With on-call pay coming in from a medical center, 27 physician and clinician offices, and outpatient surgery centers, it was dizzying to track, much less to find a cause for the problem. Becker turned to his time management data to explain the cost increases. The data showed scheduling and overtime problems.
"Whether there [are] higher volume[s], heavier procedures, or unexpected absences, we are trying to get control over when we are paying that premium pay," Becker said.
He says Stormont-Vail HealthCare had stopped using packaged scheduling software about 10 years ago in favor of its departments having non-fixed shifts (mainly inpatient nursing) and a "homegrown" spreadsheet that is updated daily or shift-by-shift to accommodate changes in patient volumes and acuity. But it wasn't addressing staffing shortfalls quickly enough when demand rose. Moreover, managers were calling in staff to call work without the benefit of knowing which team members at lower wage levels might have been available.
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Plus, when it came to tracking call coverage, Stormont-Vail was using an approach that many hospitals and health systems still use today. Becker says the system managed employee time retroactively, reviewing entries every two weeks.
"Looking back at the employee data doesn't help us look and work with the daily patient census," he notes. "When you look at the end of a two-week pay period and see all the hours of call pay, it's too late to analyze why it happened or how to fix it for the future. That can drive the cost per patient per hour in a particular unit through the roof."