Healthcare Providers - Workforce Optimization and Expense Management Initiatives for Healthcare Organizations

Successful healthcare organizations and providers seek to exceed in clinical and technological excellence to improve the quality of life for the people they serve. World-class healthcare providers are most often acclaimed for exceptional patient care and a differentiated clinical experience. These organizations need to find creative and effective ways to control costs, meet budget requirements, and address changing business needs without compromising patient care.

Automated Workforce and Expense Management Improve Performance

Executive Summary
For premier service providers in the healthcare industry, effective staffing strategies and attentiveness to cost control are vital to the success of operations, profitability and the quality of patient care. Managing and efficiently deploying the diverse workforces needed to staff hospitals, sub-acute care facilities, research facilities, pharmaceutical firms, rehab centers, clinics and other healthcare delivery organizations are top priorities. As competition for patients, physicians, nurses, therapists and top-notch researchers intensifies, healthcare administration needs to take a closer look at how to create organizations that can readily address acute situations while also offering consistent and affordable preventive care. This needs to take place without sacrificing patient treatment or compromising the flexibility to respond to emergencies, increased patient loads and the rapid developments taking place in the practice of medicine.

With the pressing need to constantly assess resource utilization, healthcare administrators are turning to technology to address enterprise issues including:
 Managing a diverse, distributed and often multi-lingual workforce comprised of professional, administrative, clerical and maintenance staffs
 Supporting the requirements of an increasingly mobile workforce
 Controlling costs to keep healthcare affordable and to remain competitive
 Tackling complex pay, work and union rules while complying with regulatory requirements
 Modernizing workforce and expense management processes to increase efficiencies and meet the needs of a diverse end-user community
 Eliminating payroll inaccuracies
 Ensuring and simplifying compliance with the organization’s policies and processes along with meeting government requirements and regulations

Healthcare providers are not immune to economic turbulence. Although healthcare hiring has steadily increased over the past few years, new financial pressures are emerging. For example, in the U.S., rising healthcare costs are not only a federal budget problem; they are also the primary driver of state and local government fiscal concerns. Healthcare providers are doubly challenged to source qualified talent to meet the daily demands of patient care while also looking far-and-wide within their organizations to do all they can to contain costs.

According to a recent Kaiser Family Foundation survey, more than half of American households have cut back on healthcare in the past year because of cost concerns. People are putting off visits to doctors and dentists, postponing necessary tests and not filling much-needed prescriptions.

Some are now relying on home remedies and over-the-counter drugs for minor as well as serious illnesses and injuries. If this trend continues, healthcare has the potential to become a discretionary purchase as it gets too costly, meaning providers must do all that they can to make sure that affordable medical care is available. Healthcare organizations need to maintain their own fiscal health to deliver affordable, cutting edge, quality patient care. An automated workforce management solution that includes scheduling offers healthcare organizations timely and accurate information to assign the right people to the right position at the right time to deliver the highest level of patient care and support profitability goals. Healthcare organizations without automated solutions simply can’t make intelligent staffing decisions and continually run the risk of over- or understaffing acuity levels.

This paper examines technology-based workforce optimization and expense management automation and the opportunities and benefits they create to drive more productive management in a variety of healthcare organizations. It also reviews the enterprise computing applications that are available to help manage and support the varied and diverse healthcare environments.

Cost Effective Operations are Critical for Survival

Medical centers, sub-acute and long-term care facilities, teaching hospitals, service providers and companies dedicated to providing products and services in the healthcare industry share a common objective to drive clinical, administrative and technological excellence to improve the quality of life for the people they serve. World-class healthcare providers are acclaimed for their exceptional patient care and a differentiated clinical experience. Among all the healthcare disciplines, quality, excellence and innovation are hallmarks of the top providers in the industry. Aligning the workforce to meet and exceed patient expectations can help to differentiate one healthcare provider from its competition. To thrive in today’s competitive landscape – one that has seen the demise of many long standing healthcare providers - organizations are investing in sophisticated technology to help balance demands that include:
Enhancing the overall patient experience
Controlling labor and expense costs
Improving employee retention
Staffing to support acuity levels

Healthcare providers are looking to technology with a renewed focus, seeking opportunities to
address ever-changing medical needs and standards, comply with government regulations, control
labor costs, overcome increased competition and operate successfully and profitably. Automated
workforce and expense management solutions can help meet fluctuating healthcare demands at
the lowest cost without compromising high standards for patient care.

