Lab Analysis

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Here is an example of what we do to develop labor standards that managers can meet, all the time. It\'s not imposed--the managers agree. This creates strong accountability! Write to me at Paul.Fogel@ExecutiveInfoSystems.com with any questions or comments.

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Lab Analysis

  1. 1. General Hospital Chicago, Illinois Laboratory Executive Information Systems, Inc., Lake Oswego, Oregon November 3, 2009
  2. 2. General Hospital Chicago, Illinois Table of Contents Introduction 3 Project Scope 3 Productive Hours 4 Lab Volumes—All Areas 4 Changes to Future Operations 6 A Break with Conventional Budgeting 6 Laboratory Division 7 Regional Lab Volumes 7 Lab Operations— Medical Offices 12 Medical Offices Combined 13 Chicago 08-003-2324 17 Holyoke 08-004-2324 19 Division 08-006-2324 21 East Interstate 08-010-2324 23 Rockwood 08-014-2324 25 Central Interstate 08-016-2324 27 Cascade Park 08-019-2324 28 South Park 08-023-2324 30 Geneva 08-027-2324 32 Sunset 08-029-2324 33 Mt. Adams 08-034-2324 35 South Central 08-037-2324 36 Jefferson 08-039-2324 38 2009 Labor Standards 1
  3. 3. General Hospital Chicago, Illinois North Washington 08-041-2324 39 Skyline 08-043-2324 41 Adams 08-058-2324 43 Monroe 08-067-2324 45 Mother Joseph 08-073-2324 46 Orchards 08-082-2324 47 Interstate South 08-091-2324 49 Medical Office Administration and Support 08-005-6268 51 Mountain Park Lab and Blood Bank 01-031-2324 53 Cytogenetics 08-005-1952 57 Molecular 08-005-2325 59 Culture Bay/Shared Prep 08-005-2327 60 Cytology 08-005-2337 62 Microbiology 08-005-2350 64 Home Phlebotomy 08-005-2351 66 SAM/Toxicology 08-005-2352 68 Core Lab 08-005-2361 70 Histology 08-005-2362 73 Hematology (Wet/Dry) 08-005-2373 75 Regional Administration 08-005-6264 77 Client Services 08-005-6266 78 Clinical Lab Systems 08-005-6267 79 2009 Labor Standards 2
  4. 4. General Hospital Chicago, Illinois Introduction This  document  serves  as  a  record  of  the  development  of  the  labor  standards  that  form  the  foundation  of  the  productivity   management  system  scheduled  for  implementation  in  2009.   In  the  tables  that  follow,  productive  labor  excludes  vacation,  sick,  and  holiday;  and  includes  any  overtime  and  temporary.   Each  of  the  cost  centers  functions  as  a  discreet  unit.  When  staff  work  in  an  area  other  than  their  home  cost  center,  the   hours  and  wages  are  properly  recorded  in  the  departments  in  which  they  work.   Project Scope What  level  of  productivity  is  General  Hospital’s  current  operating  systems  capable  of  producing?  Given  the  same   management  structure  and  operating  framework,  given  the  same  constraints,  rules,  labor  agreements,  and  operating   procedures  as  exists  today,  what  is  the  best  performance  that  can  realistically  be  achieved  and  maintained?  The  most   grounded  and  provable  answer  to  this  question  comes  from  examining  historical  best  demonstrated  performance.  By   mining  each  unit’s  actual  operating  history,  labor  standards  can  be  derived  that  managers  will  consistently  meet.  Labor   standards  are  not  mere  targets,  stretch  goals,  or  best-­‐case  scenarios,  but  designed  to  produce  dependable,  reliable,  and   predictable  results  over  long  stretches  of  time.   The  labor  standards  outlined  and  agreed  upon  in  this  document  describe  what  can  realistically  be  achieved  now.  They  do   not  alter  how  work  is  currently  performed,  nor  do  they  change  General  Hospital’s  current  level  of  service,  clinical  quality,  or   lengths  of  stay.  These  labor  standards  work  within  the  current  structure,  and  do  not  describe  what  productivity  might  be  if   operations  were  recast  differently.  Reaching  for  a  new  level  of  efficiency,  one  that  has  never  been  achieved  at  General   Hospital,  would  necessarily  entail  a  set  of  management  interventions  that  change  how  daily  work  is  performed,  or   otherwise  alter  staff-­‐patient  ratios  without  harming  clinical  or  service  quality.   3
  5. 5. General Hospital Chicago, Illinois Productive Hours In  the  department  analyses  that  follow,  hours  and  wages  are  productive,  not  paid.  They  do  not  include  nonproductive   hours  and  wages  (vacation,  sick,  non-­‐worked  holiday,  etc.).  Productive  hours  and  wages  do  include  travelers,  agency,   overtime,  double  time,  and  temporary,  along  with  straight  time.  Wages  exclude  fringe  benefits,  which  would  add  53%  to   2010’s  salaries  at  this  writing. Lab Volumes—All Areas After  reviewing  the  description  and  quantities  of  tests  performed,  volumes  were  divided  (source:  Ultra)  into  categories,   and  then  weighted  for  each  category.  Scores  were  assigned  based  on  hands-­‐on  “touch  time,”  not  wait  time  (technical  staff   can  perform  other  tests  or  move  on  to  other  activities  during  wait  times).  As  the  unit  of  measure  is  the  test  or  activity   performed,  average  batch  sizes  and  times  were  often  used  to  derive  individual  test  times  and  their  resulting  scores.   Ultra  captures  the  data  needed  going  forward,  but  some  of  the  fields  had  to  be  altered  for  individual  tests  to  reflect  the   degree  of  automation,  often  incorrectly  recorded  as  “manual.”  Lab  Clinical  Services  will  make  the  changes  so  that  Ultra  can   serve  as  a  reliable  data  source.   Automation  has  been  the  major  driver  of  productivity  improvement  in  the  lab  industry  in  the  last  few  years,  as  they  require   only  a  quarter  to  a  half  of  the  labor  of  a  comparable  manual  test.  We  want  to  preserve  the  distinction  between  manual  and   automated  tests,  not  only  for  accurate  productivity  capture,  but  to  preserve  an  incentive  to  reduce  costs  through  further   automation  in  the  future,  and  to  make  it  relatively  easy  to  calculate  the  return  on  investment  from  technological   improvements.   Laboratory  information  systems  are  composed  of  three  primary  subsystems:  GE-­‐ULTRA  for  general  lab,  CoPath+  for   pathology  and  cytology,  and  Hemocare  LifeLine  for  transfusion  medicine.  Upon  test  completion,  information  from  these   systems  is  sent  primarily  to  three  destinations—HealthConnect  electronic  medical  record,  the  data  warehouse,  and  the   Resolute  Billing  charge  capture  system.  The  aging  GE-­‐ULTRA  Laboratory  Information  System  will  be  replaced  in  the  next   few  years  with  Cerner,  which  will  require  reworking  of  the  process  used  to  generate  lab  workload  volumes  for  productivity   monitoring  purposes.   Weighted  values  in  the  following  table  were  determined  from  time  studies  General  Hospital  has  done  in  the  past,  and  by   reference  to  the  difference  in  labor  between  automated  and  manual  testing  from  College  of  American  Pathologist  (CAP)   values.   2009 Labor Standards 4
