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How Demand Manager Calculates Staffing Levels

This topic describes how Demand Manager calculates target staffing. The calculations are the same whether the profile also uses Outcomes-Driven Acuity; the only variable is the number of acuity levels associated with the ADT Adjusted Hours per Patient Day (HPPD). Profiles with Demand Manager use only one acuity level; profiles with both Demand Manager and Outcomes-Driven Acuity use multiple acuity levels.

About Demand Manager

Demand Manager is a real-time demand-driven staffing methodology. It pinpoints the number of staff needed by skill (such as RN and UAP) and by time of day to help each patient achieve better health.

Each nursing unit provides the budgeted direct care hours per patient day by skill. This value represents the care hours (workload) delivered to an average patient on the unit. For example, a patient on the 6N MedSurg unit may need an average six hours of RN direct care and one hour of UAP care per day. In a day with three eight-hour shifts, translating six RN care hours per day into RN: patient ratios for staffing gives us a ratio of 1:4. This means a RN on this unit can care for four patients during each eight-hour shift.

Demand Manager also measures the care workload associated with patient admissions, transfers, and discharges (ADT) as they occur during shifts. Units can improve their scheduling and staffing if they have accurate data about workload associated with actual and projected ADT events. Each unit provides ADT data including how patients arrive (admit versus transfer in) and depart (discharge versus transfer out) and how much time caregivers by skill, on average, spend with each patient to complete the ADT process.

Demand Manager and ADT-Adjusted HPPD

Demand Manager subtracts the amount of care needed to manage patient ADT events from the direct care HPPD, then adds that time back in when the event actually occurs. This maintains a neutral budget with the result matching or being very close to the budgeted hours of direct care. Removing the impact of ADT events from HPPD gives us the ADT Adjusted HPPD. In order to keep the budget neutral, the budgeted direct care HPPD are very close or equal to the calculated HPPD. This is based on each unit’s budgeted census and staffing pattern.

Demand Manager calculates ADT Adjusted HPPD with the following data:

• Calculated HPPD for caregivers who deliver direct patient care and whose hours vary by volume. This typically includes RNs, LPN/LVNs, UAPs, and charge nurses who take a partial to full patient assignment. Calculated HPPD does not include health unit coordinators or unit secretaries unless at least part of their work time is dedicated to direct patient care for one or more patients.
• Budgeted Length of Stay (LOS) by unit
• The percentage of patients who are admitted to this unit versus the percentage transferred in from another inpatient unit
• The percentage of patients who are discharged from this unit versus the percentage transferred out to another inpatient unit
• Average time needed to admit a patient by skill and unit
• Average time needed to transfer a patient in and out by skill and unit
• Average time needed to discharge a patient by skill and unit

For accuracy, your organization’s registration application should be used to obtain the percentage of patients admitted, discharged, and transferred by profile over the past 6 to 12 months. You should review the ADT percent data in Staff Manager annually and use it to update the demand configuration.

Clinical leaders across similar units usually define the average ADT times by consensus. It is highly recommended that each organization provide these times, as they are influenced by many organization-specific factors.

When a profile’s ADT data is unavailable, Demand Manager uses the following standards:

Critical Care Units

Intermediate Care Units

Routine Care Units

Rehab Units

Variable HPPD Staffing Care Hours/Ratio

For each nursing unit, Demand Manager calculates a budget neutral caregiver to patient ratio by time of day for each skill. It does this using the budgeted daily census, the budgeted staffing pattern for direct patient caregivers, and the ADT-Adjusted HPPD

Demand Manager converts the nurse to patient ratio to hours per patient shift (HPPS) and then calculates the sum of hours. This ensures that the blended HPPD are close to ADT-Adjusted HPPD for the unit.

Sample Calculation of Target Staffing for Demand Manager

Assume a unit provides the following data:

• The Budgeted Census is 22.
• The Budgeted LOS is 3.88 days.
• The Calculated Direct HPPD is 8.00.

The ADT Percentages and Times would then display as in the following table.

The Staffing Pattern for direct caregivers at the budgeted census of 22 is:

The client provides the direct care staffing distribution for the budgeted census of 22 in any combination of periods for each day of the week.

Demand Manager calculates the ADT Impact using the following formula. The formula uses the SUMPRODUCT function, which multiplies groups of numbers together, then adds up the results.

SUMPRODUCT ((Admit time in hours ÷ LOS) * percent of patients admitted) + (Transfer in time in hours ÷ LOS) * percent of patients transferred in + (Discharge time ÷ LOS) * percent of patients discharged + (Transfer out time ÷ LOS) * % of patients transferred out))

All times are total ADT times (all skills) and expressed in hours.

Using the data above, this is:

SUMPRODUCT ((1.50 ÷ 3.88) * 0.37 + (1.08 ÷ 3.88) * 0.63 + (1.33 ÷ 3.88) * 0.75 + (1.08 ÷ 3.88) * 0.25) = 0.65

The Calculated Direct HPPD minus ADT Impact equals the ADT Adjusted HPPD (8.00 - 0.65 = 7.35).

