Children units are included as attachment 5.11.c. The report indicates that Staff Nurse positions for both Ellison 17 and White 10 were filled to

Transcription

1 5.11 Describe how the various levels of nurse leaders ensure that the utilization of personnel resources is consistent with the established staffing plan, scheduling plan, patient needs, and model of care. A number of reports are available to nursing leaders that assist in monitoring the utilization of personnel resources and ensuring the utilization is consistent with established staffing plans and schedules, which consider both patient care needs and models of care. These include fulltime equivalent (FTE) utilization, filled positions/vacancy, financial performance, workload/productivity and flexible budget reports. Examples to illustrate the value of these reports will be provided for Ellison 17, a general care pediatric unit, and White 10, a general medical unit. FY 2007 Personnel Budget Sheets are included as a reference for the established staffing plans that consider the patient care needs and model of care (attachment 5.11.a). FTE utilization reports are produced on a monthly and yeartodate basis, and are available the first week after completion of each month. The data is presented by the major clinical role groups: Staff Nurse, NonRN Direct Care/Patient Care Associate (PCA), Operations Associate and Unit Service Associate. FTEs are further categorized by regular worked hours (straight time), overtime, patient observer and agency utilization. These reports provide a highlevel view of personnel utilization and are distributed electronically to Nursing Executive Leadership, Nursing Directors, and Operations Coordinators. The Ellison 17 FTE utilization report for April 2007 (attachment 5.11.b) demonstrates RN FTE utilization that is very close to the FY 2007 budget target. At the same time, NonRN Direct Care (PCA) FTE utilization is under budget by 1.6 FTEs, contributing to an overall direct care FTE variance of 1.9 FTEs. White 10 has a similar pattern of being close to the budget target for RN FTEs. NonRN Direct Care FTE utilization, however, is over the budget target by 2.2 FTEs which is primarily due to use of patient observers, with an overall direct care FTE variance of 1.9 FTEs. FTE utilization is closely tied to an adequate supply of available employees. To assist in tracking filled and vacant positions, Nursing Executive Leadership, Nursing Directors, and Operations Coordinators receive a monthly Filled Position Report. The report summarizes employees in categories of onstaff, hired but not started, total filled and agency FTEs (on this report agency FTEs are not included in the total filled number). In addition, separate reports are created for Staff Nurses, PCAs, Operations Associates and Unit Service Coordinators. The two areas of the April 2007 report with data for Staff Nurses in the Medical Units and the Women & 118

2 Children units are included as attachment 5.11.c. The report indicates that Staff Nurse positions for both Ellison 17 and White 10 were filled to slightly above budget targets. Workload/productivity reports are produced and distributed to nursing leaders on a weekly, monthly and yeartodate basis. This report combines a measure of direct care staff utilization (the average number of shifts used in a 24hour period) with workload, which is made up of both census and patient acuity. The resulting measure of Hours Per Workload Index (HPWI) provides an indicator of appropriate use of staffing when considering patient care need for the unit. On the April 2007 Workload/Productivity Report (attachment 5.11.d), Ellison 17 had a workload that was below the budget target (24.9 vs budget). In response the unit, on average, used fewer shifts in a 24hour period (15.4 vs budget). Combining the two, the HPWI was also lower than the budget target (4.95 vs. budget 5.20) indicating personnel use that was lower than desired. White 10 had a workload that was over budget target (49.6 vs budget) and consequently used more shifts in a 24hour period than the budget target (23.7 vs budget). The resulting HPWI was slightly above the budget target (5.27 vs. 5.20). Monthly financial performance reports are available to Nursing Directors and Operations Coordinators through an electronic report distribution system called Document Direct. As is consistent with the MGH accounting structure, the report shows expenses that are in General Ledger (GL) accounts that can help to track salary and wage expenses by role groups. There are also separate GL accounts for overtime, differential expenses, RN agency utilization and patient observer expenses. These reports provide the monthly financial performance and augment the information provided in the FTE and Workload/Productivity reports. The April 2007 financial reports for Ellison 17 and White 10 are included as attachment 5.11.e. For Ellison 17, the expense in the Salary and Wage (S&W) NonRN Regular category reflects the utilization of PCAs that is below budget targets. For White 10, the expense in Salary and Wage (S&W) Bulfinch Temporary (BFT) Patient Observers reflects the utilization seen in that category in the FTE report. A flexible budget report is also available each month to Nursing Executive Leadership, Nursing Directors, and Operations Coordinators that compares the period s personnel and nonsalary utilization compared to both a fixed budget and a revised budget that is flexed based on the unit workload. In this model, a unit that is experiencing a higher workload than budgeted is expected to use additional personnel resources that are in the same proportion, and visa versa. A portion of the April 2007 flexible budget report for the Medical Units and the Women & Children 119

