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Staffing and Labor Management

Staffing an ED appropriately and efficiently, ACEP News

Much attention is given to RN and other support staffing in the Emergency Department while neglecting to look at ED provider staffing. This article in ACEP news gives some recommendations for provider staffing that may be the most important driver of patient throughput in your ED.

Emergency department staffing - when is the right time to add provider coverage? Medical Scribes vs. PAs/NPs

This article promotes using scribes as a cost-effective alternative to adding physician, nurse practitioners, or physician assistant staffing in the emergency department.

Implementation of a Hospital-Wide Labor Productivity Monitoring System; a Case Study

This presentation at the SHS Healthcare Systems Process Improvement Conference 2013 describes how UF and Shands launched a major initiative to develop a labor productivity system to right-size the organization and to provide a sustainable tool to department directors helping them manage resources.

Registered nurses' personality traits and work assignments

This presentation at the SHS Healthcare Systems Process Improvement Conference 2013 addresses the unique set of skills, knowledge, and personal attributes for nurses in order to match individual nurses to various nursing roles.

Staffing an ED appropriately and efficiently, ACEP News

Much attention is given to RN and other support staffing in the Emergency Department while neglecting to look at ED provider staffing. This article in ACEP News gives some recommendations for provider staffing that may be the most important driver of patient throughput in your ED.

Emergency department staffing - when is the right time to add provider coverage? Medical scribes vs. PAs/NPs

This article promotes using scribes as a cost-effective alternative to adding physician, nurse practitioners, or physician assistant staffing in the emergency department.

Applying science and strategy to operating room workforce management

This article in Medscape Today describes an approach at Cleveland Clinic to improving management of the operating room workforce. It provides some interesting reference values for average staffing per room, skill mix and in-room staff utilization percentages.

Delivering consistent and lower cost care in the post-acute and long-term care setting

This presentation at the 2013 Healthcare System Process Improvement Conference addresses labor productivity in the post-acute setting. As labor rates continue to rise and represent the highest expense in the post-acute and long term care industries, providers are turning their attention to scheduling solutions that more appropriately align their workforce to patients' need. Traditional industrial engineering tools such as work measurement are leveraged to provide a more accurate definition of cost of care as well as staffing models that closely align labor to patient care demands.

How to conduct the perfect emergency department staffing study

This paper, presented at a previous Society for Health Systems Conference, provides a detailed approach to determining emergency department staffing needs.

Patient experience and physician productivity: Debunking the mythical divide at HealthPartners Clinics 

It is a common presumption that patients satisfaction and physician productivity are somewhat exclusive. This study in the Permanente Journal helps dispel commonly held myths about the exclusivity of productivity and patient satisfaction, suggesting that 1) there are many physicians who excel in both areas simultaneously, and 2) there are different characteristics associated with varying levels of performance.

Application of Lean Six Sigma in healthcare, improvement of nursing shift directors - A graduate-level-directed project experience

In this graduate-level-directed project the workload of nursing shift directors (NSD) has been analyzed. The purpose of this study is to create a baseline metric of the existing process; collect operational data and analyze ways to improve the work efficiency by eliminating the non-value-added tasks from the daily workload; automate some of the tasks performed by NSD; and monitor and provide control methodologies for sustainability.

Surviving the global healthcare perfect storm

The authors describe the application of operational planning and capacity management methods to improve patient care, improve revenue, and lower costs. Article 

Radiation dose optimization for critical organs in interventional radiology 

Yasaman Khodadadegan, an industrial engineering doctoral candidate, at the Arizona State University recently presented her research during the poster competition at the Institute for Operations Research and the Management Sciences (INFORMS) conference in Phoenix. Her presentation on Guided Interventional Radiology received second place. The poster presents a Mixed-Integer formulation which determines the initial geometry and required energy for a procedure with respect to the image quality, while improving computation time and solution quality.

Real-time forecasting of pediatric intensive care unit length of stay using computerized provider orders

Objective: To develop a model to produce real-time, updated forecasts of patients' intensive care unit length of stay using naturally generated provider orders.

Nurse Scheduling: From the Theoretical Modeling to Practical Resolution

In this paper recognized at the SHS 2011 Conference, the authors from the École Polytechnique de Montréal address the difficulty and complexity of nurse scheduling. The authors developed an algorithm to optimize nurse scheduling and also a heuristic model that can be applied without complex computer analysis that results in considerable improvement over the current methodologies. The authors applied the optimization and heuristic models to two different hospitals in Montreal.

8 ways to cut labor costs in your hospital

Summarizes the opinion of Dennis Patterson, chairman of The Collaborative for Healthcare Leadership, on the top ways to cut labor expenses in hospitals.

Case Study on transforming care at the bedside (TCAB), Good Samaritan Hospital

At a recent Premier Breakthroughs Conference and Exhibition, clinical and performance improvement staff at the 370-bed Good Samaritan Hospital in Suffern, New York presented a case study of improvement on a nursing unit using the TCAB model.

Helping a hospital shine

In an article previously published in Industrial Engineer magazine, industrial engineering researchers at Clemson University assisted Cannon Memorial Hospital in Pickens, S.C., in a number of hospital-wide and service specific improvements resulting in increased efficiency.

Patient tracker

A case study of a centralized patient tracking system at Sentara Careplex Hospital in Hampton, Va. The case study shows how Sentara was able to reduce patient registration labor by over 50 percent and save over $300,000 per year.

