Staff Efficiency – How to do more with less


When times are tough and cutbacks have been implemented, many healthcare agencies find themselves in a position where demand exceeds supply – this is where knowing how to do more with less becomes important.

The best place to start looking for efficiency improvements is at the Front Desk – this is where much of the action is (bookings, cancellations, appointment changes, arrivals, collection of co-pays).

Process simplification and increased efficiency at the Front Desk is likely to give you a good payback. Front desk is the principal link between clinicians and back office staff. If Front Desk does not operate smoothly, the entire Agency suffers.

Fixed Time vs. Floating Time Tasks
The key point to efficiency improvement in an outpatient setting is recognition that a typical workday consists of “fixed time” tasks (e.g. patient encounters, staff meetings) and “floating time” tasks. Clinicians have a higher mix of “fixed time” tasks; others typically have a higher mix of “floating time” tasks.

A happy scenario is where staff fixed time tasks “hold” (i.e. no cancellations, no changes to dates/times) and where there is sufficient time between these tasks for staff to plan, schedule and complete all of their assigned floating time tasks. Unfortunately, this rarely happens.

Scheduling Issues

Let’s take a look at scheduling issues in general with a focus on:

1. Automated resource allocation.
2. Staff micro scheduling.
3. Supervisor oversight for resource leveling and balancing across staff.

Scheduling of fixed-time tasks (outpatient settings, partial day, inpatient settings, and residence/home settings) can be automated by a software system that a) accommodates pre-schedules b) is able to compile workflows and c) has orders management capabilities.

Step One is to pre-schedule staff time to the extent possible.

Here are a few scenarios that demonstrate the need for pre-scheduling:
 
1. I am a scarce resource, I need to be kept busy, and I don’t like to do two one-hour back-to-back group sessions.

   Solution: Set up a pre-schedule.

2. I am a nurse who needs to be present with the MD for ten-minute med-checks, I don’t want to be hanging around the clinic all day when I could do six back-to-back med checks and be done.

   Solution: Pre-schedule across MDs and nurses.

3. I am a physiotherapist, my patient needs to see me and then see an oncologist without incurring long wait times between appointments.

   Solution: Pre-schedule across staff specialties.

4. I am a clinician who spends two days a week at one location and three days at another. Every second Tuesday of each month I attend a credit course at a university. I reserve Friday afternoons for tele-health sessions. 
 
   Solution: Pre-schedule the clinician for seasonal schedules.

Step Two is to be able, as and when there are cancellations, re-schedules, and no-shows, to make adjustments to pre-schedules. You don’t want to go from a free-for-all situation to the other extreme where you have “cast-in-concrete” schedules.

Step Three is to make available to supervisors an Executive Dashboard so that they can level and balance resources across their staff.

This step requires sophisticated scheduling algorithms – for starters you need in-line “best practice” workflows because patient care often requires that a series of tasks be performed, in sequence, by staff with different skill sets.

The situation is complicated in several ways:

1. The sequencing of some tasks can only be determined at ‘run’ time (e.g. we need to see the lab test results before we can determine the next step along a care pathway).
2. Staff who are capable of performing specific tasks are busy, so if the agency is short-staffed, this means inevitable delays between tasks. Supervisory oversight may be able to take care of this.
3. The durations for many tasks cannot be accurately determined in advance.
4. Business rules often require that a ‘linked chain of tasks’ be completed within a set time (e.g. perform physical exam within 72 hours of admission)

As you can see from the above, if we can’t assign timings to tasks yet there are rules that say you must perform a physical examination within 72 hours of arrival time, how do you ensure that “perform physical” will be complete within 72 hours when there are four steps from admission to “perform physical”?

Clearly you must have a logic diagram or workflow depicting the steps from arrival to your 72-hour compliance control point. You could map this up in VISIO, make a copy of your diagram for each patient and then mark up the individual patient copies with a felt pen marker to show progress. This would obviously be very cumbersome if you have 12,000 patients.

Orders Management System

A better solution is to build your workflow in an environment that allows the workflow to be compiled and turned over to an Orders Management System where tasks can be automatically posted to user InTrays for attention and action. If the User Interface lends itself to displaying “fixed” time tasks (e.g. encounters, meetings) in one zone and “floating time” tasks in another zone on the same screen, then users can drag and drop floating-time tasks for performance between fixed-time tasks – this “micro-scheduling” makes a good contribution toward improved time management.

Executive Dashboard – Staff Resource Allocation, Leveling and Balancing

The problem is how to know when a patient pathway is in trouble.

For this, you can set a countdown alarm at your 72-hour compliance control point and anchor this to the “arrival” task. If the software system you are using has the right kind of Executive Dashboard, a supervisor can look at the content of individual User Orders InTrays and see that there is countdown toward a compliance control point (e.g. 72-71-70-. . . .).

It does not take a lot of supervisor time to see that if there are 5 tasks remaining and you have 3 hours remaining to reach the control point on your workflow, you probably are in less trouble on one patient care pathway than if you have 10 tasks and 1 hour remaining on another patient care pathway.
With this type of “at-a-glance” information, the supervisor will reasonably look at a staff member who has, say, 10 tasks, with 4 green alarms showing and one red alarm and offload some or all of the 5 remaining tasks to another staff member.

To close out this white paper, staff resource allocation, leveling and balancing is a complicated and complex business that requires dynamic collaboration between an Orders Management System, staff members and supervisors.

If the only approach you have is to leaf through printed staff schedules looking for empty time slots, you need to look at better options if you want to increase efficiency within your agency.

For more information, call Walter Keirstead at 800.529.5355 or visit our web-site at www.infinityciverex.com.

About kwkeirstead@civerex.com

Management consultant and process control engineer (MSc EE) with a focus on bridging the gap between operations and strategy in critical infrastructure protection, healthcare, connect-the-dots law enforcement investigations, job shop manufacturing and b2b organizations. (C) 2010-2017 Karl Walter Keirstead, P. Eng. All rights reserved. The opinions expressed here are those of the author, and are not connected with Jay-Kell Technologies Inc, Civerex Systems Inc. (Canada), Civerex Systems Inc. (USA) or CvX Productions.
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