Staffing Analysis –
Capacity / Demand Matching
X32 Healthcare
info@x32healthcare.com
© 2011, X32 Healthcare, LLC
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Staffing Analysis Overview


A fundamental principle of lean is providing
the right
g service at the right
g time in the right
g
amount.
Aligning staff capacity (staffing schedules)
with staff demand (patient treatment) has
many flow implications.



An ED
ED’ss largest service providers are its staff
Matching capacity and demand promotes flow
Mismatching capacity and demand hinders flow
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Why is matching important?

3 potential scenarios:

Capacity
Capac
ty / de
demand
a da
alignment
g e t

Flow within the department is maximized



Staff utilization is high but manageable
Capacity / demand misalignment (too much capacity)



Length of Stay (LOS) is minimized
Flow within the department is maximized (LOS minimized)
St ff utilization
Staff
tili ti iis llow and
d resources are wasted
t d
Capacity / demand misalignment (too much demand)


Flow within the department is minimized (LOS is very high)
Staff utilization is high and unmanageable
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Matching Example

Medium sized 24-hour Emergency Department
with 95 p
patients per
p day,
y, on average.
g
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2
Matching Example
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Matching Example


Medium sized 24-hour Emergency Department
with 95 p
patients per
p day,
y, on average.
g
Physicians can treat 2.5 patients per hour, on
average. So, 38 physician-hours (computed as
95/2.5) are required per day.
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3
Matching Example



Medium sized 24-hour Emergency Department
with 95 p
patients per
p day,
y, on average.
g
Physicians can treat 2.5 patients per hour, on
average. So, 38 physician-hours (computed as
95/2.5) are required per day.
Therefore, staffing 2 physicians on duty 24hours per day should provide sufficient capacity
cushion (utilization estimate of 79%, computed
as 38/48).
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Matching Example
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4
Matching Example
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Matching Example


Estimate staff demand by dividing the patient
arrival rate byy the average
g staff productivity
p
y
rate.
For example, look at 4:00pm



Avg patient arrival rate: 5.08 patients/hour
Avg physician productivity rate: 2.50
2 50 patients / MD hour
Staff demand = 2.03 MD’s (= 5.08 / 2.50)
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5
Matching Example
Under Staffing
Excess Staffingg
Average patient wait is 74 minutes
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Matching Example

To promote flow, better align the staffed
capacity
p
y with staff demand.


Under staffing creates queues, increasing LOS
Effects are felt for hours after under staffing ends



Break even does not occur until the cumulative excess
capacity equals the cumulative sum of demand left over
from under staffing
Makes
M
k sense, but
b t how?
h ?
Try reallocating 6 hours from 1am to 6am to
the afternoon between 11am and 8pm.
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Matching Example
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Matching Example
U d St
Under
Staffing
ffi
Excess Staffing
Average patient wait is 43 minutes
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Matching Example


Results in a 31 min reduction in patient wait
((results calculated byy simulation model))
Same amount of physician coverage



48 hours of physician coverage per day
New schedule requires a bit of flexibility, but is
possible
Capacity buffer added during peak times


Under staffing minimized
Excess capacity spread throughout day to better
accommodate arrival variation
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Getting Started

The first step in a staffing analysis is creating
a staffing
g profile.
p


Download the “2011_Staffing_Analysis” Excel file
(available at www.x32healthcare.com)
3 worksheets are included:



“Instructions” – provides a quick overview of the
worksheets
“F
“From
Schedule
S h d l to
t Profile”
P fil ” – blank
bl k worksheet
k h t ready
d to
t
be used
“Example” – the above worksheet with example data
filled in
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“From Schedule to Profile”
Section 1
Section 2
Section 3
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“From Schedule to Profile”

Section 1: Data Inputs


Sect o 1 converts
Section
co e ts you
your sshiftt sc
schedules
edu es into
to a
1
2
3
staffing profile
Enter your shift schedules:
 1 – count of staff scheduled
for this shift
 2 – use the pull-down list to
indicate the start of the shift
 3 – use the pull-down list to
indicate the end of the shift
(pink cells are editable)
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“From Schedule to Profile”

Section 1: Data Inputs


Sect o 1 converts
Section
co e ts you
your sshiftt sc
schedules
edu es into
to a
4
5
scheduled profile
Review the staffing profile:
6
 4 – check the shift length to
insure correct data entry
 5 – the total number of staff
hours scheduled with this shift
 6 – the resulting staffing
profile by hour of day
(yellow cells are calculated, therefore protected)
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“From Schedule to Profile”

