In my previous post, we began to modify a staffing-to-workload analysis for our off-site testing laboratory used at a remote outpatient care clinic. The laboratory had received feedback from the care providers and their patients that we needed to complete all of the testing the same day it was collected. This would allow the care providers to contact the patients the same day they saw them or first thing the next morning with their results, and the physicians could discuss any next steps in their episodes of care.
We completed our analysis of both the direct- and indirect-effort impacts of this request. The outcomes indicate we will need additional laboratory staff to meet these new requirements, even after shifting some of the indirect effort to alternate days:
That said, we are still not complete with our staffing impact assessment, as we have not included the staffing necessary to support the operational needs of the laboratory. This post will focus on the inclusion of the on-site and off-site operational needs of the laboratory.
"On-site operational needs" refers to tasks that consume staff time that are not directly or indirectly related to testing of patient samples while the employee is on-site. Below are examples of these items:
First, we need to create a list of all the items we expect our staff members to do while they are at work that are in this "bucket" of operational needs. Some of these are fairly straightforward, such as the amount of time set aside for continuing-education opportunities, because they are predefined for us (minimum of 12 hours each year).
Others are easy to identify but hard to measure, such as the time we would set aside for test development, training, or laboratory meetings. In these instances, we have to do our best to estimate this time based on historical information or future planning. If we plan to meet twice a week for 30 minutes for lab meetings, then we can estimate that each staff member will need to spend 52 hours per year in lab meetings. If we also experience unplanned meetings about twice a month for an hour each time, we would add additional time and estimate a total of 70 hours each year in lab meetings for each staff member.
The last grouping is limited to how we support the laboratory when staff members go on break or leave for lunch. If your operation has two paid 15-minute breaks and one 30-minute unpaid lunch, then you would need to account just for the productivity loss around the breaks. This is due to the fact that an FTE is scheduled for 8 hours per day, but staff members are actually scheduled to be on-site for 8.5 hours each day. The unpaid lunch is the reason for that “extra” half hour, which is not included in the on-site operational needs. Therefore, compensating for breaks means a half hour each day, or 2.5 hours each week, or 130 hours each year for each staff member.
To keep things simple, I’ve include four items in our list of on-site operational needs. More than likely, you will identify these (and more) when performing your analysis:
Paid On-Site Operational Needs
|Allowance per FTE (hours per year)|
|CE credits for certificate maintenance||12|
|Training for updated procedures||45|
|Total Need per FTE||257 hours per year|
We need to convert the 257 hours per year into FTE. We do that by dividing the 257 hours per year by the FTE standard of 2,080 hours per year per FTE. This gives us 0.12 FTE of onsite operational need for every FTE scheduled to perform the direct and indirect work. For example, if I need 5 FTE to get the direct testing and indirect maintenance tasks done for one day, I would also need to schedule an additional 0.6 FTE (0.12 FTE × 5).
In our case study of the remote clinic laboratory that needs to complete the testing by the end of each day, our on-site operational needs affect the daily staffing needs as outlined in the chart below:
The chart above provides an understanding of what the daily schedule would look like in order for the laboratory to cover everything it is expected to do each day. You can also see the additional FTE increments associated with the inclusion of the direct, indirect, and on-site operational needs. However, we are not quite done with our model because we still need to figure out how large of an FTE roster we need to have in order to schedule the amount of FTE needed to get the work done each day.
Off-site operational needs primarily fall into two categories: planned paid leave and unplanned paid/unpaid leave. In both cases, the focus is to account for the additional staffing needed to cover the needs of the laboratory. Similar to a major league baseball team’s pitching roster, you need to have a group of "starting pitchers," "relievers," and "closers" to select from in order to make sure you have rested and healthy staff who can meet the demands of each day. Below are some examples:
To define how much time to allocate to off-site operational needs, the timekeeping system is a great place to start. Not only does it define most of the off-site categories, it also records how many hours were assigned to them. A rule of thumb would be to use at least a year’s worth of information and average it out over the number of FTE. In the table below, our lab staff pulled last year's timekeeping data and calculated the average hours per FTE they had last year:
Paid Off-Site Operational Needs
|Allowance per FTE (hours per year)|
|Unplanned time off (sick days)||20|
|Other away-from-work time||10|
|Total Need per FTE||310 hours per year|
Similar to the on-site operational needs, we need to convert the 310 hours per year into FTE. We do that by dividing the 310 hours per year by the FTE standard of 2,080 hours per year per FTE. This gives us 0.15 FTE of off-site operational needs for every FTE scheduled to perform the direct work, indirect work, and on-site operations. For example, if I need 5.5 FTE to get the direct testing, indirect maintenance tasks, and on-site operations done for one day, I would also need to have 0.8 FTE (0.15 FTE × 5.5) staff who are not scheduled to be at work.
In our case study of the remote clinic laboratory that needs to complete the testing by the end of each day, our off-site operational needs affect the daily staffing needs as outlined in the chart below:
With the chart above, our staff-to-workload “onion” is now complete, as we know how much staff we need each day in order to fulfill the request of completing all testing by the end of the day.
For example, on a Thursday, we need to:
Even at this level of detail, we are still working with averages such as average daily volume, average testing time, and average vacation time. This means that there is still a bit of over- or under-staffing occurring, depending on the specifics of each day. In the next blog post, I will walk through some of those scenarios and what types of counterbalances are available to us to better manage them.