Phase one included Respiratory, Radiology, Emergency Ser- vices, Trauma Services, Immediate Care and the Call Center. Phase two included Surgical, Nursing and Rehabilitative Services, Cath Lab, Transport, Transfer Center and ECMO. Phase three included Laboratory Services, Occupational Health, Patient Access and Patient Accounting. Phase four included satellites and clinics.
Shifting the staffi ng culture The vendor-deployed trainer joined the project manager for the two remaining visits, which were geared to staff train- ing based out of CHOA’s two largest hospital campuses. The weeklong schedules were comprised of three-hour sessions. Each session was devoted to the staff of a particular service line (Inpatient Nursing, Emergency Services, etc.) across all three hospitals.
The initial staff training was facilitated with just the use of a tip sheet (later updated to computer-based training) due to the Web-based systems simplicity and intuitive nature. In contrast, the legacy computer-based staffi ng system had taken two eight-hour days per group for train- ing sessions.
Each staff nurse creates a profi le containing his or her personal information and competencies via a customized template within the Web-based system. After manager re- view and approval, nurses can then request any open shift for which they are qualifi ed by securely logging into the system from any computer with Internet access. Once minimum scheduling commitments have been fulfi lled by each nurse, they are free to request any shift within the enterprise that matches their qualifi cations.
The training was structured to produce standardized scheduling practices so that every department across all campuses used the system in the same way. Primary phase implementation involved 2,000 employees, with to-date use of the automated staffi ng solution at 3,000, or approximately 48 percent of the entire hourly staff.
A primary challenge of the rollout involved the differing levels of computer knowledge across departments. Those departments that were transitioning from a paper-based system were slow to fully adopt the system and routinely reverted to posting paper schedules in the early days of the automated system’s use.
API Healthcare’s strategic consulting assisted CHOA lead- ers with the rollout of effective change management strategies to ensure user adoption. While changing the culture took some time, everyone is now comfortable with the system’s functionality. The vendor has been instrumental in making regular system updates (based on staff input) a simple and effi cient process.
Assessing the results
One of the main goals set forth in 2010 was to save $1 million dollars on labor-associated costs, which CHOA
dramatically exceeded by saving more than $2 million dol- lars between October 2009 and October 2011. This fi gure included contract labor, overtime, incentive pay and the discontinuation of the use of an agency nursing pool. The breakdown included a 31 percent decrease in pre- mium pay per patient day, 7.6 percent decrease in overtime per patient day and a 47 percent decrease in total incentive expenditures. Between pre-implementation in 2009 through October 2011, CHOA achieved a 31 percent decrease in premium pay (equivalent to $2.5 million dollars), reduced overtime by 33 percent and achieved a total ROI of 800 percent.
In the year since the system has been in place, the most obvious gains have been through monetary and time savings. In the past, CHOA nurse managers made hundreds of phone calls to complete the scheduling process. The Web-based system has signifi cantly reduced that number via its bidding process and automated confi rmation capability.
In the year since the system has been in place, the most obvious gains have been through monetary and time savings. In the past, CHOA nurse managers made hundreds of phone calls to complete the scheduling process. The Web-based system has signifi cantly reduced that number via its bidding process and automated confi rmation capability. The auto- mated staffi ng system has also signifi cantly increased cross- campus and intra-departmental staff fl oating. A committed hours report generated by the system now allows managers to follow up and resolve all minimum commitments with each nurse.
Moving forward After initial implementation, CHOA now provides re- fresher sessions to accommodate the system’s frequent up- grades. A primary future goal is to work with API Healthcare to implement a cross-system interface to fully integrate the new time and attendance system. Ultimately, every automated system in a hospital must serve its users effi ciently and simply to be effective. To ensure these most basic of tenets, hospitals must look at each de- partment’s individual needs when evaluating and choosing an automated scheduling system. The right system will acknowl- edge and accommodate individual departmental processes while still facilitating enterprise uniformity. Accomplishing both will enable signifi cant monetary, time, effi ciency and clinical gains.
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