  6. 6. General Hospital Chicago, Illinois Test/Activity Weight Rationale Automated  Test 1.0 This  is  the  basic  unit  of  measure.  Most  tests  are  automated,  and   regardless  of  the  type  of  test,  follow  the  same  basic  process.  These   equate  to  about  2-­‐3  minutes  each. Demographics 1.0 Generally  takes  the  same  amount  of  time  to  prepare  as  an  automated   test.  Every  venipuncture  requires  a  demographic  profile  collection,  but   not  every  demographic  comes  with  a  venipuncture,  so  demographics   counted  separately.  These  equate  to  about  2-­‐3  minutes  each. Manual  1  (partially  automated) 2.0 Some  tests  are  only  partially  automated.  This  category  captures  those   tests  that  have  only  some  aspects  of  the  process  automated.  These  tests   equate  to  4-­‐6  minutes  each. Manual  2  (completely  manual) 4.0 A  routine  manual  test  takes  four  times  as  long  as  an  automated  test.  This   category  equates  to  8-­‐12  minutes  each. Manual  3  (time-­‐consuming) 5.0 This  category  of  tests  equate  to  10-­‐15  minutes  each. Manual  4  (highly  time-­‐consuming) 10.0 This  category  of  tests  take  20-­‐30  minutes  each. Manual  5  (Cytogenetics) 24.0 Applies  to  Cytogenetics  only.   Manual  6  (Cytogenetics) 48.0 Applies  to  Cytogenetics  only.   Venipuncture  1 4.0 Draws  take  four  times  as  long  as  demographic  collections.  Every   venipuncture  requires  a  demographic  profile,  counted  separately. Venipuncture  2 8.0 Baby  venipunctures,  capillaries,  fingersticks,  and  venous  blood  gasses  are   two  times  more  labor  intensive  than  routine  venipunctures. Venipuncture  3 20.0 Equates  to  40-­‐60  minutes  to  cover  travel  time  for  home  phlebotomy. Micro  1 2.0 Applies  to  microbiology  only. Micro  2 4.0 Applies  to  microbiology  only. Micro  3 8.0 Applies  to  microbiology  only. Micro  4 10.0 Applies  to  microbiology  only. Micro  5 12.0 Applies  to  microbiology  only. Micro  6 14.0 Applies  to  microbiology  only. Cytogenetics  1 120.0 Applies  to  Cytogenetics  only;  a  highly  labor  intensive  category.   Cytogenetics  2 144.0 Applies  to  Cytogenetics  only;  the  second  highest  labor  intensity  category.   Cytogenetics  3 192.0 Applies  to  Cytogenetics  only;  the  highest  labor  intensity  category.   2009 Labor Standards 5
  7. 7. General Hospital Chicago, Illinois Test/Activity Weight Rationale POC  prefix  (point  of  care  testing) 0.0 Point  of  Care  (POC)  testing  is  performed  on  the  floors  by  the  nursing   units.  Multiplying  by  zero  eliminates  the  count  from  lab  totals  without   altering  data  collection  for  statistics.   No  Workload  Unit 0.0 These  are  counts  of  various  activities  for  statistics,  not  tests.  Multiplying   by  zero  eliminates  the  count  from  lab  totals  without  altering  data   collection.   Changes to Future Operations One  of  the  ground  rules  of  this  project  is  that  any  change  to  future  operations  would  entail  a  change  to  standard.  Having  a   foundation  of  standards  will  allow  us  to  add  or  subtract  as  operational  changes  occur,  not  just  at  budget  time,  but   throughout  the  year.  It  will  also  allow  senior  management  to  make  a  fully  informed  decision  before  deciding  to  alter   operations.  The  standards  we’ve  worked  out  are  appropriate  for  current  operations  only.  Laboratory  practice  will  not  stand   still,  and  the  technology  is  changing  rapidly.  The  conversion  to  automation  will  change  the  way  work  is  done,  and  we’ll   need  to  account  for  this  in  the  revised  standard.     A  pattern  of  improving  productivity  with  growing  volume  across  many  areas  of  lab  implies  that  there  may  be  additional   capacity  in  some  areas  for  more  tests  at  little  or  no  additional  labor.  We  don’t  know  where  excess  capacity  currently  resides   in  the  system,  or  how  much  in  future  savings  that  might  represent.  A  strong  incentive  plan  would  encourage  managers  to   take  on  additional  testing  without  additional  labor  in  those  departments  where  productivity  improvement  is  possible.   A Break with Conventional Budgeting The  new  productivity  model  represents  a  departure  from  the  way  that  General  Hospital  has  traditionally  staffed  operating   departments.  The  traditional  model  projects  laboratory  demand  based  on  demographics  and  utilization  trends,  and  the   departments  are  then  staffed  to  projected  demand.  In  some  cases,  departments  are  staffed  based  on  what  they  were   budgeted  the  year  before.  In  the  new  model,  the  link  between  projected  and  actual  is  dissolved.  Instead  of  staffing  to  what   projections  say  laboratory  demand  will  be,  or  ought  to  be,  operating  managers  and  clinicians  will  now  staff  to  actual   demand.  More  volume  means  more  staff;  less  volume  means  less  staff.   Conventional  fixed  budgets,  unresponsive  to  testing  volume,  will  be  replaced  by  flexible  labor  standards.  Since  the  new   labor  standards  use  a  ratio—hours  per  unit—and  not  a  fixed  number  of  FTE,  managers  are  encouraged  to  vary  their  staffing   levels  with  volume,  provided  they  maintain  their  hours  per  unit  standard. 2009 Labor Standards 6
