Vol. 9 Issue 14
HealthFirst empowers staff by offering unique way to fill shifts
In Florida's competitive labor market, healthcare organizations need creative and reliable solutions to ensure the effective use of existing nursing resources while improving retention and job satisfaction. When faced with an ongoing need to cost-effectively fill open shifts and meet other scheduling challenges, our health system decided to make the best use of our own workforce by implementing an online staffing management program.
Less than a year later, we have reduced the cost of contract labor by $1.56 million, completely automated the process of filling open shifts across the health system and empowered our own nursing resources to help meet the health system's staffing effectiveness goals.
And the nurses are more than happy with the program. Gwen Black, RN, at Palm Bay Community Hospital, loves how the system lets her set her own schedule so she can spend more time with her husband, a firefighter. "I try to work the same schedule he does, so I'm able to pick the shifts that allow me to do that," she said.
Katie Schmidt, BSN, RN, on med/surg oncology at Cape Canaveral Hospital in Cocoa Beach, does not use the system nearly as much as she did when she first started, but she still appreciates its convenience. "I was per diem, so I would float to ICU, telemetry and orthopedics," she said. "I found it very convenient to book my own schedule."
New Approach Needed
Based in Brevard County on Florida's Space Coast, Health First's three not-for-profit hospitals, including Cape Canaveral Hospital, Holmes Regional Medical CenterÊand Palm Bay Community Hospital were concerned with how to better manage the high cost and effectiveness of nursing staff issues. Health First is a leading provider of healthcare services in east central Florida. Our three acute-care hospitals provide a full range of services and employ more than 1,700 registered nurses systemwide.
Like many hospitals, filling open shifts across the health system was managed manually, and our process of posting unit-based lists and making countless daily phone calls to fill vacant shifts was an ongoing, time-consuming challenge for front-line managers. Frequently, Health First was required to rely on contract agency staff to fill vacant shifts. Additionally, there were no rules, standards or consistency across the system regarding our approach to staffing and filling open shifts.
Our nursing and HR leadership learned about a Web-based open shift management technology that we believed could provide the greatest potential to launch an enterprisewide staffing effectiveness strategy and help ensure that every patient received superior care from our own excellent nursing resources. We were excited at the prospect of giving our nurses more control over their own work-life balance, while helping the system meet its staffing needs and putting accountability for filling vacant shifts on the front line.
Additional project goals we identified included the ability to:
- maintain a competitive advantage in the market to prepare for growth;
- ensure a proactive vs. a reactive approach to scheduling;
- reduce contract labor expenses by 20 percent;
- provide flexibility during seasonal census shifts;
- reduce the use of winter bonus and incentive shifts;
- facilitate scheduling flexibility to give staff more choice; and
- improve recruitment and retention initiatives.
In June 2007, Health First implemented an open shift management system. The new technology gives Health First the ability to create a centralized system that identifies open shifts at each hospital and across the enterprise, providing the opportunity for nursing staff to supply the coverage needed to ensure effective staffing levels. Using the Internet from anywhere there is access, nursing staff members can view open shifts at any of the three participating facilities and request to fill any shift for which they are qualified.
Nurse managers post their open shift needs, and per diem nursing associates sign up for shifts to meet their core commitment. Associates who are looking to work extra shifts outside of their core shift commitment also can log onto the site, view openings that match their skills and request the additional shifts they want to work.
The Web-based service is based on individual employee profiles, and the system only shows shifts that employees are qualified to work. Any of our nurses interested in working extra shifts have complete access to all open shifts across the enterprise for which they are qualified, ensuring fairness and consistency in the process compared to our old manual ways.
Launching the New System
The system was internally branded CAREshift to reflect Health First's mission and vision of "changing the health and well-being of the community through compassionate healthcare provided with integrity, accountability, excellence and respect I CARE, every patient, every time." From the beginning, the project was treated as a systemwide initiative. We worked hard to ensure internal support and gain executive sponsorship up front by educating and developing buy-in among all key stakeholders whose support was important to implementation success.
During our initial planning, we chose to implement the technology enterprisewide across all nursing units simultaneously to maximize success. We also included the respiratory therapy department in the initial implementation. Training was provided for all schedulers, and we also trained a super-user at each facility to serve as a point person following the go-live.
