ESCAPE THE EMPLOYEE
STAFFING TRAP
Effective Access Management
Staffing Models
April 18, 2014
LEARNING OBJECTIVES




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Learn the components of a staff management
system
Understand why character is more important in
an employee than experience
Understand staffing model preferences and the
impact they can have on employee retention and
satisfaction
Learn how to identify and select talent in a
hurry
Learn how to build a comprehensive work
schedule with backup support in 1 try
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THE EMPLOYEE STAFFING TRAP
3
THE EMPLOYEE STAFFING TRAP
Access managers are routinely faced with
the challenge of staffing an operation across
3 shifts, 7 days per week. Moreover, access
managers must address this challenge in an
industry where employee turnover levels
can be as high as 50%!
Access professionals can meet this
challenge by understanding the key
components of an effective staff
management system.
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THE EMPLOYEE STAFFING TRAP


At your organization,
is this employee
joining or leaving
your department?
How many attendees
expect a call or
message while in
this conference
related to a staffing
issue?
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THE EMPLOYEE STAFFING TRAP
• Maybe this looks
more like the door at
your
organization……
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THE EMPLOYEE STAFFING TRAP

If the graphics below describe your
situation, this learning lab is for you!
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STAFF MANAGEMENT SYSTEMS
8
STAFF MANAGEMENT SYSTEMS
Core Considerations
Includes:
Core Considerations
Factors that must be
considered to staff any
access management
organization
Employee Selection
Operating
Environment
Internal Staffing
Philosophy
Staffing Model
Preference
9
STAFF MANAGEMENT SYSTEMS
Facilitating Considerations
Includes:
Facilitating
Considerations
Factors that must be
considered to facilitate
the support of core
staffing processes
H.R. Support
Software Tools
Data Analysis
- Reporting, Lessons
Training Programs
10
STAFF MANAGEMENT SYSTEM
All Considerations
Core
Facilitating
Employee Selection
H.R. Support
Operating
Environment
Software Tools
Internal Staffing
Philosophy
Staffing Model
Preference
Data Analysis
- Reporting, Lessons
Training Programs
11
CORE STAFFING
CONSIDERATIONS
Staff Management System
Core
Facilitating
Employee Selection
H.R. Support
Operating
Environment
Software Tools
Internal Staffing
Philosophy
Staffing Model
Preference
Data Analysis
- Reporting, Lessons
Training Programs
12
CORE STAFFING
CONSIDERATIONS
Employee Selection


"People are not your most important asset, the
RIGHT people are"
“the single biggest constraint on the success of
my organization is the ability to get and to
hang on to enough of the right people”

Source: Jim Collins, “Good to Great”
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CORE STAFFING
CONSIDERATIONS
Employee Selection

Keys To Finding The Right People


Look for alignment of the prospective employee’s
needs with your business needs
Understand that character is more important than
experience
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CORE STAFFING
CONSIDERATIONS

Alignment of Employee and Business
Needs

Basic Skills
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Schedule Availability

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
General PC Skills
Telephone Manner
Office Administrative Skills
Full-time, part-time, PRN; weekends, holidays
1st, 2nd or 3rd Shift
Goals and Objectives


Development and training?
Compensation, promotion and benefits?
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CORE STAFFING
CONSIDERATIONS

Why Character is More Important
Than Experience

All access management experience is not
created equal. Very experienced
prospects:

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
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May not wish to function in highly productive
environments
May be adverse to change
May not wish to be cross-functional
May not function well where teamwork is required
May have different views regarding attendance and
punctuality
May not see customer service as a component of care
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CORE STAFFING
CONSIDERATIONS
Employee Selection

Characteristics of the “right” people
Self motivated
 Dependable
 Care about doing a great job
 Care about delivering outstanding service
 Never satisfied with status quo
 Seek to continuously improve processes and
services

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CORE STAFFING
CONSIDERATIONS
Employee Selection
Tip – Perform “Character” Interviews


Prospects should provide examples of the following:

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Productivity and attention to detail
Adaptability
Willingness to learn and perform multiple tasks
Willingness to work with multiple departments
Record of dependability and punctuality
Service and service recovery aptitudes
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CORE STAFFING
CONSIDERATIONS
Employee Selection
“Get the right people on
the bus, the wrong people
off the bus, and the right
people in the right seats”
Source: Jim Collins, “Good to
Great”

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CORE STAFFING
CONSIDERATIONS
Staffing Operating Environment
In-House
In-House
Personnel, facilities and
procedures are
controlled by the
access management
department. No
staffing support is
provided to clinical
areas.
Main Registration
ED Registration
All Registration Sites
Financial Screening
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CORE STAFFING
CONSIDERATIONS
Staffing Operating Environment
Outsourced
Outsourced
Clinical department
assumes no
responsibility for
staffing or coverage
support. All coverage
provided by access
mgmt. department.
Radiology/Imaging
O.R.
Bed Management
Clinical Departments
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STAFFING OPERATING
ENVIRONMENT
Staffing Operating Environment
Tip – Establish Outsourcing Limits