  8. 8. General Hospital Chicago, Illinois Laboratory Division The  labs  are  comprised  of  twenty  labs  located  in  medical  offices  that  serve  the  region,  the  regional  lab  at  Airport  Way  that   perform  most  of  the  tests,  Mountain  Park  inpatient  lab  and  blood  bank,  and  administrative  departments  housed  at  Airport   Way,  with  a  total  of  about  410  FTE.   As  test  and  phlebotomy  volumes  are  consistently  weighted  across  all  departments  regardless  of  specialty,  the  entire   volume  for  the  region  will  be  counted  fairly  regardless  of  future  service  mix  changes,  and  will  automatically  adjust  for  each   department,  to  factor  out  the  productivity  effect  of  changing  test  and  draw  mixes.   Many  offices  extended  their  operating  hours  in  March  and  June  as  part  of  an  effort  to  relieve  after-­‐hours  patient  demand  at   the  urgent  care  centers.  The  number  of  patients  being  served  after  6:00pm  in  these  locations  is  quite  small.  Had  the  patient   load  per  hour  been  the  same  in  the  extended  hours  (6:00pm  to  8:15pm)  as  before  6:00pm,  hours  worked  per  test  would  be   unaffected  by  extended  operating  hours.  The  extra  volume  would  have  offset  the  extra  hours  to  leave  the  productivity   ratio  unaffected.  That  not  being  the  case,  extra  productive  hours  have  often  been  required  to  cover  the  extended  service   hours.  Since  the  effect  of  extended  hours  are  still  being  studied,  and  possibly  reversed,  the  labor  standards  for  the  Medical   Offices  are  presented  in  two  ways—one  standard  without  extended  hours,  and  one  with  extended  hours,  as  applicable.  If   General  Hospital  decides  to  return  to  pre-­‐March  operating  hours,  the  appropriate  labor  standard  can  then  be  used  as   displayed  on  those  department’s  analyses. Regional Lab Volumes Lab  volumes  have  been  growing  rapidly.  Weighted  volume  is  up  15%  from  2006.  While  Lab  Operations  (medical  office)   weighted  volumes  have  grown  by  only  5%  since  2006,  the  Regional  Lab  has  grown  by  21%,  and  Mountain  Park  by  13%.   2009 Labor Standards 7
  9. 9. General Hospital Chicago, Illinois Individual  departments  show  much  more  variation  in  volume.  Molecular   !"#$%&'"%()*& has  grown  37%  since  2007,  SAM/Toxicology  by  45%,  and  Core  Lab  by  24%   175,000 since  2006.  Other  departments’  volume  has  decreased  over  the  period,   150,000 such  as  Cytology  (down  22%  from  2006,  but  up  since  2007),  and   125,000 Hematology  (down  37%  but  about  to  double  their  volumes).  In  the   100,000 medical  offices,  Adams’s  total  weighted  volumes  have  jumped  23%,  and   Orchard’s  by  39%  (since  2007),  while  Cascade  Park  declined  7%,  Chicago   75,000 and  Interstate  South  were  down  14%,  North  Washington  and  Skyline  by   50,000 9%,  Jefferson  by  12%,  and  Mt.  Adams  by  4%  in  weighted  volumes  since   Weighted 25,000 Unweighted 2006. 0 Dividing  weighted  volume  by  unweighted  volumes  yields  an  average   2006A 2007 2008 2009A weight  across  the  years  for  comparison.  The  average  weight  is  a  labor   intensity  score  that  reflects  changes  in  the  service  mix.  A  rise  in  the   score  means  that  the  testing  mix  has  changed  to  be  more  time-­‐consuming  per  test;  a  decline  in  the  score  means  that  the   testing  mix  is  becoming  less  labor-­‐intensive  per  test.   !"#$%&'(")*+,-$ .'/*+,"0$!"#$ 12,,3-*4'$ 5+)"0$!"#$ 2.40 2.40 2.40 2.40 2.20 2.20 2.20 2.20 2.00 2.00 2.00 2.00 Avg Weight 1.80 1.80 1.80 1.80 Avg Weight Avg Weight 1.60 1.60 4 Year Avg 1.60 1.60 1.40 Avg Weight 1.40 1.40 1.40 Avg Weight 1.20 4 Year Avg 1.20 1.20 1.20 4 Year Avg 1.00 1.00 1.00 1.00 2006A 2007 2008 2009A 2006A 2007 2008 2009A 2006A 2007 2008 2009A 2006A 2007 2008 2009A Today,  average  intensities  for  Lab  Operations  are  even  with  their  2006  intensity,  Regional  Lab  has  decreased  by  just  1%,  and   Mountain  Park  is  down  by  5%  compared  to  2006.  This  reflects  increasing  automation  of  tests,  which  is  far  more  efficient.  In   total  the  entire  lab  division  service  intensity  is  down  by  3%  since  2006,  but  up  from  last  year.     After  a  rise  in  2007,  the  region’s  efficiency  in  hours  per  weighted  test  has  improved  ever  since.  In  many  cases,  the  various   labs  have  absorbed  growing  volumes  without  a  commensurate  increase  in  staff.  This  has  been  somewhat  offset  by  some   departments  maintaining  their  staffing  despite  declines  in  volumes.  Managers  may  not  have  known  the  actual  workload   and  would  not  have  been  effectively  able  to  vary  staffing  with  patient  demand.   2009 Labor Standards 8
  10. 10. General Hospital Chicago, Illinois !"#$%&'($&)**&+(,-./(0&1(%/%&& 1"/23&4$"0#5/,6(&!"#$%& 5.20 760,000 5.10 750,819 750,000 746,754 741,206 5.00 738,458 4.93 740,000 727,690 730,000 4.79 4.80 720,000 710,000 4.60 4.55 4.51 700,000 4.46 687,963 690,000 4.40 680,000 4.20 670,000 660,000 4.00 650,000 2006A 2007 2008 2009A Std (Ext Std (Not 2006A 2007 2008 2009A Std (Ext Std (Not Hours) Ext Hrs) Hours) Ext Hrs) Except  for  2006  (which  is  October  to  December  annualized)  the  lab  division  has  improved  it’s  productivity  in  each   successive  year.  Although  productive  hours  have  increased  3%  since  2007,  weighted  volumes  have  grown  16%,  producing   strong  productivity  gains.   Overall,  standard  with  current  hours  of  operation  (since  June  2009)  in  the  medical  offices  is  4.51  productive  hours  per  100   weighted  tests,  and  4.46  hours  per  100  weighted  tests  with  the  former  hours  of  operation.  The  latter  standard  of  4.46  is   directly  comparable  with  the  measurement  period  of  the  analysis.  Total  productive  hours  at  standard  (current  operating   hours)  are  4,065  hours  and  $189,000  less  than  2009,  and  12,361  hours  and  $367,000  with  the  former  hours  of  operation  at   the  medical  offices.  Dollars  exclude  vacation,  sick,  holiday,  and  fringe  benefits,  which  would  add  another  51%  to  the  total.   The  Hematology  and  Molecular  departments  will  both  take  on  significant  new  volumes  at  very  little  incremental  labor  cost,   contributing  most  of  the  productivity  gains  seen  in  the  total  lab  results,  below.  More  detail  can  be  found  in  the  department   narratives  following  this  section.   • Analysis:  although  not  true  of  every  department,  overall,  lab  in  2009  is  at  it’s  most  efficient  level  of  the  four  years   studied.  Accordingly,  standards  for  many  department  preserve  what  they  have  achieved  to  date;  for  others,  standard   sets  them  to  a  higher  level  of  performance  achieved  before,  adjusted  for  any  non-­‐volume  related  changes  in  operations.   2009 Labor Standards 9
