Issue June 2004
VOL. 53, NO. 6, pp. 19, 42-45.
|"Web-based staff scheduling
/ training" by Stan Rosen
How to make the staff-scheduling
nurse a welcome
addition to the cost-management team
|What to Look for
to make the staff-scheduling nurse a welcome addition
|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
|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.
|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
|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
|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.
|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