January 28, 2016 | JT Tan
“Transparency, or accurate observability, of an organization’s low-level activities, routines, behaviors, output, and performance provides the foundation of both organizational learning and operational control.” 1 –Ethan S. Bernstein, Assistant Professor of Business Administration, Harvard Business School
For long-term care and senior living providers, there is an unprecedented demand for transparency in staff scheduling – with pressure for change coming from multiple angles. From outside the facility, consumers and CMS are asking for more staffing level accountability via federal regulations that require transparency, such as Payroll-Based Journal and the Five Star Quality Ratings for Skilled Nursing. From inside the facility, evolving business goals and a modernizing workforce are also driving the need for transparency to make operations smarter and more efficient for both management and staff.
Payroll-Based Journal (PBJ) reporting is a hot topic across the long-term care landscape. The voluntary submission program started in late 2015 and all operators will be accountable to submit staffing data to the government later in 2016. For many providers, this is a challenging layer of complexity to add to the staffing process, as executing PBJ 
reporting with minimal ongoing effort requires a bit of prior planning and technological assistance.
But perhaps more important is the broader implication of reporting daily hours worked. At some point in the not-so-distant future, CMS has indicated that they intend to merge PBJ staffing data into the staffing component of the Five Star Quality Rating system. While PBJ simply mandates reporting of auditable data, Five Star applies judgment to your staffing levels, and then broadcasts that judgment across the market – to your potential residents and their families, to your upstream referrers, and to private payers that set your rates. In addition, new bundled payment programs are beginning to mandate minimum star thresholds, a trend that is likely to accelerate.
All of these regulatory changes have escalated the importance of transparency and control in staffing practices. With so much revenue and reputation riding on creating a good direct care work record, satisfying regulatory requirements is not merely a hoop to jump through, but a key performance outcome that deserves management’s attention and investment in tools that will make that good outcome more likely.
“Measurement is the first step that leads to control and eventually to improvement. If you can’t measure something, you can’t understand it. If you can’t understand it, you can’t control it. If you can’t control it, you can’t improve it.” –H. James Harrington
Gaining visibility into key staffing events and metrics is critical to long-term and senior care providers’ success. Labor is a community’s largest expense and the workforce is one of the strongest determinants of quality for an organization. Easily understanding labor management costs, risks, and performance within and across communities is clearly important to improving labor management, but what is often overlooked is when that information is available. What good is knowing that a person is going into overtime when you are processing their payroll? Real-time transparency when the staffing decision is being made is the crux to executing better choices that will have real impact to your organization’s bottom line.
As a senior living provider, actionable information about staffing should be available at your fingertips, wherever you are. When your decision makers are taking action, do they have all the relevant information from across your enterprise’s multiple systems (such as time clocks, payroll, HR systems and scheduling) to take the right actions? Furthermore, do you, as management, have a way to make sure they are making the right decisions?
Work to implement processes and tools where management can be alerted before staffing risks occur, so teams have time to course correct. Insight and analysis into staffing choices need to be relevant, predictive and proactive. If your decision makers understand the consequences of any given staffing choice, they can act decisively and accurately, avoiding unnecessary costs and confusion as well as mitigating staffing risks that could lead to clinical negligence, potential litigation, and disgruntled staff.
Staff scheduling software can help focus your daily efforts with predictive analysis and real-time data that provides a 360° view into organizational performance by presenting key actionable information at the right place, right time, and to the right person.
The looming labor shortage in assisted living is no longer just a rumor everyone wishes would go away. Already, we are hearing from our customers losing to other service sectors like retail and food service as they compete for local talent. So, it is becoming increasingly important to manage the employee experience. Though caregiving is one of the most humanly meaningful professions, oftentimes all the other frictional aspects of actual nursing operations get in the way of that work satisfaction. What assisted living providers need are workplace innovations that remove these points of friction and allows the job to be something more, with purpose. This is where the intersection of transparency and technology can thrive.
Leveraging new solutions, like staff scheduling software, allow employees real-time visibility into schedules, work assignments and shift openings. Moreover, mobile capabilities of these solutions enable them to request, accept or change shifts, helping to ensure the continuity and quality of care for all residents. Further, by 2020 50% of our workforce will be comprised of millennials – are your recruitment efforts visible to these new caregivers? Providers must embrace technology as a recruiting tool to access this emergent millennial workforce that has their lives tethered to their mobile devices.
Finally, it is often difficult to keep in touch with every staff members’ individual work life experience, but yet his/her work record speaks to impactful realities of that experience. Mindfulness around consistency – consistency in when they are working, how often they are working, and who they are working with - can be the difference in making one organization a better work experience than another. Staff scheduling software can be essential to making this review timely and possible.
Transparency, when government mandated, can ensure compliance and enhance a providers ranking against its’ competition. When inspired from within, transparency can boost productivity, improve care, reduce cost and empower a new generation of caregivers. Harnessing staff scheduling software to unleash these benefits is a natural evolution that all providers are going to go through. Have you started yet?
1 - Transparency, Organizational Learning, and Operational Control: Do Zones of Privacy Make Us More Productive?
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