5 characteristics of an effective open shift management strategy

Filling open shifts can be a hectic, emotional, and financially challenging process for provider organizations. The practice of doing so can vary by department, as can the incentives offered for picking up open shifts.

The result can be a chaotic, inefficient, and last-minute process that pits units against one another to compete for resources instead of the organization working together in a coordinated effort to meet demand.

Through successful practice, we have found that an open shift methodology that adheres to the following five criteria is successful at filling open shifts in a fair, efficient, cost-effective, proactive, and standardized manner.

Open shift programs should:

1. Meet patient demand with an enterprise staffing mentality
2. Entice proactive behavior to solidify staffing well in advance
3. Reward staff in a fair and consistent manner
4. Provide real-time, continual awareness and promotion of needs across the organization
5. Offer regulated and budgeted use of incentive dollars

Meet patient demand with an enterprise staffing mentality
Staffing needs for an organization are most efficiently tackled at the enterprise level. At its most effective, an open shift program is administered centrally, with staff picking up shifts based on forecasted need for areas they are competent to work, not necessarily a specific unit. When done in this manner, staff are assigned the day of the shift to the area of greatest need. A centrally administered program that accounts for needs at the enterprise level gives managers a degree of separation from recruitment, resulting in time back to focus on core responsibilities.

Entice proactive behavior to solidify staffing well in advance
An effective design of an open shift program rewards staff for picking up shifts further in advance, creating a disincentive to wait until the last minute hoping the amount of pay might increase. By promoting the behaviors you want, more shifts are picked up sooner, solidifying staffing plans further in advance.

Reward staff in a fair and consistent manner
The lack of fairness (or perceived lack of fairness) in open shift programs can have a negative impact both on adoption of the program as well as morale in general. Many effective open shift programs are structured to reward seniority or staff who are capable of working on a greater number of departments, but the protocols for this structure should be well communicated and automated whenever possible to discourage any semblance of favoritism.

Provide real-time, continual awareness and promotion of needs across the organization
Staffing needs change as volume projections rise and fall and more shifts become available or are picked up. Incentives and available shifts should fluctuate in real-time based on the very latest data relative to projected volumes and available staff. Qualified staff members should have an accurate view of all available shifts and incentives at any given instance in time to be able to plan their lives around their commitments to providing care.

Offer regulated and budgeted use of incentive dollars
Managers should resist offering one-off bonuses or special enticers, such as gift cards tucked away in their desk drawer. Incentives should be aligned with your budgeted bonus targets and offered through an automated and emotionally agnostic manner. Meaning, the dollar amount of incentives should not be set by the manager working to fill the shift. Instead, the incentive amount should align with a budget that corresponds to the severity of the need, with the highest incentive offered in advance, ideally two weeks to 30 days.

At the University of Kansas Hospital, an open shift program based on these five criteria has resulted in a 65% reduction of last-minute work requests as well as a 63% decrease in core staff floating.

Open shift is just one method of many to get contingency resources to work a shift. The organization should be concerned with making sure they have appropriate utilization of their contingency resources, while understanding if the tool/method of open shift is allowing those resources to be automatically scheduled. If more hours are necessary from certain groups, additional adjustments to incentives or the timing of when certain groups of staff have access to the shifts can be considered.

Like any initiative in healthcare, the implementation of any single strategy is not a silver bullet. It takes a disciplined, coordinated, and strategic approach to workforce management that enables certain strategies to bear fruit.

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