Position Justification Template Attach completed form to HR Position Management request Section A: Position Information Requestor: Alisha Kreider & Val Adams Date: 8/7/2014 Department: Supplemental Staff Cost Center: 3575 Position Job Title: PtCA FTE: Salary Mid-Point: 13.21 Start date: Status: X Regular Casual Entity: X LGH/WBH/Amb. LGMG The Heart Group Twin Rose VP, SVP or EVP: Karen Oxler X JD Attached Benefit Realization Schedule (BRS) Attached (VMI only) Org Chart Attached Have you completed the business capital and planning process? Yes XNo Section B: Justification Please categorize your new position request (check all that apply); avoid Miscellaneous when possible: X Decrease OT/Agency Utilization EHR (Electronic Health/Medical Record) Expansion/Increase in Clinical Volumes Expansion/Increase in Non-clinical Volumes In-sourcing/out-sourcing Mission/Community New Services/Units X Physical Safety/Security X Staffing Ratio Goals/Standards X VMI Miscellaneous (explanation): EXISTING SERVICES Volumes * Gross Revenue / Charges * Total Non-Salary Expense Data Thru: FYTD n/a n/a Budget YTD Variance from Budget (%) Prior YTD Variance from PY (%) Total Salary Expense Outsourcing Expense 0 FTEs Overtime Hours Above information is available from EPSI reports- hours are charged to the cost center in which the PtCA works. * direct patient care areas only
Additional Justification Please provide below any relevant information relative to the following items, if and as appropriate. 1. Clear explanation of the position and need. 2. Strategic fit and/or relationship to specific strategic initiatives. 3. Options considered other than filling position. Can the work be absorbed by existing staff? 4. Risks associated with not filling position. 5. Quantification of specific anticipated outcomes of filling position (e.g. $xx increase revenues, $xx decrease in expenses) 6. Internal, national or other benchmark data 7. Productivity metrics for position and trend data 8. Review of Span of Control Guidelines o # Org Layers Six (6) layers total from CEO/EVP to front-line associates o % of Mgmt with 2 or less direct reports: Less than 10% of associates in management roles should have fewer than 2 direct reports o % of Mgmt at Director level or above: Less than 20% of management team should be at or above the Director level. Accordingly, at least 80% of the management team should be Manager or below o Mgmt:Staff Ratio Administrative support and non-clinical support functions should have a management span of control ratio ranging from 1:10 to 1:15 (FTEs) Clinical / operational functions should have a management span of control ratio of 1:20 FTEs (1:40 headcount) 9. How are you funding this position? (ex: eliminating existing position, increased revenue from new services, elimination of outsourced services, etc) 1. PtCA positions are entry-level positions that are often used as a stepping-stone for advancement. These positions are heavily relied upon to assist in providing quality care to our patients. We continually struggle with the turnover of this position. PtCAs need to provide only a 2 week notice when resigning leaving a gap until positions can be posted, interviewed, hired, and on boarded. This timeline results in the nursing units not having the resources needed to efficiently provide patient care. The workload is absorbed by the remaining PtCAs working additional hours and possibly working overtime and professional nursing staff performing the tasks. This additional workload to the nurses decreases their productivity and often results in overtime from them staying late to complete their RN responsibilities that could not be completed during their scheduled hours. The nursing productivity committee completed a turnover analysis in collaboration with Human Resources. The turnover trend for those individuals leaving the organization continues to be around 20% or greater. This number does not include individuals who transfer to other positions within the organization or leave of absences that also impact patient care. Through this assessment, it has been identified that 10.0 FTEs of additional PtCA resources is needed to keep up with the current turnover levels and ensure a quality experience for patients. 2. This change has been identified as a supportive initiative for the nursing department to meet their VM financial target by decreasing contributing factors of incidental overtime of RN staff. The additional PtCAs will also help ensure that resources are available to meet the patient needs contributing to the organizational goal of patient satisfaction. 3. The additional workload will be absorbed by the RN staff. This will decrease RN productivity and increase costs. 4. Risks would include decreased patient satisfaction due to delay in meeting needs and negative financial impact on organization. Potential negative impact on nursing quality measures such as pressure ulcers and falls. 5. Improve patient satisfaction score related to needs being meet in a timely manner and improved staff satisfaction related to having enough staff to do their work. 6. According to the Advisory Board Company s Staffing Benchmarks, organization s that run a 1:4 or 5 RN:patient ratio should have.4 or.5 assistant per nurse. This is aligned with our staffing model of PtCA s being a 1:9 PtCA:patient ratio. 7. Hours per patient day is the productivity measure that the nursing department utilizes to measure productivity for PtCA s. We currently budget for 2.6HPPD on most units. FY14 averaged at least 10units per month being less than 2.6 indicating that the units ran with higher ratios than budgeted.
8. These are frontline staff positions. 4 organizational layers exist between them and Karen Oxler. This position will have no direct reports or management responsibilities. 9.These positions will be budget neutral. 4.3 RN FTE s will be converted into a total of 10 PtCAs FTE s.
