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Scheduling Staff to Impro

ove Patientt Throughp


put in the R
Radiology Departme
ent
MMany hospitals and health systems
s struggle to identifyy the number o of staff membbers needed att a given time to
aaccount for intterdepartmenttal processes and services. Optimal patieent throughpu ut and equipm ment and roomm
uutilization are difficult to acchieve withoutt appropriate staffing
s levelss to manage thhe patient volu ume. Several
oorganizations are developin ng methods to identify the necessary
n stafffing and blockks for patient procedure by using
ddata analytics to identify ne eed patterns.

O
One such orgaanization, Nortth Shore Univversity Hospita al (NSUH) loccated in Long,
Island, New Yo
ork, implemen nted a new sta
aff scheduling process by id dentifying pattterns
in procedural data
d over a four month periiod. The initia
ative took placce in the 806-b
bed
teaching hospitals radiologgy departmentt and quickly spread
s to the ssystems otheer
d
departments after
a the obserrved success in turnaround times and fin nancial savingss.

I refer to this initiative as a data-driven workforce


w optimization stafffing plan, staates John Aloissio, Assistant Vice
P
President Ra adiology Imaging Service Lin ne. The staffing model is s till in place to
oday. It may have been refinned a bit,
b
but the same elements
e are utilized.
u

R
Recognizing thet Need for Change
In 2010, the radiology deparrtment at NSU UH experience ed several envvironmental faactors that cau used the organ
nization to
implement improvements in nto the curren
nt operational processes. Th he first driver for change occcurred when tthe
d
department ob btained its 64 slice compute ed tomograph hic (CT) scann er. The new caardiac imagingg scanner alloowed the
o
organization too offer an expanded servicee in cardiac im
maging, which required moree staffing and provider timee to fulfill.

TThe second driver was the new n portable CT C scanner tha at allowed beddside service tto patients in the surgical intensive
ccare unit (ICU)). While this portable
p scann
ner did improvve the standarrd of care, it allso forced adjustments to the
imaging proocess to comp pensate for thee unique need ds of bedside imaging.
NSUH's Weekend
W Patientt Volume As a result of
o the high vo lume and dem mand associatted with the previously
mentioned drivers, the deepartment had d no choice but to implemeent
690
610 610 d process optim
staffing and mization.
475
NSUH leade ership decided d to take a twoo-step approaach toward ulttimately
Saturday optimizing imaging
i utiliz ation and stafffing levels baased on demannd.
Sunday Through driilling down thee workload byy day of the weeek over a sevven day
period and then further id dentifying volume and dem mand by hour, NSUHs
radiology de epartment waas able to deteermine staff an nd patient sch
heduling
2008 2009
best practicces.

By identifying optimal
o staffing lev
vels for the Data neede ed to drive myy decision makking process aand help me ooptimize
weekend shifts,, NSUH was able to manage its utilization and
a staffing, AAloisio notes. We wanted tto look at stafffing
radiology volumme and meet the growing patterns and d match themm with the demmand of servicces. We didnt feel like
demand throug gh quick turnaroun nd times. we had a go ood alignmentt with staffing when volumee demand wass high.

UUtilizing Data
a to Identify Innefficiencies
NNSUHs first sttep in using data
d to solve ra
adiology inefficiencies invo
olved establish
hing a baseline starting point. The
ddepartment ussed a snapsho ot of the workload for a fourr month periodd, from September to December, to help
ddetermine the days and times where the highest
h demand for servicees occurred thrrough weekly patterns. Thiss method
sshowed deman nd to be greattest on Monda ay and Tuesdaay causing sta ff members too have an uneqqual distributtion of
wwork throughoout the week.

U
Utilizing these
e data trends, the department adjusted sttaff schedulingg by time and
d day to best o
optimize throu
ughput.
W
Work shifts weere taken from
m the end of th
he week and moved
m to Mondday and Tuesdday and a shiftt was added to
S
Saturday morn ning and Sund day evening to
o help managee the volume d demand in thee beginning of the week and d reduce
o
overall turnaro
ound time.

We took another snapshot four months after


a to look at
a volume and throughput aand we had a m much better alignment
o
of work distrib
bution over the
e seven day pe
eriod, Aloisio
o states. Patieents werent w
waiting as longg to get studiees done,
especially those that came in on a Thursday or Friday. Previously many of those patients had been waiting through
the weekend or Monday to get their imaging done.

Engaging and Implementing the Process


Although the method of moving and adding shifts to certain days and times appears simple, obtaining staff
engagement for the implementation of this system required the use of several strategies. The first strategy involved
hosting informational sessions with staff members over a two month period. These meetings gave NSUH leadership
the opportunity to share data with staff and explain the benefits of the schedule adjustment.

Achieving consensus with the staff was important, Aloisio explains. We wanted to let them know that work should
be distributed evenly, and we wanted to have better shift transitions for them so when people are going home after
the day or evening shift, staff wouldnt get bombarded with cases and become stressed.

Staff members at NSUH had several concerns over switching from fixed hours to flexible hours, but after addressing
the dangers of thin staffing levels and value in improving shift transitions, engagement in the initiative grew. The
added flexibility offered an incentive for staff when requesting time off as NSUH now guarantees the technical staff
members the weekend off before and after a 5 day schedule vacation, therefore giving them nine consecutive days off
instead of five days off.

To further improve imaging and patient throughput, NSUHs radiology department implemented benchmark
standards for various processes to hold staff members accountable with the new scheduling method. The value
analysis team, along with leadership, set a guideline for staff members to complete a CT scan in seven-and-a-half
hours or less. The measure stemmed from the desire to provide service to a patient in less than one shift to prevent
potentially confusing transitions of care staff in the middle of a scan.

Since the adjustment of staff scheduling and introduction of NSUH Inpatient Weekend
benchmark standards, the department has observed significant Turnaround Time (Hours)
improvements in quality of care and in cost reduction. CT scans are
completed well below the seven-and-a-half hour standard and a 8.24
22% improvement in overall turnaround time has been observed
while volume in the radiology department increased by 5%. In 6.94
7.47
particular, the weekend turnaround time improved by almost 40%, 6.45
falling from 13 hours to 8 hours. Since the implementation, the
department has saved over $140,000 in labor expenses.
January February March April
There was no new staffing added to our model, Aloisio says. We By adding a Saturday morning and Sunday evening
expanded our services, we shuffled things around a little bit, and we shift, North Shore University Hospital's radiology
actually got rid of one full time position. By flexing the staff on the department improved patient turnaround significantly
weekends, we avoided weekend coverage costs as well. and reduced labor costs simultaneously.

To best utilize resources and ensure the optimal patient throughput is obtained, it is important for hospitals and
health systems to identify daily and hourly staffing levels that meet the volume and demand of the services offered.
For organizations working to better understand and schedule staff hours, it can be critical to review data trends and
periodically reassess the operational processes in practice, as NSUH has exemplified. By engaging staff members in
flexible scheduling and avoiding thin staffing levels, better quality care can be given to patients.