Reining in Labor Costs with Predictive Analytics

March 2, 2016 MaryPat Sullivan, RN, MSN, CNS

Chief Nursing Officer & Chief Experience Officer

Overlook Medical Center, Atlantic Health System

Conflict of Interest

MaryPat Sullivan, RN, MSN, CNS

Has no real or apparent conflicts of interest to report.

Agenda

• Who We Are

• Creating a Data-Driven Culture

• Predictive Analytics for Capacity Planning

• Outcomes-Based Scorecard

• Achievements to Date

Learning Objectives

• Evaluate the impact of data-driven decision-making on daily operations

• Demonstrate the value of reliably accurate demand forecasts for strategic, budgetary and near-term planning

• Assess how data transparency can help your organization achieve sustainable cost reductions and other desired outcomes

• Illustrate how demand forecasts can be used to actively engage the medical staff

http://www.himss.org/ValueSuite

Benefits Realization

• Patient and Staff Satisfaction

– Anticipated arrivals, reduced wait times

– Predictable schedules

• Treatment/Clinical

– Optimal resource allocation

– Engaged physician leadership

– Decreased care silos

• Electronic Secure Data

– Proactive, data-driven behavior

– Data leveraged across planning horizons

• Savings

– Right-sized capacity

– Reduced labor costs

– Increased efficiency & productivity

Size and Scale • 4 hospital system with $1.8B in

revenue

• Efficient contracts with largest areas

health insurance plans

• Alignment strategies with key

physician groups

• Non-union

Quality and Specialized Services • Gagnon Cardiovascular Institute

• Carol G. Simon Cancer Centers

• Goryeb Children’s Hospital

• Atlantic Neuroscience Institute

• UHC data base participant

Market Leader • Leading market share position, more

than double next nearest competitor

• Excellent socio-demographic

characteristics

• Currently overseeing 2 ACO‘s

At a Glance • 12,114 employees

• 3,168 physicians

• 280 medical residents

• 1,339 licensed beds

• 72,892 admissions

• 7,191 births

• 19,033 inpatient surgeries

• 28,658 same day surgeries

• 205,898 emergency visits

• 697,416 outpatient visits,833

hospice days

6

Atlantic Health System

Atlantic Health System

Vision

Empowering our communities to be the

healthiest in the nation

Mission

• Deliver high quality, safe, affordable

patient care within a healing culture

• Educate, in an exemplary manner,

present and future health care

professionals

• Innovate through leadership

Shared Values

Professionalism, Respect, Involvement,

Dignity, Excellence

• Reduce Costs

• Spend less capital on hospital bricks and mortar

• Tightly manage labor costs

• Increase Revenue

• Increase ambulatory presence

• Reduce leakage

8

Goal: Cut $70M in Costs Over 3 Years

Overlook Medical Center

• 24,478 admissions

• 5,917 inpatient surgeries

• 9,279 same day surgeries

• 96,612 ED visits

• Fortune 100 Best Place to Work

9

4

U.S. News and World Report

• Best Regional Hospital for Neurology, Neurosurgery, Gastroenterology, GI

Surgery, Geriatrics, Gynecology, Nephrology, Pulmonology and Urology

• Neuroscience Institute - Hub for New Jersey Stroke network - treat 40% of

state stroke patients

Overlook Strategic Goals

Desired End State

Desired Competencies

Proactive/real-time decision-making

Improved patient placement

Ability to address and monitor

• Service line profitability

• Labor analytics

• Improve patient

throughput, initially ED

• Match nurse staffing to

patient demand

Primary Goals

Organizational Transparency

Enabling Technology

• Self-serve analytics

The Need for Timely, Data-Driven Decisions

Strategic

Budgetary

Scheduling

Operational

3-5 years 1-2 years 1-4 months >30 days - Today

What do we need to

look like under value-

based purchasing?

Where can we find more

savings without drastic

cuts?

How do we staff for

unknown peaks and

valleys?

