When it comes to benchmarking for staffing and productivity at any facility, be as inclusionary as possible. For example, only tracking nursing departments, support areas or inpatient departments will create friction between non-benchmarked departments/areas, as well as dissatisfaction with the entire process. Another potential difficulty is the transfer of FTEs that were traditionally housed in one department suddenly finding their way into non-benchmarked departments.
The question is how do you best tackle those areas in your healthcare facility that are difficult to benchmark or who don’t currently have a variable statistic to measure their workload? To help answer that question, in this offering of Off the Shelf we will review some of the most commonly difficult to benchmark areas and provide solutions for setting benchmarks:
It is not uncommon for many departments, particularly non-clinical, to be saddled with a non-variable benchmark. This holds them to their current staffing level and budget, but can create difficulties in both management and finance as they cannot flex up or down based on hospital volumes. More common non-variable/fixed departments include corporate/administrative functions such as marketing/communications, finance, development, etc., as well as less flexible hospital support departments such as pastoral care, volunteer and community outreach.
Solution:The reality is that no department should be completely static in today’s tight fiscal environment (see Setting a benchmark below). However, as with clinical departments, these areas will have “minimal staffing” levels that should be determined by administration. These levels should be set outside of the benchmark and consider the service level and hours of operation these departments need to encompass (for example, the benchmark calls for 3.8 FTEs, but based on hours of operation that administration wants to maintain 4.2 FTEs are needed, thus 4.2 would be “minimal staffing”).
Departments without typical hours of operation or a day-to-day manager are often overlooked in benchmarking projects. Examples include nursing float pools, house supervisors and construction services. In many cases it is just not realistic to set a separate benchmark for these departments as sometimes they may not have any FTEs or their FTE numbers are wildly variable.
Solution: The best solution is usually to eliminate the departments (at least for benchmarking purposes) and allocate their FTEs to the appropriately utilized departments. Here are examples to consider:
- Nursing float pools can be allocated as a percentage of your inpatient nursing departments’ average daily census, or via another distributive method. Separate percentages can be allocated for other nursing areas assuming there are no dedicated float pools by specialty (e.g., women’s services, surgical services, etc.).
- Contracted/temporary FTEs such as in construction services should receive a finite benchmark by their managing department. Facilities, for example, may gain 2.6 FTEs for the second quarter since they have a small construction management project going on during that time period.
Setting a Benchmark
At this point, you understand the financial and managerial consequences of not providing a variable benchmark for all of your departments. However, you may not know how to set one. We recommend exploring a number of options when reviewing the best benchmark for each department in question:
General Facility-level Benchmark:Utilize general measure of facility volume such as adjusted patient days or discharges.
- Pro: Will match well with overall facility financials
- Con: May not be the best indicator of workload for a given department (e.g., marketing workload typically should not be reduced even if patient volumes are down)
Department-specific Benchmark: Use adjustable measure to match department specific workload such as bills processed, volunteers managed, events held, donated funds received, etc.
- Pro: Specific to department workloads
- Con: Workload for the department may need to be adjusted based on facility volumes and finances (e.g., volunteer workload may stay the same, but if patient volumes are down the need for volunteers for transport, reception, etc. will also go down even if the number of volunteers is static)
Consolidation: Roll FTEs and any applicable workload into one department.
- Pro: Helps prevent over-benchmarking where a benchmark may be set for a department with one or fewer FTEs or a department that doesn’t fully perform a the benchmarking standard’s function (e.g., plant ops, boiler, and ground maintenance can be consolidated under a single benchmark that reflects workload for all areas such as work orders processed or square footage rather than separate benchmarks for each area)
- Con: Workload for consolidated departments may not fit well with one another>