3 units is included as attachment 5.11.f. It demonstrates favorable variances in both the fixed and flexible budgets for both Ellison 17 and White 10. These reports are valuable tools for Associate Chief Nurses and Nursing Directors, providing a highlevel overview of utilization patterns and summary data for their areas of responsibility. The performance data, however, do not indicate an expected or intentional variance, and they do not provide explanations for variances. Rather, they serve as monitoring tools that might prompt or direct conversations that would further explain the unit activity. For example, in the FTE utilization examples provided above, discussions regarding Ellison 17 might focus on strategies to hire into unfilled Patient Care Associate positions while conversations regarding White 10 might involve exploring the clinical patient care needs resulting in the need for patient observers. Most often Nursing Directors are aware of variances even before they appear on these monitoring reports and they are able to provide meaningful explanations that better help to understand the data. The Nursing Directors for the medical general care units are currently hiring mostly new graduate nurses, which means that the availability of these candidates is dictated by the usual college semester calendar. Most have found that because of this limitation, they need to over hire somewhat in June and January in order to be able to have adequate numbers of Staff Nurses for unexpected leave of absences (LOAs) or resignations. At times units contract for experienced RN agency Staff Nurses to cover for vacant positions, LOAs, unexpected increases in census/volume, or when there are a significant number of newlyhired Staff Nurses being oriented. This can easily result in a slight overlap of the 13week agency contract, with Staff Nurses returning to work or completing their orientation. Considering both of these examples, variances occur in FTE utilization, HPWI and financial reports, but they are expected and justified as strategies to maintain adequate staffing and other favorable outcomes (e.g., length of stay) and ultimately optimal patient care. Longterm recruitment strategies can also impact utilization patterns. For the last several years the inpatient care units have been hiring nursing students (who have completed at least one clinical rotation) as Patient Care Assistants (PCA). Nursing Directors view this as an opportunity to gain knowledge about potential local graduates and even evaluate the fit of these future nursing with their unit environment. They also appreciate the added benefit of hiring new graduate Staff Nurses who have already spent many weeks working on their units. Because of these longterm benefits, Nursing Directors often over hire in the PCA role group during the summer months. 120

4 Attachment 5.11.g contains monthly data regarding PCA utilization in FY 2007, demonstrating the variance that was expected and resulted due to this practice. Patient Care Services Financial Management Systems plays an important role in working with nursing leaders to respond to questions posed by hospital administration (e.g., The MGH Budget Office) regarding variances and trends. The quantitative data regarding acuity and workload, a focus on capacity management throughout the hospital, and a strong commitment to recruitment of direct care providers has allowed MGH Patient Care Services to be extremely successful in this area. 121

5 Attachment 5.11.a Massachusetts General Hospital Patient Care Services FY'2007 Personnel Budget Nursing Director: Judy Newell Ellison 17 Description FY'06 FY'07 Diff. Midnight ADC (0.1) Classification ADC (0.3) Acuity Workload Index Hours / Workload Index Shifts / 24 Hours Indirect Time 5.0% 5.0% 0.0% Benefit Time RN 17.9% 16.7% 1.2% Benefit Time NonRN 10.3% 13.4% 3.1% Non Productive Factor (0.002) Direct Care FTEs WI Staff Nurse Non RN Direct Total Direct Care FTE Nursing Director Other RN Op. Assoc Unit Assist/ USA Other Support Other NonRN Other FTE's Total FTE's HPPD Direct Care Worked HPPD Direct Care Paid % RN Direct Care 84.0% 83.3% 0.7% % RN Total Budget 66.5% 64.4% 2.1% 122

