Right on Schedule: Flexibility for Productivity
February 08, 2008
Hospitals are embracing online programs that let the nurses choose their own schedules—and rewarding them for it
By Alex Palmer
From telecommuting to compressed workweeks, scheduling that gives employees freedom in choosing when they work has been shown to keep them happier and more productive. This kind of flexible scheduling can get more complicated in hospitals, where work happens around-the-clock and for longer shifts than a nine-to-five business day. Even so, the importance of freeing up the scheduling process remains significant.
In the past few years, online scheduling programs have been used at health care providers with increasing frequency, making the process of planning out each week's schedule more engaging for nurses and leading to some serious savings for the hospitals. And now, travel and merchandise rewards are being incorporated into these programs to help further boost morale and motivate workers to pick up an extra shift and make their workweek work for them.
Back in 2005, Nancy Zismann, the assistant vice president of patient-care services at Sun City, Ariz.–based Sun Health Boswell Hospital, was concerned about how much time was being spent getting the monthly schedules together for the hospital's nurses. At the time, the nurse manager at each of the hospital's units (between the 501-bed Sun Health Boswell Hospital and its 330-bed sister hospital, Sun Health Del E. Webb, there are about 50 units total) would post that month's schedule, and nurses within the unit could pick up additional shifts or trade shifts with other staffers.
"The schedules were all done through conversations or phone calls, where you had the forms filled out by hand, and the changes would be taken to the staffing office," says Zismann. "It was all manual."
The trouble with this was, nurse managers were spending as much as 15 hours filling the shifts for a single schedule. Nurses had to come to the hospital to see their schedule and make changes, and the nurse managers were spending lots of time calling nurses to ask them to fill open shifts. The manager could try to tap staff members from other units to fill these, but since scheduling for each unit was done separately from the others, finding a replacement with the right qualifications was rarely a quick task. Finally, when a shift could not be filled by staffers, the manager would reach out to nursing agencies for temporary workers. These agency nurses cost the hospital more per hour than staff nurses and would often require additional training to familiarize them with Sun Health's specific procedures.
Seeking a solution, Zismann and the leadership at Sun Health reached out to BidShift Inc., the San Diego, Calif.–based company that specializes in Internet-based scheduling software for hospitals, aimed at solving these types of logistical issues.
A Healthy Solution
BidShift's programs allow managers to post schedules online, where employees can log on from any browser, to request shifts or schedule changes. After a training session for all employees at the end of 2005, the system went into effect. According to Zismann, installing this employee-driven program has "paid for the system and for the maintenance many times over."
"We work with clients to identify their ROI goals," says Graham Barnes, CEO of BidShift. "We look at contract labor spending, nurses' efficiency rates, staff satisfaction, and try to identify some specific goals for the hospital. It means managing a complex fit between the variable needs of different staff with varying skill levels."
BidShift, as well as eShift, a similar product that's offered by San Francisco–based McKesson Technology Solutions, has been introduced at hundreds of hospitals in recent years.
Both programs allow hospitals to add premium dollar rates on top of a nurse's usual regular or overtime pay, and nurses can then take part in a sort of reverse eBay auction with other staff members, in which the employee who volunteers to take the lowest amount added to his or her regular pay gets the shift (hence the 'Bid' in 'BidShift'). This adds an extra element of market-based motivation to the process of taking on additional shifts that helps hospitals keep costs down while maintaining a sense of fairness for those bidding on the shifts.
However, many hospitals choose not to use this technology because of the complications it can add to payroll, and often conflicts with nurses unions' policies. Clients also cite as a deterrent the effects on workplace culture they expect monetary-based bidding would have.
"The bidding created a big buzz, but in our experience, most of our customers don't want to use bidding and most of them have no intention of using bidding," says Bob Gleason, product manager for eShift.
"The issue is corporate culture in hospitals. Managers say they don't want to pit nurses against each other in terms of bidding down and creating that type of atmosphere. They want to elevate the general atmosphere, and feel of it, to a professional level, and don't consider bidding a professional thing."
