1. Stevens, Ruth

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Even a community-owned, not-for-profit organization like Southwest Washington Medical Center, based in Vancouver, Wash., has an obligation to maintain its financial health as a means of furthering its mission, which calls for staff to "emphasize clinical and service quality, promote accessible and affordable care, and work with others to improve health status." Increasingly, meeting these objectives requires creating better access to information and using that information in more effective ways. For these reasons, and because the organization wanted to empower its nurse managers to make more informed business decisions to optimize clinical operations, Southwest recently upgraded its labor resource management capabilities.


Staff scheduling as a business tool

A frequent recipient of the 100 Top National Hospitals award, Southwest operates 360 beds with an active medical staff of 600 physicians supported by more than 3,200 skilled professionals. In 2006, the facility decided it was time to upgrade and reengineer its staff scheduling process. The primary focus was on enterprise-wide automation that would enhance nurse managers' and team leaders' business performance.


As is typical in most hospitals and health systems, the career paths of many nurse managers at Southwest never prepared them to manage others. Because these managers excel at care giving and not necessarily at overseeing teams, the facility recognized the advantages of automating its labor management processes, including staff scheduling and time and attendance tracking. The organization also realized that automation of previously centralized and paper-based processes, such as payroll tracking, overtime management, and monitoring of staff credentialing requirements, would enhance workflow and enable nurse managers to devote more time to patient care.


Ideally, nurse managers' proximity to their staff members should enable them to effectively manage day-to-day operational and personnel issues. To do so, however, they require accurate, accessible, and up-to-date labor resource information. At Southwest, nurse managers were clamoring for this information. With the right set of enhanced scheduling and payroll features supporting managers' roles, nursing staff would benefit as well. Schedules that better reflect nurses' preferences, increased management responsiveness, and more equitable application of employment policies would all contribute to increased job satisfaction, resulting in improved morale and higher employee retention rates.


In addition to revamping scheduling for inpatient nursing, Southwest also planned to introduce the automated system enterprise-wide. With a single system driving policy enforcement, reporting capabilities, and other labor resource concerns, the facility hoped to achieve a new level of consistency and efficiency in its labor resource management.



The long-standing limitations Southwest faced were due primarily to the outdated scheduling system on which it relied. The system supported only inpatient nursing, which represented less than half of the facility's entire employee population. Other departments relied on paper forms, spreadsheets, or their own proprietary systems for staff scheduling.


Time-consuming and inefficient, the existing system required cumbersome manual data entry. Based on forms submitted by managers, central staffing office personnel created and printed staff schedules, which were then returned by interoffice mail. Nurse managers and others responsible for schedules didn't interact directly with the system. Another drawback of the system was the inability to assign more than 40 activity codes housewide. These activity codes represent shift types and allow schedulers to precisely match schedule needs with nurse skill sets. Ideally, the facility needed a set of core activity codes with additional customizable code options for each department.


Acquiring time and attendance data for roughly 3,200 employees at Southwest was a tedious, manual process as well. To enter the data, virtually the entire accounting department, including payroll, benefits personnel, and even receptionists, focused solely on data entry for the better part of 1 week each month. However, this timecard information wasn't accessible to managers, so they were unable to compare actual hours against planned schedules or review productivity.


Developing a solution

Having clearly identified its challenges and objectives, Southwest knew that it needed a more advanced staff scheduling system that could serve the entire organization. This would require a highly flexible tool that would, for example, let each department produce schedules according to the department's most relevant unit of measure. For nursing, that could be acuity. Food service could schedule based on trays needed. Sterile processing might review case carts, and registration could project staffing by location.


Role-based scheduling ranked among Southwest's top selection criteria. Across all departments, this scheduling would support activity at both department and facility levels, enabling managers, directors, and other personnel to contribute to scheduling efforts according to their organizational roles. To accommodate real-time information and more detailed reporting, the scheduling system would need to fully integrate with a new time and attendance system, as well as with the facility's existing financial systems. In addition, because employees would now be touching the scheduling system, the technology had to be Web based and easy to learn.


For its part, nursing placed group scheduling, skill-based scheduling, rotating schedule capability, automated time-off requests, licensure tracking, self-scheduling options, shift trading, shift bidding, and schedule data archiving among its top-priority features.


Flexible implementation

Project planning began in February 2006, with a pilot starting in May of that same year. By August, Southwest was ready to begin implementation. The deployment team rolled out new services to additional departments every 4 weeks.


Approximately 1,800 nurses were trained on the new capabilities in four phases, instructing them on topics such as how to log onto the system to check schedules and request time off.


Several months into the implementation, flexibility became a priority. Senior managers had communicated clearly to nurse managers that they were expected to take a more active role in labor resource management. As a result, they would be held accountable for business matters, such as generating schedules, controlling overtime, and managing their budgets. Although the new process was highly efficient and successful, the nurse managers found that these additional responsibilities distracted them from hands-on work with their staff, spending time with patients, focusing on clinical issues, cross-training, and other important tasks.


In response, Southwest created the secondary role of staff support coordinator (SSC). These specialists were tasked with much of the day-to-day data input and administration. By February 2007, six SSCs were assigned, each supporting between 200 and 350 employees and an average of five units, who reported to the corresponding directors. With this adjustment, nurse managers were able to fully benefit from and enjoy real-time access to a wide range of workforce data, report generation capabilities, notifications and alerts, licensure tracking, and a highly efficient tool for creating and approving schedules. And these new capabilities didn't detract from their clinical duties.


Better decisions, greater productivity

With the current scheduling platform, Southwest's schedulers are able to take advantage of unlimited activity codes, both general and department specific, to help streamline shift assignment. Taking that one step further, the facility has developed a set of supplemental, nonproductive codes to track other workforce details such as nonrevenue-generating labor resources. Access to this type of data enables senior executives to make key budgetary and business decisions based on the most accurate information available, leading to better control of labor costs and an improved bottom line.


Southwest's comprehensive approach to labor resource management has also improved consistency throughout the nursing departments and organization-wide. Employees have more confidence that they're being treated equitably regarding timecard rounding, on-call status, shift differentials, and holiday differentials. The staffing office has redirected its employees' hours more productively, dropping its daily coverage from nearly 30 to 16 hours.


Added benefits

Because Southwest has a nurses' union, it must follow a range of guidelines. In the past, managers had to keep these rules in mind. Now, there are system controls in place that prevent or warn against scheduling a charge nurse inappropriately, for example, or assigning someone outside of her qualifications and credentials. The new system was even beneficial in recent labor negotiations, helping the organization efficiently gather key scheduling and personnel data required for negotiations.