6 Attachment 5.11.a continued Massachusetts General Hospital Patient Care Services FY'2007 Personnel Budget Nursing Director: Amanda Stefancyk White 10 Description FY'06 FY'07 Diff. Midnight ADC Classification ADC Acuity Workload Index Hours / Workload Index Shifts / 24 Hours Indirect Time 5.0% 5.0% 0.0% Benefit Time RN 10.2% 10.0% 0.2% Benefit Time NonRN 11.6% 12.5% 0.9% Non Productive Factor Direct Care FTEs WI Staff Nurse Non RN Direct Total Direct Care FTE Nursing Director Other RN Op. Assoc Unit Assist/ USA Other Support Other NonRN Other FTE's Total FTE's HPPD Direct Care Worked HPPD Direct Care Paid % RN Direct Care 82.8% 82.7% 0.1% % RN Total Budget 66.6% 64.2% 2.4% 123

7 Attachment 5.11.b Ellison 17 MGH Patient Care Services FY'07 FTE Budget Performance Report by Unit For the month of: April 2007 S/T O/T Sitter Other Agency FTE Budget Variance Total Paid Staff Nurse Direct Care Non RN Subtotal Direct Care OA USA (0.0) All Other White 10 MGH Patient Care Services FY'07 FTE Budget Performance Report by Unit For the month of: April 2007 S/T O/T Sitter Other Agency FTE Budget Variance Total Paid (0.5) Staff Nurse Direct Care Non RN (2.2) Subtotal Direct Care (1.9) OA USA All Other

8 Attachment 5.11.c MGH PATIENT CARE SERVICES FILLED POSITION REPORT STAFF RN Direct Care RN Filled Positions as of 4/3/2007 Job codes 132, 430, 442, 708, 1149 and 1201 thru 1219 Cost Center Budget On Staff Hired Total Filled % Filled Vacant % Vacant Agency Super Group 850:Medical Nursing Service Blake 7 MICU MG % % 2.7 Ellison 16 MG % % Phillips House 20 MG % % Phillips House 21 MG % (1.4) 4.6% Bigelow 9 MG % (0.0) 0.1% Bigelow 11 MG % (3.4) 8.3% 0.9 White 9 MG % % 1.0 White 8 MG % % 1.8 White 10 MG % (0.5) 1.6% White 11 MG % % White 13 MG % (3.8) 52.1% Dialysis MG % (1.5) 11.5% Anticoagulation Services MG % % Subtotal Medical Nursing % % 6.4 Super Group 858: Women & Children Nursing Service PICU Ellison 17 Ellison 18 Nurse Partners MG4526 MG4139 MG4138 MG % 105.7% 98.6% 67.5% (2.4) (1.4) % 5.7% 1.4% 32.5% Bigelow 7 MG % % 1.8 NICU / Ellison 3 Ellison 13 Nursery Blake 13 Family Unit Blake 14 LDR MG4142 MG4536 MG4167 MG4523 MG4535 MG4166 MG % 96.7% 104.7% 106.3% (0.2) 1.2 (2.3) (3.5) 0.5% 3.3% 4.7% 6.3% MG5710 Subtotal Women & Children Nursing % (4.9) 1.7%

9 Attachment 5.11.d MGH Patient Care Services FY'07 Patient Volumes Patient Classification Units Monthly Performance for Month April Census Acuity Workload HPWI SH/24 Serv/Unit Budget Actual Variance Budget Actual Variance Budget Actual Variance Budget Actual Variance Budget Actual Variance CA SICU (3.1) (0.31) (14.4) (1.34) EL (2.0) (0.04) (0.6) EL 9 CCU (0.7) (0.4) (0.38) (1.3) EL (3.7) (5.9) (0.25) EL (3.5) (5.5) (0.39) Cardiology (13.0) (25.7) (0.41) SICU (2.3) BG (0.9) (0.8) (0.05) BL (0.38) (2.1) WH (0.7) (1.2) EL (2.5) (0.39) (3.2) EL (0.6) (0.4) PH (0.5) (0.72) (3.6) BG (1.0) (0.9) (0.70) (3.0) Surgical (4.9) (0.17) (15.5) MICU (0.4) (0.22) (2.0) EL (0.9) PH (0.2) (0.27) (2.0) PH (0.48) (4.5) BG (0.6) (0.2) (0.45) (1.5) BG (0.2) (0.57) (3.0) WH (0.02) (2.9) WH (2.9) WH (0.6) (0.07) (0.8) WH (0.1) Medical (0.11) (20.1) EL (3.4) Oncology (3.4) WH (0.9) (0.12) (0.6) EL (2.0) (1.1) (0.19) (0.4) Orthopaedic (2.9) (0.16) (1.1) BL EL (1.5) (0.01) (2.1) WH (0.49) (2.3) Neurosciences (3.4) BL (0.1) Psychiatric (0.1) PICU (0.01) (0.43) (2.3) EL (1.7) (1.6) EL (1.2) (0.04) (2.6) (0.25) Pediatrics (2.4) (2.8) (0.17) BG (0.1) NICU (0.1) (0.05) (0.9) (0.77) (2.4) Women & Infants (0.0) (0.34) (2.5) Subtotal w/o OB (21.7) (0.11) (36.9) EL (2.7) BL (1.4) Obstetrics (0.30) (2.2) Subtotal with OB (22.0) (0.10) (39.1) 126