With a mission of delivering high-quality, cost-efficient healthcare through the efforts of its greatest asset – the workforce - healthcare providers need to be able to do more with fewer resources while remaining cost effective. That’s not an easy task. Healthcare demand is inherently difficult to accurately forecast and providers often grapple with excess staff on one day and not enough staff on another. Neither situation is ideal for maintaining quality care or operating cost effectively. Too often, healthcare providers do not fully recognize or utilize the skills and capabilities of their own workforces and there are significant advantages and savings inherent in having the right people with the right skills available at the right time and at the best possible cost.

World-class healthcare providers focus on innovation,
responsiveness, quality and cost effectively meeting patients’
needs. Often utilizing ‘best-of-breed’ specialty solutions for
delivering the most up-to-date and leading edge medical care,
healthcare providers know that they need to leverage technology in
all areas of their operation to remain viable. The technology they
employ is not limited to only treatment and care, but they look to
workforce and expense management solutions so that they can
operate at maximum efficiency and contain costs through tight
controls that enhance their operation as well.

Automated workforce and expense management solutions help organizations reduce payroll
preparation time, improve payroll accuracy by 1-6% of gross payroll1 and boost organizational
performance, productivity and profitability. Robust workforce and expense management solution
components consisting of time and attendance, expense management and employee scheduling
and optimization solutions that are 100% Web-based, fully integrated and scalable can help
healthcare organizations meet ongoing business challenges such as:
 Managing a diverse and distributed workforce comprised of salaried, hourly and contingent
staff
 Better overtime control with reduced payroll inaccuracies
 Productivity gains through effective and efficient employee scheduling
 Systems integration to ERP, work order and payroll
 Addressing pay, work, accrual and union rules while complying with regulatory
requirements
 Compliance with FMLA, FLSA and other Federal and state regulations
 Increasing efficiency and modernizing workforce management processes to meet the
needs of a diverse end-user community

Take Control Where It Matters Most

Controlling costs and efficiently deploying a large, diverse workforce depends on an organization's ability to effectively schedule their staff, control and track time and attendance, eliminate payroll inaccuracies and integrate with existing applications. Healthcare organizations realize the value of workforce and expense automation processes in several vital areas of their operations.

1. Reducing Operating Expenses by Controlling Labor and Expense Costs

Labor and expense costs make up the largest part of a healthcare provider’s operating budget.
Firms need to control and reduce costs to a manageable level that does not negatively impact
patient care and community services. To achieve better cost control, healthcare facilities with
integrated and automated workforce and expense management systems are able to:
 Track labor costs in a variety of configurations including across locations, patients, procedures,
cost centers, positions, departments and business units
 Staff to patient needs to minimize or eliminate potential overstaffing and coverage gaps
 Utilize an employee’s badge to make on-site purchases (such as in the hospital cafeteria or gift
shop) eliminating the need for a wallet or credit card for security and efficiency
 Address rate progressions, position step-ups/downs, departmental cross charging of labor
 Streamline compliance with HIPAA regulations, including insuring protection of privacy, data
security and auditability
 Support grants by tracking hours worked according to specific requirements
 Accumulate volunteer hours to monitor and recognize the contributions of the valuable service
they provide
 Provide labor distribution support – for example, when one employee works in two departments
during the same pay period, each department supervisor has the ability to approve respective
hours for their department and those hours are charged accordingly
 Track agency personnel time, costs and movements according to need and budget
requirements to assess agency vs. staff personnel assignments – whether analyzing a week, a
month or a year’s worth of activity to make better business and budget decisions
 Prompt supervisors as they report to work and clock in to review “open punches” that need
attention and correction on a daily basis so that accurate time punches are uploaded every day
 Automate the entire expense reporting cycle from report creation and workflow approval
through audit and reimbursement

2. Improving Accountability and Compliance

The regulatory environment continues to pose demands and challenges on healthcare providers. Recordkeeping requirements have always been a critical component of day-to-day operations and are even more pertinent today. The documentation and recordkeeping requirements of increased regulation need to be managed efficiently and effectively to minimize the impact on face time with the patient. Non-compliance has dramatic financial, legal and public consequences for healthcare organizations and compliance with external and internal regulations is critical. Providers can best meet regulatory demands through automation of the following:

 Standardize and automate workforce management processes across each department,
location or operating entity
 Support union contracts and complex business processes to manage all workforce rules
including pay, work and union rules, scheduling, accruals and others
 Support state mandated acuity levels to schedule staff based upon skills, need and state
requirements whereby the patient-to-healthcare professional ratio is met according to the
number of patients and their relative acuity levels
 Give working supervisors the ability to edit and approve time punches
 Support of best-in-class quality initiatives by measuring time, attendance and scheduling
performance while reducing payroll inaccuracies and standardizing scheduling across
operating units
 Expense management that goes beyond travel and entertainment, to process all employee
expenses, deliver greater control over costs, and improve compliance and increased visibility
into operations through data capture, reporting, validation and documentation
 Real-time integration with ERP and other healthcare management systems

3. Improving Employee Satisfaction, Retention and Patient Care

Training and acclimating staff is an ongoing cost for healthcare providers. A lot of time, effort and expense are devoted to ensuring that the workforce is properly trained in all aspects of the organization’s operation – from how to handle a hazardous spill to how to work specialized equipment to evacuating the building if needed. To minimize staff turnover, healthcare organizations seek to create collegial relationships with their employees that lead to engaged and mutually satisfying employment. This approach reduces the costs associated with constantly processing and training new hires. It also adds to the quality of patient care as employees who have been properly trained gain continued confidence through their experience and are committed to their jobs and their organization. As a result, they are more likely to deliver exceptional patient care.
 Empower the entire workforce with intuitive online access to schedules, paid time benefits and
other self-service functions
 Multi-lingual support for diverse healthcare and patient populations
 Provide the ability to capture new hire information at the time input device to minimize
processing time for new hires
 Schedule ‘non productive’ but essential time when staff is available to take required classes to
fulfill a certificate or professional credential requirement Consistently ensure the proper mix/number of staffing levels to provide patients and/or
members with the highest quality healthcare, healthcare services and innovative programs
 Manage staffing models and assignments in line with emergency response plans
 Easy user interaction to keep things simple for all employees encouraging rapid adoption
 Managers can make better decisions to address patient needs from pre-admission, hospital
stay and recovery as well as customer relationship management with practitioners, payers,
providers and suppliers
 Increase patient “face time”, i.e., time spent delivering value and service to patients by reducing
time spent on administrative tasks
 Achieve staffing and scheduling efficiencies to reduce/eliminate patient/member wait time or
product/service delivery time
 Enable managers to focus on the needs of employees and make better management decisions
 Better align schedules with employee work/life preferences
 Maintain consistent weekly and shift schedules as best as possible

4. Scheduling Appropriately Skilled Resources at the Right Time and Place

The ability to operate more efficiently includes the need to be flexible and responsive as demands
fluctuate. To be able to respond in a crisis or emergency situation healthcare providers often need
to change staffing and scheduling requirements at a moment’s notice. Manual or semi-automated
workforce systems do not offer the real-time responsiveness needed and can cause more than lost
income. Healthcare providers can meet their staffing requirements by using fully automated
systems to:
 Streamline operations through automated scheduling based upon budget and need
 Meet patient load demands while balancing cost control and efficiency
 Deploy the right mix of people on fixed or rotating schedules to respond to patient care
 Monitor security and access control to sensitive or secure areas such as a nursery or pharmacy
 Staff to patient needs to avoid arbitrary, reactionary, across-the-board workforce reductions
 Control department, location, patient, business unit or position-specific scheduling variations by
providing best practice templates reflecting the most efficient staffing models
 Eliminate or minimize the need for agency staffing while reducing overtime
 Automate the entire expense reporting process
 Eliminate potential overstaffing issues and coverage gaps by creating optimal schedules
 Increase employee productivity with incremental gains in scheduling efficiencies across
medical centers, departments or business units for a positive impact on the bottom line
 Focus on leveraging real-time information for better management decisions
 Control scheduling variations with 'best practice' templates that reflect efficient staffing models
 Find the right substitute at the best cost when managing unexpected absences
 Provide support for overtime equalization by assigning the lowest cost resource

Improving Payroll and Human Resource Processes

Payroll and Human Resource departments play a large role in defining both workforce and
expense management processes in healthcare organizations. Typical workforce transactions, such
as clocking in and out, onboarding new hires, requesting vacation time, or submitting expense
reports are touched by payroll and HR as well as by the employee’s department manager.
Automating functions through time capture devices can significantly improve the productivity of
payroll and HR functions plus eliminate many errors often produced by increased data handling
and manual entry. With accurate data capture a critical need, looking to maximize the input and
output capabilities of time entry devices is a cost effective strategy providing that processes are
user friendly and include necessary multi-lingual options.