  11. 11. General Hospital Chicago, Illinois 2009 Labor Standards 10
  12. 12. General Hospital Chicago, Illinois 2009 Labor Standards 11
  13. 13. General Hospital Chicago, Illinois Lab Operations— Medical Offices Twenty  labs  located  in  medical  offices  around  the  region  collect  patient  samples  and  perform  tests.  Venipunctures  are   performed  by  dedicated  staff  in  each  medical  office.  This  comprises  about  85%  of  the  medical  office  workload,  with  the   remainder  devoted  to  testing,  performed  by  similarly  dedicated  staff.  Most  of  the  tests  are  sent  to  Airport  Way  (AWL)  lab,   where  the  workload  is  just  the  reverse—85%  of  its  work  involves  testing,  and  only  15%  is  draws.  Since  the  medical  offices   perform  few  tests  on  the  samples  they  draw,  the  number  of  tests  performed  and  venipuncture  volumes  do  not  correlate,   but  run  independently  of  each  other.     The  count  of  venipunctures  and  demographics  may  be  somewhat  inaccurate  from  a  billing  point  of  view.  A  small  fraction  of   patients  are  sometimes  charged  multiple  times  for  what  would  only  be  billed  once  outside  of  General  Hospital.  Multiple   tests  run  on  the  same  physician  order  triggers  one  venipuncture  and  one  demographic.    When  the  same  multiple  tests  are   ordered  from  several  physicians,  venipunctures  and  demographics  are  counted  for  each  physician  order  even  though  only   one  venipuncture  was  performed.  As  long  as  these  are  counted  consistently  (even  if  not  industry  standard),  the  counts  we   have  are  representative  of  actual  workload.  If  General  Hospital  converts  its  data  systems  to  capture  statistics  consistent   with  industry-­‐standard  billable  practices,  the  standard  can  be  recalibrated.   Since  the  medical  offices  have  two  separate  staffs  within  each  cost  center—phlebotomists  and  lab  technical  staff—and   since  each  group  is  driven  by  its  own  unit  of  measure,  we  created  a  productivity  analysis  that  is  multilayered,  yet  simple  and   analytical  enough  for  supervisors  to  find  useful  and  prescriptive.  The  analyses  following  show,  by  medical  office,  a   phlebotomy  section  (venipunctures  and  demographics),  a  testing  section  (weighted  tests),  and  the  total  for  both  groups.  A   labor  standard  applies  to  each  section,  and  productivity  reports  will  need  to  divide  each  cost  center  into  phlebotomy,   testing,  and  the  total.     Further,  to  maintain  a  tight  connection  between  people  and  the  jobs  they  perform,  hours  and  wages  for  managers,   supervisors,  and  schedulers  were  pulled  out  of  Lab  Operations,  who  often  support  multiple  sites,  but  have  all  their  time   coded  only  to  their  home  cost  center.  These  administrative  staff  will  form  their  own  cost  center,  to  be  called  Medical  Office   Administration  and  Support,  whose  workload  measure  is  the  unweighted  sum  of  volume  from  all  the  medical  offices.   As  the  volumes  are  consistently  weighted,  all  twenty  medical  offices  are  comparable  to  each  other  on  a  per-­‐unit  basis,  and   work  volumes  will  be  counted  fairly  regardless  of  future  service  mix  changes.   Many  offices  extended  their  operating  hours  in  March  and  June  as  part  of  an  effort  to  relieve  after-­‐hours  patient  demand  at   the  urgent  care  centers.  The  number  of  patients  being  served  after  6:00pm  in  these  locations  is  quite  small.  Had  the  patient   load  per  hour  been  the  same  in  the  extended  hours  (6:00pm  to  8:15pm)  as  before  6:00pm,  hours  worked  per  test  would  be   2009 Labor Standards 12
  14. 14. General Hospital Chicago, Illinois unaffected  by  extended  operating  hours.  The  extra  volume  would  have  offset  the  extra  hours  to  leave  the  productivity   ratio  unaffected.  That  not  being  the  case,  extra  productive  hours  have  often  been  required  to  cover  the  extended  service   hours.  Since  the  effect  of  extended  hours  are  still  being  studied,  and  possibly  reversed,  the  labor  standards  that  follow  are   presented  in  two  ways-­‐one  standard  without  extended  hours,  and  one  with  extended  hours,  as  applicable.  If  General   Hospital  decides  to  return  to  pre-­‐March  operating  hours,  the  appropriate  labor  standard  can  then  be  used  as  displayed   below. Medical Offices Combined This  analysis  rolls  up  all  twenty  medical  offices  (not  including  the  new  Murrayhill  clinic)  to  show  before  and  after  results.   Phlebotomy  and  Testing  volumes  have  been  picking  up  in  2009,  especially  in  the    medical  clinics.  Productive  hours  increased   faster  than  volumes  2006-­‐08,  producing  productivity  losses.  Performance  has  improved  in  2009—total  hours  are  up  less   than  1%,  but  volumes  are  up  4.2%  from  2008.  This  improvement  almost  wiped  out  the  productivity  losses  incurred  2006-­‐08,   making  overall  four-­‐year  productivity  performance  less  than  two  FTE  worth  to  the  negative.   Many  offices  extended  their  operating  hours  this  year  to  improve  patient  access.  Volumes  during  these  extended  hours   have  been  small,  producing  worse  productivity  in  those  hours  and  hurting  those  particular  departments.  A  few  clinics   reduced  their  operating  hours,  which  has  generally  improved  efficiency  by  seeing  the  same  number  of  patients  in  a  shorter   time.   Dividing  weighted  volume  by  unweighted  volumes  yields  an  average  weight  across  the  years  for  comparison.  The  average   weight  is  a  labor  intensity  score  that  reflects  changes  in  the  service  mix.  