Evaluating productivity and budgeting staff

A principal objective of productivity measurement is the manager's desire to match available labor hours (capacity) with available workload (demand) while concurrently minimizing the cost of carrying that capacity. In this article, Mr. Schwartz presents technical labor capacity concepts from a management engineering perspective. Included is assistance in ascertaining the true number of labor hours in a radiology department, and in understanding workload measurement standards.

Employee leasing ... then and now

This paper examines the case history of an employee leasing plan for the Green Clinic, beginning in 1980 and terminating in 1987. The advantages, disadvantages and effects on the Clinic's operation are noted within.

Crosstraining

The small, rural hospitals have effectively crosstrained employees in multiple job skills for years. The large institutions can learn this useful and successful methodology from the small hospitals. A well-established crosstraining program can effectively build a versatile, multi-skilled staff, which can be utilized to meet the unpredictable demands on materiel management and other support services. It is an effective tool to reducing training costs and salary expenses and to improving performance, self-esteem and job security. It could very well be one of the keys to surviving in the 1990s.

Experience with staffing alternatives in a pediatric teaching institution

Staffing alternatives and recruitment and retention strategies used by the pharmacy department of a pediatric teaching hospital are described. In addition to overtime compensation, the following alternative strategies have been implemented: (1) use of contingent or "on-call" personnel, (2) coverage by management staff, (3) use of temporary agencies, (4) review of ongoing activities, and (5) use of supportive personnel. All these strategies have been effective in compensating for shortages by supplying qualified individuals on an as-needed basis, eliminating nonessential departmental activities, or delegating nonprofessional duties to technicians and other supportive personnel. Effective recruitment and retention strategies include scholarship and training programs, communication with pharmacy staff about management efforts to improve salary and practice opportunities, and insight into the nature of the local competition from chain and mail-order pharmacies. Use of alternate approaches to staffing has helped the pharmacy department at this institution maintain adequate staffing during periods of pharmacist shortages.

Impact of critical care physician staffing on patients with septic shock in a university hospital medical intensive care unit

To evaluate the effects of reorganizing physician resources in a medical intensive care unit (MICU), we studied the impact of these changes in patients with septic shock. Patients were compared during two consecutive 12-month periods: (1) an interval in which faculty without critical care medicine (CCM) training supervised the MICU (before CCM, n = 100) and (2) following staffing with physicians formally trained in CCM (after CCM, n = 112). Acute Physiology and Chronic Health Evaluation scores were utilized to compare severity of illness and were similar for each group (29 +/- 11 before CCM vs 28 +/- 10 after CCM). However, mortality was significantly lower during the post-CCM interval (74% vs 57%, respectively). There was no significant difference in the frequency of use of mechanical ventilation (83% vs 87%), although pulmonary artery catheters (48% vs 64%) and arterial catheters (24% vs 73%) were employed more frequently after CCM. The number of subspecialty consultations and MICU and hospital length of stay were similar for both intervals. We conclude that the implementation of dedicated staffing by CCM physicians in a university hospital MICU was associated with a favorable impact on patients with septic shock.

Policies and procedures for scheduling student nurses

A smoothly operating system for student clinical affiliations can save staff time and positively influence recruitment and retention. To ensure a systematic approach to scheduling students, the author shares her approach, policies, and procedures.

Evaluation of five systems to determine technician staffing in a unit dose cart-filling area

The development and evaluation of predictive systems to determine staffing needs in a centralized unit dose cart-filling area were studied. Data concerning actual cart-filling time and the hospital's daily census, by total beds and by bed type, were collected over 55 days. Four predictive systems were then developed, as follows: simple average, range average, simple regression, and multiple regression. In addition to these mathematical systems, a pharmacist "best-guess" system was devised, whereby the pharmacist directing the cart-filling area estimated the staffing needs on a daily basis during the trial period. The five systems were then used to predict cart-filling time daily over 14 days. During this time, the actual filling time was recorded and compared with the times predicted by the five systems. The differences among the actual or predicted mean cart-filling times for the five systems were not significant. The pharmacist best-guess system was on average the most accurate in detecting different staffing needs; the advantage of this system is that the pharmacist can evaluate differences in work habits among the scheduled technicians, which the mathematical models would be unable to do. The simple average system correlated well with changes in filling time and most precisely predicted variability in census. Although none of the systems was superior in all respects, a combination of the pharmacist best-guess and simple-average systems appeared to be the best method for predicting daily technician staffing needs in the central cart-filling area.

Shift system for senior house officer on call duties on a neonatal intensive care unit

To reduce the number of hours that senior house officers in the neonatal department at Southmead Hospital, Bristol, have to work continuously a new on call rota was devised. The rota changed the traditional one in three system of 24 and 32 hour periods on call to one with two shifts each day, and it spread the workload more evenly among the personnel. The continuity of care of the patients was improved, no extra staff were recruited, and the new system was favoured by senior and junior medical and nursing staff.

