Total staff productivity up: Tool adds one visit per day
Fine-tuned system tracks staff productivity
Looking for an instrument that can work wonders for your agency? Believe it or not, that magical instrument is not a wand but a productivity tool.
A productivity tool can show who your most efficient nurses are and flag the ones who drag while helping you track the profitability and production of your staff as a whole. But how do you know which tool is right for your home care agency?
Rather than shop around and choose just one, you can do what Loronda Schuler, RN, BA, PHN, director of home care at CommuniCare in Marshall, MN, did.
Schuler created her agency’s productivity tool by combining the best qualities of the different tools she’s seen.
"Our productivity study is weighted. Visits are weighted according to their technical level, so it’s fair to the staff, but it also gives them accountability," explains Schuler.
So far, staff productivity is increasing. In fact, staff visits increased from 3.5 to 4.5 visits a day in the four-year period CommuniCare has used the study. Schuler says the productivity improvement came in two areas:
• Awareness.
Simply by looking more carefully at how their time was spent, the staff were able to streamline how they operated and were able to use their time more efficiently.
• Computerization.
Documentation was moved from using predominately paper to using desktop computers at the agency. This reduced the amount of time it took for nurses to record patient information.
The added level of productivity did not require an increase in salary expense, either. "We have a higher volume of visits, but our costs for salaries didn’t go up," says Schuler.
She notes that many agencies average six or more visits a day, but the distance her staff must travel between patient visits in rural Minnesota doesn’t allow CommuniCare to stack several visits in one area.
Computing productivity
Schuler wrote the productivity tool into Report Writer, which is a software package that pulls information from the agency’s existing software. Report Writer is a software program that allows the user to produce customized reports from data entered into computers. By telling Report Writer what information should be retrieved and what to do with the information, Schuler was able to produce a productivity report customized to her agency. [Report Writer can be reached at (508) 366-1122.]
Nurses prepare daily activity reports as part of their data entry for the day. Time is coded according to activity such as travel time or a visit and what kind of visit. Report Writer then pulls the information from each nurse’s activity file for the productivity tool.
The productivity tool compiles visit-related time, which excludes sick time, vacations, and holidays. Remaining visit-related time is weighted according to its technicality. For example, an admissions visit is weighted at 1.5, a high-tech visit at 1.95, and a custodial visit at .50.
Each visit is categorized according to technical level and multiplied by that category’s factor. For example, on the sample employee productivity report, the nurse had three hours of admissions visits that month. (To see how visits are tabulated, see the productivity report, p. 128.) The three hours are multiplied by the admissions factor of 1.5, arriving at a total admissions visits equivalent of 4.5.
Report Writer calculates visit equivalent totals for each of the six categories: admit and stay visits, routine visits, maintenance nursing visits, complex visits, private duty hours, and clinic/screening time. The visit equivalent total from each category is added together to arrive at a total visit equivalent, in this case 37.02.
To figure this sample employee’s productivity percentage, you start by taking the total number of productive hours, which were 67.75 for the month, excluding non-care hours, and divide by eight (for hours in a workday) to arrive at the equivalent of days worked. The sample nurse in the example worked 8.47 days. Multiply the days worked by the agencies’ daily visit expectation of 4.5 to gain a weekly expectation for the number of visits by this nurse. In this example, the weekly expectation is 38.11.
The productivity percentage is then reached by dividing the actual number of total visit equivalents (37.02) by the weekly expectation (38.11). This informs Schuler that this nurse worked at 97% productivity for the month.
Using the information
When using productivity tools, it’s critical to monitor not only each employee’s production, but also your staff production as a whole, warns Schuler.
"We expect 90-100% productivity from each nurse, which means that 90-100% of the time they do 4.5 visits in an eight-hour day," notes Schuler. "But if everybody met 100%, then we don’t have high enough expectations."
CommuniCare recently hired a consultant to come in and take a look at its productivity tool.
"They’re using it pretty effectively," says John Richter, partner, Larson, Allen & Weishair and Co. in Minneapolis.
In particular, Richter notes that customizing a productivity tool is particularly useful for hospital-based home care agencies rather than freestanding.
"If I have a freestanding agency that has chosen to specialize in Medicare or care of the elderly or along the custodial line, the need for a productivity tool isn’t too great because a visit is s visit is a visit, with the exception of your set-up visits and supervisory visits," he says.
CommuniCare is your typical hospital-based agency, offering several different services, including a pediatric nursing program, IV program, and an elderly services program. This presented problems when it came time to evaluate the productivity of its nurses.
"It was challenging to try and put the nurses on a par with one another," he says. "Yet you had similar expectations in terms of output, and because it is a union agency, everyone is paid effectively the same."
Richter made two suggestions to CommuniCare to further enhance the use of the productivity tool. First, he felt that aide productivity was too high.
"They were achieving 120% productivity, while the nurses were right around 100%," he says. "You should have a mix of some people achieving 100% and some not."
When looking to increase productivity, 100% should be a goal rather than an expectation. To increase productivity, set standards that allow nurses to be in the 90% range and striving to reach 100%, rather than a mix that has some nurses operating above 100% and others well below.
With the customized tool evaluating the financial side of each nurse’s productivity, Richter’s second recommendation was to look at the clinical side.
"They needed a secondary evaluation tool for nurses such as a clinical path because their current tool focuses on just the financial piece."
Increasing daily visit expectation
CommuniCare is working on making two changes that it hopes will increase its expectation to five visits a day.
First, the prior authorization and intake processes will be handled by one staff nurse. Because CommuniCare is a small, rural agency, supplemental nurses were jacks-of-all-trades who did most of the visits, while primary nurses acted as case managers and handled patient charts, family conferences and other non-visit related issues. That will soon change, though.
"We’ve grown enough that we can funnel both those activities to one staff nurse who handles scheduling and other administrative activities. Taking those responsibilities from nurses will free up more time," notes Schuler.
Second, the agency’s administrators hope to receive funding to purchase laptops for nursing staff, which will decrease the amount of travel back to the office. The decrease in travel time is expected to increase productivity even more, says Schuler. The agency’s goal is to reach five or more visits each day.
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