Patient Care Assistant Profile Details Profile of the currently employed Patient Care Assistants, as of 8/9/2013 Profile of Patient Care Assistants that terminated in FY13
Years of Service for Currently Employed Patient Care Assistants as of 8/1/2013 10.1 to 15 8% 15.1 to 20.0 3% over 20.1 6% Under 1 year 25% 7.1 to 10 11% 5.1 to 7.0 14% 3.1 to 5.0 7% 1.0 to 3.0 26% Age of Patient Care Assistants as of 8/1/2013 50-59 13% 60-69 3% 70 and over 0.3% 19 and under 7% 40-49 15% 20-29 42% 30-39 20%
Race of Patient Care Assistants as of 8/1/2013 Asian 4% Black 9% Hispanic 12% Native Hawaiian or Pacific Islander 0.3% White 72% Two or More Races 3% Gender of Patient Care Assistants as of 8/1/2013 Male 14% Female 86%
Terminations by Length of Service (in years) FY13 10.1 to 15 2% 7.1 to 10 6% 15.1 to 20.0 1% over 20.1 1% 3.1 to 5.0 6% 5.1 to 7.0 10% Under 1 year 47% 1.0 to 3.0 27% Terms by Type of Reason-FY13 Involuntary 14% Voluntary 86%
Terms by Age at Termination- FY13 40-49 12% 50-59 3% 19 and under 4% 60-69 4% 30-39 16% 20-29 61% Top 80% of Voluntary Reasons for Separation- FY13 Education 11% Moved 18% Other Employment 33% Personal 28%
Terms by Race Code (FY13) Asian 1% Black 7% Hispanic 12% Two or more races 2% White 78% Terms by Gender- FY13 Male 21% Female 79%
Summary Majority of Patient Care Assistants Terminated in FY13 Length of Service less than 1 year Involuntary or Voluntary Voluntary Reason for Leaving Other Employment/Personal Age 20-29 Race White Gender Female Majority of Patient Care Assistants Currently Employed Length of Service 1-3 years Age 20-29 Race White Gender Female
Patient Care Assistants: A Review and Analysis of Turnover 8/9/2013
Agenda Turnover data Transfer data Market data, practices, and trends Profile of Patient Care Assistants Summary of Findings Cost of Turnover Recommendations
Turnover data- Yearly Turnover of Patient Care Assistants Average headcount of employees in the Patient Care Assistant job title is decreasing each year. In FY13 the Patient Care Assistants turnover was slightly lower than the previous years.
90-Day Turnover Patient Care Assistants have been among the top five positions with the highest 90-Day Turnover for the past 3 fiscal years. Terminations within 90-days of hire account for 13.8% of the total terminations of employees in the Patient Care Assistant role for FY13 and 17.6% of FY12.
Positions with highest turnover within the first year of service Patient Care Assistants are also in the top four positions that have the highest number of terminations within the first year of service. Terminations within the first year of service account for 50.8% of the total terminations of Patient Care Assistants in FY13 and 59.5 % in FY11.
Market data Data was collected from 6 salary surveys. The average of the 50th percentile of those surveys was $12.96. The mid-point of LG Health s salary range is $12.96.
Local Organizations- hiring rates and ranges Pinnacle, Hershey, and Reading hire their staff based on their previous job experience. Pinnacle and Reading have slightly higher salary ranges than LG Health, however, both organizations sited this role as one with high turnover and that most of their staff are within the first quartile of the salary range.
Profile of a Patient Care Assistant The accompanying packet creates a profile of the Patient Care Assistants within the LG Health organization that either terminated their employment with LG Health in FY13 or are currently employed with LG Health. Below is a summary of the findings.
Summary of Findings The overall headcount of employees in the Patient Care Assistant job title is decreasing each year. Turnover has been above or close to 20% for FY13 and FY12 and FY11. Turnover within the first 90 days of employment is 12-17% of total yearly turnover of Patient Care Assistants. Turnover within the first year of employment is 28-50% of total yearly turnover for Patient Care Assistants. Market data indicates that our salary range is in line with current market rates. Profiles of terminated Patient Care Assistants reveals that the highest turnover is seen among white, females, aged 20-29, employed for less than one year.
Turnover Costs Soft and Hard Costs include: Separation Processing Advertising and administrative time Reference checking and drug testing Interviewing time Orientation Co-worker burden Potential Overtime Learning curve productivity of new employee Lost productivity of departing employee and eventual vacancy Increased workload of employees slower productivity ASSUMPTIONS Turnover costs approximately 50% of the cost of the salary of the position. Having overfills and ready employees can reduce the cost of turnover by 50% by minimizing learning curves, decreased productivity, and overtime.
Estimated Overfills and Potential Costs Avoidance Example: Estimating using 22.3% Turnover Rate
Estimated Overfills and Potential Costs Avoidance Example: Estimating using 15.0% Turnover Rate
Ideas and Considerations Consider overfill strategy of 4-6 Patient Care Assistants Consider leveling (Patient Care Assistant I, Patient Care Assistant II). This option would require a detailed examination of the various areas where Patient Care Assistants are utilized. A methodology would be drafted in order to rank those positions based on carefully chosen criteria. Ideas Put Into Action in May 2013 LG Health has begun to hire based on experience rather than hiring every employee at a set rate regardless of their previous experience within LG Health or elsewhere. The hiring rate, for non-experienced employees, was raised to $11.00 rather than $10.50.