Data-Driven Labor Management Delivers Financial and Operational Improvements

SIGNIFICANT HEALTHCARE LABOR MANAGEMENT COSTS CHALLENGE HEALTH SYSTEMS

As hospitals and health systems face tighter margins, reduced cash flow, and increased competition, they are under immense pressure to improve efficiency and reduce costs. One of the major drivers of healthcare operating expenses is labor management, accounting for approximately 60 percent of hospital costs.¹

The demand for nurses, clinicians, and healthcare-support professionals is projected to increase along with the aging population, creating labor shortages that can drive up wages and lead to the increased use of contract workers and staffing agencies.²The problem is further complicated when patient volumes are lower or higher than expected and place a strain on the budget.

Managing labor costs while meeting the demands for ensuring adequate and qualified staff is a top concern for healthcare leaders who recognize that tight management of labor utilization is essential to maintaining financial health. Successfully managing labor costs requires a system that can track and benchmark labor expenses.³Effective healthcare labor management requires the right balance between quality care, safety, patient and employee satisfaction, and fiscal responsibility.

HPH是夏威夷最大的医疗保健提供者之一，拥有四个主要的医疗中心和全州70多个地点。该供应商的使命是通过其设施之外的社区服务，以及在研究、教育、培训和照顾社区中服务不足的人方面的投资，创建一个更健康的夏威夷。

DISPARATE, RETROSPECTIVE DATA LIMITS VISIBILITY AND ACTIONABLE INSIGHTS

管理劳动力成本可能是一项艰巨的挑战，通常很难知道从哪里开始。与许多卫生系统一样，HPH经历了住院病人数量的周期性下降，并寻求重新调整其工作人员的做法，以更好地管理和预测劳动力需求。

为了优化其资源管理，HPH需要减少不必要的成本，同时保持高质量的护理和患者和员工满意度。尽管该组织有一种灵活的人员配置以适应数量的文化，但它基于潜在的、回顾性的数据进行人员配置决策，导致计划不如预期的准确。

使问题更加复杂的是，该组织的劳动管理数据系统没有集成。碎片化和孤立的数据使得识别趋势和精确指出需要改进的领域变得困难。在整个系统中，数量统计的定义是不同的，这导致无法比较、隔离和干预潜在的问题领域。从不同的来源收集和交付数据，并向领导分发回顾性报告，需要耗时的手工过程，这给需要准确的人员编制和预算规划的关键信息的经理造成了时滞。

Leaders then had to review and reconcile multiple, differing reports to understand their labor utilization. Since the reports were based on payroll data that was weeks old, leaders were forced to manage labor costs by looking in the rearview mirror. The health system sought to improve its labor management, but it lacked the ability to enable labor analysis and interventions on a systemwide level.

REAL-TIME, ON-DEMAND ANALYTICS ENABLES DATA-DRIVEN LABOR MANAGEMENT

Analysis pinpoints opportunities

To gain insight into its performance, HPH partnered with Health Catalyst to conduct an opportunity analysis. The data uncovered opportunities to reduce costs in healthcare labor management and identified the top ten areas across four hospitals with the biggest potential to improve. To tackle the challenge, HPH leveraged the Health Catalyst® Data Operating System (DOS™) and a robust set of analytics applications—including PowerLabor™, an analytics application that helps managers facilitate more efficient labor force utilization by understanding basic operation and staffing indicators.

Using data from its data platform (including hours, volume, and budget data from four different data systems) HPH was able to access, for the first time, detailed information about its labor management practices in one place. Leaders can use PowerLabor to visualize labor management and understand productivity and identify hours detail versus the budget and full-time equivalent (FTE) utilization compared to budgeted FTE.

The organization assembled a meaningful representation of labor utilization with an easy-to-use interface to explore various dimensions of labor productivity, including staffing budget variance, the variance between actual and budgeted pay, and unnecessary variation in labor metrics.

HPH不再需要人工报告，可以根据每日人口普查数据按需提供数据，而不是两周前的工资数据。利用分析应用的新见解，HPH确定其员工比例接近其目标数字，并可以通过收紧流程和对员工比例进行小的调整来显著降低成本，而不是彻底改革其员工方法。尽管HPH发现了大量节省资金的机会，但实现这些节省所需的改变是现实的和可实现的。

Engagement sets the stage for success

Leveraging its culture of financial transparency, the health system engaged leaders from all departments at the start of the project. HPH listened to managers, leaders, and clinicians; validated the data; and addressed the underlying variation before implementing changes. The collaborative approach facilitated widespread support and adoption of the processes and tools as they were rolled out.

First, HPH conducted a pilot to evaluate the use of the analytics application and discover what widespread adoption throughout the system would require. It quickly realized that there were many differing meanings and assumptions ascribed to volume statistics and that data were not consistent.