Section 2: Data Refinement



Sect o 2 refines
Section
e es tthe
e data from
o sc
scheduled
edu ed
staff to “productive” staff
“Productive” staff is defined as the count
of scheduled staff minus regular breaks
Enter break and demand data:
7
8
 7 – enter the number of staff hours on meal
or rest breaks (i.e., 5 RN’s on 0.5 hour lunch
break is equal to 2.5 staff hours)
 8 – enter the demand for staff by hour, if
unknown, approximate as shown earlier
(red and green cells are editable and color coded to the chart)
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“From Schedule to Profile”

Section 2: Data Refinement



Sect o 2 refines
Section
e es tthe
e data from
o sc
scheduled
edu ed
staff to “productive” staff
“Productive” staff is defined as the count
of scheduled staff minus regular breaks
Review the “productive” staffing profile
9
 9 – review the “productive” staff counts as a
reality check for correct data entry
(blue cells are calculated (protected) and color coded to the chart)
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“From Schedule to Profile”

Section 3: Comparison Chart

Section
Sect
o 3 iss a g
graphical
ap ca representation
ep ese tat o o
of:




Scheduled Capacity (blue plus red bars)
Productive Capacity (blue bars)
Staff Demand (green line, if demand column completed)
Use this section to:


Identify periods of excess and under staffing
Lookk ffor opportunities to refine
f
shift
h f schedules
h d l (adjust
( d
“productive” profile to better match demand)
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“From Schedule to Profile”
The chart is color coded to the columns in Section 2
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Matching Challenge
The Situation:
Tiffany is in charge of scheduling nurses for a 24-hour main
emergency department which sees approximately 110 patients
each day. Traditionally, the nurses have been level staffed
throughout the day. Recently, an afternoon shift was added to
help the overworked staff. The afternoon, evening and late night
shifts feel this helped, but are still “dissatisfied” about being
understaffed.
Use the “From Schedule to Profile” worksheet to build a chart and
help Tiffany investigate the root cause of the “dissatisfaction”.
© 2011, X32 Healthcare, LLC
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Matching Challenge

After 3 weeks, of diligent work, Tiffany has
generated the following
g
g data:
Tiffany schedules 3 different shifts:
8a to 8p – 6 nurses
8p to 8a – 6 nurses
12noon to 10p – 4 nurses
Tiffany’s
y nurses,, though
g
stressed, are not slackers with
an average productivity rate of
0.67 patients per RN hour (or
1.493 RN hours per patient).
Tiffany leaves it up to the
nurses to take their meal
breaks. On average, half of the
nurses take a half hour lunch
break in the 5th hour of their
shift. The other half takes their
lunch in the 6th hour. They do
not take rest breaks.
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Matching Challenge

The answers:
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Matching Challenge

Break Schedules:
Hr 1
8a-9a
Hr 2
9a-10a
Hr 3
10a-11a
8p-9p
9p-10p
10p-11p 11p-12m
12n-1p
1p-2p

2p-3p
Hr 4
11a-12n
3p-4p
Hr 5
12n-1p
1.5 hr
12m-1a
1.5 hr
4p-5p
1.0 hr
Hr 6
1p-2p
1.5 hr
1a-2p
1.5 hr
5p-6p
1.0hr
Nurse Demand:
Example: 9am (approximate demand with arrival pattern and productivity)
5.00 patients/hr divided by 0.67 patients/RN hour =
7.46 RN demand
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Matching Challenge

The answers:
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Matching Challenge

The opportunities:
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Matching Challenge

The opportunities:

Reallocate a few overnight to the peak demand hours



B sure tto maintain
Be
i t i minimum
i i
safe
f staffing
t ffi d
during
i the
th
overnight hours
Shift changes can take a while to implement, especially if
shifts are going to be lengthened or shortened
Control breaks


Specify how many breaks can be taken each hour
For example, no more than 1 break hour taken each hour
(i.e., no more than 2 nurses taking lunch each hour)
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Further Refinement


If you need help determining staff demand,
contact us through
g info@x32healthcare.com
@
If you would like to more accurately calculate
staff demand, contact us at
info@x32healthcare.com

Demand can be further refined by incorporating:




Time intervals
Time phasing
Holds
etc
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© 2011, X32 Healthcare, LLC
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