Position'Control'Management,'Automation'and'Payroll ... · • Best tool to reduce over scheduling fixed by over-staffing, floating or cancelling • Best tool to prevent under-scheduling
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• Key to your leadership• You can’t lead if you can’t take responsibility for actual to
target variances• You can’t manage what you can’t measure • You can’t change what you can’t document• Units, service lines and departments that fail to “know
their numbers” set themselves up for changes and reductions they are helpless to change
Unit DescriptionsWhat kind of unit is your unit & why does it matter?
• Basis for defining your budget FTEs, Key Performance Indicators (KPIs) and ratios • Basis for your unit description, team and workload criteria (LMI, 2018)
• Benchmarking to other similar units gives you data to DEFEND your KPIs to tell your story
Unit Name Workload Indicator Hours Per Unit of ServiceGynecology Census HPPDAnte-partum Census HPPDPost Partum Census HPPDMother Baby Couplets H/Couplet
What is the Budget?Annual plan that establishes revenue & expense relationships• Specifies the workload type demand• Identifies deficit demand • Sets the foundation for the resource management plan
Budget assumptions• Flexible or variable budgeting is the foundation of census driven schedule• Expenses and revenue will remain relative as agreed• Volume is projected for each schedule & staffing response adjusted• Worked hours are determined for each workload unit of service (UOS)
Direct Hours Per Unit of Service (H/UOS): A standard measure that quantifies the direct care worked hours available to each patient by direct caregivers.
Example: Post Partum UnitCalculating Direct H/UOS (HPPD):Census: 20 Post Partum Patients
7 direct staff (6 RNs- includes charge & 1 NA) X 3 shifts = 21 direct staff per day
21 staff X 8 hrs. per shift = 168 worked hrs. ÷ 20 patients = 8.4 Direct Care HPPD
• Consider the model of care delivery impacting the distribution of care hours• Core direct staff• Core indirect staff• Unit description and scope of service considerations• Reconcile the Position Control list to the unit's core schedule• Budget sitter hours and FTEs• Overtime• Outsourced supplemental staffing
• Consistency • Control and management of budget• Diminished legal risk• Reports and analytics for workforce planning• Reduction of risk of missing key positions • Reporting of the positions and vacancies in the organization• Ensures discipline surrounding positions (Lockton, 2015)
• Measure of how efficiently your labor force is utilized• Skill mix, staffing patterns and workload scheduling• Timely and accurate information allows monitoring, maintaining and
adjusting labor resources to achieve optimal efficiency
• Combine core + supplemental (EMO & NP) FTEs to plan required on-call staff, resource pool FTEs or additional unit staff if you are hiring into the FTEs (no more than 50%)
Scheduling to Unit Workload CapacityWhen it’s not the Most Frequent Volume (MFV)
NOT good practice!• Increases use of non-productive (backfill) hours taking you over budget
• Increases worked hours on the unit if staffing overages not caught or if staff refuse to float or go home
• Increases risk for greater turnover because of the frequent staffing changes due to shift cancellations, floating out of the home unit or using benefit time to cover cancellations
Constructing the Schedule1. Begin with staffing and scheduling template2. Schedule policy rules3. Update work agreements & skill mix changes4. Update block, core patterns5. Assign weekends to work & be off in order of6. Schedule preceptors with orientee’s7. Enter FMLA 8. Enter approved requests for time off based on budget 9. Schedule FT, then PT rotating staff in order of DN, DE10. Assign charge nurses and other unique skills to all shifts
Hospital Unit PlanA Variable Staffing Plan exists which does not exceed the budget
Flex when census ↑ or ↓
• A plan exists for managing low census/census fluctuation • The impact of incentives, premium pay, bonuses is demonstrated• A clear plan exists for managing overtime• Advanced planning occurs for seven to ten days • The charge role is clearly defined- responsible for staffing that follows the financial
pathway of the manager and organization• When variations from the plan occurs the leader follows up to understand and
• Review of labor and productivity targets by the manager daily is the most optimal method to allow for daily trending of volume and labor hours
• Daily monitoring encourages the department to respond to changes in the volume/work units on a real time basis to ensure appropriate use of staff
• Educate and coach charge nurses to be part of the solution
• Monitoring by managers & directors each pay period allows unit managers to course-correct for the next pay period with measurable results in the fiscal or monthly reports
References CDC (2015). Worker Illness And Injury Costs U.S. Employers $225.8 Billion Annually. Retrieved from https://www.cdcfoundation.org/pr/2015/worker-illness-and-injury-costs-us-employers-225-billion-annually
Kacik, A. (2019). Operating margins stabilize, but not-for-profit hospitals still vulnerable. Retrieved from https://www.modernhealthcare.com/providers/operating-margins-stabilize-not-profit-hospitals-still-vulnerable
Labor Management Institute, Inc. (2018). PSS Annual Survey of Hours Report (28th ed.). Bloomington, MN.
Labor Management Institute, Inc. (2019) Clinical Staffing and Scheduling Certification. Bloomington, MN.
Liu, L., Lee, S., Chia, P., Chi, S., & Yin, Y. (2012). Exploring the Association Between Nurse Workload and Nurse-Sensitive Patient Safety Outcome Indicators. The Journal of Nursing Research, 20, 300-308.
Lockton, M. (2015). Position Control 101: It helps manage an organization’s structure. Retrieved from https://www.hr.com/en/topleaders/all_articles/position-control-101-it-helps-manage-an-organizati_i8x5ayua.html
Nursing Solutions Inc. (2019). 2019 National Healthcare Retention and RN Staffing Report. Retrieved from http://www.nsinursingsolutions.com/Files/assets/library/retention-institute/2019%20National%20 Health%20Care%20Retention%20Report.pdf
Paulsen, R. (2018.) Taking nurse staffing research to the unit level. Nursing Management, 7, 42-48.
Suby, C. (2010). Controlling Overtime Through Position Control. Healthcare Financial Management Association Healthcare Cost Containment, 4.
US News (2018). How Much Does a Registered Nurse Make? Retrieved from https://money.usnews.com/careers/best-jobs/registered-nurse
Witkoski Stimpfel, A., Lake, E., Barton, S., Chavanu Gorman, K., & Aiken, L. (2013). How Differing Shift Lengths Relate to Quality Outcomes in Pediatrics. Journal of Nursing Administration. 43, 95-100.
Please visit Labor Management Institute at LMInstitute.com or call at 952-746-7610 to obtain information about its educational seminars and certification programs, research and consulting opportunities or contact ChrysMarie Suby to obtain written permission to reference the material in this program at [email protected].