PI reduces staff, client cancellations
Process combats turnover, declining revenues
Three forces converged to send Charleston, SC-based Roper Procare on a performance improvement-driven mission to reduce client and employee agency cancellations:
· declining revenues;
· higher employee turnover;
· increased proportion of unfilled to scheduled shifts.
Nine months after implementing changes, Procare's cancellations have declined 50%. Catherine Hallman-Kenner, RN, nursing supervisor, estimates the improved shift fill rate has increased revenue 30%. As the for-profit private duty arm of Roper Hospital, the agency provides both in-home personal care services and supplemental staffing to area hospitals and physician offices.
"We [saw] that we were providing services for hospitals, and they would cancel our staff. At the same time, we were trying to support other agen cies but were unable to fill the time based on thinking we were full," says Deb Hepburn, RN, MS, performance improvement lead. "Our customers were saying, 'you can't fill our needs,' and our employees were not working. They signed on with other agencies because they were tired of being canceled," says Hallman-Kenner. And because they could not count on working, employees also felt less committed to work promised shifts, increasing their own cancellations, she adds.
"This was absolutely a performance improvement issue for us. It involved financial issues [because] when we scheduled someone and were then canceled, we lost revenue. And from a customer service standpoint, it affected our reliability and dependability," says Hepburn. (For further discussion of performance improvement issues, see related story, p. 145.)
Procare first developed a cancellation tracking mechanism for both clients and employees. Schedulers complete a specially created form when they receive cancellations. They record the reason for and time of the call-out and forward it to Hallman-Kenner for review. One copy goes in the employee's or client's file, and the other goes into a cancellation tracking book.
With an accurate cancellation pattern record, Procare implemented action steps, starting internally with employee cancellations. Procare's largely per diem staff do not receive minimum hour guarantees. They work shifts that match their own availability, essentially setting their own schedule. In exchange, they must work all promised shifts; the only exceptions are for emergencies or illness with a physician's excuse. However, this cancellation policy had been loosely enforced.
Armed with better information about the timing and nature of cancellations, Hallman-Kenner revised the call-out procedure. Now, employees scheduled for a morning shift, starting before noon, must call-out - a cancellation notification - before 9 p.m. the evening before.
Those booked for evening and night shifts must contact schedulers six hours before their scheduled start time. Hallman-Kenner reviews each cancellation. Staff know she will challenge certain illness claims, such as those with low infectious potential. And staff understand that call-outs count in their annual evaluations and can result in counseling or even disciplinary action. Employees received letters outlining the changes before they were implemented.
Get clients to examine their own staffing
Hallman-Kenner next addressed client-related issues. Cancellation tracking results surprised her and startled customers. Meeting with each client, she reviewed cancelled vs. booked hour trends along with cancellation patterns. In a typical situation, one hospital nursing unit would cancel Procare's scheduled shift while another in the same facility would later request nursing - usually after Procare had already cancelled or reassigned its staff. Procare and its clients collaborated to improve communication and coordination.
As a result, several clients revamped their own staffing procedures. They now better understand their staffing supply and demand and use their own resources more effectively. In several instances, demand for Procare's services has actually increased.
Procare also revised its facility contracts, requiring corporate clients to cancel four hours before the scheduled shift or pay a four-hour cancellation fee. Initially apprehensive about implementing such a penalty, Hallman-Kenner discovered clients understood the new requirement after she met with them.
Decreased cancellation rates and increased revenue are only two positive outcomes. Although the agency still is rebuilding its employee pool, many who left out of frustration have since returned, confident they will work scheduled shifts. And in addition to increasing revenue and pleasing clients and staff alike, Procare also improved internal processes, eliminating repetitive paperwork and finding more efficient procedures. With such positive results, Hepburn says the only unanswered question is: "Why we didn't look at this sooner?"
You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content