What do we need to do

to get these 7 patients

out by noon?

What is the next best

use for this capacity?

…and without hurting

care quality, patient

satisfaction or staff

satisfaction?

What is the down-

stream impact of this

OR schedule?

What can we do today

to prepare for

tomorrow?

How do we optimally deploy our capital and people resources?

Capacity Planning in Healthcare

Process by which hospitals can effectively determine the resources (beds and staff) required to meet the forecast patient demand over a given time period.

Review & Analyze

Historical Trends

Forecast Patient

Demand

Schedule Resources

To Meet Demand

Monitor & Measure

Against Plan

Adjust& Refine Plans

Aligning Resources with Predicted Patient Demand

• Identify patterns and trends

• History based on last 4 years patient demand, last 2 years staffing

• Apply assumptions based on seasonal changes

• Fine-tune timing of demand what initiatives did we put in place

Demand Forecast

Historical Data

Planning Groups

Statistical Algorithms

Staffing

Productivity Measures / LOS

Manual Adjustments

Executive Hospital Overview

14

Proactive Planning & Performance Tracking

1

5

Levers Objective InitiativeMeasures (KPI's) -

Objective Related Baseline 2014 YTD-SEPT- 2015 3 QRT(JAS) TargetPoint Person for

InitiativeSource Report

Increase Inpatient

Discharges by 12 pm 14% 0% 0% 14%

Directors, Nurse

Managers,

Daily Dashboard,

Projection Report,

Medicine/ Surgery 4.0 4.0 3.8 4.0

Neuro 4.8 4.2 4.0 4.8

Critical Care 5.5 5.2 4.8 5.5

Accelerate inpatient discharge time to

facilitate quicker admission from the ED

and reduce late afternoon "hold" bottleneck

Transfer admitted ED

patients to Inpatient bed

within 1 hour of Disposition

1,882 1,092 329 1788

Nursing,

Environmental

Services, Patient

Access

Average Daily

Occupancy, Hourly

Pattern Reports

Utilize McKesson Capacity Planner &

McKesson Performance Visibility

information to support initiatives to reduce

ED Hold time

ED Hold

Overlook & Union61,462 39,093 1,747 58,389 Target for 2015? Terri reports

Nurse managers proactively manage

staffing adjustments 72 hours out - evaluate

staffing schedules to support peak workload

demand

Utilization of Staffing

projections8 Hrs 8 Hrs 36 Hrs 72 Hrs

Staff required vs.

actual summary

report; actual versus

budget report

Initiative Planning Groups Budget 2014 YTD-SEPT- 2015 3 QRT(JAS) Budget Comments HPPD Chart

Medicine 7.24 7.40 7.48 7.24

Surgery 6.90 6.85 6.95 6.90

Neuro 7.55 7.45 7.47 7.55

Critical Care 16.86 17.55 18.12 16.86

Summit ED 2.25 2.13 2.06 2.25

Union ED 1.89 1.69 1.62 1.89

InitiativeDecrease in Overtime by

Planning GroupsUTIL 2014 YTD-SEPT- 2015 3 QRT(JAS) Target 2% Less Comments

Medicine $469,226.03 408,381.19$ 351,366.68$ 459,841.51$

Surgery $243,399.53 215,400.07$ 193,399.02$ 238,531.54$

Neuro $175,241.19 151,692.03$ 140,006.81$ 171,736.37$

Critical Care $337,470.87 244,495.33$ 229,539.55$ 330,721.45$

Summit ED $579,553.33 611,613.20$ 551,610.37$ 567,962.26$

Union ED $292,183.24 379,426.66$ 333,536.85$ 286,339.58$

InitiativeDecrease Agency Usage UTIL 2014 YTD-SEPT- 2015 3 QRT(JAS) Target 1% Less