When outsourcing coverage to clinical areas:
 Establish responsibility for training
 Determine a cap for back-up coverage
 Avoid involvement in clinical administrative
duties
22
CORE STAFFING
CONSIDERATIONS
Internal Staffing Philosophy
Characteristic
s
Normalized
Access mgmt.
organization creates
stable, predictable
schedules whenever
possible.
Stable Schedules
Stable Shifts
Scheduled Breaks
Planned Back-up
Support
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CORE STAFFING
CONSIDERATIONS
Internal Staffing Philosophy
Characteristics
Random
Access management
organization fills
whatever roles are
available according to
need. Schedules tend
to be unpredictable.
Variable Schedules
Variable Shifts
Random or No Breaks
Ad-hoc Back-up
Support
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CORE STAFFING
CONSIDERATIONS
Staffing Model Preferences
Variable Shift Model

Employee works variable shifts as
needed
Pros – Fewer schedule holes to address
 Cons - Sub-optimal for employee
satisfaction and retention

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CORE STAFFING
CONSIDERATIONS
Staffing Model Preferences
Static Shift Model

Employee works the same shift each day
 Pros - Better employee satisfaction and
retention
 Cons – May create more schedule holes to
address (not in this scenario because we
have no “grandfathered-in” promises to
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keep)
CORE STAFFING
CONSIDERATIONS
Staffing Model Preferences
Variable Staffing Model – Rotating
Weekend
 Weekly staff rotate to the weekends on
an ongoing basis
 Pros – No need for weekend-only staff.
Regular staff is usually perceived to be more
reliable
 Cons - Higher dissatisfaction and turnover
27
from rotating weekly staff rotating to
weekends
CORE STAFFING
CONSIDERATIONS
Staffing Model Preferences
Static Staffing Model – Permanent
Weekend
 Weekend-only staffing in place
 Pros – No weekend rotation needed for
current weekly staff, higher satisfaction for
weekly staff.
 Cons - Reliability issues may crop up for
weekend-only personnel.
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CORE STAFFING
CONSIDERATIONS
Staffing Model Preferences
Better Practice


Static models promote higher retention and
job satisfaction among access personnel
When properly implemented, static models
provide less of a need for managerial
involvement in the staff scheduling process
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CORE STAFFING
CONSIDERATIONS
Variable Staffing Model – Rotating Weekends
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CORE STAFFING
CONSIDERATIONS
Staffing Model Preferences
Variable Staffing Model – Rotating
Weekend

Determine weekend rotation – make this
rotation as stable as possible to maximize
employee satisfaction
 Give employees the same day off before the
weekend and the same day off after the
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weekend!
CORE STAFFING
CONSIDERATIONS
Staffing Model Preferences

Expand the Rotation

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
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
Involve all access personnel in the rotation!
Too often, only ED employees are used in
weekend rotations. Positions to include:
Outpatient registrars
Inpatient registrars
Financial screening personnel
Bed management personnel
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CORE STAFFING
CONSIDERATIONS
Staffing Model Preferences
Expanding Weekend Rotation Resources

Advantages:



The more personnel involved, the fewer
weekends any employee will have to work
Depending on the size of the access
organization, rotations can be as infrequent as
every 2 months
Full participation in the rotation is more fair
to all department employees
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CORE STAFFING
CONSIDERATIONS
Staffing Model Preferences
Variable Staffing Model – Rotating
Weekend
 Determine Your Back-up Plan
 Always know your next 3 levels of backup

Best Practices: Establish on-call coverage



Level 1: On-call employees (Usually PRNs)
Level 2: On-call leads
Level 3: On-call supervisors/managers
34
CORE STAFFING
CONSIDERATIONS
Staffing Model Preferences
Variable Staffing Model – Rotating
Weekend
 Establish leadership roles


Someone should always be in control on
all shifts
Better Practices:


Establish lead roles for 2nd and 3rd shifts during
the week
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Establish lead roles for all weekend shifts
STAFFING MODEL
PREFERENCES
Static Weekend Model
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CORE STAFFING
CONSIDERATIONS
Staffing Model Preferences
Static Staffing Model – Permanent
Weekend

Schedule Full-time employees first

Only a 1 week view is needed
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CORE STAFFING
CONSIDERATIONS
Staffing Model Preferences
Static Staffing Model – Permanent
Weekend

Hire and train weekend only staff

Select carefully for reliability


The job must be in the best interests of the
employee
Avoid students if possible**
38
CORE STAFFING
CONSIDERATIONS
Staffing Model Preferences
Static Staffing Model – Permanent
Weekend

Determine Your Back-up Plan
 Always know your next 3 levels of backup

Best Practices: Establish on-call coverage



Level 1: On-call employees (usually PRNs)
Level 2: On-call leads
Level 3: On-call supervisors/managers
39
CORE STAFFING
CONSIDERATIONS
Staffing Model Preferences
Static Staffing Model – Permanent
Weekend

Establish leadership roles
 Someone should always be in control
on all shifts

Best Practice – Hire permanent weekend
leads:

Better team building for the weekend team
40
CORE STAFFING
CONSIDERATIONS
Staffing Model Preferences
Static Staffing Model – Permanent
Weekend

Establish emergency back-up roles

Best Practice:

Hire and train 10 – 20 “PRN” employees
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BLOW-UP YOUR SCHEDULE
Discussion Exercise

You were recently hired as the access
manager of a new hospital currently
under construction and charged with
hiring a full registration team. You were
provided with the hours of operation and
the anticipated patient volumes. Armed
with this information and what we know
about staffing models, how would you
develop a staffing plan?
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BUILD A VARIABLE SCHEDULE IN 1
TRY
12 Step Process
 Heal
Schedule Addiction!
Step 1:
 Step 2:
 Step 3:
 Step 4:

Hire full-time (FT) FTEs
Hire part-time (PT) FTEs
Hire PRNs
Designate on-call personnel
Level 1: PRNs
 Level 2: Leads
 Level 3: Supervisors/Managers

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BUILD A VARIABLE SCHEDULE IN 1
TRY
• Step 5: Schedule FT FTEs
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BUILD A VARIABLE SCHEDULE IN 1
TRY
• Step 6: Rotate FT FTEs to Weekend
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BUILD A VARIABLE SCHEDULE IN 1
TRY
• Step 7: Fill FT holes with PT FTEs
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BUILD A VARIABLE SCHEDULE IN 1
TRY
• Step 8: Lock-in FT & PT schedules
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BUILD A VARIABLE SCHEDULE IN 1
TRY
• Step 9: Cover scheduled absences with PRNs
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BUILD A VARIABLE SCHEDULE IN 1
TRY
• Step 10: Add on-call Level I -PRNs
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BUILD A VARIABLE SCHEDULE IN 1
TRY
• Step 11: Add on-call Level II -Leads/Sups.
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BUILD A VARIABLE SCHEDULE IN 1
TRY
• Step 12: Exhale & Relax!
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FACILITATING STAFFING
CONSIDERATIONS
Staff Management System
Core
Facilitating
Employee Selection
H.R. Support
Operating
Environment
Software Tools
Internal Staffing
Philosophy
Staffing Model
Preference
Preference
Data Analysis
- Reporting, Lessons
Training Programs
52
FACILITATING CONSIDERATIONS
Effective Training & Support Programs
• A top reason access managers over-rely on a
search for experienced personnel is a lack of
effective training and technological support
programs. Such programs allow:
– Expansion of the pool of applicants
– Hiring for character
53
FACILITATING CONSIDERATIONS
Effective Training & Support Programs
Tip: Effective support programs should
include:
– Productivity Policy
– Quality Policy
– Both reduce staffing needs by increasing volumes
and reducing re-work
– Automation of all possible processes
– Reduces training requirements
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– Reduces process complexity
FACILITATING CONSIDERATIONS
Human Resources Support
•
Tip – Establish a HR Liaison
– Your HR support liaison should be able to identify
the “right” person better than you could. They
should:
– Screen all applications
– Ensure critical criteria are met
– Have alignment with your department on what
“character” means
55
FACILITATING CONSIDERATIONS
Human Resources Support
•
Tip – Conduct Job Fairs
– Job fairs are an incredibly underused tool. HR
departments love to do them. Job fairs allow:
– Many interviews to be performed on one day
– A wide-variety of skill-sets
– Wide-ranging work availability
– Scheduling of mass training sessions
– On-the-spot job offers (assuming references
check-out)
56
FACILITATING CONSIDERATIONS
Staffing Analysis Reporting
• The best schedules are data-driven, not exceptiondriven
– Your schedule must first meet your coverage needs
• Schedule exceptions made to accommodate personal
needs of employees can wreck a schedule when they are
inconsistent with actual coverage and business needs
– Review the schedule for predictable patient flow
patterns
• Flow by hour, shift, day, week, month and season
– Be prepared to shift staffing up or down according to
activity patterns
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FACILITATING CONSIDERATIONS
Staffing Analysis Reporting
•
Tip – Schedule Lunch Coverage
– Many managers get routinely hammered by not
addressing this “simple” issue. Items to consider:
– Providers often close for lunch and send over walkins
– Working patients often call during their own lunch
breaks
– Working while eating is not a break!
– Dissatisfaction of staff who routinely miss breaks
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FACILITATING CONSIDERATIONS
Human Resources Support
•
Tip – Staff Scheduling Software
• Use of employee scheduling software makes
scheduling much simpler
• Penny-wise hospitals often learn they can
leverage existing scheduling software
intended for other departments such as
nursing at no extra cost in the patient access
department
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SUMMARY
 In





this session, we:
Learned the components of a staff management
system
Learned why character is more important in an
employee than experience
Explored staffing model preferences and the
impact they can have on employee retention and
satisfaction
Learned how to identify and select talent in a
hurry
Learned how to build a comprehensive work
schedule with backup support in 1 try
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QUESTIONS
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CONTACT INFO
John Thompson, PMP, CHAM, CRCR
Principal, Access Management and
Technology Innovation Services
jthompson@coalitionrc.com
(301) 802-3078
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