A  rise  in  the  score  means  that  the  testing  mix  has   changed  to  be  more  time-­‐consuming  per  test;  a  decline  in  the  score  means  that  the  testing  mix  is  becoming  less  labor-­‐ intensive  per  test.   3"4#1($.#& /"0#12(.#& !"#$%&'()*+$%&,-+(.& 2.50 2.50 2.50 2.30 2.30 2.30 2.10 2.10 2.10 1.90 1.90 1.90 Avg Weight Avg Weight Avg Weight 1.70 1.70 1.70 4 Year Avg 4 Year Avg 4 Year Avg 1.50 1.50 1.50 2006A 2007 2008 2009A 2006A 2007 2008 2009A 2006A 2007 2008 2009A Average  intensities  for  Phlebotomy  and  Testing  combined  have  been  rising  in  the  Southeast  division  and  falling  in  the    by   the  same  amount.  In  total,  the  service  mix  in  2009  is  the  same  as  it  was  in  2006.   Since  the  continuation  of  the  extended  hours  project  is  still  unknown,  labor  standards  are  presented  in  two  ways—one   standard  with  the  current  operating  hours,  and  the  other  should  the  hours  of  operation  revert  to  where  they  were  before   March  2009.  The  total  effect  of  the  labor  standards  is  shown  on  the  following  graphs.  Overall,  the  standard  with  the   2009 Labor Standards 13
  15. 15. General Hospital Chicago, Illinois current  extended  hours  comes  out  to  the  same  as  that  which  the  clinics  in  total  are  operating  at  June  year  to  date.   However,  the  June  year  to  date  level  is  not  the  true  run  rate.  Since  many  clinics  extended  their  hours  in  March  or  June,  the   full  cost  presented  in  the  tables  below  has  not  yet  been  incurred.  Standard  for  current  operating  hours  does  represent  a   productivity  improvement.   How  much  are  these  extended  hours  costing?  Were  the  operating  hours  to  revert  to  their  pre-­‐March  times,  the  medical   offices  collectively  could  save  8,500  productive  hours  and  over  $200,000  in  productive  salaries.  As  shown  below,  hours  per   test  without  extended  hours  would  be  at  their  most  efficient  level.   !"#$%&'($&)**&+(,-./(0&1(%/%&& 1"/23&4$"0#5/,6(&!"#$%& 5.40 5.33 260,000 5.24 5.15 5.15 250,399 250,180 5.20 248,261 250,000 5.03 244,457 4.98 241,883 5.00 240,000 4.80 232,410 230,000 4.60 220,000 4.40 210,000 4.20 4.00 200,000 2006A 2007 2008 2009A Std (Ext Std (Not 2006A 2007 2008 2009A Std (Ext Std (Not Hours) Ext Hrs) Hours) Ext Hrs) 2009 Labor Standards 14
  16. 16. General Hospital Chicago, Illinois The  clinic’s  relatively  small  volumes  do  not  help  efficiency.  Minimum  staffing  levels,  regardless  of  volumes,  are  almost  as   high  at  many  clinics  as  their  current   productive  hours.  The  graph  to  the  left   shows  the  relationship  between  size  and   efficiency.  The  correlation  is  only  9%,   meaning  that  as  volume  increases,  there  is   only  a  slight  relationship  towards  lower   hours  worked  per  test.  If  Monroe,  Mother   Joseph,  and  Central  Interstate  (the  smallest   clinics)  are  eliminated  from  the  sample,  the   correlation  actually  goes  the  other  way—a   slight  relationship  for  hours  per  unit  and   volume  to  increase  together.   • Analysis:  overall,  with  the  new  extended  hours  of  operation,  standard  is  the  same  as  June  2009  year  to  date.   However,  the  run  rate  for  many  medical  offices  since  March  2009  is  higher  than  shown  here,  to  cover  the  addi-­‐ tional  operating  hours  for  which  patient  volume  is  slight.  Year  to  date  figures  dilute  the  effect  on  productivity.  The   standard  without  extended  access  hours  would  save  8,500  productive  hours  and  $201,000  were  those  hours  to  be   rolled  back  to  former  hours  of  operation.   2009 Labor Standards 15
  17. 17. General Hospital Chicago, Illinois 2009 Labor Standards 16
  18. 18. General Hospital Chicago, Illinois Chicago 08-003-2324 The  Chicago  building  (which  includes  other  services  besides  lab)  moved  from  a  primary  care  dominated  practice  to  specialty   care.  Some  primary  care  physicians  were  moved  out  to  other  locations  to  effect  the  change.  The  hours  of  operation  have   remained  the  same.   Phlebotomy  volumes  are  somewhat  lower  than  in  recent  years,  while  Testing  volumes  have  grown.  Productive  hours  have   held  fairly  steady.     Dividing  weighted  volume  by  unweighted  volumes  yields  an  average  weight  across  the  years  for  comparison.  The  average   weight  is  a  labor  intensity  score  that  reflects  changes  in  the  service  mix.  A  rise  in  the  score  means  that  the  testing  mix  has   changed  to  be  more  time-­‐consuming  per  test;  a  decline  in  the  score  means  that  the  testing  mix  is  becoming  less  labor-­‐ intensive  per  test.   ./%(0"#"12& !(*#+,-& !"#$%&'()#& 2.50 2.30 2.50 2.30 2.10 2.30 2.10 2.10 1.90 1.90 1.90 1.70 Avg Weight 1.70 Avg Weight 1.70 Avg Weight 4 Year Avg 4 Year Avg 4 Year Avg 1.50 1.50 1.50 2006A 2007 2008 2009A 2006A 2007 2008 2009A 2006A 2007 2008 2009A Phlebotomy  intensities  are  down  5%  in  2009  from  2006.  The  Testing  section  average  intensity  is  also  down  5%  from  2006,   and  close  to  it’s  four  year  average.  In  total,  Chicago’s  service  mix  today  is  5%  lower  than  it  was  in  2006.       For  the  Phlebotomy  section,  2007  hours  per  unit  was  chosen  as  the  appropriate  standard.  For  Testing,  we  used  2008   performance  as  the  labor  standard.     2009 Labor Standards 17
  19. 19. General Hospital Chicago, Illinois   Action:  Phlebotomy-­‐the  variable  standard  is  4.77  productive  hours  and  $90  per  100  Weighted  Tests,  or  4,160  hours  per   year  (2  FTE),  whichever  is  greater.       Action:  Testing-­‐the  variable  standard  is  7.14  productive  hours  and  $182  per  100  Weighted  Tests,  or  1,664  hours  per   year  (o.8  FTE),  whichever  is  greater. • Analysis:  overall,  standard  saves  569  productive  hours  and  $11,997  (at  June  year  to  date  actual  wages)  compared   to  2009  annualized.     2009 Labor Standards 18
