NWRPCA Staffing Ratio Presentation 05-19-09

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STAFFING RATIOSPLANNING FOR PRODUCTIVITY& COST EFFECTIVENESSGuidian Healthcare Consulting

Guidian Healthcare ConsultingGuidian works with Community Health Centers toplan financiallypy sustainable operationspthat meet theneeds of the organization and its community.G idian proGuidianprovidesides operations planningplanning, strategic planningplanning,facility planning & pre-development services that include: Market Analysis Financial ProjectionspPlanningg Space Functional Floor Plan Layout Operations Analysis and Patient Flow Grant Writing Guidian Healthcare Consulting 2009Page 2

Staffing RatiosRatios- OverviewSTAFFING RATIOS – THE BIG PICTUREStaffing Ratios & Operations ManagementCalculating Staffing RatiosBenchmarkingWrap-up & Questions Guidian Healthcare Consulting 2009Page 3

Staffing Ratios – The Big PictureStaffing ratios define the relationshipbetween your revenue producing employeesand the staff needed to supportppthem.Staffing ratios are a tool to evaluate theimpact of your staffing strategy onoperational effectiveness & service delivery. Guidian Healthcare Consulting 2009Page 4

Staffing Ratios – The Big PictureMeasuring Staffing Ratios is Importantbecause . Staffing expense is generally the largestexpense forf a healthh lth centert Staffingg decisions impactpqualityqy ofpatient care Staffing levels & functional allocationdrive operating efficiency Guidian Healthcare Consulting 2009Page 5

Staffing Ratios – The Big PictureStaffing Ratios are used in OperationsManagement to . Determine optimal levels of staff overall DetermineD ti optimalti l levelsll off stafft ff byb functionfti Evaluate productivity and efficiency Guidian Healthcare Consulting 2009Page 6

Staffing Ratios – The Big PictureNational Staffing Ratio Benchmark DataUDS Staffing Benchmarks– Health center specific data– Gross staffing ratios onlyMGMA Annual Cost Survey– Staffing ratios by specialty & region– Staffing ratios by functional area Guidian Healthcare Consulting 2009Page 7

Staffing Ratios – The Big PictureExample MGMA Staffing RatiosClinical Support Staff perProviderAncillary Support perProviderFront Office Staff perProviderBusiness Operations Staffper Providerp Number of RN, LPN, MAper Physician provider Number of Lab, Xray,Enabling staff Number of Reception, MedRec., Scheduling, Transcript Number of Pt Acct, Admin,IT, Maintenance staff Guidian Healthcare Consulting 2009Page 8

Staffing Ratios – The Big PictureGetting StartedWhat does CHC want to measure– Provider pproductivityy as a function of direct clinicalsupport levels– Optimal number of billing staffDefine appropriate staffingg ratio– Medical Asst per Provider– Pt Acct Staff per Provider Guidian Healthcare Consulting 2009Page 9

Staffing Ratios – The Big PictureGetting StartedMeasure data points over time– Use historical data for provider productivity & staffing– Calculate staffing ratios– Chart over timeCComparewithith BenchmarksBhk wherehavailableil bl Guidian Healthcare Consulting 2009Page 10

Staffing RatiosRatios- OverviewStaffing Ratios – The Big PictureSTAFFING RATIOS & OPERATIONS MANAGEMENTCalculating Staffing RatiosBenchmarkingWrap-up & Questions Guidian Healthcare Consulting 2009

Staffing Ratios & Operations MgmtEffective Operations Management UnderstandsHow Staffing Effects Overall OperationsStaffing Affects Provide Productivityy & RevenuesQuality of Patient CareBilling and CollectionRecruitment and RetentionBudgetingP ti t FlowPatientFlPatient SatisfactionStaff Satisfaction Guidian Healthcare Consulting 2009Page 12

Staffing Ratios & Operations MgmtEffective Operations Management AnalyzesStaffing in Relation to Operational MeasuresOperationsAnalysis Evaluate productivity as a function ofstaffingt ffi levelsll over timeti Identify functional area inefficiency dueto misallocation of staff Identify operational improvements bybenchmarking internally & externally Guidian Healthcare Consulting 2009Page 13

Staffing Ratios & Operations MgmtEffective Operations Management UsesStaffing Analysis to Plan for the FutureOperationspPlanning Effective allocation of staff Recruitment pplanningg Budgeting Guidian Healthcare Consulting 2009Page 14

Staffing Ratios & Operations MgmtEffective Operations Management UsesStaffing Ratios as a Tool Measure operating efficiency (process)& productivity (staff)Measurement Guidian Healthcare Consulting 2009Page 15

