Hospital uses industrial formula for staffing
Hospital uses industrial formula for staffing
Time studies form the foundation
(Editor’s note: This is the second article in a continuing series on how admitting departments around the country determine what staffing levels they need.)
Washington County Hospital in Hagerstown, MD, applies an industrial model of measurement in determining staffing for admissions as well as for other departments, says Beverly David, RN, director of admissions and registration.
The idea is the same as for staffing a restaurant open 12 hours a day, David says. "How many people do you need? You need enough to cover 12 hours no matter how many or few customers come in. And when it gets busier, how do you know when to add somebody else?"
Washington County’s formula is based on three components:
• Relative value units (RVUs).
There are 100 RVUs per hour. If an actual admission takes 21 minutes, that’s 35% of 60 minutes, so that activity is represented by 35 RVUs. (35% of 100). The entire admissions process, however, is represented by 80 RVUs, because it also includes posting (10 RVUs), bed assignment (17 RVUs), insurance verification (13 RVUs) and discharge (5 RVUs). (See chart showing breakdown of activities in admissions and registration, at right.)
• Productivity.
If employees work efficiently and to their capacity, productivity is 100%. However, work can’t always be done at a consistent rate, such as during slow periods, so productivity can be less than 100%. On the other hand, productivity can surpass 100% through automation.
• Activity value.
The value of a particular activity, as explained above. An admission has a value of 35.
• Number of events.
The number of registrations, admissions, or emergency department registrations, for example, performed or projected during a month.
• FTEs (full-time equivalents).
At Washington County Hospital, an FTE represents 153 hours per month, or 15,300 RVUs.
Based on the above definitions, then, here is the method of determining the appropriate staff level for ambulatory services registration:
Twelve hours of coverage a day is needed, which represents 1,200 RVUs, but the actual activity being done is only 800 RVUs, so productivity, represented by "Z," is 66%.
There are a projected 800 patient events, or registrations, in a month, represented by "Y."
The activity value for an ambulatory services registration is 38, represented by "X." That’s made up of posting (10 RVUs), registration (17 RVUs), insurance review (4 RVUs), and charge batching (7 RVUs).
The formula is:
(Y x X) ÷ (Z x value of 1 FTE for 1 month) = number of FTEs needed.
The actual figures are:
(800 x 38) ÷ (66% x 15,300) = 3 FTEs needed.
All the RVUs are determined by time studies, by actually plotting activities through the system, David says, so as new duties are taken on they need to be added to the equation.
"Before, we didn’t have the added calls required by managed care companies, but now we have to have somebody to hang on the phone with those."
Of course, she points out, everything is subject to budgetary constraints, so her continuing focus is, "How do I streamline? How do I make the processes better even if I can’t get the number of FTEs I need?"
That’s when productivity goes up to compensate for less staff, she says.
[Hospital Access Management is interested in how staffing levels for your department are determined, as well as how you supplement them through volunteers, for example to do more with less.
Please contact Editor Lila Moore at (404) 636-9264 or by e-mail at [email protected]. Or contact Managing Editor Glen Harris at (404) 262-5461 or by e-mail at [email protected]. We look forward to hearing from you.]
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