While the rise of certain technologies like predictive analytics and automated workforce management software can help streamline scheduling and anticipate staff needs, many hospitals and health system administrators continue to struggle with staffing and scheduling issues amid the nation's ongoing clinician shortage.
In a 2016 survey of 85 nurse managers conducted by AMN Healthcare, 94 percent of respondents said understaffing caused by scheduling and staffing issues hurts workforce morale and 90 percent said it makes nurses feel underappreciated. Additionally, nearly 70 percent of nurse managers said they were concerned about the effect of staffing issues on patient satisfaction.
During a Sept. 19 webinar hosted by Becker's Hospital Review and sponsored by GE Healthcare and Intel, William Christy, senior services director of workforce management with GE Healthcare, Jill Larkin, DNP, MBA, RN, senior director of strategic initiatives, and Lorraine Brock, MSN, RN, director of workforce management, both with the UPMC Center for Nursing Excellence in Pittsburgh, discussed how UPMC is evolving from disparate scheduling processes to an automated workforce management approach across their system.
A new solution at a large-scale health system
Pittsburgh-based UPMC boasts more than 30 hospitals, records $14 billion in annual revenue and has approximately 65,000 employees, over 15,000 of which are nurses. UPMC initiated its first go-live for the Centricity ShiftSelect Staff Scheduling solution with four hospitals in January 2016 to begin to address disparate and ineffective scheduling issues driven by outdated methods and technologies. The first four hospitals included UPMC Presbyterian, UPMC Shadyside, UPMC Mercy, and Magee Women’s Hospital of UPMC.
"Our strategic plan was to face the challenges that we had as a large health system," Dr. Larkin said, regarding the implementation of the scheduling system. "We had some users that were still using paper and Excel spreadsheets … and we also had some technology systems that were outdated."
Specifically, UPMC sought to provide standardized practices that allow for individual unit and staff needs, effectively utilize interfaces to improve efficiencies, and provide a means for transparency of staffing needs and schedules. Since the initial implementation, the scheduling system is currently being used in 121 nursing units and inpatient departments by 8,450 employees. UPMC's system-wide rollout of the scheduling solution is ongoing.
A 'great win' for staff satisfaction and a reduction in overtime spend
During the webinar, the presenters acknowledged that with a complex initiative such as this, the outcomes can be influenced by a number of variables in addition to electronic scheduling. However, UPMC feels that, among the three measures, scheduling satisfaction among nurses has been the most positively influenced by electronic scheduling
UPMC participates in the National Database of Nursing Quality Indicators Nurse survey, which is used in more than 2,000 hospitals nationally. UPMC uses the RN Survey with Job Satisfaction Scales and the specific question "how much influence do you have over the hours or schedule that you work" as the data point for pre and post implementation measure. After comparing the results from 2015 to 2016, UPMC found the initial four hospitals increased their scores by a range of 2.27 percent to 6.73 percent at nearly one-year post implementation and all hospital ranked above the national mean for the survey question.
While some may interpret these findings as minor increases, the uptick is significant, according to Ms. Brock.
"For those of you … who work with NDNQI or other similar surveys, you know how difficult it is to increase those numbers especially with an initial roll out to over 4800 users, so we see a 6.3 [percent] increase as a really great win for us," Ms. Brock said.
To further illustrate the influence of the scheduling system on satisfaction, Ms. Brock presented the data for each of the four hospitals, comparing units who use ShiftSelect to those who do not use ShiftSelect. The ShiftSelect units had a greater percentage scoring above the national mean when compared to the units that do not use the scheduling platform. The differences ranged from 33 percent to 62 percent.
To determine the possible influence of the scheduling system on overtime spend, UPMC compared the percent of overtime against the total hours paid in the four UPMC hospitals. In order to assure comparable figures, these percentages were then volume adjusted. All experienced a reduction in percent of overtime compared to total hours paid when volume adjusted, with the reduction being between 0.14 percent and 0.84 percent.
Workforce management a top priority
UPMC is not alone in their focus on staffing and workforce management challenges. During the discussion, Mr. Christy shared the results of a survey of 75 finance executives conducted by Becker's Hospital Review in April. When asked what three organizational financial concerns kept them up at night, 73 percent of finance executives listed managing labor costs among the top three concerns. The second and third most-listed concerns were uncertainty around reimbursements (71 percent) and staying competitive in the markets (61 percent).
"With workforce accounting for the largest portion of operating expenses, it's no surprise that issues around managing staff are keeping healthcare executives awake at night," Mr. Christy said.
To view the webinar, click here.
To view past webinars, click here.
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