Practice Matters

Staffing though Web-based open-shift bidding

For most healthcare facilities, meeting the staffing requirements necessary to deliver high-quality patient care is an ongoing struggle. All nurse-managers have grappled with the challenge of filling vacant shifts. Traditional approaches—unit sign-up sheets, overtime, float pools, incentives, and use of agency personnel—are inefficient and can be extremely costly. And for individual nurses, having to fill vacant shifts at the last minute can cause disruption that profoundly affects work-life balance.

Recently, though, many progressive facilities have been implementing flexible workforce management programs—including shift-bidding technology—to centralize visibility and communication regarding open shifts, motivate the existing resource pool to provide the staffing coverage needed, and improve nurse satisfaction and retention.

Offering online options
Tri-City Medical Center, serving the north coast of San Diego County, continually focuses on finding new ways to improve patient care. We recognize that our nurses are invaluable to the quality and continuity of that care. Faced with an increasing need to rely on costly temporary agency workers to fill shift gaps—and with use of overtime and per diem spending on the rise—we knew we needed a better approach to minimize staff vacancies.

Our nursing leadership wanted our workforce (which includes both union and nonunion employees) to be part of the solution, with the ability to choose when and where to work extra shifts. We believed a flexible workforce management solution using online open-shift technology would offer the greatest potential to advance our enterprise-wide staffing effectiveness and help ensure that every patient receives superior care from the best possible resources.

Focusing on system requirements
As our team began evaluating the available open-shift technology solutions, we focused on the following key requirements:

  • The system must be Web-based to allow 24/7 access by all employees.
  • It must be easy to use.
  • It must have a quick implementation phase.

We evaluated several time- and attendance-based systems that incorporated shift-
bidding features, as well as niche applications that focused exclusively on shift bidding. Because we didn’t expect our staff to be computer experts and wanted the program to be accepted at all staff levels, we sought an application with a flexible, intuitive, and straightforward user interface. We also wanted it to support our existing scheduling policies and pay practices. Ultimately, we chose BidShift, a program that offers creative incentives—including a point-based rewards program—for motivating staff to fill open shifts.


Building in fairness, consistency, and incentives
The concept is straightforward: Nurses can access our system from any Internet-enabled computer. Nurse-managers post their open-shift needs, and nurses looking to work extra shifts outside their departmental commitment (for instance, per diem, part-time, or full-time) log on to the website, view the openings that match their skills, and request the shifts they want to work. All nurses interested in working extra shifts can view a particular week or month at a time, ensuring fairness and consistency. The program is based on individual employee profiles, so the system screens and shows only those shifts that the particular employee is qualified to work. The real magic of the system is that it gives managers the flexibility to target and incentivize employees to work shifts where the need is greatest.

Planning for change
During initial planning, we decided to implement the program across all nursing units simultaneously to maximize the chance for success and build on our goals of showing fairness across units. The system gave us a chance to focus collectively on staffing effectiveness, and we wanted all managers to agree on the approach.

Our new shift-bidding software gave us the option of posting shift openings with set rates (such as fixed per hour, with bonuses), using point reward programs, or using variable reverse-auction incentive rates. Our managers would decide what kind of pay to offer based on staff vacancies. Ultimately, we decided to post all open shifts at regular-time pay or (with director approval) time-and-a-half or double-time pay for hard-to-fill shifts. All qualified employees had complete visibility into open shifts throughout the hospital, ensuring that extra shifts and incentive pay were made available equally among staff.

A rewarding result
Web-based shift bidding has generated a return on investment through better use of our existing workforce. It has also reduced our use of temporary agency staff, increased productivity, and improved staff recruitment and retention initiatives. Managers are posting a wide variety of shift lengths and times that meet departmental needs while providing options for staff to work 6-hour shifts, 4-hour shifts, or varying shift times.

What’s more, the technology has enhanced our nurses’ work lives by giving them flexibility and choice in their schedules. Within a few weeks after implementation, employees were using the system to explore working in units other than their primary assignments. Having the choice to work across a variety of nursing units has provided new opportunities and increased job satisfaction.

To date, 523 (58%) of the roughly 900 eligible employees have signed up to use the program. Within the first 3 months of use, the current workforce filled over 11,000 direct-care hours. We’ve decreased time-and-a half use by nearly 29%, double-time use by nearly 7%, and agency use by approximately 5%. (Fiscally, agency use has declined about 15%). Nurse-managers have gained approximately 1 hour daily because they’re spending less time on scheduling, which has freed them to refocus their time on advancing patient-related and other organizational initiatives. Also, the hospital’s overall vacancy rates have started to drop.

Bottom line: Open-shift bidding has helped our facility improve efficient workforce allocation, providing flexible work options across the hospital and reducing labor costs. By applying structure through technology, we expect to see continuing benefits from the power of effective staff­ing to deliver high-quality, cost-effective patient care.

Selected references
McKnight B, McDaniel S, Ehmann V. Try point incentives for employee reward and recognition, Nurs Manage. 2006;37(12):42-45.

Suellyn Ellerbe, MN, RN, CNAA, is Chief Operating Officer/Chief Nurse Executive at Tri-City Medical Center in Oceanside, Calif.

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