Personnel Schedules for Advanced Deployment Systems Jonathan D. Washko, BS-EMSA Director of Deployment – REMSA President – Washko & Associates, LLC Partner – Stout Solutions & FirstWatch

“Developing schedule patterns that mirror demand is an art as much as a science. Equally challenging is creating a real-world work schedule that takes into account what employees really value”

Session Overview Homeostasis & The EMS Success Triad Scheduling Components & Steps for Advanced Deployment Systems Building a Triad Balanced Schedule Pitfalls & Tips / Tricks Summary / Review / Questions

Homeostasis & The EMS Success Triad The Constant Balancing of 3 Key Elements Patient Care Employee Well-Being Financial Success (however you define it) Success Triad Patient Care Economic Stability Employee Wellbeing

Homeostasis & The EMS Success Triad Patient Care Response Times Clinical Performance Customer Service Success Triad Patient Care

Homeostasis & The EMS Success Triad Employee Well-Being Retention Health / Safety / Welfare Satisfaction Schedules Work Environments Compensation Recruitment Family Success Triad Patient Care Employee Wellbeing

Homeostasis & The EMS Success Triad Financial Success A/R Billing Practices EMS Delivery Model & System Design Operational Efficiency & Effectiveness Employee Compensation Safety & Risk Management Systems Engineering Profitability Subsidy Needs Success Triad Patient Care Economic Stability Employee Wellbeing

Scheduling Components & Steps for Advanced Deployment Systems Step 1: Have Good, Clean Data – Crap In / Crap Out Theory Step 2: Perform a Temporal Demand Analysis The Science The Art (someday may be science) Step 3: The Schedule Build…A Matter of Supply, Demand & Playing Tetris Playing it Old School Zoll’s Resource Planner (formerly ISERA Deployment Planner) This isn’t a plug….it’s the only software of its kind in existence today Step 4: The Shift Bid Step 5: Building the Bridge Step 6: Schedule / Production Fulfillment Step 7 (Optional): Purchase Order Unit Hours Step 8: Repeat as Necessary

Scheduling Components & Steps for Advanced Deployment Systems Step 1: Have Good, Clean Data – Crap In / Crap Out Theory Clean and accurate data is important Bad 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 definition Look for anomalies that can skew your results e.g. – MCIs, HazMats, Large Multi Unit Responses Decide what type of responses are in and what are out

Scheduling Components & Steps for Advanced Deployment Systems Step 2: Perform a Temporal Demand Analysis The Science Mathematical models that drive your demand prediction curves Stoutian Theory Based Advanced Statistics Based Task Time Adjustments Discussed first day here at the conference The Art (someday may be science) A Unit Hour Buffer based on numerous variables Performance requirement, system efficiency, service area size & makeup, seasonality, system effectiveness, etc. This is typically a S.W.A.G.

Scheduling Components & Steps for Advanced Deployment Systems Step 3: The Schedule Build…A Matter of Supply, Demand & Playing Tetris Playing it Old School Graphs, colored pencils & time Microsoft Excel Templates Zoll’s Resource Planner (formerly ISERA Deployment Planner) This isn’t a plug….it’s the only software of its kind in existence today Allows you to easily build a complex schedule that meets your predetermined demand curves and patterns Allows for different variables to adjust scheduling based on Demand, Costs, FTEs, Resource Availability, Lost Unit Hours and others This 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 session Start of Shift and End of Shift Lost Unit Hours

Scheduling Components & Steps for Advanced Deployment Systems Step 4: The Shift Bid The Shift Bid is used to migrate the schedule into the workforce Can have one of the largest impacts on employee well-being of all HPEMS concepts MUST be balanced, fair & accurate Typically seniority based Multiple ways to do this Individual bid on paper Buddy bid using the college signup approach Hybrid models (combination of the two) REMSA’s going on-line successes HEADCOUNT / HEADCOUNT / HEADCOUNT!!!!!!!!!!! Only bid out shifts you have headcount to fill, otherwise your weekend and night shifts will look like Swiss cheese

Scheduling Components & Steps for Advanced Deployment Systems Step 5: Building the Bridge A transitional “bridge” schedule from an old schedule to the new schedule MUST be built This is MANDATORY This 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 PERFECTLY Failure to do this will be disastrous! Did I mention that this is MANDATORY?

