As a manager, one of your responsibilities is to create an employee staffing plan and scheduling roster to make sure all the work gets done. In the current climate of staffing shortages, patient consumerism and regulatory challenges, this can be more difficult than ever. Your hospital's financial wizards may pressure you to do more with less. By knowing how hard your people are working and where to put them in your schedule, you can do just that.
Productivity is Key
As it turns out your job isn't just about getting the work done. Your job is to do it efficiently, using the least amount of resources (goods and materials, technology, payroll) to produce the highest yield (laboratory results, patient interactions, customer service). Efficiency--how your system converts resources into products--is measured as productivity, defined as outputs per unit of input. It is calculated by dividing average output per period by resources (capital energy, material, labor) consumed.1
Output (e.g. number of tests performed)
If your administration is interested in total revenue divided by expense, reduced output (test volumes) is perceived as lowering productivity. Thus, either raising prices on remaining items (cost output or revenue) or reducing expenses (payroll) maintains productivity. Many factors affect your laboratory productivity. Common factors and how to address them are summarized in Table 1.2
---------------------------------------------------- = Productivity (tests/hr)
Input (e.g. number of hours worked)
Table 1: Common Productivity Factors
|Common Productivity Factors
||How to Improve
How many and what type of employees - how many total productive hours worked
Change in management (e.g. flexible schedules)
Your service menu - what tests and services are offered by your laboratory
|Investment in new technology to offer new tests at lower cost
Expand phlebotomy hours
||How the work is being done (best practice)
||Research and development into better ways of working
||How much work can be done (instrument throughput)
||New technology that can work more efficiently
||Market share, competition, negotiated wages, etc.
||Adjust services to meet demand
||Maintenance, control, organization, education, etc.
||Quality improvement programs to reduce waste and assess performance
But as one freelance writer for a small business site puts it, "Employees are scheduled to manage the workload of a company."3 Since labor is a manageable productivity factor of significant expense, changing a schedule has short-term effects. Your business needs should determine when and for how long employees are scheduled and how they are replaced when unavailable. Forecasting workload helps anticipate those needs.
Your administration, while aware of total productivity, won't understand much detail. That's why they hired you! Using your information system and a spreadsheet such as Microsoft Excel, you can analyze your output (tests per hour) to adjust input (how many techs are working) throughout the day.
Know Your Productivity
Additional terms to consider are listed in Table 2.4,5 This article considers hours worked instead of payroll cost. However, labor expense can be significant if phlebotomists and/or assistants perform waived or moderately complex testing, which can be analyzed separately using the same process.
Table 2: Common Productivity Terms
|Common Productivity Terms
Units produced divided by labor hours or labor expense, including overtime
|Test codes billed
Total hours worked
Percent of units produced as ordered
|Number of orders
|Line Item Fill Rate
||Percent of line items produced as ordered
||Number of orders
|On Time %
||Percent of orders completed on or before a target
||Number of orders
Number within target
|Labor Efficiency Variance
||Measures productivity of labor time
||Actual worked x Rate
Hours allowed x Rate
Your accounting department can supply data for a sufficient period (e.g., six months) to give a statistically accurate average. Depending on your current staffing and mix of skills, this broad average may be adequate; assuming this information is in your information system, your IT department can help. Issues to consider:
- Generalists average productivity compared to specialized work stations. Chemistry stations with automated instrumentation enable higher throughput than microbiology, for example; generalists likely fall somewhere in between.
- Support staff, such as phlebotomists and clerical staff, who augment productivity should be considered if not a constant. For example, if venipuncture charges are included, you may choose to include phlebotomists, or map venipunctures against phlebotomists only.
- Administration statistics that include associated or bundled charges may not accurately reflect hands-on work, and analytical processes like autoverification skew productivity. A tally of reports completed (initialed) may be more accurate.
- Weekdays, weekends, and off shifts with different work patterns have different productivity. You may consider separating this data if your staffing and workload are significantly different to have more accurate data.
- Overtime, or labor efficiency variance, may exist because of a flaw in your current staffing plan. Unnecessary hours and expense lowers your productivity.
Assume your laboratory is a small one in a critical access hospital. All staff members are generalists who rotate all work stations. You have calculated your productivity to be four tests/hour.
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