领导成员明白一致的标准数据对于成功是至关重要的，所以他们会见了试点领域的领导者，探索组织可以更好地对齐和理解每个成本中心的方法。乍一看，问题似乎是人员过多，但在深入研究数据后，领导们发现问题更多的是归因错误。

一旦数据经过验证和筛选，HPH领导层就会使用这些数据来设定目标，并根据新模型确定节省的费用。他们还为员工提供了有目的的培训，解释了这些变化背后的“原因”，并根据需要为管理者提供个人指导和跟进——目标是培训员工如何有效地使用工具。

因为该组织已经有了一种“量体无为”的文化，临床和运营领导者了解自己作为财务管家的角色，并欣赏拥有一个易于访问的工具，具有实时、可操作的数据，以支持他们实现财务目标。领导们终于有能力迅速了解与人员配备相关的部门正在发生的事情，然后做出数据驱动的、主动的决定。六个月的试点成功地展示了数据驱动的医疗保健劳动管理的价值，该组织决定将该工具推广到整个系统。

Collaboration and innovation produce wins

HPH知道，劳动力管理不仅仅是减少开支，而是优化资源，寻找创新和协作的方式来实现其劳动力管理目标。Successfully improving labor management required collaboration, financial transparency, and accountability.

The organization has seen many examples of managers thinking outside the box to address labor needs and manage employees within the budget. For example, managers on a very busy medical unit strived to improve patient satisfaction while staying within their staffing limitations. Data demonstrated that the unit could still meet its staffing goals while adding one additional staff member for the first four hours of the shift—the busiest time—to help answer call lights and respond to patient needs. This innovative four-hour shift started to yield an increase in patient satisfaction scores.

As the census has rebounded, HPH uses the tool to inform strategies to accommodate unpredictable changes in volumes and explain variances:

• 组织中其他人认为工作人员过多的单位使用这些数据来证明需要增加额外的FTE。
• Another unit analyzed the amount of overtime and double-time employees were using and converted those high-expense dollars to regular hours by adding one staff member. In many cases, a re-allocation of positions improved staffing without adding additional costs.
• The emergency department (ED) had been working on different ways to manage its staffing, making incremental gains. Following respiratory therapy’s example of using on-call staff, the ED manager decided to trial on-call staff to manage unpredictable volume variation. The small change helped the ED meet its goals, without compromising high-quality outcomes.
• The pharmacy department had experienced unexpected absences and turnover and noticed that it was over budget in training dollars. By drilling into the data, it was able to better design training and orientation to skill mix, eliminating unnecessary training costs.

整个HPH的部门已经跨越通道互相支持，现在一个部门可能会缓慢地将员工借给一个护理部门来满足病人的护理需求，这是很常见的，腾出一个注册护士来安全照顾另一个部门的病人。

HPH provided additional training for employees interested in providing one-on-one patient monitoring. They also trained the staff in housekeeping, transportation, and respiratory therapy to successfully and safely fulfill the patient monitoring role, when needed.

RESULTS

通过使用数据驱动的方法进行劳动力管理，HPH现在对作业有了详细的了解，支持制定干预措施，以降低费用，同时提高作业效率和满意度。卫生系统仅在6个月内就改善了4个试点设施的劳动力利用率，显著降低了劳动力成本。Building on its initial success, the organization has rolled out the program across its entire system, resulting in substantial savings and operational efficiencies:

• $2.2 million savings in 16 months, while maintaining high-quality outcomes.
• With on-demand, real-time access to data, managers spend 15 minutes—instead of four hours—proactively managing operations, reducing the administrative burden on managers.
• The organization can now answer basic business questions (e.g., the number of FTEs in a given hospital department) in minutes rather than weeks, allowing managers to immediately identify budget errors, in terms of where people are assigned versus where they should be, before making decisions based on faulty data.
• 随着数百名员工每天使用该工具积极管理他们的资源，该应用程序的利用率继续增长。

“我们使用数据来推动改进，我们在劳工管理方面看到了改善我们业绩的机会。我们希望更加灵活，依靠实时数据而不是回溯数据来做出决策。我们已经建立了一种文化，让每个人都成为我们资源的好管家，我们的管理层也采用了帮助他们做到这一点的工具。”

Art Gladstone, RN, MBA, FACHE Chief Executive Officer, Straub Medical Center and Pali Momi Medical Center, Chief Nursing Officer, Hawai’i Pacific Health

WHAT’S NEXT

HPH is continuing to refine its capabilities to optimize and manage labor expenses and is in the process of incorporating labor dollars into its labor-management analytics, giving leaders detailed insight into the financial impact of their decisions.

REFERENCES

1. LaPointe, J. (2018).Hospitals target labor costs, layoffs to reduce healthcare costs.RevCycleIntelligence.
2. Bannow, T. (2018).Health systems find unique ways to cope with rising labor costs.现代医疗保健。
3. Becker’s Hospital Review. (2010).8 ways to cut labor costs in your hospital.