10 Attachment 5.11.e Report ID: PHGL003Q Run Date 14MAY2007 Partners HealthCare System DEPARTMENT ACTIVITY BY ACCOUNT April 2007 Bus Unit: 1200 Dept: MG4139 Bus Name: The General Hospital Corp Dept Name: Ellison 17 Account Actual Budget Varaince $ S&W RNRegular MGH $ 156,499 $ 169,144 $ 12,645 S&W RNOvertime MGH S&W RNW/E Diffs MGH $ 2,720 $ 2,238 $ (482) S&W RNW/E Spec MGH $ 2,912 $ 3,548 $ 636 S&W RNHoliday Diffs MGH S&W RNEve Diffs MGH $ 2,740 $ 2,256 $ (484) S&W RNNight Diffs MGH $ 8,680 $ 8,291 $ (389) S&W NonRN PtCareRegular MGH $ 6,520 $ 13,380 $ 6,860 S&W NonRN PtCareTemp Agency S & W Pt ObserversBulfnch T S&W Service regular MGH $ 20,333 $ 22,999 $ 2,666 S&W Adm/Othr Wkly Exempt MGH $ 8,027 $ 8,132 $ 106 S&W Other Overtime MGH $ 876 $ (876) S&W Other WE Diffs MGH $ 451 $ 323 $ (128) S&W Other Hol Diffs MGH S&W Other Eve Diffs MGH $ 726 $ 876 $ 150 S&W Other Night Diffs MGH $ 13 $ 13 S&W Payroll Accrual $ 15,677 $ 16,242 $ 565 S&W Earned Time Accrued $ 26,119 $ (26,119) S&W Earned Time Taken $ (29,190) $ 29,190 Fringe Charge Other Person $ 58,936 $ 64,602 $ 5,667 Fringe Charge Temps Salary & Wage Expenses $ 282,026 $ 312,044 $ 30,

11 Attachment 5.11.e continued Report ID: PHGL003Q Run Date 14MAY2007 Partners HealthCare System DEPARTMENT ACTIVITY BY ACCOUNT April 2007 Bus Unit: 1200 Dept: MG4162 Bus Name: The General Hospital Corp Dept Name: White 10 Account Actual Budget Variance $ S&W RNRegular MGH $ 154,883 $ 169,108 $ 14,226 S&W RNOvertime MGH $ 168 $ (168) S&W RNW/E Diffs MGH $ 2,928 $ 3,740 $ 812 S&W RNW/E Spec MGH $ 4,416 $ 3,010 $ (1,406) S&W RNHoliday Diffs MGH S&W RNEve Diffs MGH $ 1,182 $ 1,182 S&W RNNight Diffs MGH $ 11,123 $ 10,714 $ (409) S&W RN Temp Agency S&W NonRN PtCareRegular MGH $ 17,235 $ 19,072 $ 1,837 S&W NonRN PtCareTemp Agency $ 185 $ (185) S & W Pt ObserversBulfnch T $ 2,388 $ (2,388) S&W Service regular MGH $ 22,268 $ 26,433 $ 4,165 Accrued Payroll S&W Adm/Othr Wkly Exempt MGH $ 8,469 $ 10,135 $ 1,666 S&W Other Overtime MGH $ 3,696 $ (3,696) S&W Other WE Diffs MGH $ 1,045 $ 1,005 $ (40) S&W Other Hol Diffs MGH S&W Other Eve Diffs MGH $ 1,430 $ 1,139 $ (291) S&W Other Night Diffs MGH $ 1,016 $ 945 $ (71) S&W Payroll Accrual $ 17,408 $ 17,130 $ (278) S&W Earned Time Accrued $ 23,504 $ (23,504) S&W Earned Time Taken $ (21,781) $ 21,781 Fringe Charge Other Person $ 64,030 $ 68,893 $ 4,864 Fringe Charge Temps $ 239 $ (239) Expenses 314, ,508 17,

