Vol. 4 Issue 11
Experts laud the benefits of computerized scheduling and are hard-pressed to think of drawbacks
It seems that just about everything is automated these days. You want to listen to songs from several CDs without having to select them each time? Easy, just hit "shuffle" on your multi-CD player. How about a mocha cappuccino with light sugar? On some coffee machines now, all you have to do is press two buttons, and your steaming brew awaits. You want to watch a favorite movie scene without having to fast-forward to get to it? No problem, just put on your DVD and click through the selections to see Luke Skywalker take on Darth Vader in the climactic light saber duel.
But such automation does not affect only pop culture. In health care, one of the latest trends is computerized staffing and scheduling. An anomaly as recently as a few years ago, such staffing systems have become increasingly prevalent, to the point that there are few facilities that aren't at least investigating the possibility. The greatest reason? Convenience.
Better Than Manually
"Computerized scheduling is critically important to us and is certainly better than doing it by hand," said Sally Millar, MBA, RN, director of patient care services information systems at Massachusetts General Hospital, Boston. "I used to be a nurse manager and I know that creating a 6-week schedule would take me 3 full days for a unit with 70 nurses. Nurse managers can now do that same kind of work in about 8 hours."
The current computerized scheduling system has been in place at Mass General since 1998. Originally implemented only for the department of nursing, the system is now also used for physical therapy, occupational therapy and respiratory therapy services.
"The goal is to have it in place throughout patient care services, which includes nursing and the health professions, for a total of about 4,000 users," Millar said.
Prior to selecting a software product, Mass General put together a document listing functions the system must have, functions that were desirable and functions that would be nice but weren't top priority.
"Some of the areas of concern included security, overall functionality, data file structure symbols, coverage, shifts, employee preferences, scheduling, reports and interfaces," Millar recalled.
In the must-have category, functions included network capability, ease of use, ability to support centralized and decentralized staff scheduling, as well as self-scheduling or manager scheduling, and the capability for multiple users to access the system simultaneously.
Today, 4 years after implementation, Millar is pleased with the system's overall functionality.
"The interesting thing about this application is that both Mass General and Brigham & Women's Hospital use it. And both institutions do scheduling very differently. At Brigham & Women's, the nursing staff are unionized, so there were very specific union contract rules that they had to abide by in their scheduling. And this product was able to accommodate that. And 180 degrees away from that is Mass General, where scheduling is very decentralized and, with each unit being unique, models staffing based on its own needs. We highly prize our flexible scheduling, and this product was able to do that as well."
Millar provided an example about how different units at Mass General use the program successfully.
"It's able to work in both our OR and our ED. Our OR has 270 on staff. And we're able to do scheduling there with multiple start times and shift lengths and different schedule permutations. And then we have a very small 15-person dialysis unit that the application works in too."
While Mass General has found the right software for its needs, officials at other facilities say they're still shopping around, looking for the right fit.
The Greater Baltimore Medical Center (GBMC) is in the process of selecting software to implement for its computerized staffing system. On the cusp of making a selection, the medical center has conducted an intensive search for the past several months, explained Ann Creech, MS, RN, specialistinformatics.
"January 23 was the date I received approval from administration," Creech noted. "So that's when I really got this project going. The first step was to determine about 10 leaders in the marketplace for staffing and scheduling systems, and to do that we conducted searches on the Internet, gathered information and made calls to area sites to determine what systems they were using. Then we selected seven vendors to actually take through the selection process."
Structure and Organization
To provide structure and organization for the selection process, GBMC developed a decision-point document, a series of four steps of analysis for each company. The first step was to look at the vendor's functional, technical and strategic objectives to determine if they met GBMC's objectives. Second, the facility defined key functionality and benchmarked each vendor to determine if the cost was justifiable versus functionality for each software product. The third step was to find out if the vendor's product fit with GBMC's defined strategic information system plan, philosophy and guiding principles. Finally, GBMC looked at whether the vendor was financially viable. Any vendors who made it through all four decision points were invited to the facility for a software demonstration.
