7 Homeostasis & The EMS Success Triad Financial SuccessA/R Billing PracticesEMS Delivery Model & System DesignOperational Efficiency & EffectivenessEmployee CompensationSafety & Risk ManagementSystems EngineeringProfitabilitySubsidy NeedsSuccessTriadPatient CareEconomic StabilityEmployee Wellbeing
8 Scheduling Components & Steps for Advanced Deployment Systems Step 1: Have Good, Clean Data – Crap In / Crap Out TheoryStep 2: Perform a Temporal Demand AnalysisThe ScienceThe Art (someday may be science)Step 3: The Schedule Build…A Matter of Supply, Demand & Playing TetrisPlaying it Old SchoolZoll’s Resource Planner (formerly ISERA Deployment Planner)This isn’t a plug….it’s the only software of its kind in existence todayStep 4: The Shift BidStep 5: Building the BridgeStep 6: Schedule / Production FulfillmentStep 7 (Optional): Purchase Order Unit HoursStep 8: Repeat as Necessary
9 Scheduling Components & Steps for Advanced Deployment Systems Step 1: Have Good, Clean Data – Crap In / Crap Out TheoryClean and accurate data is importantBad data or incorrectly filtered data can KILL (how)Decide what is “system” coverage and what is “out of system” coverage then filter your data to this definitionLook for anomalies that can skew your resultse.g. – MCIs, HazMats, Large Multi Unit ResponsesDecide what type of responses are in and what are out
10 Scheduling Components & Steps for Advanced Deployment Systems Step 2: Perform a Temporal Demand AnalysisThe ScienceMathematical models that drive your demand prediction curvesStoutian Theory BasedAdvanced Statistics BasedTask Time AdjustmentsDiscussed first day here at the conferenceThe Art (someday may be science)A Unit Hour Buffer based on numerous variablesPerformance requirement, system efficiency, service area size & makeup, seasonality, system effectiveness, etc.This is typically a S.W.A.G.
11 Scheduling Components & Steps for Advanced Deployment Systems Step 3: The Schedule Build…A Matter of Supply, Demand & Playing TetrisPlaying it Old SchoolGraphs, colored pencils & timeMicrosoft Excel TemplatesZoll’s Resource Planner (formerly ISERA Deployment Planner)This isn’t a plug….it’s the only software of its kind in existence todayAllows you to easily build a complex schedule that meets your predetermined demand curves and patternsAllows for different variables to adjust scheduling based on Demand, Costs, FTEs, Resource Availability, Lost Unit Hours and othersThis is NOT schedule fulfillment software…it’s schedule building software…there’s a HUGE difference!If we have time, I will demo it at the end of the sessionStart of Shift and End of Shift Lost Unit Hours
12 Scheduling Components & Steps for Advanced Deployment Systems Step 4: The Shift BidThe Shift Bid is used to migrate the schedule into the workforceCan have one of the largest impacts on employee well-being of all HPEMS conceptsMUST be balanced, fair & accurateTypically seniority basedMultiple ways to do thisIndividual bid on paperBuddy bid using the college signup approachHybrid models (combination of the two)REMSA’s going on-line successesHEADCOUNT / HEADCOUNT / HEADCOUNT!!!!!!!!!!!Only bid out shifts you have headcount to fill, otherwise your weekend and night shifts will look like Swiss cheese
13 Scheduling Components & Steps for Advanced Deployment Systems Step 5: Building the BridgeA transitional “bridge” schedule from an old schedule to the new schedule MUST be builtThis is MANDATORYThis allows any gaps between the two schedules to be “repaired”It’s like building a bridge…if one side of a bridge is being built while the other side is also being built…when then they meet in the middle they must match PERFECTLYFailure to do this will be disastrous!Did I mention that this is MANDATORY?
