Grant Thornton: Optimizing the Ambulatory Workforce

In this business profile, David Howard, principal at Grant Thornton LLP Health Care Advisory Services practice, discusses the importance of a data-driven approach to workforce management. Grant Thornton LLP is a sponsor of the HFMA Large System Controllers Council.

What factors are driving the need for healthcare organizations to focus on workforce management in the ambulatory setting?

Over the past 10 years, there has been a good deal of consolidation in health care, with larger entities, such as health systems and integrated delivery networks (IDNs), absorbing physician practices. As a result, a parent organization’s ambulatory ecosystem may include a substantial number of providers and support staff, as well as diverse sites and locations. Although these massive ambulatory operations can yield billions of dollars for the parent organizations, they also can generate significant costs. Getting a handle on ambulatory staffing and ensuring the entire function performs efficiently and effectively is critical to realizing lasting ROI from the investments.

What are some of the challenges involved in managing the ambulatory workforce?

It used to be relatively easy to manage an ambulatory care organization’s staff on an office-by-office basis. If you had three physicians, an office manager, a few nurses, and some billing staff, for example, maintaining an efficient operation was reasonably straightforward. The traditional model would look at staff-to-provider ratios and aim to keep them consistent over time. Even if you staffed to 120 percent of median demand to make certain you had enough resources should someone get sick or take vacation, the waste you would incur would be manageable. However, as the number of physician practices and ancillary sites under one umbrella expand, the waste generated by this methodology starts to rise exponentially and quickly becomes cost prohibitive. This approach also doesn’t consider any fluctuations in volume or the technological resources that a larger organization can deploy across its ambulatory sites to make things more streamlined and consistent.

Larger organizations also must be thoughtful in how they manage a common brand across their various locations and ensure a top-notch patient experience. Since all ambulatory sites will appear to the patient to be part of the broader organization, a bad experience in one will be applied to the reputation of the whole.

What are some of the opportunities that can come from digging into workforce management?

With a consolidated organization, there are opportunities to have greater visibility into staff across the entire organizational landscape. So, if a provider is going to be out of town for a week, then the volume of patients for the practice may be lower and the need to hold staff in the practice during that time may go down. These individuals can be allocated elsewhere to tackle an increase in volume. Managing across the system allows an entity to address fluctuations in real time while keeping costs in check.

What are some key strategies for optimizing the ambulatory workforce?

One especially valuable strategy involves leveraging a float pool. This is a stable of clinical or nonclinical staff that can fill in any holes across an organization, ramping up or down depending on the volume of patients and staffing requirements. A float pool lets an organization weather various staffing fluctuations, such as individuals leaving the organization, taking vacation, attending conferences, and so on. For example, staff can be shifted out of a practice in which one of the doctors is going on a two-week vacation to cover for another practice where there is a new physician who is struggling to navigate the influx of patients. Not only is this a cost-effective method for managing the workforce, but it also fosters a better patient experience because each location has sufficient staff to handle the demand. By standardizing processes and procedures across an organization, you can dispatch resources to the areas that need them most and deliver a consistent experience no matter where the patient enters the organization.

Although float pools have existed for a long time, they typically are managed manually, meaning a float pool manager calls around each day to see which practices need help. This is both time consuming and reactive. As a result, an organization might misfire when shifting staff, putting resources in areas where they are not the best fit. A manual approach does not allow you to see patterns, anticipate trends, and fine tune deployment over time. It also can yield unnecessary costs because a float pool that’s not tightly managed can be a drain on resources.

To optimize the use of a float pool, organizations must embrace a data-driven approach. A first step in this process is to fully describe the current workforce. What is the size of the organization’s staff overall? How many FTEs do you have? How many part-time employees? What do those individuals spend their time doing? What are their skills sets? Where are they located? An organization can gather this information out of a time and attendance system and/or payroll system. There are also some good business informatics tools that can supply this information.

Next, you should seek to gain an understanding of patient volume by week, month, day, and provider. How are you staffing your organization based on these volumes? Are you looking at it in terms of relative value units (RVUs) or number of visits? What fluctuations exist, and what might be causing those fluctuations? You basically want to get an awareness of your volume and how you’re leveraging your staff.

At that point, you can start to look for patterns that reveal opportunities. Perhaps there are ways to be more thoughtful in allocating staff to meet demand.

Although organizations can engage in these efforts on their own, they may run into some challenges as the data analytics become more sophisticated. Grant Thornton has deep experience in helping organizations better understand their volume and how to best deploy their workforce. Using advanced algorithms, we determine what the current demand for staff is as well as what it will be a month from now—and we drill down into that demand, looking at 15-minute intervals. This allows organizations to be more proactive and precise in their workforce management.

To assist with this work, Grant Thornton developed a unique solution called “teamBuilder” that uses advanced analytics to predict demand and align resources. We’ve used this solution to optimize the workforce of several health systems across the country. For example, we recently conducted a pilot with Mt. Sinai Medical Center in New York. After analyzing the staff and workflow for 15 specialties on its St. Luke’s campus, located on Manhattan’s upper west side, we found that the organization had challenges with overstaffing and understaffing depending on the specialty and location. By addressing both these aspects and better aligning the organization’s workforce to meet volume and demand, we were able to help the organization achieve a 24 percent labor savings, while improving patient throughput and experience.

Are there any resources you would like to share to help organizations in this effort?

For more information about Grant Thornton and our solutions for healthcare clients, go to https://www.grantthornton.com/services/advisory/featured-industries/health-care-advisory-services.aspx

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