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Outsmarting Agencies

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The nationwide nursing shortage is nothing new to Carol Heckenkemper, R.N., director of nursing operations for 300-staffed-bed Rio Grande Regional Hospital in McAllen, Texas. Her nursing directors deal with it every six weeks when schedules are posted. Over the past couple of years, however, a new online shift-bidding program has helped ease the financial and staffing burden of the facility and boosted morale, as well.

In 2004, the hospital, which is owned by Nashville, Tenn.-based HCA, regularly used contract labor to fill 70 full-time-equivalent posts. “Our contract labor cost was out of control,” says Heckenkemper. When the nurse managers began looking for ways to address the problem, shift-bidding—allowing staff nurses to place an online “bid” to work an open shift at a higher rate of pay—was a novel idea that showed potential.

Nurses have always had the option of working extra shifts, but not at the higher rate afforded to agency hires. The shift-bid platform allows the hospital to “knock out the middle man” and increase the overtime pay for staff nurses from just a few additional dollars per hour to a rate greater than time-and-a-half, Heckenkemper says. Agency fees, which can be as high as $30 per hour, are taken out of the equation.

Rio Grande contracted with Austin, Texas-based Decision Critical, Inc., to use its Web-based StaffBid program in July 2004. “It has worked out extremely well for us because the nurses were on board before we even started it,” Heckenkemper says.

Of the 343 employees who have access to the program, including nurses and surgical technologists, 73 percent have used it. Staff agency usage has been cut by 55 percent. Although Heckenkemper declines to quote numbers, a vendor case study finds that agency labor expenses for the hospital dropped from $800,895 in the first quarter of 2004 to $372,000 in first-quarter 2005.

The program also means that contract nurses, some of whom worked nearly full-time at the hospital through an agency, no longer have access to open shifts until staff nurses have had their pick. As a result, about 20 agency nurses have joined the hospital either full time or part time.

—Kara Olsen



Supplemental Efficiency

Three years ago, Tuality Healthcare in Hillsboro, Ore., worked with 40 local and national staffing agencies to book as many as 22,221 hours in supplemental shifts a year. “Nothing was standardized, so every agency had its own method,” says Steve Krautscheid, the two-hospital system’s employment coordinator. “It was craziness.”

With a frustrated staffing office fielding multiple phone calls and faxes from various agencies after a new opening was posted, Krautscheid knew the process had to be streamlined. After attempting to work with the agencies, Krautscheid turned to ShiftWise, a Lake Oswego, Ore.-based company looking for facilities to help develop its Web-based healthcare staffing management service.

Tuality has never looked back. Krautscheid says the system allows supervisors from nursing to the cath lab to log on and post open shifts. Vendors submit online profiles for the managers to browse. “When the manager is satisfied they’ve found the person they want, they click to confirm and that person shows up for the shift,” says Krautscheid. Because users can compare the amounts charged, the hospital has seen a significant drop in hourly rates.

Krautscheid also touts other benefits—specifically access to real-time data. Users can view the number of supplemental staff used on a given day, over a specific period of time or for a particular shift. Tuality adds FTEs to their float pools wherever they see a buildup of agency usage. “It’s much more convincing if we can demonstrate that we’ve needed somebody for a shift for the past six months,” Krautscheid says.

The service is currently used by 275 hospitals that pay an implementation and training fee. Agencies pay a fee for each shift they fill using the system.

—Kara Olsen