  20. 20. General Hospital Chicago, Illinois Holyoke 08-004-2324 Hours  of  operation  were  increased  two  hours  per  day,  from  6:00pm  to  8:15pm,  effective  March  2,  2009.  Testing  and  draw   volumes  during  the  extended  hours  are  slight.  Although  it  would  be  less  expensive  to  add  two  hours  to  the  daily  shift   schedule,  there  are  minimum  time  commitments  when  adding  staff  of  one-­‐half  FTE.  Phlebotomy  staff  hours  were  boosted   one-­‐half  FTE  to  cover  the  extended  hours,  but  Testing  was  able  to  cover  by  staggering  shifts.   Phlebotomy  volume  has  been  steady  over  the  last  four  years,  but  Testing  volumes  have  grown  considerably.  Productive   hours  have  grown  steadily  in  both  Phlebotomy  and  Testing,  and,  despite  the  extended  operating  hours,  both  sections  are   running  more  efficiently  this  year  compared  to  last.  Phlebotomy’s  productivity  for  2009  in  the  table  below  understates   today’s  run  rate,  however,  as  the  extended  hours  took  effect  in  March,  and  2009  in  the  tables  below  are  annualized  from   June  year  to  date.     Dividing  weighted  volume  by  unweighted  volumes  yields  an  average  weight  across  the  years  for  comparison.  The  average   weight  is  a  labor  intensity  score  that  reflects  changes  in  the  service  mix.  A  rise  in  the  score  means  that  the  testing  mix  has   changed  to  be  more  time-­‐consuming  per  test;  a  decline  in  the  score  means  that  the  testing  mix  is  becoming  less  labor-­‐ intensive  per  test.   ./%(0"#"12& !(*#+,-& !"#$%&'()#& 2.25 2.40 2.25 2.20 2.20 2.30 2.15 2.15 2.20 2.10 2.10 Avg Weight 2.10 Avg Weight Avg Weight 2.05 2.05 4 Year Avg 4 Year Avg 4 Year Avg 2.00 2.00 2.00 2006A 2007 2008 2009A 2006A 2007 2008 2009A 2006A 2007 2008 2009A Phlebotomy  and  Testing  intensities  are  only  slightly  changed  today  from  where  they  were  in  2006,  but  below  the  peak  of   2007.  In  total,  Holyoke’s  service  mix  declined  1%  in  labor  intensity  in  2009  from  2006,  and  3%  less  in  2009  than  2007.       For  Phlebotomy,  2007  represented  the  most  efficient  performance  to  date  (2006  is  annualized  from  three  months,  and  may   be  an  anomaly),  and  was  used  for  the  labor  standard.  For  the  Testing  section,  2009  performance  was  used.     2009 Labor Standards 19
  21. 21. General Hospital Chicago, Illinois   Action:  Phlebotomy—the  variable  standard  is  4.60  productive  hours  and  $85  per  100  Weighted  Tests,  or  4.24  hours   and  $78  without  extended  operating  hours.  Minimum  staffing  is  8,320  hours  per  year  (4  FTE).   Action:  Testing—the  variable  standard  is  9.28  productive  hours  and  $263  per  100  Weighted  Tests.  Minimum  staffing  is   4,160  hours  per  year  (2  FTE). • Analysis:  overall,  standard  costs  804  productive  hours  and  $14,886  (at  June  year  to  date  actual  wages)  compared   to  2009  annualized,  due  to  extended  operating  hours.  Without  extended  hours,  standard  would  save  111  hours   and  $2,047  per  year  compared  to  2009  annualized. 2009 Labor Standards 20
  22. 22. General Hospital Chicago, Illinois Division 08-006-2324 Since  March  2009,  Division  has  been  open  an  extra  two  hours.  The  number  of  patients  served  after  6:00pm  is  quite  small.   While  the  Phlebotomy  section  is  not  affected,  extra  productive  hours  for  the  Testing  section  are  required  to  cover  the   extended  service  hours,  which  hurts  overall  hours  per  test  compared  to  past  years.   Phlebotomy  and  Testing  volumes  have  increased  over  the  last  few  years.  At  a  slightly  faster  pace,  productive  hours  for  both   sections  has  also  increased  over  the  years. Dividing  weighted  volume  by  unweighted  volumes  yields  an  average  weight  across  the  years  for  comparison.  The  average   weight  is  a  labor  intensity  score  that  reflects  changes  in  the  service  mix.  A  rise  in  the  score  means  that  the  testing  mix  has   changed  to  be  more  time-­‐consuming  per  test;  a  decline  in  the  score  means  that  the  testing  mix  is  becoming  less  labor-­‐ intensive  per  test.   ./%(0"#"12& !(*#+,-& !"#$%&'()#& 2.50 2.50 2.50 2.40 2.40 2.40 2.30 2.30 2.30 2.20 2.20 2.20 Avg Weight Avg Weight Avg Weight 2.10 2.10 2.10 4 Year Avg 4 Year Avg 4 Year Avg 2.00 2.00 2.00 2006A 2007 2008 2009A 2006A 2007 2008 2009A 2006A 2007 2008 2009A Phlebotomy  intensities  fell  slightly  this  year,  reflecting  a  faster  increase  in  demographics  (weighted  at  1.0)  than   venipunctures  (weighted  at  4.0).  The  Testing  section  average  intensity  is  slightly  higher  in  2009  than  in  prior  years.  In  total,   Division’s  service  mix  is  slightly  less  labor-­‐intensive  in  2009  than  in  prior  years.     For  the  Phlebotomy  section,  we  used  2007  performance  for  the  standard.  For  Testing,  we  used  2007  hours  per  Weighted   Test,  and  added  two  hours  per  weekday  to  account  for  the  unproductive  extended  operating  hours.   2009 Labor Standards 21
  23. 23. General Hospital Chicago, Illinois   Action:  Phlebotomy-­‐the  variable  standard  is  4.05  productive  hours  and  $76  per  100  Weighted  Tests,  or  4,160  hours  per   year  (2  FTE),  whichever  is  greater.   Action:  Testing-­‐the  variable  standard  is  12.17  productive  hours  and  $296  per  100  Weighted  Tests,  or  9.99  hours  and   $243  per  100  Weighted  Tests  without  extended  operating  hours.  Minimum  staffing  is  2,704  hours  per  year  (1.3  FTE). • Analysis:  overall,  standard  for  current  hours  of  operation  saves  203  productive  hours  and  $3,464  (at  June  year  to   date  actual  wages)  compared  to  2009  annualized;  without  extended  hours,  standard  saves  723  hours  and  $16,122. 2009 Labor Standards 22
