Chapter 7: Staffing and Workload Management in Healthcare

Workload Management Systems

Link staffing and scheduling to resource capacity.

Patient Acuity Systems

Evaluate patient needs for staffing and scheduling.

Human Resource Expenditures

Major costs for many healthcare organizations.

Flexible Staffing

Setting a core level staff based on a long term needs

assessment which is then augmented by short-term

(daily) adjustments using various methods to match

staffing levels and patient needs.

Full-Time Equivalents (FTEs)

Measure of staffing based on work hours.

Operational Procedure

Scheduling who is on and off duty.

Reallocation

Adjust staffing decisions daily or shift-wise.

Work Standard

Predetermined time allocation for service units.

Acuity Adjusted

patient days are adjusted for the acuity level of the patients being served

Procedural Standard

Staffing based on specific procedures performed.

Average Census Estimation

Historical method for staffing standards development.

problems with average census of entire organization standard

doesn’t account for unit to unit variation

dependent upon a physician estimate of length of stay

adequate staffing system components

reliable patient classification and acuity system

development of time standards to reflect the time needed

a method of converting total service time needed to FTEs

Patient Classification and Acuity System

Determines service needs based on patient characteristics.

fewer staffing adjustments are necessary

Core Level Staff

Base staffing determined by long-term assessments.

Patient Acuity System

necessary to measure the amount of care required by any given patient

Prototype Systems

Classify patients by care type needed.

patients grouped into 3-10 categories based on expected time commitments, diagnosis, mobility, and education needed

highly subjective; easy to implement

Factor-Analysis Systems

Classify by summing values of patient needs.

Fixed Activities

Do not change with patient volume.

Variable Activities

Change based on services offered.

Direct Care

Care activities centered around the patient.

Indirect Care

Support services for patient care.

Work Sampling

Method to assess activity frequency.

often done by outside source

Time and Motion Studies

Analyze efficiency; costly and time-consuming.

not common in healthcare

Estimation

Low-cost method for activity time assessment.

minimal time

Historical Averaging

Uses past data for estimating workloads.

easiest and least $

Logging

Records activities; low-cost tracking method.

excellent, low cost

Workload Standard

Hours required per activity divided by volume.

Utilization Estimation

review historical levels and agree to a target

quantify delays and downtime and allow for acceptable levels

calculate a weighted average utilization

Procedural Based Staffing

Staffing based on procedure volume demand.