hns_the_six_sigma_way

8/7/2019 HNS_the_Six_Sigma_Way

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Hospital Nurse Staffing, the Six Sigma Way

What is Six Sigma?

Six Sigma is a quality management system that originated in the manufacturing industry but has becomeincreasingly popular in healthcare. Hospitals are implementing Six Sigma programs to improve andcontrol organizational processes that can help reduce clinical errors, achieve higher levels of care, reducecosts, and increase patient and employee satisfaction.

Six Sigma improves processes by focusing on understanding and reducing the variations in processexecution. The Six Sigma methodology centers around five phases, commonly referred to as DMAIC (seeFigure 1):

• Define: Identify the problems to be solved. Develop the criteria for success via an objective statement.Define performance metrics.

• Measure: Map process flow. Develop data collection plan for the process. Collect data. Establish dataand metric validity. Establish performance baseline.

• Analyze: Brainstorm potential sources of variation. Statistically validate the few, most important rootcauses and identify improvement opportunities.

• Improve: Develop, implement, test, and standardize improvement solutions.

• Control: Establish process to ensure that the solutions are sustained and measured. Correct problemsas needed.

The final step Control is a hallmark of the Six Sigma methodology.

By implementing the DMAIC method to reduce both the magnitude and frequency of variations, outcomesare easier to control and plan for.

s

Figure 1. The DMAIC Model

DEFINE

• Identify the problem

MEASURE

• Map process flow

ANALYZE

• Separate the vital few from thetrivial many

• Identif im rovement

IMPROVE

• Develop, implement test

CONTROL

• Sustain solution

• Correct as needed



Six Sigma and Hospital Nurse Staffing

Applying Six Sigma to Hospital Nurse Staffing

One of the key challenges in hospital nurse staffing is ensuring that there is always the right number andskill mix of caregivers. This can be challenging for several reasons:

• The census fluctuates and is hard to predict, especially on an individual department level

• The nurse managers who are responsible for scheduling don’t always know which qualified andcompetent nurses are available for work, especially those from other departments

• There is no real-time view of overstaffing or understaffing based on actual census and acuity

• There is no real-time view of where nurses are working to allow managers to redeploy them as needed.

Consequently, many hospitals are finding that they can easily either overstaff (thus incurring unnecessarycosts) or understaff (thus risking quality of care and employee morale). This is where Six Sigma, with itsemphasis on reducing process variations, can help a hospital better match the number of nursing hours(and skill mix) to the fluctuating work volume. The Workforce Central® suite from Kronos® can play an

important role in such an initiative. A description of how the Workforce Central suite can help in a SixSigma initiative is given below, using the DMAIC framework.

Define

The first step in any Six Sigma initiative is to clarify the problem in the form of a problem statement. Anobjective statement is then developed to spell out the criteria by which success is measured.

For the problem of matching nursing hours to work volume, an example of a problem statement may be:

“Actual number of worked ICU RN hours is 40% above FY05 staffing target

for the first six months of FY05.”

and an example of an objective statement may be:

“Reduce the variation in the actual number of worked ICU RN hours to +/-10% of

the FY05 staffing target for the last five months of FY05.”

“Actual number of worked hours” needs to be clearly defined, i.e., they are the hours spent directly orindirectly on patient care and not on training, leave, and other non-productive activities. The target alsoneeds to be clearly defined, i.e., “staffing targets” are the hours that should have been spent, given theactual census and acuity levels and taking into account nurse-to-patient ratios and other labor standards.

To determine whether the objective is achieved, metrics first need to be defined. For this problem, a

possible metric is the number of times the absolute value of the variance between actual and earned hoursexceeds 10% of the earned hours. Another possible metric is the number of times productivity (which issimply the ratio of actual vs. earned hours) dips below 90% or exceeds 110%. Either of these metrics canprovide a baseline performance evaluation of how well labor is matched to the actual work volume.




Measure

The outcome of the second step, Measure, is a performance baseline against which improvements can bemade. A key challenge in obtaining an accurate performance baseline is data collection. The task of manually collecting actual worked hours information can be time-consuming and error-prone, and can

generate inconsistent data. In contrast, an automated time and attendance solution such as WorkforceTimekeeper™ can provide highly accurate, timely, and consistent data. Since a time and attendancesolution is used to record worked hours for payroll purposes, there is a strong incentive for both employeesand managers to maintain the accuracy and timeliness of the data.

While a payroll system may provide the labor data needed for analysis, a time and attendance system ispreferred for the following reasons:

• Payroll systems do not always include all types of labor, e.g., agency hours. Agency nurse hours canbe (and should be) put on a time and attendance system to provide an accurate view of how they arebeing utilized.

• Payroll systems generate data once per payroll period, usually biweekly. More precise data, e.g., datacollected on a daily basis, is preferable for a Six Sigma project. An automated time and attendancesystem can generate data on a daily or per shift basis.

Kronos’ labor analytics solution, Visionware®, can provide time series data (actual worked hours andworkload volume) all together and in one place for generating a performance baseline. Visionware firsttakes data feeds from the time and attendance system, as well as from systems containing actual dailyvolume of activities (e.g., billing systems). It then applies the labor standards against the volume of activities to calculate earned hours and productivity. Finally, Visionware produces daily trending reportsthat can readily be used to establish a performance baseline.