  24. 24. General Hospital Chicago, Illinois East Interstate 08-010-2324 Before  2008,  the  Interstate  campus  was  an  emergency  center,  open  at  all  hours.  Since  2008,  it  operates  7am  to  11pm  every   day.  There  were  no  other  changes  to  operations.   Phlebotomy  volumes  have  been  rising,  while  Testing  volume  is  steady  and  low.  The  Testing  section  has  increased  hours   without  extra  volume,  causing  a  productivity  loss.  Some  of  the  tech’s  time  probably  should  have  been  coded  to  Interstate   South  and  not  remained  in  this  cost  center,  so  2008  was  used  to  set  the  standard.  Still,  because  of  very  low  volumes  and   minimum  staffing,  the  Testing  section  will  always  suffer  from  relatively  low  productivity  compared  to  Interstate  South.  A   way  to  eliminate  this  problem  may  be  to  merge  all  the  testing  for  the  Interstate  campus  in  Interstate  South. Dividing  weighted  volume  by  unweighted  volumes  yields  an  average  weight  across  the  years  for  comparison.  The  average   weight  is  a  labor  intensity  score  that  reflects  changes  in  the  service  mix.  A  rise  in  the  score  means  that  the  testing  mix  has   changed  to  be  more  time-­‐consuming  per  test;  a  decline  in  the  score  means  that  the  testing  mix  is  becoming  less  labor-­‐ intensive  per  test.   ./%(0"#"12& !(*#+,-& !"#$%&'()#& 2.30 2.30 2.30 2.20 2.20 2.20 Avg Weight 2.10 2.10 4 Year Avg 2.10 2.00 Avg Weight 2.00 2.00 Avg Weight 4 Year Avg 4 Year Avg 1.90 1.90 1.90 2006A 2007 2008 2009A 2006A 2007 2008 2009A 2006A 2007 2008 2009A Phlebotomy  intensities  have  been  steady  for  the  last  three  years,  and  the  Testing  section  service  mix  has  been  very  steady.   Virtually  all  the  tests  are  in  the  Manual  1  category.  The  vast  majority  of  work  is  in  Phlebotomy,  and  East  Interstate’s  total   service  mix  reflects  the  pattern  for  that  section.     The  Phlebotomy  standard  uses  2008  actual  performance.  Although  2009  hours  per  unit  have  been  lower,  it’s  the  result  of   some  phlebotomists  not  charging  their  hours  correctly  when  they  split  their  time  between  Interstate  South  and  East   Interstate.     2009 Labor Standards 23
  25. 25. General Hospital Chicago, Illinois   Action:  Phlebotomy-­‐the  variable  standard  is  4.39  productive  hours  and  $78  per  100  Weighted  Tests,  or  8,320  hours   per  year  (4  FTE),  whichever  is  greater.   Action:  Testing-­‐the  variable  standard  is  75.07  productive  hours  and  $1,373  per  100  Weighted  Tests. • Analysis:  standard  saves  hours  762  productive  hours  in  Testing,  but  adds  1,568  hours  in  Phlebotomy  compared  to   2009  annualized.  This  may  be  a  result  of  miscoded  hours  in  2009,  not  a  productivity  change.   2009 Labor Standards 24
  26. 26. General Hospital Chicago, Illinois Rockwood 08-014-2324 Hours  of  operation  were  increased  two  hours  per  day,  from  6:00pm  to  8:15pm,  effective  March  2,  2009.  Testing  and  draw   volumes  during  the  extended  hours  are  slight.  Rockwood  has  been  able  to  cover  the  extended  hours  by  staggering  shifts,   and  the  operation  continues  to  run  efficiently.   Phlebotomy  volumes  were  fairly  steady  2006-­‐08,  and  then  increased  this  year.  Testing  volumes  have  grown  throughout  the   four  year  period  in  the  analysis.  Productive  hours  grew  steadily  in  Phlebotomy,  and  then  declined  slightly,  producing   productivity  near  its  best.  While  Testing  productive  hours  have  grown,  volumes  have  grown  even  faster,  to  produce  the   best  productivity  of  the  four  years.     Dividing  weighted  volume  by  unweighted  volumes  yields  an  average  weight  across  the  years  for  comparison.  The  average   weight  is  a  labor  intensity  score  that  reflects  changes  in  the  service  mix.  A  rise  in  the  score  means  that  the  testing  mix  has   changed  to  be  more  time-­‐consuming  per  test;  a  decline  in  the  score  means  that  the  testing  mix  is  becoming  less  labor-­‐ intensive  per  test.   ./%(0"#"12& !(*#+,-& !"#$%&'()#& 2.30 2.10 2.30 2.20 2.05 2.20 2.00 2.10 2.10 1.95 2.00 2.00 1.90 Avg Weight Avg Weight Avg Weight 1.90 1.85 1.90 4 Year Avg 4 Year Avg 4 Year Avg 1.80 1.80 1.80 2006A 2007 2008 2009A 2006A 2007 2008 2009A 2006A 2007 2008 2009A Phlebotomy  intensity  in  2009  is  1%  higher  than  in  2006,  while  Testing  intensities  are  off  3%  from  where  they  were  in  2006.  In   total,  Rockwood’s  service  mix  in  2009  is  the  same  as  it  was  in  2006.         For  Phlebotomy  and  Testing,  2009  performance  represented  the  most  efficient  (or  very  close)  performance  to  date,  and   was  used  for  the  labor  standard.     2009 Labor Standards 25
  27. 27. General Hospital Chicago, Illinois   Action:  Phlebotomy-­‐the  variable  standard  is  3.67  productive  hours  and  $67  per  100  Weighted  Tests,  or  7,280  hours  per   year  (3.5  FTE),  whichever  is  greater.       Action:  Testing-­‐the  variable  standard  is  8.48  productive  hours  and  $233  per  100  Weighted  Tests,  or  2,704  hours  per   year  (1.3  FTE),  whichever  is  greater. • Analysis:  overall,  standard  is  the  same  as  2009,  the  most  efficient  of  the  four  years. 2009 Labor Standards 26
  28. 28. General Hospital Chicago, Illinois Central Interstate 08-016-2324 Before  2008,  the  Interstate  campus  was  an  emergency  center,  open  at  all  hours.  Since  2008,  it  operates  7am  to  11pm  every   day.  There  were  no  other  changes  to  operations.  Central  Interstate  has  no  testing  section.   Volumes  have  held  fairly  steady  in  Phlebotomy,  but  productive  hours  have  crept  up,  causing  a  productivity  loss.  Some   minor  amount  of  draws  are  done  for  research  nurses,  and  are  not  counted.  Bone  marrow  prep  work  applies  to  those   locations  in  which  specimens  are  collected,  but  we  had  difficulty  in  assigning  a  specific  location.  However,  at  least  95%  of   outpatient  bone  prep  is  done  at  Central  Interstate,  and  all  inpatient  bone  prep  is  done  at  Mountain  Park.  A  very  small   amount  of  bone  prep  is  done  at  Longview,  Skyline,  and  North  Washington.  For  data  collection  and  monitoring,  our  rule  is   that  all  outpatient  bone  prep  volume  will  be  assigned  to  Central  Interstate,  and  all  inpatient  work  assigned  to  Mountain   Park. Dividing  weighted  volume  by  unweighted  volumes  yields  an  average  weight  across  the  years  for  comparison.  The  average   weight  is  a  labor  intensity  score  that  reflects  changes  in  the  service  mix.  A  rise  in  the  score  means  that  the  testing  mix  has   changed  to  be  more  time-­‐consuming  per  test;  a  decline  in  the  score   !"#$%&'&()* means  that  the  testing  mix  is  becoming  less  labor-­‐intensive  per  test.   2.47 Phlebotomy  intensities  have  been  rising  slightly,  reflecting  a  small   2.45 decrease  in  demographics  (weighted  at  1.0)  compared  to  more  complex   2.43 draws  and  venipunctures. 2.41 The  standard  was  based  on  a  mix  of  2006-­‐07  performance.   2.39 Avg Weight   2.37 4 Year Avg 2.35 2006A 2007 2008 2009A   Action:  Phlebotomy-­‐the  variable  standard  is  5.00  productive  hours  and  $96  per  100  Weighted  Tests,  or  2,080  hours   per  year  (1  FTE),  whichever  is  greater. • Analysis:  standard  saves  977  productive  hours  and  $18,849  (at  June  year  to  date  actual  wages)  compared  to  2009   annualized.   2009 Labor Standards 27
