Part III: Tools to Analyze Financial Operations CHAPTER 8: STAFFING: THE MANAGER’S RESPONSIBILITY

Staffing Requirements In Health Care, many positions Must be filled, or covered, 7 days a week, and Must also be filled, or covered, 24 hours a day.

Productive and Non-Productive Time Why analyzed? Employees are paid for more hours than the hours they are on duty (vacation days, etc.), so Annualizing allows the full cost of the position to be computed through a “burden” approach.

FTEs for Annualizing Staff Positions Productive Time — Represents the employee’s net hours on duty. Non-Productive Time — Represents the paid-for time when the employee is not on duty (such as vacation time).

FTEs for Annualizing Staff Positions FTE Definition for purposes of understanding annualizing positions: The equivalent of one full-time employee paid for one year, including both productive and non-productive time. Two employees working half-time for one year would be the same as one FTE.

FTEs for Annualizing Staff Positions The calculations to annualize staff positions is a two-step process: 1. Compute the net days worked. 2. Convert the net paid days worked to a factor. See Exhibit 8-2 as an example.

Number of Employees Required to Fill a Position Why calculate by position? Because computing by position is used in controlling, planning and decision-making. The scheduled position method is often used when forecasting new programs and services. You will also find scheduling software using this method.

FTE definition for purposes of filling a scheduled position: Number of Employees Required to Fill a Position FTE definition for purposes of filling a scheduled position: A factor expressing the number of employees required measured against, or the equivalent of, one full-time employee’s standard work week.

The calculation to fill scheduled positions is as follows: Number of Employees Required to Fill a Position The calculation to fill scheduled positions is as follows: Compute the number of hours for a full-time position filled for one year. This measure is the baseline. Compute a factor representing the position to be filled for the required number of days (a required seven-day week to cover, for example, versus a five-day work week equals a factor of 1.4). See the cast room example in the chapter.

Tying Cost to Staffing In the case of the annualizing method the cost of nonproductive days is already in the formula. So, multiply the factor times the base hourly rate to compute cost. Study the example in the chapter.

Tying Cost to Staffing In the case of the scheduled position method the base rate must be increased, or burdened, by the nonproductive time. First, increase the hourly base rate by a percent or factor that represents the nonproductive time. Then multiply the burdened based rate by the factor to compute the cost. Then, multiply the factor times the base hourly rate to compute the cost. Examine the examples in the chapter.

Tying Cost to Staffing The actual cost is attached to staffing in the books and records, though. A subsidiary journal and a basic transaction record (both of which are described in the previous chapter). Study the examples shown in the chapter.

Subacute Unit Master Staffing Plan Staffing for Eight-Hour Nursing Shift Shift 1 Day + Shift 2 Evening Shift 3 Night = 24-Hour Staff Total RN LPN NA 2 1 5 4 3 11

Calculation for Annualizing Master Staffing Plan Example Step 1: Compute Net Paid Days Worked Total Days in Business Year Less two days off per Week Number of Paid Days per Year RN 364 104 260 LPN NA Less Paid Days Not Worked: Holidays Sick Days Vacation Days Education Days Net Paid Days Worked 9 7 15 3 226 2 227 1

Calculation for Annualizing Master Staffing Plan: Example Step 2: Converting Net Paid Days Worked to a Factor RN LPN NA 364 226 = 1.6106192 227 228 1.6035242 1.5964912

FTEs to Annualize Staffing: Practice 1. Compute Net Paid Days Worked Total days in business year Less two days off per week Number paid days per year Less paid days not worked Holidays Sick days Education days Vacation days Net paid days worked _______ _________ 2. Convert Net Paid Days Worked to a Factor. Total days in business year divided by net paid days worked equals factor ____________________ 2. Convert Net Paid Days Worked to a Factor. Total days in business year divided by net paid days worked equals factor 364/241 = 1.510373 364 104 260 241 8 5 1 19 1. Compute Net Paid Days Worked Total days in business year Less two days off per week Number paid days per year Less paid days not worked Holidays Sick days Education days Vacation days Net paid days worked

