The ways in which staff scheduling affect a practice’s bottom line are often unseen, despite a significant financial impact. These scheduling issues include overtime, underutilization of staff, inappropriate staff assignments, and short-staffing.
Jackie* works in the emergency department of a large state hospital. It was just past 11:00 pm on a slow night in February when Jackie was trying to decide which of her nurses to send home. Two were always asking for extra hours, but Jackie had been told in the last departmental meeting that the budget was tight and she was supposed to restrict overtime. She pulled out her copy of the schedule and tried to figure out how much overtime her nursing staff had worked, and how much they were scheduled for the remainder of the month.
After half an hour, she gave up. The task was impossible.
Jackie knew that all the nurses had already been added to the schedule for the rest of the month, but there was no way to see how much overtime had been worked without the payroll data. Of course, as if to be perverse, the payroll data was run on a biweekly basis – not monthly, like the staff schedule - so all the data had to be inputted separately into payroll to determine overtime. This was such a hassle that it was only done at the end of each pay period – which meant there was no way for Jackie to know tonight how much overtime each of her nurses had worked.
In the end, she sent the nurse home who most wanted to go, hoping she wasn’t going to hear about overtime costs in the next departmental meeting.
Jackie’s department was actually ahead of the curve in thinking about the impact of overtime. Yet, without access to the necessary data, there was no way for her to make an informed decision. Only after payroll was run would there be a count of hours worked – and their process guaranteed that information would always arrive too late.
Underutilization: The Costly Flip Side of Overtime
While Jackie’s department understood the impact of overtime, they did not understand the concomitant issue, underutilization of staff. Underutilization occurs when staff are contracted to receive a set salary for full-time work, but then work fewer than full-time hours.
In Jackie’s situation, it turned out that the nurse who was sent home had actually not yet worked the full 40 hours stipulated in her employment contract; she was being underutilized.
In addition, one of the nurses who did remain at work that night was already over 40 hours. That means that Jackie’s department paid twice for the hours worked after the first nurse was sent home – once to the underutilized nurse, who was still paid for a full 40 hours, and again to the nurse working overtime.
As overtime is more costly than regular time, Jackie’s department actually paid more than double for the hours worked that night after the one nurse was sent home.
Luis is an anesthesiologist who works for a large private practice and specializes in liver transplants and obstetrics. Throughout the week, he works in a variety of facilities, from hospital surgical wards to private birthing clinics.
Last Tuesday, he arrived for a 7:00 am surgery only to find the case was a cardiac patient. The usual round of frantic calls and paging took place, as the team tried to locate an anesthesiologist with the proper cardiac certification.
A cardiac specialist was eventually located – 45 minutes later. This backed up the surgical ward for the rest of the day and required that one surgery be re-scheduled, while Luis was left unutilized for the first hour of the morning.
Inappropriate Staff Assignments
Luis’ situation was not an uncommon event. Several times a month, this type of mistaken scheduling would occur to someone in his practice. When someone had traveled across town only to be told they were not needed, tempers flared. Worst of all, delays posed a risk to patient care.
There was also a financial cost to these scheduling errors. Anesthesiologists must be paid, even when they are left idle, and hours lost due to rescheduling of procedures mean lost money to the practice.
The corollary to Luis’ inappropriate scheduling, is short-staffing – something he also frequently experiences. For instance, three weeks ago, Luis arrived at a birth center. Their supervisory rules required one anesthesiologist for every three residents. That night, there were five residents working, but Luis was the only supervisor. When no other anesthesiologist could be found, a locum was called. Of course, locums cost considerably more than permanent staff, so a small scheduling error regarding staffing quotas resulted in a large and needless expense for the practice.
Staff Data and the Bottom Line
Both Jackie and Luis had to navigate difficult situations that could have been avoided. With timely access to scheduling data and hours worked, Jackie would have known exactly which nurse should have been sent home first – and her department would not have wound up paying twice.
Likewise, had Luis’ staffing rules and quotas been incorporated into the schedule, patients would not have experienced delays and his practice would not have been out the costs of wasted hours. They would also not have needed to pay for locums.
Mistakes in staff scheduling can be costly – yet, by monitoring the proper data, they can be also prevented.
*Names, situations, and example data presented throughout this post are meant to serve as fictional examples only. They have been created as composites representing common situations, but do not reflect specific individuals or organizations.
This post is an excerpt from Analytics of Healthcare Staffing (formerly titled, Get Your Master's in Staff Scheduling).