Patient Transport – One Hospital's Approach to Improve Both Service and Productivity

In this SHS conference presentation the authors provide an analytical framework for addressing patient transport at Christiana Hospital, a large Level I trauma center. The authors describe data collection, analysis, and countermeasures that resulted in a 35 percent increase in productivity and an almost 10% increase in on-time performance. The presentation uses a number of different methods of data presentation that enhanced the analysis.

Improving Quality of Care with Engineered Nursing Ratios

This presentation was developed for the HIMSS Safe Staffing Work Group. The presentation compares mandated staffing ratios to engineered standards, advocating for the latter and shares a high level methodology for establishing standards focusing on the needs of the patient. For more information regarding engineered staffing and mandated ratios, please view the HIMSS/SHS joint white paper, "Position Paper on Mandated Staffing Ratios, August 2005."

The Importance of Communication for Patient Satisfaction

A discussion of survey results regarding communication between providers and the patient. The visit quality as perceived by the patient increases with fewer communications.

Adding Value to the Surgical PAT Process

Using Lean Six Sigma tools, a hospital redesigns its PAT department process so that all charting is completed 72 hours prior to the day of surgery.

Management Engineers

Management Engineering: What is it?

An Introduction to External Funding for Health Care Improvement

Management engineers may need money to implement healthcare improvement. This article outlines several potential funding sources.

Improving Medical Equipment Availability at Barnes-Jewish Hospital

One hospital details improvements to their medical equipment retrieval, cleaning and distribution process.

Recruiting Change: Process and Productivity Improvement in Human Resources

A traditional process improvement methodology leads to changes within a hospital's HR department. Results from time studies, swim lanes, and simulation are used to support the proposed solutions.

Optimizing Caregiver Workflow in a PICU

Physician and Nursing roles and responsibilities within a PICU are redefined using lean tools to decrease LOS while increasing outcomes.

Medication Administration and the Complexity of Nursing Workflow

This article studies the work processes of nurses involved in the administration of medication. The goal is to reduce errors and improve efficiency.

Enhancing Hospital Health Information Management using Industrial Engineering Tools

Lean tools and simulation are used to recommend improvements to HIM operational processes.

Hospitals Need IE Data to Drive Staffing Decisions

Examples are used to detail the need for use of IE methods in the setting of departmental staffing levels

SHS Staffing budgets: It’s not just FTEs

A system for appropriate oversight of budgeted FTE's is discussed.

SHS Simple Queuing Theory Tools You Can Use in Healthcare

Queuing simulation results are applied to healthcare problems.

SHS Attacking Waste and Variation Hospital-Wide: A Comprehensive Lean Sigma Deployment

Improvement projects in surgery, nursing, and the ED are discussed. The process of moving a hospital towards adoption of Lean Six Sigma is also described.

SHS Encouraging Management Engineering in Safety Net Hospitals

Several change management projects are covered in brief, moving rapidly through high-level descriptions of problem / intervention / impact steps.

SHS In the Quest for Performance Excellence: Deployment of Lean Manufacturing Principles in Healthcare Delivery Processes

Three successful lean projects are discussed in detail.  The ED, Radiology, and HR departments all show significant improvement.

SHS Productivity and Quality Indicator Monitoring

A productivity monitoring system is installed and used to manage budget

SHS Finding the Right Improvement Opportunities - BEST Bang for the Buck

A productivity monitoring system is installed and used for each department in the system to measure budget compliance, production efficiency, and patient satisfaction.  Decisions must be made regarding the weighting factors of each input to determine each department's relative score.

SHS Re-positioning Accountability in Labor Management: Success Stories

Implementation of productivity monitoring programs are discussed

SHS StaffingMatrix - A Powerful Tool for Balancing Staffing and Demand

A hospital implements improvements in staffing to hourly changes in RN demand.

SHS Creating a Flexible Position Control Process--Linking Management Engineering and Human Resources

Process improvement within the HR department is shown through this project dealing with RN flex staffing.

SHS Changing Organization Culture through Performance Management

A systemwide linking of departmental performance to manager and employee annual pay is discussed.

SHS Gain Competitive Advantage by Aligning Process Improvement with Hospital Strategy

Changing managerial thought is a process; this presentation demonstrates one way that managers are forced to confront the reality of differing goals/expectations of other managers they must work with.

SHS How to Build a Lean Sensei Army for Continuous Improvement!

What's the benefit of developing a team of lean experts? This presentation proposes an answer.

SHS Design the Greatest Emergency Department - Applying Basic & Advanced Lean Healthcare Tools!

The author facilitates a lean educational journey through an ED.

SHS Weekend Services: The Patient is Here, So Why Aren't We?

A 848-bed hospital is experiencing long LOS and targets ancillary service availability as one potential source of improvement. The project discussed tracks the data, demonstrates immediate results, and suggests future improvements.

SHS Optimizing Cargiver Workflow in a New Pediatric Intensive Care Unit

A lean project generated proposals for rescheduling the providers' workload. During testing of the proposals, daily departmental volume was completed significantly earlier in the day.

SHS Recruiting Change: Process and Productivity Improvement in Human Resources

Improvements within an HR department are proposed and implemented. Results are examined, as well as a simulation of the process.

SHS A World of Innovation: Beyond Productivity at The Ohio State University Medical Center

A system-wide reporting tool for each cost center is developed and implemented. It is adopted as part of the budgeting process.

SHS Henry Ford West Bloomfield Hospital Recruitment Redesign

HR process redesign cuts down the time spent at each process step. Lessons learned, sustainability, and metrics are discussed with the group during this presentation.

SHS Premium Pay - Are You Paying Too Much for Your Labor?

HCA discusses its methodology for monitoring its usage of premium pay to ensure they use as little as possible.



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