Comments

RN FTE's $2,506,458.71 1,179,061.28$ 333,568.26$ 2,481,394.12$

Sitters FTE's $2,651,626.37 1,764,756.03$ 450,269.49$ 2,625,110.11$

* Baseline numbers # what was utilizated 2013 NOTE: Sitter Dollars include OVL staff (PCT)

Capacity Planner - Overlook Medical CenterProject Scorecard Matrix (QRT 3# JULY, AUGUST, SEPTEMBER)

MA

RG

IN G

RO

WT

H Q

UA

LIT

Y

Improve

patient

throughput

Match

Staffing to

Demand

Implement robust daily planning &

management process including review and

enhancement of daily meeting structure and

outcomes (Neuro, M/S, CC)

Plus/ Minus 0.3 care hours (ex. Medicine=

x HPPD, target x - HPPD) Productivity

Improvement by Planning Group

Decrease Overtime by 2% at each

Planning Group

Hours Per Patient

Day Chart

Client report on OT

trends Productivity

Report per PP

Forecasting center,

Resource Planning

Centre weekly

agency report PP

Utilization of Planner in ongoing projects to

Agency & Sitters(NEURO, CC, M/S, ED)

Utilization of Planner in ongoing projects to

decrease LOS (Neuro, CC, M/S)

Case Management,

Nursing

Care hours listed is the

avg for the planning

groups Allowed to be

.30 over budget

Use Baseline 2015

Use Baseline 2015

Historic ALOS

Trend Chart

STEPS: Satisfaction

• Staff • Predictable

schedules managed at unit level

• Patients • Arrival and

needs are anticipated

• Patients • Reduced ED

wait times • Hold hours

halved from

~4,800 hours to

~ 2,800 hours

per month

“If the staffing is not balanced appropriately, then my staff get pulled

to other units, which is always a dissatisfier. Now that we know what

type of admissions are arriving and when, we can assign the right

staff and prepare for them.”

Anticipating Hourly Admissions and Discharges

Why are we behind

on projected

discharges? Where

are the delays? What

can we do?

STEPS: Treatment/Clinical

• Optimal resource allocation

• Standardized staffing model

• Balanced workloads

• Engaged physician leadership

• Decreased care silos

• Cooperation at planning group vs. unit level

20

Cooperation at Planning Group Level

Physician Engagement

• Monthly Executive Patient

Throughput Team

– CMO

– Nurse managers

– Physician over Case

Management

– Directors of Neuroscience,

Finance, Operations, ED,

Special Projects Capacity Executive Team

STEPS: Electronic Secure Data

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• Proactive, data-driven behavior

• Reliance on single source of truth

• Leveraging data across planning horizons

• “It’s like scarily predictable.”

• “I love that all the information

can be gathered in one place.”

• “The biggest thing is how

accurate it is and how much you

can look at things ahead of time

and then make decisions based

on that.”

• “It creates transparency … that

is the first step in improving

processes.”

23

Projection Accuracy

Leveraging Data Across Planning Horizons

24

STEPS: Savings

• Labor costs • $700,000 in

reduced OT use

• Productivity • .2 day reduction in

NHPPD

• Efficiency • .2 day reduction in

LOS (4.4 to 4.2) • Earlier discharges

• Right-sizing capacity • Flexing surgical and

critical care units

based on predicted

demand @~$3,400

savings/day for

$150K+ savings

to date

http://www.himss.org/ValueSuite

Benefits Recap

• Patient and Staff Satisfaction

– Anticipated arrivals, reduced wait times

– Predictable schedules

• Treatment/Clinical

– Optimal resource allocation

– Engaged physician leadership

– Decreased care silos

• Electronic Secure Data

– Proactive, data-driven behavior

– Data leveraged across planning horizons

• Savings

– Right-sized capacity

– Reduced labor costs

– Increased efficiency & productivity

Questions

MaryPat Sullivan, RN, MSN, CNS

Chief Nursing Officer & Chief Experience Officer

Overlook Medical Center Atlantic Health System

Marypatricia.sullivan@atlantichealth.org