1. Anderson, Dianne J. RN, MS
  2. Shelton, Wanda MSW, MBA

Article Content

Although the Beth Israel Hospital and The New England Deaconess Hospital were both using the same nursing department scheduling solution when they merged to form Beth Israel Deaconess Medical Center (BIDMC), Boston, Mass., their experiences with the product were vastly different. While one campus was using the system as part of a strategic model for workload measures and management decision-making, the other side of the street simply relied on it for staff scheduling. The presence of the systems inside of both organizations provided a common ground that should've helped expedite the integration of the two separate entities, but an agreement about how best to use the product had to be reached before administrators could move forward.


Steps to success

Fortunately, senior managers from both organizations embraced the product and the decision was made to continue to use it for real-time data collection to support management decisions throughout the medical center. It became our responsibility to ensure that we were collecting management information about what our labor force was doing at all times-for both nursing and nonnursing professionals.


An enterprise-wide upgrade was installed as part of the integration, ultimately providing BIDMC with a fully integrated scheduling and payroll system. However, our task wasn't yet complete. We had to get department managers onboard to champion the product to their units.


With the recent merger, only half of our user base was accustomed to using the product for anything beyond staff scheduling. We had to change that mind-set and help staff understand how thorough and accurate recording of information with this tool could influence management decision-making at all levels of the organization.


Training became a critical tool in the deployment of this solution and was required for staff and management at all levels. The upgrade brought integration to our payroll system so there was something new and different for everyone. The integration with payroll also provided an accountability factor. If users entered information into the system that was incorrect, it would show up in payroll. Managers appreciated that feature and widely supported our ongoing training efforts.


Seeing results

Because of these efforts, we were able to implement a much more consistent use of the system-something that has greatly increased the quality of the data collection. We now have data on every metric we need regarding labor overall: FTE overall, per patient day, overtime, and professional time. Any information we want to track can be captured at a cost-center level. The data can then be rolled up to a high-level management view.


Our financial executives review the management roll-up reports compiled from system data. They want to know about labor cost per patient day, as well as how we use our staff and where we have high usage, in order to plan for next year's budget. Our ability to view vacancies on any given unit at any time ensures accurate allowances for staffing in that budgetary plan. Executive use of the information provides reinforcement to managers and staff regarding the importance of their efforts at accurate record keeping. Over time, we've identified how important it is for managers at all levels to use the data on an ongoing basis (for both scheduling and overall labor management). The immediate availability of this information significantly contributed to a recent financial turnaround.


Best practices

We recently rolled out a tool that automates the shift selection process, carefully taking advantage of the many lessons learned from the last enterprise-wide product deployment, while incorporating some new and compelling best practices. The difference with this deployment was that it was an entirely new product for our staff.


The first step was to engage resources from the communications department, specifically, assistance in building a professional campaign to help promote this new system internally to staff and practitioners and externally to the community at large.


Due to technology, our vacancy rate has decreased from 14% to 3%, and turnover has dropped to 5%.


Next, we had to grow our first enthusiasts. We began with a pilot in order to test the product in a more controlled environment. The pilot lasted about 6 weeks before rollout, and then our home-grown enthusiasts served as a virtual marketing team for the product when they went to work in other departments. This was our best practice for generating motivation and excitement. Meanwhile, communications helped reinforce the message about the application's user-friendliness, increase in professionalism, and its use in improving recruitment efforts.


Initially, there was anxiety about integrating a new payroll system, but the pilot helped administrators restructure the process. Consequently, the transition was completely seamless to the staff. The tool now alleviates many of the burdens of staff scheduling for nurse managers. Instead of posting paper schedules and filling holes a few days in advance, the new system allows users to post openings 6 weeks in advance.


The old operational mode involved working deals with nurses by "wheeling and dealing" them. Nurse managers rarely have to do that anymore, but when they do have to ask, staff members are much more receptive. Having an enterprise-wide view of the schedule opens more opportunities for qualified nurses to pick up shifts in other departments. It provides a great opportunity for newer nurses to explore career directions without having to attend additional meetings or transfer to another unit.


With R&R, technology is key

The new technology has markedly helped retention and our recruitment efforts. We greatly increased employee satisfaction by creating an environment where staff members have as much control over their schedule as possible. They have the freedom to access their schedule from work or home, and they appreciate it.


The tools have proved beneficial to our competitive recruiting environment. Over the past few years, the vacancy rate has decreased from 14% to 3%, and turnover has dropped to between 4% and 5%. Our technology is especially attractive to younger staff and newer graduates more accustomed to working with technology. The product garners much interest during the interview process, as most candidates are concerned with scheduling.


Looking to the future

As our needs have changed, we've adapted technology and expanded the way data are used. More departments have joined in using the staff management tool. We continue to grow in our use of the system's data, and it continues to be a dynamic tool. Ongoing training (for existing personnel and new hires) is important, as we continue to educate staff and managers about how helpful the tools can be.


BIDMC is a much different organization today than it was before solution implementation. For 5 years in a row, the organization has been recognized by Hospitals & Health Networks Magazine as one of the "most wired" hospitals in the country. Technology has really become a key differentiator for us and is a focus of our ad campaigns. Staff management tools are critical to BIDMC's operation, and we'll continue to maximize the use of our systems and the data they produce.