Instead of biddable dollars, flat per diem rates or, more recently, points are being used to reward employees for taking on extra shifts. BidShift's ShiftRewards program encourages nurses to do the online scheduling by awarding them with points that can then be redeemed for merchandise or travel rewards.
Powerful Points
 USC University Hospital in Los Angeles demonstrates what a range of areas ShiftRewards' point system can be applied to. Just offering to take on an extra shift grants the employee points, whether he or she ends up actually picking the shift up or not. The earlier that nurses sign up, the higher points they receive (USC's Chief Nursing Officer Ellen Whalen reports that this has helped reduce the number of last-minute schedule changes). Points also are programmed to vary by how hard the shift is to fill. A shift on Mother's Day earns more points than one on a random weekday. Points can even be awarded for good works not related to scheduling, like serving as an interpreter for a non-English-speaking patient, helping to start a difficult IV, or acting as a mentor to a new nurse—an 18-week commitment.
These points can then be redeemed for a range of rewards, from a $5 coffee card good at the espresso cart out front of the hospital, to a variety of gift cards in varying denominations (Target, Home Depot, and Macy's are some popular ones). Employees can also redeem points for merchandise from the gift shop for USC scrubs, or for a night at the Ritz-Carlton.
Noting the demand for this kind of incentive program, and the advantages it has over monetary systems of reward, eShift is going to be introducing its own points-based rewards program next month.
"I've watched this happen for a number of years, [where] the nurses want more pay, but once an increase in pay is put in, the enthusiasm for it wears off pretty quickly," says Gleason. "Rewards can be a little more varied and a little more interesting. It's not just flat money."
Staying ahead of the game, BidShift has already expanded ShiftRewards, partnering with SEI Meetings & Incentives to offer a vast, tiered online merchandise catalog from which nurses are now able to make select-ions. USC has already signed up for this service, which relieves the hospital from having to stock and help the nurses redeem the gift cards and merchandise in house. The shift to SEI will allow clients to do all of this automatically, where employees can see how many points they have in their account, choose rewards from SEI's catalog, and have their rewards mailed directly to them, saving everyone time and giving the worker a lot more choice in his or her rewards.
Though the programs are expanding their incentive options, they have already proved themselves effective in saving hospitals time and money, as the facilities can more efficiently schedule their own full-time nurses while relying less on outside staffing agencies. Spartanburg Regional Medical Center's use of eShift led to a decrease in its use of agency nurses, resulting in a savings of almost $2.5 million in its first year of using the program. Six months after putting BidShift in place, Tucson Medical Center had cut its use of temporary contract nurses by almost half.
The reason for this increased use of staffers comes from the better transparency these programs offer nurses looking for available shifts. While before, they could only see what shifts were available in their own unit, using BidShift and eShift allows employees to see all available shifts that they are qualified for (the programs are able to track nurses' competency levels to verify that they are able to work in various units or capacities). This gives nurses more options if they want to take on more shifts, and actually boosts the workers' attitudes by having more full-time staff on the floors.
Morale Booster
"[Using BidShift] is better for the morale in the unit, because the nurses are working side by side with someone they know, and they don't have to worry about this agency nurse and what they might know and not know," says Whalen.
By allowing employees to more easily work in other units, there is increased likelihood that nurses who want a change will transfer across units instead of out of the hospital completely. Whalen reports that the control nurses have over their scheduling through BidShift has aided retention. Sun Health, which introduced BidShift in early 2006, has seen turnover drop by nearly 10 percent in the past year, moving the company's hospitals from above the state average to below it.
Computer-based systems like BidShift and eShift also ensure fairness in the assignment of shifts, which helps cut down on any favoritism or last-minute trades between coworkers.
"The process of staffing is much less adversarial," says Zismann. "What it used to be was the staff would hold off until they could get the highest incentive, the managers would know who they could always call, and now, instead, it really puts it back on the staff. They can put in [a request], and they know what all the rules are, and it's applied the same throughout."
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