Management: Making Sense of the Census
Features
Written by Ashley McGown   
Thursday, 01 October 2009
Management: Making Sense of the Census
Forecasting systems can help hospital directors better predict staffing needs. Here’s how.


Census-based scheduling is inexpensive yet effective. It can reduce operational costs and improve patient care—in short, it makes sense. So why aren’t more hospitals adopting the method?

Although it has proven efficient in recent years, some hospital directors are cynical about the forecasting approach, weary of its seemingly counter-intuitive nature. It’s true; directors have been using less-technical methods for decades, but what most don’t realize is how significant a financial burden it is to over- or under-staff a unit.

Managing labor in a cost-effective way can be challenging, but it’s one of the most influential components affecting an organization’s operational budget.

Due to their 24/7 status and wide assortment of services, hospitals staff an exceptionally diversified team, making labor management all the more difficult. Managing nurses has proven especially challenging. With a nationwide nursing shortage affecting most regions, recruiting a permanent inhouse team and creating schedules that work for everyone isn’t easy.

Hospitals that can’t retain sufficient staff resort to hiring agency nurses to fill temporary gaps in their schedules while facilities with ample bodies tend to overcompensate when scheduling, often booking more nurses per shift than they need. Neither option is ideal, and both are extremely costly.

To reduce costs and better manage staff, directors need to rethink the way they write employee schedules. Directors should be encouraged to build their monthly schedules based on information drawn from historical census points, such as how many nurses were needed on a specific unit each Tuesday of the previous month.

The census-based process eliminates a lot of the guesswork involved with traditional scheduling, which often calls for the same number of nurses each day of the week, regardless of past trends.

Fort Myers, Fla.-based Lee Memorial Health Systems (LMHS) has seen a significant decrease in labor costs since introducing a census-based forecasting system. According to Kristie Huff, RN and director of resource management and staffing, the five-hospital system saved $11 million the first year.

During that 12-month period, LMHS saw a 50% reduction in the number of agency nurses it hired, and in the 16th month, zero agency nurses were used. Today, the organization only uses agency nurses during the height of its peak season, which occurs sometime between January and April each year as retirees flock south to escape brutal winters.

“We still have to use agency nurses during peak season because of the dramatic increase in the number of patients we see,” Huff said. “However, with the forecasting system, we have been able to reduce the number of agency nurses we use during those months as well. Last season, we used 50% less than the year before.”

Using the census points, the team at LMHS is able to better predict how many nurses each department will need on any given day. Predictions are made by shift, by day, and by unit. Huff said forecasting by shift is a bit of a wild card. “To get that specific is a difficult thing to do. Predictions made according to what day of the week it is are slightly more accurate, and forecasting by unit is definitely the most accurate,” she said.

Achieving buy-in
When implementing a forecasting system to help with labor management, three key players need to be involved: nursing directors, each department’s staff, and the hospital’s operations improvement team. Without buy-in from each, a smooth integration can be difficult to achieve, and because employees are accustomed to performing their roles in a certain way, initial resistance should be expected when such a change is introduced.

The team at LMHS held two-hour information sessions with each department director before the forecasting system was introduced. “We explained what we were going to do, the premise of the census points, and what their involvement would be. This allowed us to receive input and immediately respond to feedback, and it helped us identify which employees were speculative about the process,” Huff said.

Getting buy-in from the people responsible for carrying out the process is important for obvious reasons, but convincing these individuals of the benefits involved may not be easy.

“Some of the people here had been using the same scheduling method for years and years, and this was a big change for them, so we had to make sure everyone truly understood the benefits,” Huff said. “The old method said we needed the same number of nurses every day of the week, but in reality, we don’t. We see a different number of patients each day.”

Reducing agency use
St. Louis, Mo.-based SSM Healthcare also decreased its bottom line by reducing the number of agency nurse its team uses. According to Debbie Walkenhorst, regional VP of HR, and Lynn Lenker, RN and regional VP of nursing, SSM Cardinal Glennon Children’s Hospital (one of 20 in the system) reduced agency staff by adopting what they call an over-hiring process.

The idea is to predict the hospital’s future needs by looking at historical trends, as opposed to waiting until a certain individual or number of employees resign or retire. The pair said the prediction takes into consideration past experiences, such as the anticipated amount of turnover, occurrence rate of leaves of absence, and changes in business, like the opening/closing of beds due to growth patterns.

Ultimately, the method results in an inhouse staff that’s slightly larger than necessary, but its maintenance costs significantly less than the constant rehiring of contingent labor, and because the nurses who step in are staff employees, their familiarity with the organization results in top-quality care.

Although they haven’t measured outcomes related to care in hospitals within SSM that are agency-free versus those that use agency nurses, Walkenhorst and Lenker said they have seen increased productivity and lower labor costs in the former.

Looking at these results, the benefits of census-based forecasting are clear. An easy-to-implement process that leads to reduced spending and improved care—what more could healthcare providers ask for?
 
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