Part one of a two-part series ...
Initially, healthcare information technology meant financial systems. More recently, much of the focus in healthcare has been on clinical applications.
But there are other computer systems serving the healthcare industry that help make provider operations safer and more efficient, systems that are neither solely financial nor purely clinical but draw on information used by both.
Vendor management and human resources tracking are areas in which software has helped smooth out operations while implicating the business and the clinical sides of the house.
Barbara Medvec, chief nursing officer at four-hospital Oakwood Healthcare System near Detroit, relies on such technology to help track nurses, particularly those provided by outside agencies.
Clinical staffing at Oakwood, headquartered in Dearborn, requires the efforts of nearly 2,000 nurses, about 65% of whom are full-time employees. Another 25% are part-timers while just 10% of the nursing workforce on an average day is made up of contingent workers supplied by nurse-staffing agencies.
'Like flight control'
Keeping all of the Oakwood facilities fully staffed with nurses "is like flight control basically," Medvec said. "It's a series of validations to make sure we have the right people in the right place at the right time. That, with the paper process, was fraught with error. We probably had a good 20 FTEs (full-time equivalents) that were engaged in various pieces and parts of flight control."
Medvec said the bulk of the staffing work while Oakwood was still using a paper-based system came from dealing with the smallest but most problematic staffing componentthe agencies.
Computerization of the nurse-staffing function at Oakwood began in late 2004, though it was not done in isolation. "We were in the midst of a process change, centralizing our contingent nursing staff," Medvec said. "I was working on a new model, centralizing that and centralizing our external vendor contracts."
To add IT to the program, Medvec said the hospital chose a Web-based staffing support system from ShiftWise, a vendor that specializes in these systems.
Now, Medvec said, "I sleep better at night. If you think about what we are challenged with as we strive to provide great patient care at our bedside, we need to have excellence there 24/7. In this era of nursing shortage, we have to provide staffand often they are contingent staff who are not full timeand we have to go to agencies that broker staff. But we have to ensure they have the same competency and approach to care as our full-time staff."
External nurses from agencies are required to take a minimum of eight to 16 hours of training for each unit he or she might work in, she said. "We have about 72 units across four hospitals. I have 72 units that may have different elements of training for agency staff.
"This product automates for us the profile of every individual we bring in from an outside agency," she said. "It validates all of their skills and confirms for us their credentials. It assures (us) they have all of the regulatory stuff completed and they've gone through our Oakwood training."
The system also helps the hospital network rein in its outside staffing costs, said David MacIntyre, director of Oakwood Staffing Solutions, the vendor-management unit of Oakwood Healthcare System.MacIntyre's in-house staffing agency draws against its own company of about 140 contingent nurses to plug gaps in the schedules across all four Oakwood hospitals.
"We get needs from the hospitals and the various sites up from a month ahead of time," MacIntyre said. "They might know someone is going out for maternity leave and they know they have a four-week block opening." MacIntyre said he uses ShiftWise to give his 140 nurses first dibs on open shifts in an operation that books 5,000 to 6,000 nursing hours a week. "The nurses we have working for us have a couple of weeks to bid on the open shifts for all four of our hospitals," MacIntyre said.
"Before, the hospitals would try to fill it themselves and they would immediately call it out to the agencies" where costs per hour run 25% to 50% higher than at Oakwood Staffing, he said.
"We also use it for billing, which to me, is like a miracle," MacIntyre said. Nurses from the agencies clock in and out of the Web-based system at each Oakwood facility at a great savings of time and labor both for the hospital and the agencies.
According to MacIntyre, before the IT system was installed, "I had one person who did nothing but verify payroll. This alleviates all of that calling and getting signatures on a time card signed by a charge nurse. If a time card came back with one shift missing it had to go back to the hospital. Sometimes it could be weeks. This way, the nurse goes into ShiftWise, enters a code and number, and it goes back to the agency."
MacIntyre said that before coming to Oakwood he had worked at several nurse-staffing agencies, and the fast turnaround on payments the new computerized system enables is a benefit to them, even if it has meant reduced hours. "One of the agencies I ran in New York actually closed because of collections," he said. "We had huge amounts of money over 120 days. With this, they get (paid) in 10 days. This is tremendous."
Medvec said the staffing administration department has been able to relocate about four or five FTEs since instituting the new scheduling system, including the use of ShiftWise. "We talked about a $1.2 million savings in 2006, that was really through efficient use of our contingent staff and getting from them more hours to cover shifts and using our agencies more effectively," she said.
This story initially appeared in this week's edition of Modern Healthcare magazine.
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