As it happened, two vendors were eliminated on step one, another two fell out of the running at decision point two, and none were eliminated at decision points three or four, leaving three vendors who came to the facility for on-site demonstrations.
To determine the organization's objectives in regard to decision point one, Creech interviewed a select group of about 12 people in the hospital who set up the staffing and scheduling on a manual basis.
"We don't have a current computerized system," she noted. "So it's not like we're moving from one system to another. We do it all manually and we have a central staffing office."
Creech prepared a detailed report about what GBMC wanted in a computerized system, what kind of technical and hardware capabilities it expected the vendor to have, as well as what it was prepared to pay for the new system. Creech also gave vendors background information about the hospital, its size and number of employees so vendors could get a feel for GBMC, its staff and future needs.
"There were a couple vendors who eliminated themselves at that point either because they had never done the interfacing we needed or because they looked at [our proposal] and didn't feel it was a good fit for them."
Cost vs. Functionality
For decision point two, cost versus functionality, Creech produced a grid detailing the functionality requirements and gave each vendor 10 points if it could provide a certain function, 0 points if it couldn't and 5 points if it could provide the function but it would require customization of the product.
"So I had a decent process to figure out how they compared against each other functionality-wise, and then I put the cost for each one on the grid and came up with a formula to do a fair comparison for each vendor."
Following this decision point, two of the vendors clearly lagged behind.
The third decision point, determining whether the vendor system solution fit with GBMC's defined strategic information system plan, philosophy and guiding principles, consisted of a few specific questions that each vendor had to satisfactorily answer. For example, it was part of the philosophy and principle of GBMC that it would not serve as a beta-testing site for a product that still needed to have the kinks worked out of it.
All three remaining candidates passed through this point, leaving only decision point four before the demonstration stage began.
"Point four was 'Is the vendor financially viable?' We were basically asking how healthy their company was, to make sure they'd be there down the road if there was a problem with the system. And for that, we asked them for their revenue for the last 3 years and how many customers they have, and we also asked for references and things like that."
All three remaining candidates then progressed to the demonstration stage, and Creech developed scripts that aligned exactly with the functionality requirements. For example, the script would say, "Nurse A works on this unit and has this type of schedule, can you show me how to schedule her using your program?"
"So the vendors were required to come in and go through the scripts, which included all the different issues that I knew based on my interviews with the staff who actually did the scheduling."
One of the demonstrations took place at the end of March and the other two in April.
"All three were within a span of about a couple weeks – we tried to keep them as close as possible," Creech said.
The vendors were graded based on their demonstrations of the scripts, and the next step will be to work out any unsolved customization or cost issues. Then GBMC will pick a vendor and begin contract negotiations.
"We hope to make a decision by the end of May and start our contract negotiations in June so that we can have all of nursing operating under the system by the fall," Creech said.
Well Worth It
If the comments of others are any indication, the intensive process will have been well worth it once the system goes live.
Like Millar, Donna Padgette, MSN, RN, program nurse specialist at the Medical University of South Carolina (MUSC), Charleston, lauded the benefits of computerized scheduling when she spoke to ADVANCE, and struggled to think of any drawbacks. MUSC proved itself far ahead of the national curve by implementing its system in 1989. Today about 1,800 nurses and other staff at the facility are scheduled using the automated system.
"Just from my own personal experience of having had to do manual schedules, I can't imagine there would be anything that would outweigh the benefits of having an automated system," Pad.gette commented. "And I can't really say there are any drawbacks to this system. The only drawback I can think of is a general one, regarding the transition for clinical staff to utilize information technology to do their job. Some are simply more savvy at it than others and have better access to work on it and develop their own skills. But that's not anything inherently wrong with the system, just a learning curve. You have to look at the overall picture of where we stand with nursing skills and use of computers."
Brian W. Ferrie is associate editor at ADVANCE.