14 Scheduling Components & Steps for Advanced Deployment Systems Step 6: Schedule / Production FulfillmentThis is the true “Production Factory” of your HPEMS systemMost medium to large size HPEMS systems have scheduling departmentsMany new software programs are available that help make this process highly efficient and effectiveZoll’s Crew Scheduler, eCore’s Net Scheduler Pro, ADP’s Scheduling Suite and othersMost important step in production fulfillment is understanding the SIGNIFICANT impacts of unfilled or overfilled production schedules on the Success TriadUnfilled = adverse patient & employee effectsOverfilled = adverse financial effectsProperly filled = balance & harmony
15 Scheduling Components & Steps for Advanced Deployment Systems Step 7 (Optional): Purchase Order Unit HoursP.O.U.H. are used in larger HPEMS systems to adjust their temporal unit hour supply up or down based on seasonal volumetric variances, compliance variances or other system problemsEssentially, they add or remove shifts (unit hours) on a weekly or daily basis based on predicted volume changes, response time performance issues, hospital delay problems, etc.Must have a solid PRN / Part Time employee pool and/or flexible FT employee pool in order to successfully achieve this level of dynamic schedulingThis is a solid approach for aggressive deployment models to meet their financial needs while also balancing the needs of the rest of the Triad
16 Scheduling Components & Steps for Advanced Deployment Systems Step 8: Repeat as NecessaryMost HPEMS systems perform a new scheduling cycle (all these steps) every 6 months or soThis allows the HPEMS system to adjust their unit hour supply with any changes in demand curves including seasonality and growthBased on the culture of your organization, this process may be sacred or loathed, but it is a necessary evil of Production Model EMS systemsMany things can be done to help employees manage their way through this process with positive outcomes and happy personnel…
17 Building a Triad Balanced Schedule The Constant Balancing of 3 Key ElementsPatient CareEmployee Well-BeingFinancial Success (however you define it)SuccessTriadPatient CareEconomic StabilityEmployee Wellbeing
18 Building a Triad Balanced Schedule A Look at the Triad & Schedules…Patient CareDemand patterns must be metMay cause some less desirable shifts to be requiredFinancial Success / StabilityRevenue, costs & profit (or your budget) typically will dictate unit hour availabilityUHU, your ability to perform in an efficient and effective manner and your deployment plan aggressiveness also dictate the number of unit hours needed to be successfully balancedEmployee Well-beingDifficult to balance here with other competing interests but there are ways…
19 Building a Triad Balanced Schedule Employee Well-beingDifficult to balance here with other competing interests but there are ways…The Shift Bid CommitteeGroup of employees of various stake holder groups that come together and drive the entire scheduling process from start to implementationThey typically survey the workforce to see what kind of shifts, work weeks, patterns, etc. their peers wantThey do it all (with help from management content experts where needed)They help with the demand analysis, they build the schedule and they do the actual shift bidNo Good ‘Ole Boy StuffThe bid is the way the bid is, don’t change it!The empowerment of quality is based on the quality of empowerment
20 Building a Triad Balanced Schedule Employee Well-beingDifficult to balance here with other competing interests but there are ways…Go on-line!Technology has allowed this process to become a live and dynamic process which improves employee satisfactionAt REMSA, we use a single bid process where employees submit a paper bid (as a backup), however, on bid day the process is performed live on the internetEach employee is assigned a bid time based on seniorityEmployees then see the bid as it unfolds live and we allow changes from their submitted paper bid when their turn arrivesWhen the employee picks a shift it is theirs and they know immediatelyThey also immediately know who their partner will be
21 Pitfalls, Tips & Tricks Pitfalls Tips & Tricks Bad data and/or bad demand analysis = bad scheduleBidding out more shifts then you have headcount to fillNot building a bridge / transitional scheduleNot taking into account ALL employee stakeholder group needsTips & TricksDo a supply to demand graph of the new schedule to ensure it matchesWith today’s software tools, excess UH waste can be minimized to +/- 3% or soUse a Shift Bid Committee and properly empower themConsider creating multiple schedules and having employees pick the one they like best
22 Summary / Review / Questions Contact Information for Jonathan WashkoREMSAPhone: x140Website:Washko & Associates, LLC.Phone: /Website:
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