Baylor plan’ helps fill weekend staffing needs
Weekend staff get full benefits
When confronted with the need for additional therapy staff on weekends, Teresa Woodard, PT, director of acute rehab at St. Francis Hospital in Greenville, SC, took a tip from her hospital’s nursing department.Instead of rotating more of the regular therapy staff on weekends, Woodard hired a physical therapy assistant (PTA) who works 12 hours a day on Saturday and Sunday, is paid for 32 hours, and receives the same benefits as full-time employees.
The staffing model, called a "Baylor plan" for Baylor University in Dallas, TX, where it was developed, was so successful that Woodard is hiring a physical therapist to work under the same arrangement to replace a therapist who worked only weekends at a daily rate.
The regular staff are happy because it minimizes weekend duty and allows them to operate with an almost full staffing contingent during the week.
A survey of physicians three months after the plan went into effect showed that 85% felt the weekend coverage boosted their satisfaction with the hospital’s services; 86% said it improved patient care; and 78% said it helped reduce the length of stay.
The acute rehabilitation department is made up of 15.2 full-time equivalent (FTE) physical therapists and physical therapy assistants who treat patients in the 252-bed acute care hospital, which includes a 30-bed skilled nursing unit.
Weekend therapy is provided by the PTA who works 12 hours a day, the daily rate therapist who works eight hours a day, and weekday staff who rotate weekend duty to fill eight-hour slots on Saturday and Sunday.
Coverage increasing
When the second Baylor staff member is hired, weekend coverage will increase by a total of eight hours.Woodard received permission from the administration to hire the Baylor staffer in February 1996 when she needed to provide more therapy on weekends.
"We were seeing only about 30% of the patients over the weekends," she says. "A lot of our orthopedic surgeons do surgery late in the week. There were more and more patients who needed to have therapy on weekends."
At the time, orthopedic volume in the acute care hospital had increased 40% in a year, and the number of referrals on weekends had also increased 40%.
"Orthopedic volume has been the driver of this," Woodard says. "A lot of our orthopedic surgeons do surgery on Thursday and Friday. If consumers have surgery on Friday, they expect to get the same care the next day as the patients who had surgery on Tuesday."
Knee patients who had surgery on Friday and were discharged early in the week often went home less functional than those who had surgery earlier in the week.
The staff always saw orthopedic patients on weekends, but the Baylor plan allowed them to see them twice a day on weekends.
To further bolster her case presented to the administration, Woodard tracked the number of billable hours vs. charged hours and found that therapists who worked weekends were being asked to do more in a typical eight-hour day than during the week.
Staff already had expressed dissatisfaction about having to rotate on weekends and didn’t want to put in any more weekend time, she says.
Therapists who responded to a survey said they felt too many patients were crammed into too little time on weekends. They complained that when only two staff worked on weekends, it was difficult to schedule treatments when the therapist needed someone to assist them.
Woodard filled the PTA Baylor position with a woman who home-schools her child and was happy for a full-time job on weekends. She works part-time at St. Francis during the week and is paid hourly. This schedule allows her to attend the weekly patient conference to give continuity to the weekend care.
Because the weekend PTA’s duties include a lot of paperwork and setting up and taking down equipment, the 12-hour shift isn’t too tiring.
"As it is, she’s treating patients only about 10 hours. If she had 12 hours of heavy duty treatment, it might be too much," Woodard notes.
The regular staff are assigned a number for the weekend rotation. If coverage is needed for any reason (including vacation for the Baylor staff) the person whose number is next works that weekend. Staff who work weekends are given compensatory time off during the same pay period.
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