12 Attachment 5.11.f MASSACHUSETTS GENERAL HOSPITAL MTD Operating Budget Variance Report Vice President Jeanette Ives Erickson Month Ending April 30, 2007 Labor Expense Department Actual Budget Fixed Bud. Variance Flex Budget Flex Bud. Variance Super Group 850: Medical Nursing Service Blake 7 MICU $ 604,192 $ 576,589 $ (27,603) $ 591,063 $ (13,129) Ellison 16 $ 546,679 $ 552,677 $ 5,998 $ 581,982 $ 35,303 Phillips House 20 $ 301,961 $ 311,682 $ 9,721 $ 331,023 $ 29,062 Phillips House 21 $ 392,146 $ 372,898 $ (19,248) $ 409,275 $ 17,129 Bigelow 9 $ 439,372 $ 432,578 $ (6,794) $ 435,230 $ (4,142) Bigelow 11 $ 439,506 $ 429,677 $ (9,829) $ 442,776 $ 3,270 White 9 $ 354,985 $ 375,210 $ 20,225 $ 416,771 $ 61,786 White 8 $ 431,329 $ 456,521 $ 25,192 $ 510,751 $ 79,422 White 10 $ 312,926 $ 332,508 $ 19,582 $ 346,043 $ 33,117 White 11 $ 379,891 $ 393,412 $ 13,521 $ 423,409 $ 43,518 White 13 $ 176,440 $ 142,878 $ (33,562) $ 142,878 $ (33,562) Dialysis $ 233,410 $ 232,779 $ (631) $ 204,809 $ (28,601) Anticoagulation Service $ 130,617 $ 118,758 $ (11,859) $ 89,294 $ (41,323) $ 4,743,454 $ 4,728,167 $ (15,287) $ 4,925,304 $ 181,850 Super Group 858: Women & Children Nursing Service PICU $ 380,650 $ 356,794 $ (23,856) $ 375,093 $ (5,557) Ellison 17 $ 285,097 $ 312,044 $ 26,947 $ 298,068 $ 12,971 Ellison 18 $ 363,994 $ 373,515 $ 9,521 $ 349,832 $ (14,162) Pediatric Transport $ 1,723 $ 4,250 $ 2,527 $ 2,125 $ 402 Nurse Partners (Pedi) $ 79,960 $ 78,221 $ (1,739) $ 78,221 $ (1,739) Child Life $ 21,276 $ 30,340 $ 9,064 $ 30,340 $ 9,064 Bigelow 7 $ 260,698 $ 308,972 $ 48,274 $ 316,425 $ 55,727 NICU $ 661,716 $ 594,979 $ (66,737) $ 584,549 $ (77,167) Ellison 13 $ 291,129 $ 448,010 $ 156,881 $ 508,833 $ 217,704 Blake 13 $ 904,310 $ 679,095 $ (225,215) $ 688,286 $ (216,024) Blake 14 LDR $ 798,925 $ 720,686 $ (78,239) $ 648,473 $ (150,452) Family Education $ 17,479 $ 18,487 $ 1,008 $ 18,487 $ 1,008 OB Home Visit $ $ $ $ $ $ 4,066,957 $ 3,925,393 $ (141,564) $ 3,898,732 (168,225) $ 129

13 Attachment 5.11.g Department FTE Utilization Patient Care Associate (PCA) Role Group FY 2007 Oct06 Nov06 Dec06 Jan07 Feb07 Mar07 Apr07 May07 Jun07 Jul07 Aug07 PCAs Coop Student Nurse PCAs Student Nurse/PCAs Total PCAs Budget PCAs Variance