and credentialing details, complying with union regulations, or trying to recruit staff to fill open shifts—can occupy 50 percent or more of a manager’s time, according to anecdotal reports.

    In 2010, the 381-bed CVPH moved to a centralized approach to staffing and scheduling for nursing and other departments, such as pharmacy and respiratory therapy. It also replaced manual and, at times, paper-based processes with automated scheduling solutions. A time study of inpatient nursing units revealed a return of 7 hours of work per manager for every pay period. Managers have been able to redirect their time from scheduling activities to patient care and staff mentoring. 

    Establishing a Centralized Staffing Office

    One challenge many healthcare organizations struggle with is a silo approach to labor management, which usually involves a director or manager controlling the unit’s scheduling, deployment, and administrative duties. At first glance, allowing managers to administer those functions may seem like a good idea because they are familiar with the work performed and the skills of staff members on each shift. However, in the end, managers find themselves spending too much time planning and handling day-of-shift chaos that results from last-minute call-ins or scheduling errors.

    In addition, the silo approach to labor management can result in overstaffed units sending staff home while similar units run short on staff and  need to use overtime or bring in more expensive, last-minute sources of external staffing. The end result is excessive overtime and the use of temporary employees because the system is unable to effectively coordinate resources.

    By centralizing resource management, deployment, and alignment strategies at the enterprise level, organizations can leverage economies of scale and use real-time coordination of staffing to use on-hand resources effectively. This concept is not reserved solely for large, multi-site organizations. Economies of scale increase the larger the organization is, but stand-alone organizations, like CVPH, have seen tremendous benefits from the coordination of resources, the consistent and fair application of policies, and efficient deployment of contingency staff.

    CVPH’s resource management center is a 24/7 operation that balances schedules, ensures staff are scheduled to their FTE, proactively identifies upcoming gaps in the schedule, and handles administrative duties previously carried out on the unit. The resource management center works directly with the clinical decision makers (typically the house supervisors), providing them with the most up-to-date understanding of the entire staffing picture.

    Seeing the Real-Time Impact of Scheduling Decisions 

    Many of CVPH’s staffing efficiencies are the result of the hospital’s scheduling software. CVPH’s staff resources can be viewed in real-time across the organization so managers can make quick and accurate decisions without having to consult different systems, spreadsheets, or scheduling data. For example, the following illustration shows the impact of staffing decisions in both dollars and hours.

    Staffing and Schedule Exhibit 1

    The scheduling software allows CVPH staff members to submit scheduling and time-off requests electronically. Once a staff member submits a request, a manager is sent a notification that automatically shows the impact the request will have on staffing.

    As soon as the request is approved, the schedule is updated as shown in the following illustration.

    Schedule and Staffing Exhibit 2

    Notifications are sent to staff members. In addition, the changes are transmitted to CVPH’s time-and-attendance system, eliminating the need for double entry of information and diminishing the likelihood of data entry errors.

    CVPH also made sure that its scheduling software would integrate with existing systems, such as the organization’s time-and-attendance software and systems that track:

    • Licensures and certifications
    • Float profiles for approved scheduling outside of core work units
    • Turns for staff members to float off the unit or have a shift cancelled
    • Seniority dates

    Ensuring integration with other systems in the organization eliminates the need for paper-based workarounds. 

    Automating Open Shift Management

    An open shift management protocol should be configurable to allow for an almost limitless number of rules and protocols, such as those governing:

    • Hour thresholds
    • Target percentages of staff
    • Incentive ranges
    • Hour lockouts before the start of the shift
    • Hours to be scheduled before incentives begin
    • Manager override limits

    For example, CVPH required customization of its open shift management to accommodate its business and union rules.

    At CVPH, once a cyclic schedule is copied and pushed forward for future shifts its staff members are able to self-schedule and use the automated system to fill holes in the schedule and meet their FTE requirements. Following this, the system uses a seniority-based, equitable process of filling the remaining shifts.


    Implementing an Enterprise Strategy

    The success CVPH has experienced is a direct result of its effort to transform its culture, as well as adopt new processes and technologies. The path to transformational change, like CVPH experienced, is a succession of small steps, with three major components:

    • Selecting the right executive sponsor
    • Understanding the organization’s current state
    • Getting buy-in from key contributors, influencers, and decision makers

    Change is difficult for any organization, and it is impossible for organizations that do not want to change and don’t see the value. This need for change is what must be communicated effectively. CVPH was successful in its transition to an enterprise staffing model because its leadership and staff alike understood that their previous approach to managing labor resources was not effective, resulted in too many errors, and was not sustainable given the changes that the healthcare industry was and is facing.

    CVPH’s enterprise model for automated staffing delivered enormous returns both in dollars and in managers’ time. The staffing software created a framework for repeatable outcomes that are in line with CVPH’s goals and provide managers with the time to focus on their responsibilities to their patients and staff.

    Jackie Larson is senior vice president of client services, Avantas, Omaha, Neb. (JLarson@eavantas.com).

    Rhonda Kowalowski is supervisor, patient services, Champlain Valley Physicians Hospital, Plattsburgh, N.Y. (RKowalowski@cvph.org).