1. QE Staffing & Scheduling Methods Presented by George Ricci of the QE Foundation, Inc. of Wilmington, DE Workshop For 24/7 Health Care Facilities www.qefoundation.org

2. QE Foundation, Inc. A Delaware Nonprofit Corporation An IRS Tax Exempt 501 (c) 3 Foundation Cultural and Health Care Economics Education and Research Projects Based on the QE Foundation's Concepts of Economics and Work Productivity Network of Consultants and Fellowships

3. Workshop Question-Part One If you were a patient in a health care facility, would you rather be cared for by very large numbers of different and haphazardly scheduled and deployed nurses and assistants that are often overworked and tired with little priority on the consistency, continuity and cohesiveness of the care provided to you

4. Workshop Question-Part Two Or by a very small number of regular well organized and well rested team oriented nurses and assistants who are scheduled and deployed with a high priority on the consistency, continuity and cohesiveness of the care provided to you.

5. Definition of Adequate Staffing Although everyone agrees that adequate staffing is the key to quality care, the definition of adequate staffing in this workshop will focus less on number ratios and more on how the staff is organized, trained, teamed together, scheduled, rested and deployed.

6. Understanding Current Staffing & Scheduling Issues Adequate vs. Inadequate Staffing Minimum Staffing Ratios Overwhelmed & Overworked Staff Typical Staff Scheduling Methods Part-Time, PRN & Ad Hoc Staffing Computerized Staff Scheduling Quality & Cost-Effectiveness

7. Poor quality nursing care and out of control nursing costs in 24/7 health care facilities are primarily due to unregulated and unaddressed issues of bad staffing and scheduling methods. The typical chaotic methods used today in 24/7 health care facilities are causing billions of dollars of unnecessary costs, and at the same time, are causing poor quality nursing care.

8. Objectives of the QE Staffing & Scheduling Methods Maximize Consistency Continuity Cohesiveness (Team Staffing) Team Synergy (Do More with Less) Minimize Attrition/Turnover Nursing Shortages Poor Staff Morale High Staffing Costs Problems/Mistakes Due to Overworked and Tired Staff

9. Primary Schedule Model 8 Hour Shift Three employees are teamed together into a partnership. Three employees are assigned to two job slots. Two job slots are assigned to one patient section. Number of patients in a section is set according to workload. Team Partnership Shaded Area=Working

10. 8-Hour Employees A, B & C Schedules

11. Primary Model Mathematically Designed Schedule Patterns Consistency, Continuity & Cohesiveness Equal Schedules & Equal Days Together Team Members Back-up Each Other (Lower Risk of Overtime) Stop Costly Reliance on Part-time, Overtime, Agency & Weekend Nurses (Baylor Method)

12. Primary Model Team Nursing Benefits Training/Mentoring New Staff Team Diversity Dynamics Job Sharing Schedule Flexibility Empowerment & Team Supervision Team Responsibility & Accountability Team vs. Employee of the Month Incentive High Performance Specialty Teams

13. Primary Model Schedule Patterns Full Time Days and Work Hours Average Work Week-37 1/3 Hours Work No More Than 4 Consecutive Days Work No Less Than 2 Consecutive Days 2 Weekends Off Every 6 Weeks 3 Consecutive Weekdays Off Every 6 Weeks Limited Part Time Job Sharing for Students, Older Workers & Workers with Disabilities

14. Limited Part Time Primary Model Using Four Team Members Two Full Time & Two Part Time Part Time Older Workers Part Time Workers with Disabilities Part Time Students and Trainees Inclusion & Transition Opportunities

15. Secondary Schedule Model Limited 12 Hour Shift Full-Time

16. Secondary Schedule Model Patterns-Full-Time or Part-Time

17. Other Considerations of the 12 Hour Shift Model Work Patterns Most Used Model But Problematic Meant to Complement 8 Hour Shift Model Recommended Mostly for Supervisors Pattern Can Be Used for Part-Time Staff Modification for Older and Disabled Workers and Students with Custom Models Considerations for Minimizing Part-Time

18. Transition & Implementation Strategies Trial Research Projects Small Scale Research Project Create a Few Teams One or More Shifts One Section Float Team Possibilities Trial Period-26 Weeks Study Team Synergy Dynamics

19. Consultants and Fellowships Consultants University Student Fellowship Grants Findings & Recommendation Reports Sponsored Research Projects Private Sector Participation Government Agency Participation