Implementation of the new system was very straightforward because the technology is intuitive and easy to learn. Software access is provided via a "Software-as-a-Service" (SaaS) model, where the services vendor manages and hosts the system, and staff access the software remotely via the Internet. Although the system can be tailored to each hospital's unique requirements, there was no hardware to buy or software to maintain. We particularly liked the fact that monthly costs for the SaaS model could be covered out of the operating budget, instead of having to justify a capital expenditure.
No Learning Curve
The nursing staff learned how to use the system by following simple directions posted on each unit, and no formal staff training was required. At Palm Bay Community Hospital, Black confirmed this ease of use.
"There really wasn't any learning curve. My boss just showed me what to do, and the system had been preset for me. Every time, I just click on what level of care I need, whether ICU, med/surg or ED, and the system shows the shifts that need nurses," she explained.
The program shows Black and other users the shifts that are available for the next 2 months or so. "I click whatever days I want to work, and if a unit has open positions for those days, I'll access the system and request a shift."
It takes 1-5 days for a shift request to be approved or denied by a manager. Requestors receive an automated e-mail telling them whether their shift request has been approved.
All three hospitals were active in just 6 weeks, with no information services department involvement. User adoption was fairly rapid, although in the beginning we were over-eager to use the capability and posted too many open shifts. With continued oversight and evaluation, we learned the importance of not posting excessive shifts and removing any extraneous information to communicate an accurate reflection of the organization's needs at any given time.
In the 9 months since implementation, our new approach to staffing has generated a 6.76 percent return on investment through better use of the existing workforce, complete elimination of external contract agency staff, and standardization in how we schedule per diem shifts. In addition, the technology has enhanced the work and personal lives of nursing managers and staff by giving them flexibility and choice in their schedules and removing the chaos previously associated with filling open shifts.
Our health system completely eliminated outside contract labor 100 percent and reduced the use of our internally owned staffing agency by 24 percent, representing a reduction in outside labor costs of $3.12 million. Open shifts were covered by internal staff at regular pay, resulting in an annual net savings of $1.56 million in agency premium pay.
The health system eliminated the need to invoke mandatory overtime during the busy winter season.
Holmes Regional Medical Center opened a 22-bed overflow unit and completely staffed the new area without hiring from the outside. In the first 9 months, Holmes awarded more than 37,800 shifts internally.
Nurses like the flexibility and choice more than 2,200 RNs and nursing support personnel have logged in to the system, and more than 73 percent have requested shifts.
The system also has helped break down staffing barriers and fostered a collaborative approach to staffing across the health system. Within a few weeks after implementation, employees were using the system to voluntarily explore working in non-home units.
The ability to share the existing workforce across the entire system helps ensure we retain nurses seeking to work second jobs within our own health system. Statistics demonstrate powerful self-directed floating at work: 46 percent of shifts awarded to date were to non-home unit RNs. Prior to the use of CAREshift, there was a very low incidence of voluntary floating.
Challenges & Considerations
Facilities interested in implementing an open shift management program must consider several factors.
They need to invest time upfront to devise a solid strategy and plan. The project should be treated as a strategic initiative rather than a project. Before starting the implementation process, the organization should have accurate baseline staffing data.
All stakeholders from staff to managers should be involved from the beginning of the initiative to ensure staff and department manager acceptance and corporate sponsorship. Strong leadership, consistency and accountability are keys to success.
The project should have strong internal "champions" and an external vendor guide to facilitate the implementation.
Continued program evaluation and oversight are essential for long-term success. To further streamline the process, the technology should be interfaced with the core scheduling system.
Not Just Nursing
Our new staffing approach has been expanded to help with open shift fulfillment for radiology, laboratory, environmental services, hospice, and the HMO call center, with no additional costs involved for expanded use.
The use of an electronic system to fill open shifts has been a major driver in helping Health First improve the efficient allocation of its workforce, improve nurse satisfaction, and significantly reduce labor costs.
Jan McCoy is vice president, patient care services and chief nursing officer at Cape Canaveral Hospital, Cocoa Beach; Bonnie Rudolph is vice president of patient care services and chief nursing officer at Holmes Regional Medical Center, Melbourne; and Karie Ryan is director of clinical nursing at Palm Bay Community Hospital.