Personnel Schedules for Advanced Deployment Systems

1. Personnel Schedules for Advanced Deployment Systems Jonathan D. Washko, BS-EMSA Director of Deployment – REMSA President – Washko & Associates, LLC Partner – Stout Solutions & FirstWatch

2. “Developing schedule patterns that mirror demand is an art as much as a science. Equally challenging is creating a real-world work schedule that takes into account what employees really value”

3. Session Overview • Homeostasis & The EMS Success Triad • Scheduling Components & Steps for Advanced Deployment Systems • Building a Triad Balanced Schedule • Pitfalls & Tips / Tricks • Summary / Review / Questions

4. Homeostasis & The EMS Success Triad • The Constant Balancing of 3 Key Elements • Patient Care • Employee Well-Being • Financial Success (however you define it) Success Triad Patient Care Economic Stability Employee Wellbeing

5. Homeostasis & The EMS Success Triad • Patient Care • Response Times • Clinical Performance • Customer Service Success Triad Patient Care

6. Homeostasis & The EMS Success Triad • Employee Well-Being • Retention • Health / Safety / Welfare • Satisfaction • Schedules • Work Environments • Compensation • Recruitment • Family Success Triad Patient Care Employee Wellbeing

7. Homeostasis & The EMS Success Triad • Financial Success • A/R Billing Practices • EMS Delivery Model & System Design • Operational Efficiency & Effectiveness • Employee Compensation • Safety & Risk Management • Systems Engineering • Profitability • Subsidy Needs Success Triad Patient Care Economic Stability Employee Wellbeing

8. Scheduling Components & Steps for Advanced Deployment Systems • Step 1: Have Good, Clean Data – Crap In / Crap Out Theory • Step 2: Perform a Temporal Demand Analysis • The Science • The Art (someday may be science) • Step 3: The Schedule Build…A Matter of Supply, Demand & Playing Tetris • Playing it Old School • Zoll’s Resource Planner (formerly ISERA Deployment Planner) • This isn’t a plug….it’s the only software of its kind in existence today • Step 4: The Shift Bid • Step 5: Building the Bridge • Step 6: Schedule / Production Fulfillment • Step 7 (Optional): Purchase Order Unit Hours • Step 8: Repeat as Necessary

9. Scheduling Components & Steps for Advanced Deployment Systems • Step 1: Have Good, Clean Data – Crap In / Crap Out Theory • Clean and accurate data is important • Bad data or incorrectly filtered data can KILL (how) • Decide what is “system” coverage and what is “out of system” coverage then filter your data to this definition • Look for anomalies that can skew your results • e.g. – MCIs, HazMats, Large Multi Unit Responses • Decide what type of responses are in and what are out

10. Scheduling Components & Steps for Advanced Deployment Systems • Step 2: Perform a Temporal Demand Analysis • The Science • Mathematical models that drive your demand prediction curves • Stoutian Theory Based • Advanced Statistics Based • Task Time Adjustments • Discussed first day here at the conference • The Art (someday may be science) • A Unit Hour Buffer based on numerous variables • Performance requirement, system efficiency, service area size & makeup, seasonality, system effectiveness, etc. • This is typically a S.W.A.G.

11. Scheduling Components & Steps for Advanced Deployment Systems • Step 3: The Schedule Build…A Matter of Supply, Demand & Playing Tetris • Playing it Old School • Graphs, colored pencils & time • Microsoft Excel Templates • Zoll’s Resource Planner (formerly ISERA Deployment Planner) • This isn’t a plug….it’s the only software of its kind in existence today • Allows you to easily build a complex schedule that meets your predetermined demand curves and patterns • Allows for different variables to adjust scheduling based on Demand, Costs, FTEs, Resource Availability, Lost Unit Hours and others • This is NOT schedule fulfillment software…it’s schedule building software…there’s a HUGE difference! • If we have time, I will demo it at the end of the session • Start of Shift and End of Shift Lost Unit Hours

12. Scheduling Components & Steps for Advanced Deployment Systems • Step 4: The Shift Bid • The Shift Bid is used to migrate the schedule into the workforce • Can have one of the largest impacts on employee well-being of all HPEMS concepts • MUST be balanced, fair & accurate • Typically seniority based • Multiple ways to do this • Individual bid on paper • Buddy bid using the college signup approach • Hybrid models (combination of the two) • REMSA’s going on-line successes • HEADCOUNT / HEADCOUNT / HEADCOUNT!!!!!!!!!!! • Only bid out shifts you have headcount to fill, otherwise your weekend and night shifts will look like Swiss cheese

13. Scheduling Components & Steps for Advanced Deployment Systems • Step 5: Building the Bridge • A transitional “bridge” schedule from an old schedule to the new schedule MUST be built • This is MANDATORY • This allows any gaps between the two schedules to be “repaired” • It’s like building a bridge…if one side of a bridge is being built while the other side is also being built…when then they meet in the middle they must match PERFECTLY • Failure to do this will be disastrous! • Did I mention that this is MANDATORY?