Staffing Ratios & Operations EfficiencyCCaseStStudy:dA small CHC felt it could increase the number of patientsit treated by hiring more clinical support staffstaff, but werereluctant to spend the resources to hire additional staff.Medical Assistant to Provider Ratio1 : 1 Ratio 2 : 1 Ratio VariancePRODUCTIVITYper HourPatients pPatients per DayAnnual VisitsAverage NPSR1.9133,059 351,785Cost of 1.0 FTE MA 35 880 35,8802.3173,864 444,3600.43.5805 92,575Cost of lost NPSR 92 575 92,575 Guidian Healthcare Consulting 2009Page 16

Staffing Ratios & Operations MgmtEffective Operations Management UsesStaffing Ratios as a Tool Identify process bottlenecks bybenchmarkingg staffingg ratiosIdentification of Operational Issues Guidian Healthcare Consulting 2009Page 17

Staffing Ratios & BottlenecksCCaseStStudy:dA growing CHC noticed that its cycle times were increasing.Management was unsure of the cause because it hadincreased the number of clinical staff with increased demand.New CHCMGMAPRODUCTIVITYper HourPatients pCycle Time per Patient2.185 minutes3.946 minutesFront Office Support per Provider1.3 : 11.6 : 1 Guidian Healthcare Consulting 2009Variance1.839 minutes0.3Page 18

Staffing Ratios & Operations MgmtEffective Operations Management UsesStaffing Ratios as a Tool Maximize revenue and minimize costbyy optimizepstaffingg allocationOptimize Staff Allocations Guidian Healthcare Consulting 2009Page 19

Staffing Ratios & Misaligned StaffingCCaseStStudy:dA busy CHC determined that its AR and bad debt were toohigh and were actually growing month over monthmonth. Afterevaluating the billing process they determined that althoughthey had sufficient patient accounting staff, the allocation ofstaff was misaligned. They had an insufficient number ofbillers and could not complete timely filing.CHCPRODUCTIVITYAccounting Staff per ProviderBilling per ProviderCharge Entry/Coding per ProviderPosting/Cash Mgmt per ProviderBenchmarkVariance2.72.700.550.120 350.350.770.120 250.25 Guidian Healthcare Consulting 2009(0.22)0010.1Page 20

Staffing RatiosRatios- OverviewStaffing Ratios – The Big PictureStaffing Ratios & Operations ManagementCALCULATING STAFFING RATIOSBenchmarkingWrap-up & Questions Guidian Healthcare Consulting 2009

Calculating Staffing RatiosStaffSpecific RatioFunctionalpDepartmentStaffing RatioSite Specific Staffing RatioOrganizational Staffing Ratio Guidian Healthcare Consulting 2009Page 22

Calculating Staffing RatiosDefine CategoriesF nctional CategoryFunctionalCategorCategoryCategor Staff Clinical Support RN, LPN, MA Business Operations Admin, Pt Accounting,Payroll BillingPayroll, Front Office Operations Check-in, scheduling,operators, medical records Ancillary Support Lab,L b XX-ray, enablingbli Guidian Healthcare Consulting 2009Page 23

Calculating Staffing RatiosCollect DataRNLPNMATOTALPh i iPhysicianMid-LevelTOTALCalculate Ratio1.25 FTE2.15 FTE7 75 FTE7.7511.15 FTE5 0 FTE5.02.5 FTE7.5 FTEClinical Support to Provider Ratio1.49:1 Guidian Healthcare Consulting 2009Page 24

Calculating Staffing Ratios Guidian Healthcare Consulting 2009Page 25

Staffing RatiosRatios- OverviewStaffing Ratios – The Big PictureStaffing ratios & Operations ManagementCalculating Staffing RatiosBENCHMARKINGWrap-up & Questions Guidian Healthcare Consulting 2009

Benchmarking Staffing RatiosDefinitionBenchmarksPoints of reference or comparison, which may includestandards,t d d criticaliti l success ffactors,tiindicators,di tmetrics.tiBenchmarkingMeasuring your performance against that of organizationswith best practices, determining how these best-in-classachievehiththese performancefllevelsl andd usingi thithisinformation as a basis for your own operationspstrategygyimprovement Guidian Healthcare Consulting 2009Page 27

Benchmarking Staffing RatiosImportance in Organizational Planning Provide an objective basis for planning operationsimprovement Provide data that useful in budgeting process Provide data that can be used to create anincentive program ProvidesP id a process tto ididentifytif andd creativelyti laddress operating problems Guidian Healthcare Consulting 2009Page 28

Benchmarking Staffing RatiosImportance in Operations Management Show how efficiently the practice is functioning Show how efficiently the staff is functioning Identify areas whose performance may lag Determine optimal staffing levels and allocations Measure individual performance to identifyinternal best practices Guidian Healthcare Consulting 2009Page 29

