COVID-19 has put an unprecedented financial strain on healthcare organizations. To exacerbate matters, these institutions already face razor-thin margins as many hospitals are relying on non-operating and investment income to survive.
To achieve financial stability, it may be necessary for organizations to cut operating costs quickly, which can be difficult and painful. Labor cost reductions in particular are hard to achieve and sustain, but important to manage; they still represent the single largest category of expense in a hospital — above 50% of total operating expenses, according to the Healthcare Management Financial Association.
However, before hospital leadership implements any labor cost reduction initiatives, it’s important to evaluate other opportunities in non-labor costs and revenue cycle enhancements so that you’re taking a balanced approach to financial health. This allows employees to be prioritized and labor reductions to be used as a last resort if non-labor cost reductions and revenue cycle improvements aren’t enough to meet a hospital’s financial goals.
If you’ve exhausted opportunities in non-labor and revenue cycle and need to implement labor cost savings initiatives, you have options before you start reducing your workforce.
Below, we outline key communication tips and seven alternative steps you can take before you decide to make widespread layoffs.
Communication tips
Communications is key to successfully implementing any change to your organization.
An essential component of leadership is the ability to communicate that your people are a top priority for your organization. Develop a clear and consistent message about why you need to take action for the organization’s long-term viability.
Here are some tips on how to achieve good communication with frontline staff during this time:
Set up a communications team to craft a messaging plan.
Consistently track the plan over weeks and months and be clear about what your workforce can expect next.
Establish a transparent and trustworthy tone paired with audience-focused content.
Schedule employee forums and luncheons to answer questions; some frontline staff may not have available access to your intranet.
For those working from home due to shelter-in-place directives, technology such as Zoom, WebEx, or Microsoft Teams should be used to hold video meetings and updates with their supervisors and hospital leaders.
Walk the floor and equip your leaders with consistent talking points so messages are unified, clear, and consistent at all levels.
Establish separate channels with physicians if you have targeted or sensitive information to share; enlist their partnership and engagement.
Celebrate wins and recognize high performers.
Seven steps to reduce labor costs
Once you have emphasized the importance of your people, your organization can continue to implement those communication tips as they go through the following steps.
1. Focus on managing pay practices.
Overtime and premium pay — such as double-time and triple-time pay–can be a significant expense, so evaluate opportunities to reduce these costs. To do this, analyze overtime and premium pay expenses by department to identify areas with high utilization. The financial data you’re reviewing should reach back at least 12 months.
From there, you can drill down to individuals incurring overtime and premium pay to determine if it’s appropriate. Take a look at on-call and call-back utilization by department to understand the total dollars being spent, and identify areas that incur on-call expenses while rarely calling-back the on-call employees.
A good overtime target is 3% or less each pay period. Premium pay utilization should be as close to 0% as possible.
2. Review your management structure.
There are several benefits to reviewing your management structure. Cutting management positions and layers demonstrates to the front-line employees that management isn’t exempt when cutting labor costs.
This review can lead to significant labor savings, improve decision making, and result in a leaner organization.
To conduct a review, consult best practices and benchmarks around manager-to-staff ratios by department and explore how to flatten a padded hierarchy.
3. Decrease reliance on outside agency staff and travelers.
This step can yield significant cost savings and other benefits.
Approaches include:
A focus on decreasing the reliance on temporary and traveling nurses, temporary workers, and locums — which are expensive, short-lived solutions that can lead to lower quality of care because they’re not tied to the organization
Developing a strategy to hire full-time people using human resources and recruitment tactics, such as signing bonuses for hard to recruit positions, higher base salaries, national recruiting footprint, and the use of search firms
Filling spots internally; if one department has to make a reduction in force, explore how you can reposition current staffers for these roles.
4. Evaluate sitter protocol.
Evaluating the appropriate use of sitters in a patient care unit can lead to significant cost savings.
There are multiple strategies and tactics to manage sitter utilization and costs including the following:
Pull reports to analyze the number of sitters and their total cost.
Evaluate if current guidelines on the usage of sitters is appropriate for those patients.
Assign one manager with overall sitter utilization responsibility including daily authorization.
Evaluate if the use of pro re nata (PRN) medications is appropriate.
Evaluate if the use of restraints is appropriate.
Have clinical staff perform frequent checks.
Hire and train sitters at a lower average hourly wage than nurses’ aides.
Investigate technology and equipment-driven solutions that could reduce reliance on sitters such as lower beds, bed alarms and enclosure systems, video monitoring, IV protection products, and activity aprons.
5. Evaluate skill-mix changes.
This step entails pushing work down to the lowest cost job description in the department when appropriate: patient care aides taking on nurse responsibilities, pharmacy techs doing more of pharmacists’ responsibilities, or laboratory techs taking on clinical laboratory scientists duties.
6. Reconsider time allotted for education, orientation, and training.
There’s a great deal of variation around how much time organizations spend on education, orientation, and training (EOT). You may find opportunity to modify to realize cost savings while meeting your EOT requirements.
During times of crisis, you should evaluate pushing EOT activities to the future so that you can focus your resources on the current needs of your hospital.
7. Implement a flexible staffing plan for all departments.
Both variable departments and fixed or overhead departments should be flexible with their staffing as volumes fluctuate.
Utilize appropriate volume indicators — such as patients days, visits, and procedures — for each department to determine if flexing needs to occur.
