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Reining in Labor Costs with Predictive Analytics
March 2, 2016 Tamira Harris, PhD, MBA, MSN
Business Advisor
McKesson Capacity Management
Conflict of Interest Tamira Harris, PhD, MBA, MSN Has no real or apparent conflicts of interest to report.
Agenda • Who We Are • Creating a Data-Driven Culture • Predictive Analytics for Capacity Planning • Outcomes-Based Scorecard • Achievements to Date
Learning Objectives • Evaluate the impact of data-driven decision-making on daily
operations • Demonstrate the value of reliably accurate demand forecasts for
strategic, budgetary and near-term planning • Assess how data transparency can help your organization achieve
sustainable cost reductions and other desired outcomes • Illustrate how demand forecasts can be used to actively engage the
medical staff
http://www.himss.org/ValueSuite
Benefits Realization
• Patient and Staff Satisfaction – Anticipated arrivals, reduced wait times – Predictable schedules
• Treatment/Clinical – Optimal resource allocation – Engaged physician leadership – Decreased care silos
• Electronic Secure Data – Proactive, data-driven behavior – Data leveraged across planning horizons
• Savings – Right-sized capacity – Reduced labor costs – Increased efficiency & productivity
Size and Scale • 4 hospital system with $1.8B in
revenue • Efficient contracts with largest areas
health insurance plans • Alignment strategies with key
physician groups • Non-union
Quality and Specialized Services • Gagnon Cardiovascular Institute • Carol G. Simon Cancer Centers • Goryeb Children’s Hospital • Atlantic Neuroscience Institute • UHC data base participant
Market Leader • Leading market share position, more
than double next nearest competitor • Excellent socio-demographic
characteristics • Currently overseeing 2 ACO‘s
At a Glance • 12,114 employees • 3,168 physicians • 280 medical residents • 1,339 licensed beds • 72,892 admissions • 7,191 births • 19,033 inpatient surgeries • 28,658 same day surgeries • 205,898 emergency visits • 697,416 outpatient visits,833
hospice days
6
Atlantic Health System
Atlantic Health System
Vision Empowering our communities to be the healthiest in the nation
Mission • Deliver high quality, safe, affordable
patient care within a healing culture • Educate, in an exemplary manner,
present and future health care professionals
• Innovate through leadership
Shared Values Professionalism, Respect, Involvement, Dignity, Excellence
• Reduce Costs
• Spend less capital on hospital bricks and mortar
• Tightly manage labor costs
• Increase Revenue
• Increase ambulatory presence
• Reduce leakage
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Goal: Cut $70M in Costs Over 3 Years
Overlook Medical Center
• 24,478 admissions
• 5,917 inpatient surgeries
• 9,279 same day surgeries
• 96,612 ED visits
• Fortune 100 Best Place to Work
9
4
U.S. News and World Report
• Best Regional Hospital for Neurology, Neurosurgery, Gastroenterology, GI Surgery, Geriatrics, Gynecology, Nephrology, Pulmonology and Urology
• Neuroscience Institute - Hub for New Jersey Stroke network - treat 40% of state stroke patients
Overlook Strategic Goals Desired End State
Desired Competencies
Proactive/real-time decision-making Improved patient placement Ability to address and monitor
• Service line profitability • Labor analytics
• Improve patient throughput, initially ED
• Match nurse staffing to patient demand
Primary Goals
Organizational Transparency
Enabling Technology
• Self-serve analytics
The Need for Timely, Data-Driven Decisions
Strategic
Budgetary
Scheduling
Operational
3-5 years 1-2 years 1-4 months >30 days - Today What do we need to look like under value-based purchasing?
Where can we find more savings without drastic cuts?
How do we staff for unknown peaks and valleys?
What do we need to do to get these 7 patients out by noon?
What is the next best use for this capacity?
…and without hurting care quality, patient satisfaction or staff satisfaction?
What is the down-stream impact of this OR schedule?
What can we do today to prepare for tomorrow?
How do we optimally deploy our capital and people resources?
Capacity Planning in Healthcare Process by which hospitals can effectively determine the resources (beds and staff) required to meet the forecast patient demand over a given time period.