Benchmarking Staffing RatiosInternalBenchmarking Monitor internal progress over time Track changes against operationalmeasures Validate that process improvementis having desired effectExternalBenchmarking Compare CHC to similar sizedorganizations Measure CHC performance againstaverageg pperformers & againstghighgperformers Identify where CHC could be moreproductive or efficient Guidian Healthcare Consulting 2009Page 30

Benchmark Staffing Ratios - InternalAnnual Visits per Provider VS. MA to Provider Ratio4,0001.901.851.803,5001.751.701.653,0001 601.601.552,5001.50Annual Visits per ProviderMA to Provider Ratio Guidian Healthcare Consulting 2009Page 31

Benchmarking Staffing RatiosInternalBenchmarking Monitor internal progress over time Track changes against operationalmeasures Validate that process improvementis having desired effectExternalBenchmarking Compare CHC to similar sizedorganizations Measure CHC performance againstaverageg pperformers & againstghighgperformers Identify where CHC could be moreproductive or efficient Guidian Healthcare Consulting 2009Page 32

Benchmarking Staffing RatiosExternal Benchmarking Select data sources that measure similarorganizations– Size, population treated, location Select data source with good specificity– Ratios for FP,, Peds,, OB/GYN– Ratios for clinical, operations, business functions Sample data source– UDS– MGMA,G , AAFP,, NAPP Guidian Healthcare Consulting 2009Page 33

Benchmarking Staffing RatiosMap or group your staff positions to align withdefinition used by benchmark ratiosCHCCli i l Support:ClinicalStProvider:Provider FTE:MGMARN, LPN, MA(Predominant-MA)RN, LPN, MA(Predominant-LPN)Physician & Mid-LevelPhysician1,610 hrs/yr2080 hrs/yrCompare “apples-to-apples” by using acommon nomenclature Guidian Healthcare Consulting 2009Page 34

Benchmark Staffing Ratios - ExternalCCaseStStudy:dA practice performing at the 90th percentile has 2.21 clinicalsupport to Physician and that practice has a panel size of4,716. A practice performing at the 10th percentile has 0.96clinical support to Physician and has a panel size of 1,159.From a revenue perspective huge difference in performance.Highlights issues with underlying operational processes.Panel Size per ProviderVisits per UserRevenue per Provider90th Percentile 10th Percentile VariancePracticePractice4,7161,1593,5571.5 884,2501.75 253,531 Guidian Healthcare Consulting 2009(0.25) 630,718Page 35

Benchmark Staffing Ratios - PlanningCCaseStStudy:dA practice wanted to bring on 2 new providers over the next 12months It needed to determine how much additional supportmonths.staff to hire in order to maintain its current productivity andfinancial performance.New Providers – 2 FTECHC Practice90th Percentile PracticeRatioFTEBusiness Support Ratio2.00 : 14.0 FTE1.08 : 12.16 FTEClinical Support Ratio1.96 : 13.9 FTE2.21 : 14.4 FTEFront Desk Ratio0.99 : 11.9 FTE1.59 : 13.2 FTEAncillary Support Ratio1.58 : 11.2 FTE0.45 : 10.9 FTETOTAL13 1 new FTE13.1 Guidian Healthcare Consulting 2009RatioFTE10 7 new FTE10.7Page 36

Benchmark Staffing RatiosLi it tiLimitations Staffing Ratio benchmarking will not tell the wholestory – provides a red flag – more useful inconjunctionjwith operationspanalysis.y Unique characteristics of CHC mean findingmeaningful benchmarks is challenging – may affectvalidityy of results. Guidian Healthcare Consulting 2009Page 37

Benchmark Staffing RatiosCConclusionl i Staffing Ratio benchmarking can help you defineissues, identify solutions and measure yoursuccess. Staffing ratio benchmarking can help you plan youroperations and optimize your efficiency. Staffing ratio benchmarking is a key tool in theprocess of continuous operations improvementimprovement. Guidian Healthcare Consulting 2009Page 38

Staffing RatiosRatios- OverviewStaffing Ratios – The Big PictureStaffing Ratios & Operations ManagementCalculating Staffing RatiosBenchmarkingWRAP-UP & QUESTIONS Guidian Healthcare Consulting 2009

Questions? Guidian Healthcare Consulting 2009

Contact InformationGuidian Healthcare ConsultingCathy MarchiandoCmarchiando@guidianconsulting.comChi d @ idilti770-932-3230Mary MurphyMmurphy@guidianconsulting.com617 302 3736617-302-3736www.guidianconsulting.com Guidian Healthcare Consulting 2009

Staffing Ratios Staffing Ratios –– The Big PictureThe Big Picture Staffing ratios define the relationshipStaffing ratios define the relationship between your revenue producing employees and the staff needed to support them. Staffing ratios are a tool to evaluate the impact of your staffing

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