Healthcare organizations should look for workforce and expense management solutions that can
provide, at minimum, the following functionality:
 Provide working supervisors with the ability to edit and approve time punches by prompting
them as they report to work and clock in to review “open punches” that need attention and
correction on a daily basis so that accurate data is uploaded every day
 Labor distribution support – for example, one employee working in two departments during the
same pay period
 The ability to ask employees questions, such as “Did you have an accident-free day?” and get
responses directly at the time capture device
 Printing of American Payroll Association (APA) approved timecards
 Elimination of the need to print and distribute checks. Time capture devices need to be able to
accept payroll data after each payroll is run so that employees can obtain pay stub information
at the device
 Expense report reimbursement check information available through time capture device

Making the Second Largest Expense a Top Priority

Employee business expenses are regarded as the second largest controllable expense after labor costs. Expense Management Automation (EMA) solutions are increasingly recognized as essential components in a business strategy that focuses on controlling costs, increasing employee satisfaction and improving bottom line performance. Employee expenses are no longer limited to travel and entertainment costs paid by the employee and reimbursed by the company. The spectrum includes expenses and payment options from the entire range of employee discretionary expenses including office supplies, mobile phones, meetings, MRO, p-cards, corporate payment cards, fleet cards, direct vendor billing and more.

With a growing number of mobile workers and workers that need to be in communication through
smartphones or other hand held devices, rising costs of travel, tighter government regulations and
uncertain economic conditions, healthcare providers and other businesses have come to realize
that enterprise-wide technology solutions are no longer luxuries but necessities. Optimization of
administrative and back office processes associated with employee expenses has taken on a new
urgency as firms realize the need to better manage and control escalating employee business
costs. Visionary healthcare organizations rely on user-friendly, intuitive, best-of-breed technology
solutions that deliver bottom line results along with a rapid return on investment (ROI).

An Expense Management Automation solution provides the power to attack the high cost of
expense processing at its source: the “point of spend.” These solutions allow automation of the
entire expense reporting cycle from pre-trip authorization, expense report pre-population, and
workflow approval and report creation through to travel booking integration, audit, reimbursement,
receipts management and post-payment reporting and analysis. EMA solutions handle every
aspect of employee business expense processing and increase efficiencies when integrated with
back end General Ledger systems.

The Challenges of Mobility

Within a healthcare organization’s workforce, there are “untethered” segments that are by nature
mobile, i.e., spending more time outside of the facility than in it. These segments include
physicians, technicians, administrative and managerial positions and nurses that often cover more
than one facility. Healthcare providers today are facing increased requirements and challenges to
enable and empower this expanding “untethered” workforce. These challenges go beyond
delivering Internet or email access to mobile workers to providing select, critical business
applications in a consistent, secure and robust deployment. The goal of these efforts is to bring the
enterprise applications to mobile workers wherever they are rather than forcing the mobile workers
to the enterprise applications.

Mobile employees have the same pressures as on-site employees to comply with existing corporate policies, approvals and business processes. Mobile employees need to have secure access to enterprise-class applications in real-time to perform productively and effectively, while adhering to corporate policies and standards. Whether it is a physician that juggles time between a hospital and his practice office, a day trip for a head nurse attending a conference or an equipment service technician working between two facilities to keep equipment in top operating condition, best-in-class solutions offer support for time capture, employee self-service, labor distribution, expense reporting and management approvals to address the needs of the growing mobile workforce.

Match Labor Supply with Patient and Demands

Without a system in place, the tasks of staffing, managing absence replacements and responding
to fluctuating demands are laborious and can be unproductive. Visibility into resource availability is
limited and without a dashboard view of the current, available workforce, providers may not know
or realize if they’re paying for unnecessary overtime or scheduling employees to work hours
beyond what is considered safe or within contractual guidelines.

With an automated workforce management system in place, employers benefit from the ability to
track key performance indicators (KPIs) that provide real-time data visibility as it relates to staffing
and expenses allowing for the most productive and cost effective staffing. Organizations can
optimize schedules based on need and patient demand, and as a result, realize an increase in
productivity, while enhancing operations and ensuring the right resources with the right skills are
available when and where they are needed.

Scheduling software delivers real-time information that enables organizations to allocate staff
according to relevant metrics, such as placing nursing staff in certain areas, locations or in
departments to accomplish the tasks or services that generate better bottom-line results.
If a hospital knows that there are a dozen women expected to give birth between Friday morning
and Sunday evening, from the maternity department manager’s perspective, he/she needs to
identify doctors, delivery and baby care nurses and other support staff who have the right skill sets
to meet this demand. The manager also needs to determine who is already scheduled to work as
opposed to scheduling others whose Saturday hours may result in time and a half or double time.
By utilizing a software solution for this type of scheduling situation, managers and department
heads can easily gauge their resource availability, consider the costs of the skill sets they need
and ensure that patient needs are met cost effectively.