Review &
Analyze Historical Trends
Forecast Patient
Demand
Schedule Resources
To Meet Demand
Monitor & Measure
Against Plan
Adjust& Refine Plans
Aligning Resources with Predicted Patient Demand • Identify patterns and trends • History based on last 4 years patient
demand, last 2 years staffing • Apply assumptions based on seasonal
changes • Fine-tune timing of demand what
initiatives did we put in place
Demand Forecast
Historical Data
Planning Groups
Statistical Algorithms
Staffing
Productivity Measures / LOS
Manual Adjustments
Executive Hospital Overview
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Proactive Planning & Performance Tracking
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Levers Objective Initiative Measures (KPI's) - Objective Related Baseline 2014 YTD-SEPT- 2015 3 QRT(JAS) Target
Point Person for Initiative Source Report
Increase Inpatient Discharges by 12 pm
14% 0% 0% 14% Directors, Nurse Managers,
Daily Dashboard, Projection Report,
Medicine/ Surgery 4.0 4.0 3.8 4.0Neuro 4.8 4.2 4.0 4.8
Critical Care 5.5 5.2 4.8 5.5
Accelerate inpatient discharge time to facilitate quicker admission from the ED and reduce late afternoon "hold" bottleneck
Transfer admitted ED patients to Inpatient bed
within 1 hour of Disposition1,882 1,092 329 1788
Nursing, Environmental
Services, Patient Access
Average Daily Occupancy, Hourly
Pattern Reports
Utilize McKesson Capacity Planner & McKesson Performance Visibility information to support initiatives to reduce ED Hold time
ED Hold Overlook & Union 61,462 39,093 1,747 58,389 Target for 2015? Terri reports
Nurse managers proactively manage staffing adjustments 72 hours out - evaluate staffing schedules to support peak workload demand
Utilization of Staffing projections
8 Hrs 8 Hrs 36 Hrs 72 Hrs
Staff required vs. actual summary
report; actual versus budget report
Initiative Planning Groups Budget 2014 YTD-SEPT- 2015 3 QRT(JAS) Budget Comments HPPD Chart
Medicine 7.24 7.40 7.48 7.24Surgery 6.90 6.85 6.95 6.90Neuro 7.55 7.45 7.47 7.55Critical Care 16.86 17.55 18.12 16.86Summit ED 2.25 2.13 2.06 2.25Union ED 1.89 1.69 1.62 1.89
Initiative Decrease in Overtime by Planning Groups UTIL 2014 YTD-SEPT- 2015 3 QRT(JAS) Target 2% Less Comments
Medicine $469,226.03 408,381.19$ 351,366.68$ 459,841.51$ Surgery $243,399.53 215,400.07$ 193,399.02$ 238,531.54$ Neuro $175,241.19 151,692.03$ 140,006.81$ 171,736.37$ Critical Care $337,470.87 244,495.33$ 229,539.55$ 330,721.45$ Summit ED $579,553.33 611,613.20$ 551,610.37$ 567,962.26$ Union ED $292,183.24 379,426.66$ 333,536.85$ 286,339.58$
InitiativeDecrease Agency Usage UTIL 2014 YTD-SEPT- 2015 3 QRT(JAS) Target 1% Less Comments
RN FTE's $2,506,458.71 1,179,061.28$ 333,568.26$ 2,481,394.12$ Sitters FTE's $2,651,626.37 1,764,756.03$ 450,269.49$ 2,625,110.11$
Project Scorecard Matrix (QRT 3# JULY, AUGUST, SEPTEMBER)
MA
RG
IN
G
RO
WTH
Q
UA
LITY
Improve patient
throughput
Match Staffing to Demand
Implement robust daily planning & management process including review and enhancement of daily meeting structure and outcomes (Neuro, M/S, CC)
Plus/ Minus 0.3 care hours (ex. Medicine= x HPPD, target x - HPPD) Productivity
Improvement by Planning Group
Decrease Overtime by 2% at each Planning Group
Hours Per Patient Day Chart
Client report on OT trends Productivity
Report per PP
Forecasting center, Resource Planning
Centre weekly agency report PP
Utilization of Planner in ongoing projects to Agency & Sitters(NEURO, CC, M/S, ED)
Utilization of Planner in ongoing projects to decrease LOS (Neuro, CC, M/S)
Case Management, Nursing
Care hours listed is the avg for the planning
groups Allowed to be .30 over budget
Use Baseline 2015
Use Baseline 2015
Historic ALOS Trend Chart
STEPS: Satisfaction
• Staff • Predictable
schedules managed at unit level
• Patients • Arrival and
needs are anticipated
• Patients • Reduced ED
wait times • Hold hours
halved from ~4,800 hours to ~ 2,800 hours per month
“If the staffing is not balanced appropriately, then my staff get pulled to other units, which is always a dissatisfier. Now that we know what type of admissions are arriving and when, we can assign the right staff and prepare for them.”
Anticipating Hourly Admissions and Discharges
Why are we behind on projected discharges? Where are the delays? What can we do?
STEPS: Treatment/Clinical
• Optimal resource allocation
• Standardized staffing model
• Balanced workloads
• Engaged physician leadership
• Decreased care silos
• Cooperation at planning group vs. unit level
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Cooperation at Planning Group Level
Physician Engagement • Monthly Executive Patient
Throughput Team – CMO
– Nurse managers
– Physician over Case Management
– Directors of Neuroscience, Finance, Operations, ED, Special Projects
Capacity Executive Team
STEPS: Electronic Secure Data
EXAMPLE
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• Proactive, data-driven behavior
• Reliance on single source of truth
• Leveraging data across planning horizons
• “It’s like scarily predictable.” • “I love that all the information
can be gathered in one place.” • “The biggest thing is how
accurate it is and how much you can look at things ahead of time and then make decisions based on that.”
• “It creates transparency … that is the first step in improving processes.”
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Projection Accuracy
Leveraging Data Across Planning Horizons
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STEPS: Savings
• Labor costs • $250,000 in
reduced OT use • Productivity
• .2 day reduction in NHPPD
• Efficiency • .2 day reduction in
LOS (4.4 to 4.2) • Earlier discharges
• Right-sizing capacity • Flexing surgical and
critical care units based on predicted demand @~$3,400 savings/day for $150K+ savings to date
http://www.himss.org/ValueSuite
Benefits Recap • Patient and Staff Satisfaction
– Anticipated arrivals, reduced wait times – Predictable schedules
• Treatment/Clinical – Optimal resource allocation – Engaged physician leadership – Decreased care silos
• Electronic Secure Data – Proactive, data-driven behavior – Data leveraged across planning horizons
• Savings – Right-sized capacity – Reduced labor costs – Increased efficiency & productivity
Questions Tamira Harris, PhD, MBA, MSN Business Advisor McKesson Capacity Management [email protected]
