A large, not-for-profit health system in a Midwest metropolitan area has operating rooms (ORs) in six acute care hospitals and seven for-profit surgery centers. The system historically generated strong financial returns, with more than 90,000 annual inpatient and outpatient surgeries.
But even the most profitable hospitals can benefit from a labor workload analysis. Results from these findings enable an optimal staffing model that reflects both strong staff expertise and efficient utilization of resources, while ensuring physicians are fully engaged and satisfaction is high. System leadership was determined to uncover additional efficiencies that would not adversely affect patient care and physician satisfaction.
The health system called upon Vizient experts to identifying staffing inefficiencies. The initial review by Vizient, focused on ORs in four acute care hospitals and three surgery centers, uncovered very high registered nurse (RN) utilization throughout perioperative units.
Some departments were almost 100 percent staffed by RNs who regularly engaged in tasks such as escorting families and transporting patients, which could easily be carried out by lower-cost staff. The units also scheduled staff far in excess of the standards recommended by the American Society of PeriAnesthesia Nurses (ASPAN) and other industry standards for perioperative units.
The potential for improvement was clear. However, the surgeons and medical directors were concerned that changing the staff-to-patient ratio would hinder scheduling flexibility. Adding to the overall complexity, the physicians owned 49 percent of the surgical centers.
Vizient worked collaboratively with the health system’s perioperative leadership and staff over a three- to four- month period to design an optimal care model. The end result was staff scheduling that was better aligned with industry standards, met physicians’ block requirements, and saved the health system millions of dollars in perioperative labor expenses.
Perform comprehensive current state analysis
Vizient first compiled a year’s worth of scheduled surgery data, which provided detailed insight into room occupancy by unit (pre-op, OR and post-op), procedure type, day of the week, and hour of the day. Vizient also classified full- time employee (FTE) perioperative hours by employee type, then paired this analysis with physical, on-site observations of employee workload. One of the most significant conclusions was that blocked rooms weren’t always used. This gave administration a true “a-ha” moment and provided compelling information to share with physician leaders.
Develop availability-based scheduling model
Vizient and the health system developed a new staffing model based on OR blocks in use and procedure type. Patient acuity was included as a scheduling consideration because certain phases of the recovery process are more labor-intensive than others. The staffing tool was designed to enable multidimensional views of staffing needs into a single pane. Users could see scheduled blocks, projected patient volume, and other scheduling criteria — then pull a recommended staffing configuration based on those numbers.
Identify the right skill mix
Vizient worked closely with the perioperative leadership team to configure a staffing ratio that improved productivity and reduce RN costs by attrition and reallocation to other open positions. In turn, workload was realigned, enabling RNs to focus on delivering patient care and work at the top of their licensure.
Establish relationships as trusted advisors
To ensure the new staffing model would maintain patient care and satisfaction, Vizient continually tracked and monitored various quality indicators (including hospital- acquired infections, falls, and Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores).
Leaders were on the right track when they originally suspected there was savings to uncover. Vizient identified $9.2 million in savings across all perioperative units. The health system implemented $5.7 million in the first year. This included $4 million in the pre- and post-op recovery rooms and $1.7 million in the ORs, with the remainder to be saved over time.
Vizient’s valuable, data-driven insight and innovative staffing model helped optimize perioperative staffing and efficiencies, while freeing up skilled nurses to fill new needs throughout the health system.
The Vizient solution proved so effective that the health system asked Vizient to implement staffing efficiencies in their rural hospitals, with an expanded focus on nonclinical staff. While a labor workload analysis is beneficial for any organization, it often frees up otherwise difficult-to-find resources for rural hospitals with more limited budgets.
Over the next 12 to 18 months, Vizient will work alongside this health system to uncover new efficiencies in a rural surgery center and two ORs. As with all work to date, future improvements will be sustained through the use of targeted tools and ongoing performance and quality monitoring.
- Labor workload analysis revealed blocked ORs were not always used
- New staffing ratio for nurses improved productivity and reduced costs
- Using new scheduling tool based on patient need and volumes delivers flexibility to add relief staffing when needed
- Established productivity, financial and quality targets to monitor and sustain improvements