Vacancy Brainstorming

Vacancy Brainstorming

Purpose:

To ensure optimal staffing, morale, efficiency, patient access and service by identifying and addressing gaps and opportunities with creativity, collaboration and management engineering. These should be the basic practices and expectations of any exceptional hospital for any new investment: We investigate and engineer efficiency first, before spending money.

Common Scenarios:

1. Workload Variation: Positions might be closed due to insufficient work, though this is rare in healthcare. More often, vacancies lead to unmet tasks or lower volumes, unless filled or creatively managed.  

Recruit Replace Retrain and Retain

It is common practice, though short-sited, to look at current volumes and merely staff to them without investigation. Where turnover is higher, lower margin is the natural result. This is counter-intuitive to older thinking. What appears as a reduced volume may in fact be a self-inflicted wound on the hospital's margin  by its failure to recruit, replace, retrain and retain.

Consider the simple truth that an hour of professional labor often produces several times the dollar impact on margin than the labor cost of that hour. 

Considering the nature of incremental volume and incremental income, the potential to improve the bottom line rapidly, even faster than labor consolidation, needs to be investigated. Is a reduction of volume due to leakage? That's immediately available for recapture if we have the resources and the efficiencies to do so.

2. Often lagging volume is a flag for lost competitive standing or leakage: High turnover often means loss of crucial and valuable talent. All those skills must be replaced, retrained, restored. And their absence has an inevitable impact on the quality of care, patient access, scheduling efficiency, vigilance, and yes, volume.

What looks like an opportunity to reduce staff may in fact be a need to re-invest and regain both market share and higher patient access. But this can only be determined if the processes of care, scheduling and coordination, leakage and potential demand in this region are investigated, understood. With that understanding must follow appropriate retraining, rehiring of needed talent, and reengineering for optimal patient, provider and surgeon ease-of-use and efficiency of service.

Solutions: Work simplification, better scheduling, cross-training, on-call pools,  networking with partner organizations to build shared staffing pools (Engineered Staffing Pools, or ESP), and process improvements are all part of the process of building and rebuilding the hospital. Creative solutions require piloting to optimize teamwork. And this is the best possible management and team building exercise because the result is better patient access and service right along with enhanced morale and crew retention.

Daily Management System - an essential platform for teamwork and better service

The Daily Management System tools are utilized daily for planning and evaluation, and they provide critical information for improving efficiency through vacancy brainstorming among supervisors and managers.  A daily management system provides immediate feedback for any new pilots tested. The goal is to adapt more efficient approaches by analyzing daily work variations, and to do so rapidly.

Where there are needs for investment, the daily management system provides hard evidence for exactly what those needs are,  to those who are not in the department but who participate in the decision-making. The system also provides evidence for improved efficiency and patient demand that are crucial as evidence for further investment.

For those in the department, the daily management system provides objective feedback as the appropriate balancing context for subjective experience.

Key Questions for Staffing Plans and Performance Evaluation:

Staff Training:

1. Is the staff sufficient for projected requirements?

2. Is there a proper mix of skills and experience?

3. Are training efforts maximizing employee potential?

4. Are employees motivated to broaden their abilities?

Method:

1. Are current methods effective for timely, quality service delivery?

2. Are service interruptions caused by internal or external factors?

3. Do job assignments support good organization or cause interruptions?

4. Are work redundancies necessary or performance circumventions?

5. Are outdated practices still in use?

6. Are activities holdovers from outdated technology?

Department Structure:

1. Does current work compartmentalization enhance throughput and output?

2. Are there excessive cross-departmental hand-offs causing delays?

Work Balancing:

1. Are work activities assigned based on need?

2. Is there a mechanism for assigning project work or time-off during low activity?

3. Is each person working at a reasonable pace?

4. Are employees' skills fully utilized?

5. Is work scheduling based on workload plans and reviewed regularly?

Communication:

1. Are goals and objectives measurable and communicated effectively?

2. Do all levels of staff communicate goals and share resources as needed?

3. Is accountability for shared outcomes established?

4. How many times must requests be made before action is taken?

Individual Performance:

1. Is each employee providing quality services within time limits?

2. How does the manager track completed duties?

3. How easy is it for employees to contribute to department goals?

4. Who contributes to the department’s progress, and how can more employees be engaged?

5. Is contributing to change rewarding or punishing for employees?

6. Is each employee working to the top of their license (spending most of their time on the activities that require their training and certification, and less time on tasks that could be delegated through coordination and skill mix?)

Additional Vacancy Brainstorming Questions:

1. What unique skills are needed that aren't currently available?

2. Is there a financial return for the position?

3. How is work prioritized and distributed?

4. How would the workload be managed without filling the position?

5. Are there cross-training opportunities?

6. Can work be shifted to other sites or rescheduled?

7. Will changes in hours help avoid costs without losing patient volume?

8. What is the impact on agency or overtime use?

9. Is the department meeting quality measures?

10. Is the workload increasing?

11. Does the job status match the vacancy?

12. Are there opportunities for skill mix savings?

13. Is the position hard to fill, requiring lengthy recruiting?

Vacancy Brainstorming Submission To the Weekly Workforce Steering Team

When Requesting A Replacement of Crew Resources:

- Date Submitted:

- Submitted By:

- Title:

Assessment Summary:

"We have completed an assessment using the process, performance, and vacancy brainstorming questions, reviewed available data, and brainstormed alternatives with other leads and managers. Below is our conclusion."

Details:

- Cost Center

- Position Name

- Job Code

- Budget Paid FTEs

- Vacancy Date

- Annual Cost Impact

Task Review and Engineering:

- Prioritize tasks by necessity

- Identify who can do high-priority work now and after cross-training

- Find efficiencies for lower-priority tasks

- Address workload and staffing gaps

- Explore technology to reduce task time

- Brainstorm alternatives with peers

Results and Support Needs:

- Short, middle, and long-term plans for change

- Temporary coverage while re-engineering work

- Milestone dates