Case study: Stagger shifts to cut overtime costs
Keep your employees happier, too
Like many hospital-based home health care companies, Seton Medical Center Home Care in Austin, TX, was spending too much money on overtime pay for evening and weekend visits, says the company's director, Elizabeth Clarke RN, BSN.
Despite spending months looking at other companies' solutions to this problem, Clarke and her staff couldn't find a way to change their system that would both cut costs and keep staff happy.
Eventually they came up with a solution to the problem that is all their own: They staggered work shifts throughout the day and week.
Now there are four shifts for nurses and aides:
* those who start working early in the morning and finish in the afternoon;
* those who start late in the morning and work into the evening;
* those who work traditional hours;
* those who only work on weekends.
In addition to cutting costs, this system has improved employee morale markedly. Clarke's nurses are able to work the hours they want, allowing many of them to solve their child-care problems.
This is how the staggered-shift system works:
Give staff a choice
* Field staff members can choose between early morning shifts, late night shifts, three-day, 12-hour weekend shifts, and traditional shifts. This way, some nurses have only weekend duty, and they never see working weekends as extraordinary. There are two weekend shifts: Saturday, Sunday, and Monday; or Friday, Saturday and Sunday. Each day is a 12-hour day of work, so people who work these shifts are full-time equivalents, and have the other four days of the week off to do what they like.
* The nontraditional shifts are completely optional.
* Staff may change their shifts if they are unhappy with them.
* The nurses who choose to work the nontraditional shifts are free from on-call duties.
* There is no difference in the pay rate for any of the shifts.
The idea for this system came from Seton Medical Center Home Care's durable medical equipment (DME) company. In the past, there had been a problem at the DME company if patients needed equipment delivered after 5 p.m., when the DME company was closed for the day.
Surprise! You've saved money
To solve this problem, the DME staggered the shifts of its delivery people. The cost savings brought about by fewer overtime hours worked was simply a pleasant, surprise byproduct of this solution. So, when looking to cut costs on the home care side, Clark and her agency manager, Tammy Killebrew, RN, BSN, sought to employ the same solution. These are some of the system's benefits:
* Little or no overtime cost.
Using staggered shifts cuts out the need to pay nurses overtime when a patient needs two visits a day. Now, if a patient needs to be visited at 7 am. and 7 p.m., an early-shift nurse can do the first visit, and a late nurse can do the second visit, rather than making a nurse work a 12-hour day to cover both visits.
* Employee dissatisfaction reduced.
The staggered shifts also lowered the levels of employee dissatisfaction that Seton Medical Center Home Care had been experiencing.
"We had so many late evening visits that our nurses were often working 12- and 14-hour days. They were not very happy workers that way," Killebrew says.
Now staff have time to take care of their other responsibilities in life and have some free time, too, Killebrew says. For example, the staff who work during the week are happy because they get their weekends back, she says. "The staff say they love it."
Here is how Clark and Killebrew suggest setting up a staggered-shift program:
Get input from nurses
* Ask staff to help design a solution.
Clarke and Killebrew brought up the problem of overtime hours at a regular nurses' staff meeting and suggested the idea of having staff start later and work into the evening hours.
Killebrew then asked the nurses what the hours were that were must difficult to cover, and they concurred that the evening hours were the hardest to staff. The nurses then suggested that a 11 a.m. - 8 p.m. shift be introduced.
"The staff were very excited with the idea because they would have staff to assist with the evening and weekend coverage," Killebrew explains.
* Allow staff to volunteer for nontraditional shifts.
There was no resistance to the idea of staggered shifts because everyone thought the proposed system would make their own job easier, Killebrew says.
"The staggered or weekend shift works well for some people but not for all. This way everyone is happy," Killebrew says.
For example, the weekend shift may work well for someone who is going to school during the weekdays, or who shares child-rearing responsibilities with a spouse who works during the week. And some nurses who aren't "morning" people appreciate the flexibility to work hours that are more comfortable for them, Killebrew says.
* Provide an incentive for nurses to work nontraditional shifts.
To encourage staff to take on the nontraditional shifts, Clark and Killebrew decided that those who work the nontraditional shifts would be free from on-call responsibilities.
"There has to be an incentive for them to do this," Clark says.
Keep an eye on patient satisfaction
* Ensure that patient satisfaction doesn't go down using staggered shifts.
Clark and Killebrew monitored patient satisfaction surveys to make sure the new shifts wouldn't affect patients' opinions of the care they were receiving.
Thus far, the surveys have shown that patients are happy with the arrangement, as well as the staff.
* Try to lessen any drawbacks to the system.
One downside of this system is that nurses working the early or traditional shift some- times must talk with the late-shift nurses early in the morning to discuss a patient's case.
"This infringes on their time off," Killebrew explains.
So far, Killebrew and Clark haven't worked out a solution to this problem, as communication about patients must go on, regardless of people's schedules. But the staff all understand this, they say. *
* Elizabeth Clarke, Director, Tammy Killebrew, Manager, Seton Medical Center Home Care, 4200 N. Lamar, Suite 220, Austin, TX 78756. Telephone: (512) 323-1884.
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