In the past ten years, hospitals’ revenue has increased by 50% while their financial return has decreased. That’s because costs have skyrocketed, such as for medication and real estate. The biggest chunk of that, approximately 70% of total, is the cost of personnel. The trick is reducing these costs while increasing the quality of care and employee satisfaction. How? By better planning and duty scheduling.
There are several different reasons for the increase in personnel costs. The first is simply that more people are being deployed: 40% more, as shown by an analysis of financial statements. In addition, personnel have become more expensive, given the trend in collective labor agreements.
There are several different reasons for the increase in personnel costs. The first is simply that more people are being deployed: 40% more, as shown by an analysis of financial statements. In addition, personnel have become more expensive, given the trend in collective labor agreements. And finally, more external employees are being deployed: 5% more when rounded off. The latter has to do with the tight labor market conditions and sick leave.
The main success factors for lower personnel costs and higher quality are better planning and duty scheduling.
The main success factors for lower personnel costs and higher quality are better planning and duty scheduling. Because these are the factors you can control and that have a direct effect. For example, by avoiding having to hire in external help in a panic to cover all duties. Moreover, people experience less work pressure if everything is well planned and their duties are properly scheduled. And that has a positive impact on the quality of care.
In hospitals, personnel and medical specialists often feel that they’re either running or standing still. That can – except for during extreme peaks – be prevented. Better planning lowers the variability of the number of patients and the amount of care they need and makes everything more predictable. Good planning starts with continually matching the demand for care to its supply. You can read more about that in the presentation on integrated capacity management.
Next, you need to organize your processes more logically and efficiently. Now many specialists make their rounds, for example, when it’s most convenient to them and for their own patients only. As a result, rounds are made all day long, and nurses have to spend the whole day keeping records of that, such as filling out forms for hospital discharge. It would help if one specialist were to make the rounds for all patients falling under a certain specialism and to do that at set times. That would enable the nurse to plan his or her own work properly too.
It’s more practical to start planning follow-up care from the point of admission or even during preoperative screening.
Another example of organizing processes more logically has to do with follow-up care. That’s often not addressed until the patient has finished with treatment. It’s more practical to start planning follow-up care from the point of admission or even during preoperative screening. A specialist sets the criteria for discharging the patient, monitors progress, and discusses this with family and other care providers. In this way, the actual organization of the follow-up care will no longer come to the nurses as a surprise on the day itself.
Good duty scheduling starts with the question: how many people do we need? That’s expressed by the nursing work index: the ratio of the number of nurses to the number of occupied beds. This is based on the amount of care the patients need and on the ward or unit. In other words, the index for IC is different than for the pulmonary unit and different at night than during the day. Many hospitals haven’t figured this index out yet, or the index doesn’t match the number of beds. So if a ward has an index of 1:4, for example, and 18 beds, that means there’s always going to be overcapacity or undercapacity. The latter can be resolved through greater flexibility: deploying personnel in multiple wards. Those wards would, however, need to have uniform duty scheduling processes.
The next step is therefore to start by taking careful stock of the duty scheduling process. There’s often a proliferation of expectations and rules, which also vary per unit or ward. Some examples are the number of weeks that personnel can take off in a row, how much in advance they have to ask for time off, to whom they have to submit that request, and how much leeway there is to choose working days and night and weekend duties. After that, you can clearly define the procedural arrangements and the responsibilities and work out a duty scheduling protocol with the people working in that ward or unit. It’s important here that employees really get to have their say about vacation days and which days they prefer working. Everyone will decide together which requests will be honored or not. This way, you can avoid weekly discussions about working Wednesday afternoons.
The flextime office can play a vital role in optimizing your duty scheduling. In many hospitals, the flextime office is relatively reactive. It has a group of nurses, mainly, who are deployed if there’s a gap somewhere. That goes on until the whole group is used up. If the flextime office has a coordinating role, you solve two problems at once. First, you optimize the deployment of personnel across wards and units, such as if someone’s absent or if the nursing work index doesn’t match the number of beds. Second, the flextime office will know much earlier on whether people from its group will need to be deployed. That makes it much easier to plan things and makes it less likely that an external employee will have to be called in.
The rule for all these success factors is that they will only work in practice if you design and implement them with your personnel.
The rule for all these success factors is that they will only work in practice if you design and implement them with your personnel. That also means evaluating on a regular basis and actually doing something with the results of that evaluation. If you make a habit of that, our experience so far is that your cost of external employees will drop by at least 20%. In addition, people will experience less work pressure, and both team stability and employee satisfaction will increase.
You have the most control over planning and duty scheduling. There are also other factors that can affect your costs and that are connected to planning and duty scheduling. The first is absenteeism. You can drive this back with a smart combination of reducing the pressure of work, empowering your personnel, and personal attention. You can read more about this in the presentation From Percentages to People.
Another factor is the tight labor market. Figures show that many healthcare organizations can still push forward by increasing their online visibility and pulling power, through smarter and faster selection processes, and by coming up with more interesting and effective ways to familiarize new personnel with their work. You can read more about how that works in practice in the presentation Towards Less Recruitment in Healthcare.