INDUSTRIAL ENGINEERING APPLICATIONS IN HEALTH CARE SYSTEMS:APPLICATION OF STAFFING METHODOLOGIES

APPLICATION OF STAFFING METHODOLOGIES

Introduction

Staffing refers to the number of employees of a given skill level needed in a department to meet a given demand for services. The determination of the staffing is basically a problem of work mea- surement. It requires listing all the different tasks done by a certain skill level in the department. The departmental tasks are classified as constant or variable. Constant tasks are those tasks that are not directly related to the departmental output, that is, they are independent of the level of demand for services. For example, cleaning the work area and equipment every morning in a blood-testing lab- oratory is a constant task that does not depend upon the number of specimens tested. Variable tasks are those that are directly related to the output of the department. For example, a variable task may be the actual testing of a specimen. The total time spent during a day in testing specimens would be equal to the time taken to test one specimen multiplied by the total number of specimens tested in a day.

After the identification of constant and variable tasks, the work content associated with each task is measured. The work content could be measured using any of the traditional work-measurement techniques such as stopwatch time study, predetermined motion time systems, and work sampling. Work content could also be established using the Delphi approach in which a group of individuals familiar with a well-defined task try to reach a consensus about the time required to accomplish the task. The frequency at which each variable task occurs per day is also determined. The total number of hours of work to be performed for each skill level is then determined by adding the time taken

to perform the constant tasks and the variable tasks at a given frequency level associated with a given demand for services.

One disadvantage of using the common work-measurement techniques is that the process is very cumbersome and time-consuming. Moreover, any time the method changes, the work content of various tasks has to be measured again. Another alternative may be to use one of the standard-staffing methodologies available in the health care industry. These methodologies describe the typical tasks that are performed in a particular hospital department and assign a standard time to each task. Resource Monitoring System (RMS), developed by the Hospital Association of New York State, is an example of one such system.

The time available per full time equivalent (FTE) is also calculated. If the department is open 8 am to 5 pm with a one-hour lunch break and if two 15-minute breaks are allowed during the shift, the time available per FTE per day will be 7.5 hours. The actual required FTE depends on demand variability, coverage issues, scheduling constraints, skill level requirements, and similar factors. One approach is to determine the efficiency level (a number less than one) that could be expected because of these factors. Efficiency is defined as the ratio of the actual hours of work done to the actual number of hours used to do the work, including idle time, if any. The FTE needed is then determined using the following equation:

A Case Study in the Ambulatory Surgery Center

An ambulatory surgery center can be defined as a specialized facility organized to perform surgical cases in an ambulatory setting. Ambulatory surgery centers are normally staffed by registered nurses (RNs), who provide care in preoperative, operating, and recovery rooms. A staff of nurse anesthetists (CRNAs) works in the operating rooms and also performs patient assessments in the preoperative area before the patient enters surgery. Nurses’ aides clean and package surgical instruments and assist with room turnover between cases. Room turnover involves cleaning and restocking the operating room between cases. The patient registration and all the initial laboratory work are done prior to the day of the surgery. On the day of surgery, the patient is asked to arrive one hour prior to the scheduled surgery time. After checking in with the receptionist, the patient is sent to preoperative area for assessment by CRNAs. After the surgery, the patient is in the recovery room until the patient is stable enough to be sent home.

The objective of the study was to determine the staffing requirement for each skill level including RNs, CRNAs, and nursing aides. As stated above, all the constant and variable tasks were identified for each skill level. The time required to perform each task was determined using a combination of approaches including direct observation and Delphi consensus-building methodology. The calcula- tions for determining staffing requirements for nursing aides are shown in Table 1.

The actual efficiency should be computed and monitored each week. If there are definite upward or downward trends in efficiency, adjustments in staffing levels should be made. The work level at which a department is staffed is a critical parameter. One approach could be to perform a sensitivity analysis and compute the FTE requirement at various levels of case activity and then decide on the appropriate staffing level.