  29. 29. General Hospital Chicago, Illinois Cascade Park 08-019-2324 Hours  of  operation  decreased  two  hours  per  day,  from  8:15pm  to  6:00pm,  effective  March  2,  2009.  Productivity  has   improved  with  the  change.  There  were  no  other  changes  to  operations.   Phlebotomy  and  Testing  volumes  have  grown  slightly  over  the  last  few  years.  Productive  hours  in  2009  are  down  from   where  they  were  in  2006-­‐08  to  cover  the  reduced  operating  hours.     Dividing  weighted  volume  by  unweighted  volumes  yields  an  average  weight  across  the  years  for  comparison.  The  average   weight  is  a  labor  intensity  score  that  reflects  changes  in  the  service  mix.  A  rise  in  the  score  means  that  the  testing  mix  has   changed  to  be  more  time-­‐consuming  per  test;  a  decline  in  the  score  means  that  the  testing  mix  is  becoming  less  labor-­‐ intensive  per  test.   ./%(0"#"12& !(*#+,-& !"#$%&'()#& 2.20 2.20 2.20 2.00 2.00 2.00 Avg Weight 1.80 1.80 4 Year Avg 1.80 1.60 Avg Weight 1.60 1.60 Avg Weight 4 Year Avg 4 Year Avg 1.40 1.40 1.40 2006A 2007 2008 2009A 2006A 2007 2008 2009A 2006A 2007 2008 2009A Phlebotomy  intensities  are  about  even  today  from  where  they  were  in  2006.  The  Testing  section  average  intensity  has   dropped  9%  since  2006-­‐07.  In  total,  Cascade’s  service  mix  declined  2%  in  labor  intensity  in  2009  as  2006.       For  both  Phlebotomy  and  Testing  sections,  2009  represented  the  most  efficient  performance  to  date,  and  used  for  the   labor  standard.       2009 Labor Standards 28
  30. 30. General Hospital Chicago, Illinois   Action:  Phlebotomy-­‐the  variable  standard  is  4.80  productive  hours  and  $90  per  100  Weighted  Tests,  or  10,400  hours   per  year  (5  FTE),  whichever  is  greater.     Action:  Testing-­‐the  variable  standard  is  9.27  productive  hours  and  $256  per  100  Weighted  Tests,  or  4,160  hours  per   year  (2  FTE),  whichever  is  greater. • Analysis:  standard  is  even  with  2009  annualized  performance.     2009 Labor Standards 29
  31. 31. General Hospital Chicago, Illinois South Park 08-023-2324 In  mid-­‐2008,  this  location  closed  on  Sundays.  Productivity  was  somewhat  better  in  2007,  due  to  more  use  of  part-­‐time   employees.  Turnover  proved  to  be  a  problem  since  part-­‐timers  are  not  benefitted,  and  the  department  moved  to  more  32-­‐ hour  staff  at  full  benefits.  Turnover  was  reduced,  and  there  is  no  overtime  or  agency  used  anymore.   Phlebotomy  volumes  are  higher  than  in  recent  years,  while  Testing  volumes  have  diminished  from  their  peak  in  2007.   Productive  hours  overall  have  crept  up  a  bit  each  year.       Dividing  weighted  volume  by  unweighted  volumes  yields  an  average  weight  across  the  years  for  comparison.  The  average   weight  is  a  labor  intensity  score  that  reflects  changes  in  the  service  mix.  A  rise  in  the  score  means  that  the  testing  mix  has   changed  to  be  more  time-­‐consuming  per  test;  a  decline  in  the  score  means  that  the  testing  mix  is  becoming  less  labor-­‐ intensive  per  test.   ./%(0"#"12& !(*#+,-& !"#$%&'()#& 2.30 2.10 2.30 2.00 2.10 2.10 1.90 1.90 1.80 1.90 1.70 1.70 Avg Weight Avg Weight 1.70 Avg Weight 4 Year Avg 1.60 4 Year Average 4 Year Avg 1.50 1.50 1.50 2006A 2007 2008 2009A 2006A 2007 2008 2009A 2006A 2007 2008 2009A Phlebotomy  intensities  are  about  even  in  2009  compared  to  2006.  The  Testing  section  average  intensity  is  down  10%  from   2006,  as  the  proportion  of  automated  tests  has  increased  quickly.  In  total,  Longview’s  service  mix  today  is  about  the  same   as  in  2006. For  both  the  Phlebotomy  and  Testings  sections,  2009  hours  per  unit  was  chosen  as  the  appropriate  standard.   2009 Labor Standards 30
  32. 32. General Hospital Chicago, Illinois   Action:  Phlebotomy-­‐the  variable  standard  is  4.78  productive  hours  and  $90  per  100  Weighted  Tests,  or  10,160  hours   per  year  (5  FTE),  whichever  is  greater.   Action:  Testing-­‐the  variable  standard  is  12.97  productive  hours  and  $386  per  100  Weighted  Tests,  or  4,160  hours  per   year  (2  FTE),  whichever  is  greater.   • Analysis:  standard  is  equal  to  2009  annualized.     2009 Labor Standards 31
  33. 33. General Hospital Chicago, Illinois Geneva 08-027-2324 This  draw  station  opened  in  mid-­‐2007.  Only  a  very  small  number  of  point  of  care  tests  are  done  at  Geneva.  Routine   specimens  are  routed  to  Airport  Way  regional  lab.  Stat  tests  are  routed  to  KSMC  laboratory. Dividing  weighted  volume  by  unweighted  volumes  yields  an  average  weight  across  the  years  for  comparison.  The  average   weight  is  a  labor  intensity  score  that  reflects  changes  in  the  service  mix.   A  rise  in  the  score  means  that  the  testing  mix  has  changed  to  be  more   !"#$%&'&()* time-­‐consuming  per  test;  a  decline  in  the  score  means  that  the  testing   2.40 mix  is  becoming  less  labor-­‐intensive  per  test.   2.30 Phlebotomy  intensities  have  declined  from  2007.  As  the  volume  has   2.20 picked  up  since  2007,  it’s  likely  that  the  mix  fluctuated  too.   2.10 As  a  startup  period,  hours  per  unit  for  2007  are  not  comparable  to   2.00 2008-­‐09.  The  Phlebotomy  standard  was  derived  from  2009  hours  per   Avg Weight 1.90 unit,  the  most  efficient  year.   4 Year Avg 1.80 2007 2008 2009A   Action:  Phlebotomy-­‐the  variable  standard  is  4.70  productive  hours  and  $89  per  100  Weighted  Tests,  or  2,080  hours   per  year  (1  FTE),  whichever  is  greater. • Analysis:  standard  is  equal  to  current  2009  performance.   2009 Labor Standards 32

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