Healthcare systems like to think of themselves as different from other industries, and they are to a certain extent. The service they provide is diagnosis, care, and healing, they provide it 24x7x365, and they can do so in some of the most trying times—think natural disasters and epidemics. Healthcare is different, but a lot of the challenges in healthcare today are mirrored in other industries, i.e., shrinking margins, intense competition, and talent shortages.
It is estimated that between 9 million and 13 million more people will have health coverage through the federal and state insurance exchanges. While hard, reliable figures on the number of uninsured have been hard to pin down, the CDC’s National Health Interview Survey estimated that the number of uninsured has dropped by 2.3 million since 2013. More individuals with access to healthcare is coming at a time when currently 55% of the RN (nursing) workforce is age 50 or older.
So what does an organization do to ensure it has the staff to be prepared to handle increased volumes while working to cut expenses? The answer lies in a mix of strategies, technologies, and change management due diligence.
There is a lot of talk about predictive modeling in healthcare. While most of the buzz is related to population health, predicting disease, and foreseeing the likelihood of readmissions, these applications are still in their infancy. The ability to predict patient volumes, however, is going on its second decade. Predicting future volumes relies on a number of inputs, including CDC and Google flu data, historical volume levels, and number of customized variables and input on anticipated events at the local level. This data is fed into a modeling engine and forecasts are generated. This data is essential to accurately solidify hiring targets.
The Right Numbers
Once an organization has developed an accurate volume forecast, it is capable of determining how many staff it actually needs to care for patients. In this process the provider organization must make sure every department has a good mix of middle-career, seasoned professionals, and new grads. Care staff fall into two categories: core or contingency.
Core staff are those who hold an ongoing FTE (full-time equivalency) commitment within a department. As an example, an RN who is full time (1.0 FTE, or 40 hours per week) in the ICU is a core staff member for the ICU.
All hours, other than those worked by core staff members within their FTE, are sources of contingency. This includes those who are in float pools (those who are deployed to work in various departments as need arise), agency and travelers, and core staff working in overtime.
Determining how many of each you need can be achieved with a deep dive into the analytics of the provider organization. For core staff, a fair amount of volume analysis is required to discover the right numbers on a unit-to-unit basis. The point is to hire the number of core staff needed to keep them working to their FTE without the need for excessive floating, overtime, or cancelled shifts.
Finding the right numbers of contingency staff involves an analysis of core staff behaviors and trends (expected and unexpected time off, etc.), historical volume levels and acuity spikes, predicted future volume, staffing levels, payroll, and various HR information.
A Shift In Care
With the transition from volume to value reimbursement models, there has been a corresponding shift from inpatient care to outpatient. Because of this, much more emphasis is being placed on the operational components of medical groups. Many outpatient clinics have traditionally operated under fixed staffing models where the number of staff available to care for patients is based on the number of physicians working. In the most progressive organizations, the switch to variable staffing models has begun. Like the inpatient world, with a variable staffing model the number of staff is based on forecasted patient visits. As the demand on outpatient areas increases organizations may consider transitioning acute care staff to the clinic setting as well as deepening contingency resources so care staff can operate across the enterprise in a number of areas.
The Staying Power Of Satisfaction
Like any organization, healthcare providers want to have low turnover. This is especially the case with the fear of a talent shortage looming and the cost of recruiting and placing open positions, typically estimated between 1.1 to 1.6 times the annual salary for a registered nurse. With “staffing” consistently ranked as one of the top reasons for turnover, it makes sense for organizations to want to right-size staffing sources and develop balanced schedules based on forecasted demand. It is also imperative to implement strategies that reduce staff dissatisfiers, like floating, cancellations, and continual recruitment to pick up more shifts.
About the Author: Jackie Larson is senior vice president at Avantas, a provider of labor management technology, services and strategies for the healthcare industry. At Avantas, Jackie has been the driving force in building out the Avantas client services and consultation teams into a world-class organization providing guidance and support to customers on a wide range of issues including workforce optimization, productivity, labor pool and incentives, system integration, resource management and business analytics.
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