Scheduling Components & Steps for Advanced Deployment Systems Step 6: Schedule / Production Fulfillment This is the true “Production Factory” of your HPEMS system Most medium to large size HPEMS systems have scheduling departments Many new software programs are available that help make this process highly efficient and effective Zoll’s Crew Scheduler, eCore’s Net Scheduler Pro, ADP’s Scheduling Suite and others Most important step in production fulfillment is understanding the SIGNIFICANT impacts of unfilled or overfilled production schedules on the Success Triad Unfilled = adverse patient & employee effects Overfilled = adverse financial effects Properly filled = balance & harmony

Scheduling Components & Steps for Advanced Deployment Systems Step 7 (Optional): Purchase Order Unit Hours P.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 problems Essentially, 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 scheduling This is a solid approach for aggressive deployment models to meet their financial needs while also balancing the needs of the rest of the Triad

Scheduling Components & Steps for Advanced Deployment Systems Step 8: Repeat as Necessary Most HPEMS systems perform a new scheduling cycle (all these steps) every 6 months or so This allows the HPEMS system to adjust their unit hour supply with any changes in demand curves including seasonality and growth Based on the culture of your organization, this process may be sacred or loathed, but it is a necessary evil of Production Model EMS systems Many things can be done to help employees manage their way through this process with positive outcomes and happy personnel…

Building a Triad Balanced Schedule The Constant Balancing of 3 Key Elements Patient Care Employee Well-Being Financial Success (however you define it) Success Triad Patient Care Economic Stability Employee Wellbeing

Building a Triad Balanced Schedule A Look at the Triad & Schedules… Patient Care Demand patterns must be met May cause some less desirable shifts to be required Financial Success / Stability Revenue, costs & profit (or your budget) typically will dictate unit hour availability UHU, 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 balanced Employee Well-being Difficult to balance here with other competing interests but there are ways…

Building a Triad Balanced Schedule Employee Well-being Difficult to balance here with other competing interests but there are ways… The Shift Bid Committee Group of employees of various stake holder groups that come together and drive the entire scheduling process from start to implementation They typically survey the workforce to see what kind of shifts, work weeks, patterns, etc. their peers want They 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 bid No Good ‘Ole Boy Stuff The bid is the way the bid is, don’t change it! The empowerment of quality is based on the quality of empowerment

Building a Triad Balanced Schedule Employee Well-being Difficult 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 satisfaction At 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 internet Each employee is assigned a bid time based on seniority Employees then see the bid as it unfolds live and we allow changes from their submitted paper bid when their turn arrives When the employee picks a shift it is theirs and they know immediately They also immediately know who their partner will be

Pitfalls, Tips & Tricks Pitfalls Tips & Tricks Bad data and/or bad demand analysis = bad schedule Bidding out more shifts then you have headcount to fill Not building a bridge / transitional schedule Not taking into account ALL employee stakeholder group needs Tips & Tricks Do a supply to demand graph of the new schedule to ensure it matches With today’s software tools, excess UH waste can be minimized to +/- 3% or so Use a Shift Bid Committee and properly empower them Consider creating multiple schedules and having employees pick the one they like best

Summary / Review / Questions Contact Information for Jonathan Washko REMSA Phone: 775-858-5700 x140 Email: jwashko@remsa-cf.com Website: www.remsa-cf.com Washko & Associates, LLC. Phone: 804-347-3337 / 775-626-4459 Email: jw@washkoassoc.com Website: www.washkoassoc.com