Ancillary Demand Staffing
Current health systems are plagued by bottlenecks and inefficiency. Much time and effort are expended on trying to service multiple components of the health care system and when demand for ancillary services is exceeded, some components will be delayed.
The solution to this has been to look at artificial variability and smooth the variability to improve efficiency and streamline the process, a standard industrial practice. In health care, this model is challenging secondary to:
- (1) Political challenges
- (2) Financial challenges
- (3) Private physician models
- (4) Life-style impact related to week-end rounding
These challenges become significant, especially in the surgical realm. Health care is a unique financial model not emulated in the real industrial world and controlled by multiple bodies including governmental agencies, commercial insurers, and other regulatory bodies. This has resulted in a model that is driven predominantly by higher margin surgical cases. When 35% of the admission volume is providing 60% of the revenue, then a mismatch resulting in selective priorities and significant decision-making power by minorities rules the day.
If indeed OR leveling for example is an area which cannot be impacted secondary to reasons given, then organizationally decisions must be made to accommodate this artificial variability. In essence, the OR would be viewed as a variable model BUT with known impact on ancillary demands.
An example would be orthopedic surgery. The current orthopedic schedule is highly variable with 85% plus of cases scheduled on Monday and Tuesday. Standard orthopedic LOS is 3 days and results in the majority of these cases being discharged on Thursday and Friday. This type of scheduling places significant demand on ancillary services. Radiology is now in high demand in the OR on Monday and Tuesday drawing resources away from ED, Floor units, or scheduled outpatients. Physical Therapy is in high demand Tuesday through Friday based on the large volume of orthopedic cases and draws resources away from the floors which may result in delays in discharge or disposition and increase LOS.
Ancillary demand level staffing would provide accommodation for these known variables by adjusting resource allocation to level the needs of all organizationally and improve overall system performance and efficiency. This is an option to at least consider.