Once the organization has access to a dashboard view of the workforce and insight into the skill
sets of the available staff, managers are able to maximize staffing decisions. This enterprise-level
visibility ensures better alignment with contract requirements, worker certifications and skills and
shifts schedules to meet forecasted demand, further enabling companies to provide quality patient
care on a cost efficient basis.

A workforce management solution with scheduling optimization also eliminates errors that result
from time-consuming manual processes and should include data entry options such as Biometric
Devices that support Wireless GPRS, Cordless, 56K Modem, LAN, etc. These data entry devices
can also include the ability to ask questions, such as “Did you have an accident free workday?”
and receive replies directly at the device.

Many healthcare organizations are looking to eliminate shipping, printing and distributing of payroll
check stubs and look to their time entry devices to be able to print American Payroll Association
approved timecards. A system that can send a payroll gross-to-net file after each payroll so that
employees can obtain pay stubs directly at the device significantly reduces time, effort and cost
and speeds ROI.

Along with increased accuracy from electronic data entry, a workforce scheduling solution ensures
time and attendance entries are correct, reduces time theft (resulting from extended breaks, tardy
arrivals and early departures) and “buddy punching” (when one employee “clocks in” for another),
while enforcing adherence to business rules and facilitating compliance with government
regulations, as well as with internal policies and union requirements. Since these rules drive
accruals, paid time off, time accrued towards participation in retirement programs and leave
management, having them properly tracked and validated can result in greater accuracy of benefits
accruals and lower payroll costs.

Maximizing Service and Productivity

Any system that requires extensive training or takes too long to deploy
is not a 'best practice' solution. Successful Workforce and Expense
Management solutions should foster rapid adoption through ease-ofuse
along with offering a positive user experience. In addition, a rapid
Return on Investment (ROI) along with demonstrating value over the life
of the system are key factors to look for in selecting the best-fit
workforce and expense management systems for the organization.

Select a provider that can work with the organization to develop the
most cost effective implementation plan to maximize ROI, minimize
TCO (Total Cost of Ownership) and exceed business objectives.
Enterprise-class solutions give healthcare providers the ability to accurately manage schedules
and time and attendance for all employees and contingent workers to effectively staff peak periods
and special scheduling situations, ensuring improved patient satisfaction and increased operational
efficiencies.

In addition, solutions for complex, mid- to large-tier healthcare organizations that include large
clinics, hospitals, research facilities, and rehabilitation centers need to streamline operations,
increase responsiveness and agility and reduce payroll costs. Regardless of the size of the
workforce and the number of departments, locations or business units involved, workforce and
expense management solutions will help to improve operational performance and productivity
while dramatically increasing employee productivity and satisfaction and enhancing the patient
care experience.

When choosing a solution, healthcare organizations need to look for applications that meet their cost requirements. The flexibility of either an in-house license fee model or the popular Software-as-a-Service (SaaS) On-Demand delivery model which speeds the implementation process at a more affordable price should be available. Having this flexibility ensures the solution will continue to meet operational needs going forward.

As competition for healthcare dollars intensifies, providers are turning to technology to improve
operational processes whenever and wherever possible. Data heavy manual or semi-automated
time keeping, scheduling and expense report processing practices are often prone to error and do
not provide the flexibility to address the responsiveness that a healthcare provider needs to remain
competitive. Increased responsiveness, enhanced mobility and self-service and workflow
capabilities are technology initiatives available today that can contribute to enhanced patient care,
greater operational efficiencies and control of labor costs for healthcare organizations.

About CyberShift, Inc.

CyberShift, Inc. is a leading provider of workforce and expense management software and
services focused on helping mid-sized to large, complex organizations improve organizational
performance and profitability. Through its integrated CyberShift Workforce™ suite, which includes
time and attendance, advanced scheduling and reporting and analytics, companies can more
effectively plan, manage and deploy their workforces, reduce costs and improve processes across
business operations. CyberShift Expense™ automates the processing and facilitates the
management of employee business expenses such as travel and entertainment and helps
companies improve compliance, enforce expense policies and procedures and increase visibility
into operations. Offered in both traditional license fee and Software-as-a-Service (SaaS) delivery
models, CyberShift’s innovative solutions have been awarded U.S. and Canadian patents.
CyberShift is the first enterprise-class workforce and expense management solution provider to
enable support for the BlackBerry platform.