Analyze

In the Analyze phase, the performance baseline collected in the Measure phase is examined. Statisticalcorrelation analyses are performed. The purpose is to determine the key drivers responsible for thevariations, i.e., separate the vital few from the trivial many. In this phase, Visionware can help highlightsignificant variations using both at-a-glance executive dashboards and detailed diagnostic reports. Youcan then set up control charts and feed them with actual productivity, labor utilization, and cost data fromVisionware.

Based on the specific variations, the Variance Improvement Plan (VIP) feature of Visionware also offers“canned” analyses that point out possible reasons for further research by the project team. These analysesleverage over 15 years of experience in healthcare labor management and learning from 800+ installations.Visionware also helps estimate the hours and dollars impact for each variation to help prioritize the vitalfew from a business perspective.

Improve

In the Improve phase, solutions are developed, tested on a small scale, and then rolled out across theorganization. For each of the “canned” analysis, VIP also suggests potential actions to take. It additionallyprovides a tracking spreadsheet for managers to track progress and maintain accountability of the solutiondevelopment, testing, and roll out.

A key component of any nurse staffing improvement plan is an automated time and attendance solutionsuch as Workforce Timekeeper. Workforce Timekeeper provides nurse managers with a real-time view of employees currently on premise and what departments they are working in. Armed with this information,




managers can re-assign their people in real-time to meet changing census.

Another key component is an automated scheduling decision support solution such as WorkforceScheduler™. Workforce Scheduler provides automatic translation of census forecast into workload, and awhole-house view of staff availability, preferences, certification, and skill set. Managers can thus create

staff schedules that most closely match forecasted needs using the best people for the job at the lowest cost and use regular FTE before overtime or agency.

The benefits of Workforce Scheduler can be significantly enhanced if the application is used across alldepartments and for all types of staff (including agency nurses and interns), and schedules are coordinatedvia a central staffing office. This allows staffing to be optimized at the enterprise level.

Control

To achieve long-lasting benefits, improvement solutions need to be monitored, sustained, and adjustedover time. To achieve this, a control tool needs to be implemented. Visionware is such a tool because itprovides productivity and labor utilization variance reports at all levels, from department to enterprise. On

the input side, daily automatic data feeds ensure that the labor, census, and budget information are accurateand up to date. On the output side, the Management Exception Desktop (MED) provides a clear, easy tounderstand dashboard for senior management to monitor processes. Finally, VIP provides an automatedspreadsheet to help managers conveniently make adjustments and track their impact. In summary, with thehelp of Visionware, hospitals can ensure that the benefits of a nurse staffing initiative will be sustained.

Benefits of the Workforce Central Suite in a Six Sigma Project

There are several advantages of buying an integrated suite instead of separate applications. The integratedWorkforce Central suite can help simplify the implementation and sustainment of a Six Sigma labormanagement project by providing:

• Accurate data no error in reading from the wrong tables

• Timely data no latency

• Precise data definitions “worked hours” mean the same thing in Workforce Timekeeper, WorkforceScheduler, and Visionware

• Convenience all data in one place

• Ease of implementation pre-integrated data interfaces

• More efficient training common look-and-feel and navigation allow end users to be trained faster.

By buying an integrated suite from one vendor instead of separate components from different vendors, a

hospital can reduce the total cost of ownership, streamline implementation and IT support, and reducecomplexity for end users on an ongoing basis.

Case Study: Reducing Labor Costs Through Better Matching ofLabor to Volume

A large community healthcare system consistently exceeded its budgeted nurse staffing levels. To solvethe problem, a Six Sigma project focusing on effective staff scheduling was launched as part of a widerSix Sigma initiative.

The objective of the project was to develop a replicable staff scheduling process with actual staffing of lessthan ten percent from target. In the Measure phase, the Six Sigma team calculated the baseline process




capability by looking at the number of instances where actual staffing hours were more than +/- tenpercent of earned hours.

Next, by analyzing the data, the team isolated overtime, agency hours, and census as the key drivers of staff-level variation. Once these drivers were identified, the team designed and implemented process

changes such as better communication during shift transitions to reduce overtime and agency labor.Finally, with the changes implemented, the hospital implemented a process-control tool to ensure that thesolutions were sustained.

With the new process changes, the hospital estimated that it could save more than $500,000 in overtimeand agency costs in just one pilot unit.

About Kronos

Kronos Incorporated is the most trusted name in workforce management. Kronos helps organizations staff,develop, deploy, track, and reward their workforce, resulting in reduced costs, increased productivity,better decision-making, improved employee satisfaction, and alignment with organizational objectives.

More than 20 million people use a Kronos solution every day. Learn more about Kronos' high-impactenterprise solutions at www.kronos.com.

©2005, Kronos Incorporated. Kronos, the Kronos logo, Workforce Central, and Visionware are registered trademarks, and “Improving thePerformance of People and Business,” Workforce Timekeeper, and Workforce Scheduler are trademarks of Kronos Incorporated or a related company.All other product and company names mentioned are used for identification purposes only, and may be the trademarks of their respective owners. Allspecifications are subject to change. All rights reserved. 1353-05 Rev. B

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