FTEs to Annualize Staffing: Assignment Compute Net Paid Days Worked Laboratory Medical Records Total Days in Business Year Less Two Days off Per Week Number of Paid Days Per Year 364 104 260 Less Paid days Not Worked Holidays Sick Days Education Days Vacation Days Personal Leave Days 9 7 3 15 21 Net Paid Days Worked 34 226 30 230 Covert Net Paid Days Worked to a Factor: For the Lab. Total days in business year divided by net paid days worked = factor 364/226 = 1.610619 For Medical Records Total days in business year divided by net paid days worked = factor 364/230 = 1.582609 Compute Net Paid Days Worked Laboratory Medical Records Total Days in Business Year Less Two Days off Per Week Number of Paid Days Per Year _________ ________ Less Paid days Not Worked Holidays Sick Days Education Days Vacation Days Personal Leave Days Net Paid Days Worked _______ Covert Net Paid Days Worked to a Factor: For the Lab. Total days in business year divided by net paid days worked = factor _______________ For Medical Records

FTEs to Fill Position: Example 8 Hour Emergency Department Scheduling for Eight-Hour Shifts: Shift One Day Two Evening Three Night = 24-Hour Scheduling Total Position: Emergency Room Intake 1 Eight Hour Shifts Staff needed to cover position 7/24 1.4 4.2 FTEs One full time employee works 40 hours per week. One eight-hour shift per day times seven days per week equals 56 hours on duty. Therefore, to cover seven days or 56 hours requires 1.4 times a 40 hour employee.

FTEs to Fill a Position: Practice 8 Hour Scheduling for Eight-Hour Shifts: Shift One Day Two Evening Three Night = 24-Hour Scheduling Total Position: Admissions Officer Four Eight Hour Shifts FTEs to cover position equals Position Clerical One Eight Hour Shift Scheduling for Eight-Hour Shifts: Shift One Day Two Evening Three Night = 24-Hour Scheduling Total Position: Admissions Officer 2 1 Four Eight Hour Shifts FTEs to cover position equals 2.8 1.4 5.6 Position Clerical One Eight Hour Shift

FTEs to Fill a Position: Assignment 8 Hour Scheduling for Eight-Hour Shifts: Shift One Day Two Evening Three Night = FTEs Seven Day Week Position: Nursing Supervisor Technician Nurses Clerical Aides 2.8 4.2 1.4 5.6 7.0 9.8 Total FTEs needed to cover all shifts 25.2

FTEs to Fill a Position: Example 12 Hour Emergency Department Scheduling for Twelve-Hour Shifts: 36 Hour Week Shift One Two = 24-Hour Scheduling Total Position: Emergency Room Intake 1 Twelve Hour Shifts Staff needed to cover position 7/24 2.33 4.66 FTEs One full time employee works 36 hours per week. One twelve-hour shift per day times seven days per week equals 84 hours on duty. Therefore, to cover seven days or 84 hours requires 2.33 times a 36 hour employee.

FTEs to Fill a Position: Assignment 12 Hour Scheduling for Twelve-Hour Shifts: 36 Hour Week Shift One Two = FTEs Seven Day Week Position: Nursing Supervisor Technician Nurses Clerical Aides 4.66 2.66 7 1.4 2.33 9.33 11.66 Total FTEs needed to cover all shifts 31.75

FTEs to Fill a Position: Example 12 Hour Emergency Department Scheduling for Twelve-Hour Shifts: 48 Hour Week Shift One Two = 24-Hour Scheduling Total Position: Emergency Room Intake 1 Twelve Hour Shifts Staff needed to cover position 7/24 1.75 3.5 FTEs One full time employee works 48 hours per week. One twelve-hour shift per day times seven days per week equals 84 hours on duty. Therefore, to cover seven days or 84 hours requires 1.75 times a 48 hour employee.

FTEs to Fill a Position: Assignment 12 Hour Scheduling for Twelve-Hour Shifts: 36 Hour Week Shift One Two = FTEs Seven Day Week Position: Nursing Supervisor Technician Nurses Clerical Aides 3.50 5.25 1.4 2.33 1.75 7 8.75 Total FTEs needed to cover all shifts 24.73