Adj A/Prof LEE Siu Yin Senior Director, Special Projects (Ambulatory Services) National University Hospital, Singapore Manpower Optimization Using IT Enabled Rostering and Patient Acuity Systems

Objectives: 1)Gain awareness of IT Enabled Systems to optimize manpower a)E-Rostering System b)Patient Acuity System 2) Recognize systems capabilities a)Synchronize patient care requirements and nursing staff management b) Achieve better management decision for nursing manpower

To address those challenges NUH interfaced two IT enabled systems 1.E-Rostering system, and 2.Patient Acuity system Challenges in Healthcare Environment 1)Aging population with chronic illness 2)Escalating healthcare demands 3)Development in patient care standards 4)Numerous advancements in clinical practice

NUS Professors developed software engine for e-Rostering With hard constraints / soft constraints Software engine search for best match Funding from WDA / Union partnership Better scheduling support for Nurse Managers (NM)

1.Captures detailed skill mix Designations & language proficiency per shift are noted 2.Incorporates information of ward coverage and staff competencies To generate rosters that best meet staffing level & skill requirements forquality patient care

Jasmine Tan 3.Minimizes favoritism and bias from scheduling process Staff empowered to indicate their shift preferences and plans for leave through e-bidding

4.Eliminates manual payroll claim Electronic management of claims submission/approval reduces errors 1)Nurses’ roster auto translates to number of claims earned for that specific month 2)Once claims approved, the information will flow to payroll for processing

Conventional SchedulingE-Rostering Reliance on professionals whose primary function is not scheduling State-of-the-art technology Planning time in terms of daysPlanning time in terms of hours Huge variation in utilization & deployment of staff Reduced variation and improved utilization & deployment of staff Huge variation in fulfillment of staff preferences, possibility of unfairness Maximized fulfillment of staff preferences, guaranteed fairness High fatigue, low morale, poor job satisfaction, increased turnover rates and absenteeism Fatigue reduction, high morale & job satisfaction, reduced turnover rates and absenteeism

E-Rostering system integrated with a Patient Acuity system Integration further enhanced timeliness and effectiveness of staff deployment vis-à-vis patients’ needs

A computerized patient acuity and clinical pathway management system Program developed on broad experiences in  clinical nursing  clinical costing  quality improvement processes and  human resource management 16 years of R & D Wide client base 1 st Singapore hospital to adopt system

The system is able to support the following: a)Synchronized staffing levels to patient acuity b)Fair distribution of nurses’ workload within the wards c)Optimal staff deployment d)Generate system reports for staffing and patient acuity trends

1)Inter-Rater Reliability Audit a)Audit conducted annually, assuring accuracy of data (>95%)

2)Enhanced Job Satisfaction for Nurses a)Since 2006, retention rate increased from 90% to 92% 3)Better Ability to Manage Nursing Staff Schedules a)Peaks and troughs in patient acuity across days of the week and shifts of each day are identified b)Staff rosters improved when matched against patient load

Synergy allows for better, more informed hospital-wide decisions: 1)Fair Workload Distribution a)Roster and Patient Acuity system interface allows fair distribution according to patients’ needs. b)Nurses neither overworked nor under-challenged with equitable workload distribution

2)Roster Re-engineering a) Enhanced staff scheduling based on patient trends E.g. Peak period for this ward is Wednesday to Friday. Hence the nurse manager schedules more nurses on these days

3)Staff Deployment a)Optimal deployment with daily review of staffing alignment to patient needs b)Plan future deployment based on reports generated from Patient Acuity System

4) Justification for Manpower Requirements a)Accurate derivation of manpower requirements for new or existing services based on staffing and patient trends. b)Since 2006, these numbers have been instrumental in the 87% increase in nursing manpower

5)Mass Casualty Incident (MCI) Support a) List of MCI-Trained nurses are captured in Patient Acuity System b) Allows for immediate activation c)Efficient and effective deployment of staff based on real-time information in the system

Integrating E-Rostering and Patient Acuity System… Provides an overarching view of staffing and patient acuity Allows for better and informed decisions on manpower needs and staff deployment Allocates nurses’ time against patients’ needs better Increases job satisfaction and improves staff retention rate (from 90% to 92% since 2006)

Flow from e-Rostering