Improving Staffing Effectiveness in a Complex Union Environment

Cambridge Health Alliance

As healthcare organizations grapple with increasing costs and dwindling resources, it’s more important than ever to find ways to enhance workforce productivity, reduce labor costs, and ensure patient care is safe and effective. At Cambridge Health Alliance (CHA), we faced all these pressures with an added twist: 16 unions and six different payroll runs. This environment made it exceptionally challenging to manage staffing issues and protect our organization’s financial health.

We needed a way to better align labor expenses to patient care needs and ensure staffing was in sync with demand across our three hospitals and 16 off-site clinics. And we needed to do it in a complex union environment.

Automated, Accessible Data

McKesson’s workforce management solutions gave us tools to help us address our challenge. Our scheduling is now accessible by everyone in a single database. By having accurate, actionable data, we can deploy the right number of people, in the right places, with the right skills, at the right times. Here are some specific ways the technology has helped us meet our biggest challenges.

Staffing to Patient Volume

The system enables us to provide staffing and scheduling consistency, as well as to align staffing with patient demand. Previously, our nursing units tended to staff to bed capacity. Now, we can easily compare targeted staffing to actual staffing, and budget staff according to the census on each unit on each shift. In our staffing offices, paper is “out” in favor of a single, electronic staffing dashboard that clearly identifies where people are working, who can float and where supplemental staff is needed.

Controlling Overtime Costs

Like many other hospitals, CHA’s overtime costs were well over budget. Given the specific overtime allowances in our union contracts, there is only so much we can control. With our staffing management system, we can:

• Flag premium shifts for first cancellation
• Identify incidental overtime
• Distinguish between short-notice and scheduled overtime
• Allocate overtime to the appropriate cost center for labor distribution
• Track overtime patterns by employee, day and shift

Managing Union Contracts

Because no two of our union contracts are alike, they are incredibly complex to manage. The system enabled us to hard-wire pay rules for each contract into the system. Having the system apply the rules removes the guesswork in applying shift differential, overtime pay and other policies for each contract. Our time and attendance tool enables CHA to properly adhere to each contract’s pay rules in a consistent and measurable manner. In addition, electronic tracking makes it easy for us to monitor whether per-diem staff is meeting the monthly commitment, and we can flag tardiness and incremental overtime. Attendance data is readily available for our annual reviews.

Internal and External Reporting

Our staffing tools enable us to know where we stand in respect to budget on a timely basis. This has helped us transform our budgeting process. We can correct variances shift by shift; identify vacant hours, turnover and HPPD by skill; check licensure and certification status; and see census and fluctuation patterns in real time.

Our external reporting is simpler and more accurate as well. We voluntarily report our staffing plans to the Massachusetts Hospital Association for public posting. If The Joint Commission shows up, we can quickly assemble staffing data on sentinel event alerts and other directives.

Managing Non-Productive Costs and Supplemental Staff

Employee attendance was always cumbersome to monitor, but now we can track and trend data such as three sick calls in three months, bereavement leave, family sick time and chronic tardiness. Issues are identified and addressed promptly.

Where it was once difficult to schedule and account for supplementary staff hours, we track usage easily and charge cost centers appropriately. Our temporary staff (30 RN travelers) that floats among all three facilities soon will benefit from swiping in and out – a big improvement over the previous practice where hours were reported manually on paper. And we can keep tabs on termination reasons to avoid re-engaging a traveler who may not have been a good fit.

More Productivity, Less Paperwork

Staffing is still the largest part of CHA’s operating budget, and careful management is crucial. Automating staff management has empowered us to do more with less. By applying proactive management and visibility into our true staffing needs, based on census and staffing matrices of care, we’re better able to reduce costs and improve operational efficiency. In addition, we can effectively manage complex staffing and workforce issues in a union environment. Now management can focus on productivity, not paperwork. And our staff can focus on patient care.

Gitta Gilyan has been working in the healthcare industry since 1985, with 25+ years of experience in patient care, including budgeting, staffing and overall financial modeling. As the Senior Director for Patient Care Finance at CHA, she has deployed and managed staffing solutions for five years. Prior to her experience with CHA, she has successfully implemented staffing solutions at two other Boston-area facilities and has spoken at numerous conferences. Gitta holds an MBA in Finance from NYU and a Bachelor’s Degree in Economics from Harvard.