90 ◾ Kelly Arnold
e obvious impact on needs for sta from acuity is that a higher complexity of care requires
more personnel. e approach to measuring and applying acuity impact on stang can be either
art or science or both. Again, nursing areas are the 900-pound gorilla in the room when deal-
ing with acuity measurement. Some hospitals will apply science in measuring acuity by having
computer-based systems with specic algorithms that give precise stang recommendations on a
shift or daily basis. ere are many such systems on the market today. Some facilities will take this
scientic approach utilizing systems developed in-house by IT or other technically savvy person-
nel (including management engineers [MEs]). ese systems that apply mathematical precision to
acuity measures are the best and most accurate approach to acuity measurement.
e art side and approach to acuity is based on the experience and intuition of the person
responsible for making stang decisions on a daily basis. e important decision driving stang
on a daily basis in many clinical areas is how many patients the professional or assistive employee
can care for at one time. e data from systems above will give a more precise picture of patient
assignment, but the same decision will likely be made by an artful and clinically experienced deci-
sion maker. While the exact measure of acuity associated with an individual patient is not avail-
able, the care needs contributing to complexity are known. e artful decision maker will be aware
of these care needs on all patients and attempt to factor these into the nal decision regarding
stang. As nancial pressures increase on many hospitals, there has been a migration away from
a science-based approach to acuity measure with many hospitals relying on the artful decision
maker’s judgment, clinical knowledge, patient care experience, and intuition.
Workforce Implications
ere are a number of workforce implications that impact the stang and scheduling functions
in healthcare organizations. is discussion will focus on two that are most important—com-
petition for employees and an aging workforce. Given the recent Great Recession of the last four
years, there have been several industries that continue to be areas of job growth. Healthcare has
typically been high on all lists in the media. Given the ongoing need for healthcare personnel, the
demand and competition for talent has intensied. One of the allures of the healthcare profession
is the relative certainty of employment and diversity of jobs and locations even for a single profes-
sion in healthcare. All of these factors contribute to high levels of healthcare employee turnover
relative to other industries. e phrase “the grass is greener on the other side of the fence” cap-
tures the movement of these employees within and between hospitals. Adding to the diculty
of stang and scheduling related to this issue is that the best employees have options elsewhere
and will take them if their present setting is not meeting their personal and professional needs
and goals.
Continuous long-term employment has been a feature of many people’s experience in hospi-
tals and has contributed directly to the second issue—an aging workforce. Plentiful careers and
jobs in healthcare have attracted large numbers of new and younger sta. At the same time, large
numbers of professional and other healthcare sta have stayed in the same job and frequently
worked at the same hospital for much of their career. Many healthcare employees had periods of
leave from jobs for the birth of children. Now, at a later point in their careers, these same people
are taking extensive leaves to care for aging relatives or address their own illnesses related to dis-
eases of aging and lifestyle. While these employees have a wealth of knowledge and experience,
they may not have the physical stamina or emotional capacity to deal with the ongoing demands
of caregiving.
Stafng and Scheduling ◾ 91
Technology Impact on Stafng and Scheduling
As with the previous section, there are numerous technology factors that directly impact stang
and scheduling in hospitals. e use of computer-based systems to measure acuity was discussed
previously. ere has been a dramatic rise in the number of stang solutions available on the
market in recent years. While some of these systems still reside on hospital-based LANs, there
has been a logical shift toward web-based systems and applications. e wide availability of these
products has greatly eased the eort involved in producing schedules for a specic timeframe.
ese systems can also have a positive impact on the changes made to stang on a day-to-day
basis. However, these types of daily and shift changes to stang levels still require input from
managers or supervisors who rely heavily on that person’s intuition and experience. erefore,
these technology-based aids to scheduling are of limited use on day-to-day stang decisions.
Another signicant area of technology impact on stang is the relatively recent emergence of
electronic medical records (EMRs) and computer-based charting. A full discussion of these topics
is beyond the scope of this chapter, but they do have an impact on the levels and amount of sta
needed to provide care. Many hospitals are in the early phases of bringing these systems into their
organizations. Payment, privacy, and quality concerns will likely ensure that all hospitals in the
near future implement these systems. Given the relative newness of these technologies and early
phases of development and deployment, hard data regarding these systems is not widely available.
It is certain that there are issues relating to moving from paper-based systems to computer-based,
which will have negative impacts on stang throughout hospitals. e rst issue identied early
on is the learning curve associated with any new systems. Hospitals are lled with examples of the
latest and greatest equipment and technology. Given the relative age of many employees in hos-
pitals, learning curves and associated times to eectively take advantage of the new technologies
can be lengthy. e second associated issue is the time involved in charting and documenting in a
computer-based system. A clear advantage to EMR is integration of data and rapid access to that
data for all those providing care to an individual patient. is integration and access comes at a
cost as the systems in use today still require more time to chart.
Many hospitals are attempting to quantify the time impact of changing from paper to com-
puter EMRs. Some are further along than others, but nancial constraints make it dicult to sta
at higher levels to compensate for the extra time involved.
Healthcare Reform and Quality Implications Impacting Stafng
e exact details of healthcare reform resulting from the Aordable Care Act are still emerging
and changing over time. It is clear, however, that access to high-quality, aordable care for all
citizens is a key goal of the legislation. Many hospitals are in the position of making decisions
regarding the relative importance of cost of care versus quality. While all hospitals understand
that both are important, many are now confronted with the dicult task of providing quality
care that is measured against published standards of quality. Quality need not cost more, but
many hospitals have numerous systems issues that make it dicult to balance the cost and qual-
ity equation. Clinical leaders and sta will often question that the overall care being provided
in a hospital is not at an acceptable level of quality. ere are frequent cries over past years that
stang levels need to be raised in order to meet the demands for higher quality of care. e
diculty in hospitals versus other industries is the ability to clearly dene the standard mea-
sures of quality associated with patient care. In most industries, the quality associated with
92 ◾ Kelly Arnold
dierent products is tangible and higher quality can be priced higher. Neither pricing or quality
in healthcare are straightforward.
Management Engineer’s Role in Stafng and Scheduling
Management engineers (MEs) or industrial engineers in healthcare have always had a role to play
in the improvement of operations and performance in hospitals. e biggest barrier to achieving
signicant impact in healthcare is a lack of understanding of what an ME is and the tools and
skills they can bring to bear. Engineers by training and nature are problem solvers and critical
thinkers. Most, but not all clinical employees in hospitals, need these skills to perform their jobs
at a high level. ere should be a natural synergy between these two groups of professionals. In the
areas of stang and scheduling, an ME would apply their analytical skills to greatest eect. Many
clinical managers are uncomfortable with analysis of data, which is not clinical in nature. e
ability to transform data into information for decision making is a needed skill in many hospitals.
Such an analysis of stang and scheduling data by MEs will lead to better decisions by clinical
managers than they will make in the absence of the analysis.
An additional area in which ME skills can be applied would be operational analysis with
subsequent process redesign. Many hospitals are pursuing a variety of in-house and consultant-led
initiatives that fall under the broad terms of Lean or Six Sigma. MEs have these skills as part of
their education and often as part of their past professional experience. ey are well suited to lead
these initiatives. A big challenge that confronts MEs who are new to healthcare organizations is a
lack of understanding or exposure to clinical operations. e ability of an ME to positively impact
stang and scheduling can be greatly enhanced by exposing themselves to clinical operations.
By reaching out to partner with clinical leaders for education on the clinical world, MEs will be
more eective and trusted when applying their skills to assist in the improvement of stang and
scheduling processes.
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