Developing a successful recruitment/retention plan for hospital pharmacy personnel

Due to various external factors, recruitment through traditional methods, such as newspaper ads, failed to produce the pool of applicants for hospital pharmacy staff positions it had in the past. As a result of this and other factors specific to University Hospital, the number of staff pharmacists decreased from 11 to four full-time equivalents (FTEs). The number of technicians dropped to the point where per diem nurses had to be hired to help make IV admixtures. Through some short-term measures (salary increases, intensive recruitment efforts, etc), the number of pharmacist and technician vacancies was reduced by 60%. However, a long-range recruitment/retention plan was needed to achieve full staffing and to prevent such drastic staffing shortages in the future. The four components of the plan that was developed included: commitment to provide for full-time human resources management, improved forecasting of personnel turnover, supply, and demand, design and implementation of retention strategies, and design and implementation of innovative recruitment programs. Seven months after initiation of much of the plan, there was no pharmacist turnover and minimal technician turnover. In fact, one pharmacist stays on staff despite relocation 90 miles away. Almost all positions are filled, despite a large number of openings at other institutions in the area.

Nursing hours per patient: a method for allocation of staff in midwifery

This paper describes the findings of a study of 43 midwifery wards in Northern Ireland. The Nursing Hours Per Patient (NHPP) index is extended to the calculation of appropriate indices for five categories of midwifery ward, antenatal, delivery, postnatal, special care baby units, combined units (including delivery wards) and combined antenatal and postnatal wards. These indices are used to examine the distribution of nursing staff in relation to occupied beds.

Student Reaction to the 12-Hour Shift in an Undergraduate Baccalaureate Nursing Program

Over the past two years, students in their final year of nursing studies at our university have rotated through a combined medical-surgical Intensive Care and Coronary Care Unit where they have been required to work 12-hour shifts. This article presents the reactions of those students to this scheduling pattern and describes faculty concerns regarding the experience.

Alternative work scheduling for professional social workers

The authors present some practical evidence that the changing nature of today's work force requires innovative alternatives to traditional scheduling based on the 9 to 5, five-day workweek. They support alternative work scheduling (AWS) as an updated and promising approach. Described is their experience with a two-year AWS pilot project in the Social Work Service of an urban medical center, with their focus upon the processes of negotiating, programming, and implementing the concepts of "flex-time," "compressed workweek," and "job sharing." Informal assessment indicates strongly positive responses from the participating social workers, other members of the health care team, and the consumers of the services.

Employment freeze management: an approach to attaining retrenchment goals

This article describes a management philosophy for retrenchment and down-sizing within a major health care institution. The author focuses on an unique approach for reducing staff to attain retrenchment goals in light of ever decreasing operating budgets, increased cost containment and accountability, and increased demands for productivity enhancement and service in a competitive customer-oriented health care market.

Creative staffing models in medical transcription

This article is a summary of staffing alternatives for medical transcription developed over the years and proven successful in certain hospital facilities. Creative approaches to staffing the medical transcription unit have proved to be effective tools in the maintenance and even expansion of transcription services on a cost-effective basis in a changing marketplace.

Costs, commitment, and rewards: factors influencing the design and implementation of internal labor markets

Much research on internal labor markets has been hampered by the failure to differentiate the wide variety of ILMs, by accounts of their determinants that too heavily emphasize isolated causal factors, by the lack of detailed material describing the economic and organizational dimensions of their design and implementation, and by the neglect of managerial perceptions of and motivations for constructing ILMs. This paper presents detailed case studies of three organizations that have constructed very different ILMs. Based on this material, a model of the determinants of ILMs is developed that centers around the concepts of costs, commitment, and rewards and that attempts to assess the interactions of effects of markets and hierarchies on ILMs. The model is built on the premise that the underlying imperatives typically held to affect ILMs are inevitably filtered through managerial beliefs and the constraints on managerial decision making. The implications of these findings for theory and research on ILMs are discussed.

Determination of radiology staffing needs by regression analysis

In the past, analysis of staffing needs has caused friction between radiology departments and hospital administration. To overcome this difficulty, the department of radiology at the University of New Mexico developed a regression-based analysis which ties departmental staffing needs to hospital statistics. Patient days and number of facility outpatient visits are used to project procedure statistics and staffing needs.

Implementation and evaluation of a flexitime program involving pharmacy i.v. admixture technicians

The purpose of this article is to describe the implementation of a flexitime program involving i.v. admixture personnel and to evaluate its impact on three work-related behaviors. Flexitime, also known as flex-time, is an alternative to the standard work schedule. Flexitime programs have been shown to have a positive effect on productivity, overtime, turnover, tardiness, absenteeism, and job satisfaction in various work settings. The i.v. admixture technicians and interns chose a flexitime program called the variable day. During both the baseline and the flexitime period, three work-related behaviors were measured: absenteeism, tardiness, and satisfaction. Tardiness was almost eliminated during the flexitime program; absenteeism decreased from 4.61% during the baseline period to 2.66% during the flexitime program, although this difference was not statistically significant. General job satisfaction did not significantly change during the flexitime program. Overall, all of the technicians favored the flexitime program and suggested that it be expanded to include the unit dose technicians. If future investigations support the usefulness of flexitime programs, pharmacy managers should consider its implementation as an additional strategy for reducing departmental costs.

Variability in nurse staffing research

Variability in nurse staffing research has existed and still exists in two major areas: the method of data collection and analysis, and the method of reporting. The authors take a broad look at these two areas of variability and consider the implications for future nurse staffing research. It has become imperative that nurses take responsibility for the determination of what constitutes nursing work and who should perform that work.