If you have been a follower of the Avantas blog or are a regular reader of our eNewsletter you are probably well versed in the three KPIs I’ll outline in this article. I write and talk about these quite often, and I do so for two main reasons. First, they are what we like to call “low hanging fruit.” That is to say, they are some of the most immediate savings opportunities with regard to managing labor. Savings in these three areas can occur with the implementation of some basic enterprise strategies and tools to improve transparency.
The second reason I write and talk about these KPIs so often is that they have impact well beyond the balance sheet. With continual focus, these three metrics will lead to quality improvements as well as result in improved morale.
1. FTE Leakage: Avantas coined this term more than a decade ago in reference to the hours a staff member has not worked but should have based on their FTE commitment. For example, a staff member hired at a .8 should be working 32 hours per week/64 hours per pay period. If that staff member is only scheduled 56 hours in a pay period they have FTE leakage of 8 hours. These 8 hours will be filled by a more expensive form of contingency staff – a staff member that should be working in an area of real need. Even if census is down and the staff member isn’t “needed,” they are still receiving benefits based on their hired commitment. At the hospital or system level, instances of FTE leakage create avoidable costs and complications and cause a drain on resources.
2. Incidental Worked Time (IWT): This refers to additional time a staff member is on the clock before or after the start or end of their original shift or during a scheduled meal break. Anyone who has ever cared for patients knows that this is part of the profession. In the midst of providing patient care, nursing staff will work through a lunch or stay late. It happens, but our research suggests that only 40 percent of IWT is clinically necessary. The remaining 60 percent should be avoidable through a variety of training/education initiatives.
IWT is a serious issue because it can negatively affect employee morale and quality. Care staff need and deserve the opportunity to take an uninterrupted meal break and leave work at the expected time. Failure to do so creates unnecessary stress, negatively affecting the caregiver and the patient. Additional work stress is created when caregivers feel like they are treated differently when IWT practices are not uniformly administered.
For more on the causes of and strategies for reducing IWT, check out our free white paper, Managing Incidental Worked Time.
3. Core as Contingency: This is essentially two metrics; staff working extra and staff working overtime. At Avantas we define “contingency” as any source of staffing that is not a core staff member, and core staff members who are working above their FTE. Again, if a core staff member is hired at a .8 but schedules an extra shift, putting them up to 40 hours in a week, that extra shift is considered “contingency,” even though it is not overtime.
Staff working above their FTE has both hard cost and soft cost ramifications, including fatigue, staff burnout, and poor morale. Some staff view overtime as a benefit – a way to earn extra money while helping out their unit. While this is a perfectly normal sentiment, the practice is destructive if done with regularity. Staff working extra and overtime is occasionally unavoidable, but it should be rare.
When we conduct a Workforce Analysis engagement with a new client we discover, almost without exception, the existence of overtime and FTE leakage. Meaning, some staff are working overtime while other staff are not working the hours they should. Core staff working as contingency is by and large avoidable when the right strategies are implemented, namely, right sizing core staff and properly layering contingency sources.
To learn what tools and strategies are available to assist you with controlling these three KPIs feel free to email me at firstname.lastname@example.org.