I hope that you had the opportunity to look at Rich Daly’s cover story in the October 2019 edition of edition of hfm. Between his review of ideas to control labor costs and my nagging you to consider how your past programs have worked, you have probably read a lot about staffing already. Well, that was just the start.
In his story, Daly mentioned several outstanding ideas for labor cost control — connections to educators (much appreciated by yours truly), retention and automation. But one point made in that article keeps ringing in my head: “Stealth cost” and its tie to process change. Process change seems like a good idea until you implement an idea that worked somewhere else but in your organization creates lost efficiency and turnover. In these areas, it pays to be an innovator or more so, a disruptor – what works for others may not work for you. The organizations, processes, skills of staff and stakeholders all wield different influences on efficiency.
For many years as a CFO, I heard vendors tell me how much labor I could save by implementing their technology solution. When I asked them to show me numbers, all I usually got was a blank stare. Technology seems like a great solution for staffing problems but only if that change is accompanied with a critical evaluation of process.
If work processes are not considered along with the capabilities of technology, then an organization is at great risk to have at least one of two possible bad outcomes:
- An increase in staffing over and above prior levels
- A reduction in measurable levels of quality of care due to errors and staff workarounds
When technology and process are not considered in tandem, I see way too much evidence of bad things happening. Innovative thinking should get us the right connection between the capabilities of our technology and the way things happen in our organization.
Making innovation stick
Consultants can be helpful partners when it comes to process change, but it’s important to look internally first. You need to look critically at your processes from within before you do anything else. You do not need to spend a lot of money to have someone tell you that a process or a step in the process lends nothing to patient care; your staff have probably been saying it for years already. Let staff design the process. More often than not, they can make it better at far less cost with only a little coaching on how to evaluate and document a process. They can probably help you understand how that “cutting-edge” application that some vendor talked you into can yield the promised cost-saving results.
It’s true that when you look at processes and staffing levels, there is a good chance that some FTE could be deemed unnecessary. That’s a risk in this process. But in-house innovation can work well for two reasons. First, many of those FTE inefficiencies are probably going to be in your agency, overtime or pool staffing. It’s not a bad thing to impact average hourly rates by trimming steps in processes and getting more efficient by trimming high-cost FTEs devoted to work that adds no value to patient care. Protect your core staff where possible, and look at how your process calls for premium staffing you don't need.
But then there is the question of what to do when processes are lean and contribute to patient care with minimal wasted effort. Consider looking at the roles people play. We can’t change the essential roles of a nurse or other licensed clinician, but there is likely to be some room for change in the other support staff roles.
Lessons from the airline industry
To frame this idea, I think about all of the times I travel on regional airliners and see the same person check in my luggage, give me a boarding pass, tell jokes at the gate, load my baggage on the airplane and finally drive the truck to push the airplane away from the gate. I had a chance to talk to one of these folks recently and found out that they also work with the airline to do administrative tasks such as calculating weight and balance for the airplane to make sure that the flight will be safe. They also assist the airline dispatchers with filing flight plans. Yes, that is a pretty busy job. But it is one that to me exemplifies staffing innovation. You can take someone with some aptitude with math and basic customer service and with a few weeks of training, make them successful. That agent does not need to know how to calculate airplane weight and balance, they just need to know the important factors in that calculation and convey them to somebody who is trained in that skill.
The airline has looked at the ground procedures for turning a flight around, pulled out the activities that do not add value, and found a way to staff that job with one or two people. If we calculated a cost per passenger on my jam-packed 50-seat jet, we would see a pretty high degree of cost efficiency. The young woman I spoke to a few days ago is an aspiring pilot. So, in this case, the worker has a broad interest in the field and can connect the dots on multiple related tasks to getting that plane in the air. Could you not look at developing similar roles in patient care?
Consider for a moment advancement tracks and academic partnerships. Is there a way to tie in top students with a healthcare interest from your local school and make them the healthcare equivalent to the regional airline ground agent? It also might be attractive to the up-and-coming healthcare employee to get a broader exposure to healthcare skills and build experience that will make that person an even-more valuable team member in the long term. Add on a continued-employment pathway, and maybe you are on to developing a winning innovation to help address that ever-growing labor spend.
There are plenty of similar models that you could imitate to address your particular challenges with labor cost. However, as we try to innovate to address this challenge, let’s focus on some key ideas to make that innovation stick. First, let’s look at processes from a very simple local perspective. Our staff can help us understand what activities contribute – or don’t – to delivering patient care. Activities that do not directly advance patient care should be critically evaluated for elimination. The rest of the work that does add value to patient care should be evaluated to see if there are other ways to staff it at a lower cost. Academic partnerships can be incredibly valuable in helping to move the needle.
I’ll be grateful someday soon knowing that the young lady that used to drive the pushback tugs for the airline I typically fly is now up in front piloting the plane. She’s seen the big picture and knows how to make my trip as safe as possible. Many of us could benefit if our staff had similar experience, couldn’t we?