14. Scheduling Components & Steps for Advanced Deployment Systems • Step 6: Schedule / Production Fulfillment • This is the true “Production Factory” of your HPEMS system • Most medium to large size HPEMS systems have scheduling departments • Many new software programs are available that help make this process highly efficient and effective • Zoll’s Crew Scheduler, eCore’s Net Scheduler Pro, ADP’s Scheduling Suite and others • Most important step in production fulfillment is understanding the SIGNIFICANT impacts of unfilled or overfilled production schedules on the Success Triad • Unfilled = adverse patient & employee effects • Overfilled = adverse financial effects • Properly filled = balance & harmony

15. Scheduling Components & Steps for Advanced Deployment Systems • Step 7 (Optional): Purchase Order Unit Hours • P.O.U.H. are used in larger HPEMS systems to adjust their temporal unit hour supply up or down based on seasonal volumetric variances, compliance variances or other system problems • Essentially, they add or remove shifts (unit hours) on a weekly or daily basis based on predicted volume changes, response time performance issues, hospital delay problems, etc. • Must have a solid PRN / Part Time employee pool and/or flexible FT employee pool in order to successfully achieve this level of dynamic scheduling • This is a solid approach for aggressive deployment models to meet their financial needs while also balancing the needs of the rest of the Triad

16. Scheduling Components & Steps for Advanced Deployment Systems • Step 8: Repeat as Necessary • Most HPEMS systems perform a new scheduling cycle (all these steps) every 6 months or so • This allows the HPEMS system to adjust their unit hour supply with any changes in demand curves including seasonality and growth • Based on the culture of your organization, this process may be sacred or loathed, but it is a necessary evil of Production Model EMS systems • Many things can be done to help employees manage their way through this process with positive outcomes and happy personnel…

17. Building a Triad Balanced Schedule • The Constant Balancing of 3 Key Elements • Patient Care • Employee Well-Being • Financial Success (however you define it) Success Triad Patient Care Economic Stability Employee Wellbeing

18. Building a Triad Balanced Schedule • A Look at the Triad & Schedules… • Patient Care • Demand patterns must be met • May cause some less desirable shifts to be required • Financial Success / Stability • Revenue, costs & profit (or your budget) typically will dictate unit hour availability • UHU, your ability to perform in an efficient and effective manner and your deployment plan aggressiveness also dictate the number of unit hours needed to be successfully balanced • Employee Well-being • Difficult to balance here with other competing interests but there are ways…

19. Building a Triad Balanced Schedule • Employee Well-being • Difficult to balance here with other competing interests but there are ways… • The Shift Bid Committee • Group of employees of various stake holder groups that come together and drive the entire scheduling process from start to implementation • They typically survey the workforce to see what kind of shifts, work weeks, patterns, etc. their peers want • They do it all (with help from management content experts where needed) • They help with the demand analysis, they build the schedule and they do the actual shift bid • No Good ‘Ole Boy Stuff • The bid is the way the bid is, don’t change it! • The empowerment of quality is based on the quality of empowerment

20. Building a Triad Balanced Schedule • Employee Well-being • Difficult to balance here with other competing interests but there are ways… • Go on-line! • Technology has allowed this process to become a live and dynamic process which improves employee satisfaction • At REMSA, we use a single bid process where employees submit a paper bid (as a backup), however, on bid day the process is performed live on the internet • Each employee is assigned a bid time based on seniority • Employees then see the bid as it unfolds live and we allow changes from their submitted paper bid when their turn arrives • When the employee picks a shift it is theirs and they know immediately • They also immediately know who their partner will be

21. Pitfalls, Tips & Tricks • Pitfalls • Bad data and/or bad demand analysis = bad schedule • Bidding out more shifts then you have headcount to fill • Not building a bridge / transitional schedule • Not taking into account ALL employee stakeholder group needs • Tips & Tricks • Do a supply to demand graph of the new schedule to ensure it matches • With today’s software tools, excess UH waste can be minimized to +/- 3% or so • Use a Shift Bid Committee and properly empower them • Consider creating multiple schedules and having employees pick the one they like best

22. Summary / Review / Questions • Contact Information for Jonathan Washko • REMSA • Phone: 775-858-5700 x140 • Email: jwashko@remsa-cf.com • Website: www.remsa-cf.com • Washko & Associates, LLC. • Phone: 804-347-3337 / 775-626-4459 • Email: jw@washkoassoc.com • Website: www.washkoassoc.com