The staff utilization metrics large medical practices should be monitoring include overtime, underutilization and, for academic medical centers, academic and clinical time. In addition, provider flow data should be compiled in real time.
These metrics are all easy to calculate, but practices with a large number of providers will save considerable time by using healthcare staff scheduling software.
Overtime and Underutilization
In order to monitor overtime and underutilization, your practice will need to collect the following data for each provider:
• Hours worked to date for current pay period
• Hours projected to work through rest of pay period
• Hours contracted to be worked per pay period
Utilization Score = (Hours Worked + Projected Hours) / Hours Contracted
For each provider, use the above equation to calculate their Utilization Score. A score of 1.0 indicates the provider is working their full contracted hours with no overtime. A score above 1.0 indicates the provider is working overtime, and a score below one indicates the provider is being underutilized. Utilization Scores can be sorted to easily show who is in overtime and who is underutilized.
The following chart shows the hours worked by the nurses on shift the night Jackie* was asked to decide who to send home early. It can be seen that Hannah is working overtime and Anthony is being underutilized.
Use the following steps to determine how many overtime hours could be reduced.
For each provider in overtime, calculate:
Total Overtime Hours Per Provider = (Utilization Score - 1) * Hours Contracted
For each provider being underutilized, calculate:
Total Undertime Hours Per Provider = (1-Utilization Score) * Hours Contracted
Calculate Overall Overtime by adding up Total Overtime Hours for all providers in overtime.
Calculate Overall Undertime by adding up Total Undertime Hours for all underutilized providers.
In the above example, Hannah’s Total Overtime Hours equal 8 and Anthony’s Total Undertime Hours equal 15.
If Overall Undertime is greater than Overall Overtime, then Overall Overtime represents the time that could have been saved with improved scheduling.
In the example, Overall Undertime is 15 and Overall Overtime is 8. As the number of underutilized hours is greater than the number of overtime hours, improved scheduling would save Jackie’s practice the cost of 8 hours of time.
In a large practice, some overtime will likely always be necessary. However, by monitoring Utilization Scores, as well as Overall Overtime and Undertime, practice managers can:
• Keep costs down by making sure staff are being fully utilized before overtime is extended.
• Enhance transparency by making sure staff hours are fairly distributed.
Academic and Clinical Time
Academic medical centers need to ensure attendings are working academic and clinical time in accordance with the work ratios stipulated in their employment and grant contracts.
Academic medical centers will need to collect the following data for each attending:
• Academic days worked to date for current quarter
• Academic days projected to work through rest of quarter
• Academic days expected in quarter (based on contract)
• Clinical days worked to date for current quarter
• Clinical days projected to work through rest of quarter
• Clinical days expected in quarter (based on contract)
For each attending, calculate the following:
Total Academic Days = (Academic Days Worked + Projected Academic Days)
Academic Day Difference = Total Academic Days - Academic Days Expected
Repeat for clinical days for each attending:
Total Clinical Days = (Clinical Days Worked + Projected Clinical Days)
Clinical Day Difference = Total Clinical Days - Clinical Days Expected
Let’s return to the example of Luis, the anesthesiologist who was being underutilized. Luis is also an attending at a large teaching university. Academic and clinical time data for Luis and his colleagues are presented in the following charts:
For both Academic and Clinical Day Differences, a result of 0 means the attending is working the expected number of days. A negative number means the attending worked fewer days than expected, and a positive number means they worked more days than expected. From the chart above, it can be seen that Luis has worked fewer academic days than expected and more clinical days.
By monitoring academic and clinical days, academic medical centers are able to
• Ensure compliance with employment agreements.
• Ensure compliance with grant contracts.
Another component of staff utilization is provider flow, which tracks where each provider is and when. Ideally, these data are available in real time and are updated as changes are made to the schedule.
In tracking provider flow, practices should collect:
• Name and contact information for all providers available at each facility
• Provider certifications
• Staffing quotas for each assignment
• Supervisory rules for each assignment
• Team preferences
By having this information compiled in real-time, practices are able to:
• Prevent inappropriate or short-staffing.
• Reduce delays when additional providers are required on a case.
• Avoid personality clashes among team members.
*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.
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