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Stop Letting Poor Scheduling Bleed Hospital Payrolls

 |  By John Commins  
   November 10, 2011

Just-in-time scheduling can often mandate when employees will work, when they'll work overtime, and when they'll be sent home with little notice for any contingency—all of which is designed to save money by more closely linking labor with immediate demand.

One human resources expert says, however, that a poorly designed just-in-time scheduling system will do exactly the opposite and will end up costing healthcare providers more money in higher absenteeism and turnover.

"I'm not arguing that it should be eliminated. I'm arguing for effective scheduling," says Joan C. Williams, founding director of the Center for WorkLife Law. "Just-in-time scheduling is a fact of life. Designing it efficiently is a business imperative."

Williams says there is "a big difference" between flexible scheduling and just-in-time scheduling, and to a degree it is dependent on the class of workers. "Flexible scheduling is generally used to refer to professionals and indicates that they are allowed to do something more flexible than just come to work and stay until the work is done, which is often more than eight hours a day," she says.

"Just-in-time scheduling refers to hourly workers, most often low-income workers. That refers to a scheduling system that attempts to control labor costs by achieving a tight fit between labor supply and demand. To do that, the employees typically have schedules that change from day to day and week to week. Often, they have no guarantee of any given number of hours."

In a hospital setting, "one of the persistent examples that [is] given in just-in-time scheduling is nurses' aides who show up for a shift and find that the patient census is lower than expected, so they are sent home without the hours," Williams says. "Or people are ordered to stay overtime with no notice. Mandatory overtime is sometimes necessary. We have to deliver the services as employers. The question is how do you design the mandatory overtime system again to achieve that tight fit?"

Matching the Workplace to the Workforce

It is exactly that rigid format that will drive workers to quit, often because personal commitments such as child- or elder-care make uncertain scheduling impossible to work around. "I'm asking employers to match today's workplace to today's workforce," she says.

"Rather than making believe we have the breadwinner homemaker workforce of 30 years ago, because we don't. We have a workforce where many of the men and women have really pressing important and non-negotiable family care requirements."

"If employers try to pretend they don't exist, they are going to have extremely high absenteeism as people call in sick because they have no alternatives, or extremely high turnover," she says. "The message for every employer is: 'If you want to decrease absenteeism and drive down turnover you have to match today's workplace with today's workforce.'"

3 Steps to Better Labor Scheduling
Williams offers a three-step approach to building an effective scheduling platform that relies on transparency  and flexibility:

  1. "A very simple step is to go from mandatory to voluntary overtime," she says. "That is important because some people want overtime and others can't show up because they are tag-teaming or they are single mothers."
  2. "Use one of two methods to handle the situation, if after shifting to voluntary overtime, you still need people to work," she says. "Some employers give employees coupons or vouchers that allow you to bid for more overtime or to bid off overtime. The second system is to divide your workforce into four groups, one of which will be on call in week one of every month, the second group for week two, etc. That way people can find back-up if they are called in to overtime at short notice."
  3. "The third overriding principle is to work hard to design a system where people get notice of overtime to the maximum extent possible," she says.

Fortunately, Williams says, the advent of cloud-based computing is making online scheduling affordable and available to most every provider, often for as little as $1.25 per employee per month. That is actually cost effective, she says, because it eliminates the cost of the scores of hours that supervisors spend each month devising schedules.

A small community hospital can shift to online scheduling and see immediate positive results. "It allows you in a very time-efficient way to register what are those times when your given employees can't work because they don't have child care or grandma needs to go to dialysis. You plug those in," Williams says.

"The second step is to arrange for an efficient shift swapping system that can all be done on line. The third step is to arrange for mandatory overtime. For example, using the coupons we talked about so you can efficiently staff overtime."

Mandatory overtime is a fact of life in most hospitals, Williams says. But employees will be much more willing to comply with the mandate if they understand the process. "The literature shows that if properly implemented, it is going to drive labor costs down sharply because it will drive down absenteeism and drive down attrition," she says. "The main point is I am not asking employers to be do-gooders. I am asking them to design one of their major business systems in an effective way."

John Commins is a content specialist and online news editor for HealthLeaders, a Simplify Compliance brand.

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