The ADT Adjusted HPPD divided by the Calculated Direct HPPD equals the percent ADT Adjustment (7.35 ÷ 8.00=0.919).

Demand Manager converts the staffing distribution to ADT Adjusted Staffing by multiplying the direct staffing value by the percent ADT Adjustment of 0.919.

Staff Manager makes all Demand target calculations using the ADT Adjusted Staffing.

The ADT-Adjusted Staffing is converted to caregiver to patient ratios by dividing the budgeted census of 22.00 by the ADT Adjusted Staffing:

Staff Manager uses nurse to patient ratios to configure the minutes of care needed over time. Staffing ratios, by skill, are converted to the minutes of care required each hour. This is done by dividing the patient ratio value by the duration.

Examples: Simple RN/Patient Ratios Converted to Minutes of Care

Example: Calculating the Number of Caregivers Required for a Shift

Assume that the census at 0700 on Monday was 18 and that no ADT activity was recorded over the next 24 hours. This would result in a census of 18 at 0700 on Tuesday (that is, the same patients were still on the unit).

The target staffing for each ADT adjusted staffing variable would be as follows.

The following table outlines what the Target Staffing would be in hours per 8-hour shift by skill for a census of 18 with no patient turnover.

Impact of Patient Events: Other Patient Events

Demand Manager allows you to enter Other patient events in order to override or augment the workload generated by Demand to capture the target staffing more accurately. Other patient events can be used to generate the workload associated with a patient’s need for a care companion, caregivers that accompany a patient off the unit, and bedside procedures. Event duration by global skill may be specified for each patient; the caregiver to patient ratios are 1:1, 2:1, or 3:1.

• Target staffing for Other patient events replaces or adds-to the Demand-based target, by global skill, for the length of the event.
• Other patient event workload does not overlap the workload for ADT events for the same skill. If there is no ADT workload defined for the global skill, the other patient event workload continues for the duration of the ADT event.

Example 1

A patient has a 1:1 care companion event for global skill PCC (patient care companion) from 0800 -1000. The Other event for PCC is entered as an Add event. What is target nursing workload from 0700 to 1100 for this patient? Assume that there are no other events for the patient.

Target Staffing in Hours for 1 patient 7:00 to 11:00

Example 2

A patient has a 2:1 event for 2 RNs to accompany the patient off the unit from 0800 -1000. The Other event for RN is entered as a Replace event. What is target nursing workload from 0700 to 1100 for this patient? Assume that there are no other events for the patient.

Target Staffing in Hours for 1 patient 7:00 to 11:00

Demand Manager calculates Demand target staffing in real-time by patient each time an actual or projected event is processed throughout the length of the patient’s progress pattern. In addition, backdating an Other patient event or publishing a backdated configuration that includes a change, such as a change to ADT-adjusted HPPD or the staffing distribution, triggers Demand target staffing re-calculation for past dates.

Impact on Staffing Projections

Projected Demand Target staffing can be seen in the following views and reports.

• Housewide Staffing for Demand and Outcomes-Driven Acuity Report
• Daily Staffing Board for Demand and Outcomes-Driven Acuity
• Target/Schedule Analysis Report
• Enterprise Staffing page
• Target/Schedule page
• Patient Assignment view and edit pages
• Staff View graphs on the Admin Dashboard
• In Staff Manager Client, Schedule Editor (when staffing to Demand) and Daily Editor

Projected Target Staffing is calculated as follows for 36 hours from now (now being the current time, regardless of the report period selected).

1. Target Staffing includes current demand workload values adjusted for time of day and projected departure and discharge event workload as calculated by using the pattern end date as originally assigned or by using updated dates and times entered on the Administer Patient Pattern window (or updated through an alternate source solution) for each patient. Projected departure and discharge dates on the Administer Patient Pattern window must be kept up to date to ensure accurate target staffing calculations.
2. In reports and views that include direct care and non-direct care global skills, the application pulls target staffing calculated from the workload matrix, which is stored in Workload Planner. This forces the inclusion of non-direct care staff such as managers and clerical staff. Demand targets for demand-driven staff (such as the RNs and UAPs used in this example) or staff associated with an Other Patient event entered in Demand Manager replace the target staffing from Workload Planner. This approach produces an accurate staffing projection for the next 36 hours based on current patients, acuity, and expected departures. From a process perspective, the only data missing is the calculated impact of expected admissions and transfers in. When Demand Manager auto-pushes patterns forward, the projected dates on the Administer Patient Pattern window do not change and departure workload is not calculated. When running reports for past dates, the targets include workload for actual ADT events; the target only includes workload for events that actually occurred.

Beyond 36 hours from now, a 6-week historical average is used to calculate the Projected Demand Target. The average includes the actual demand workload and workload associated with actual admissions, discharges and transfers, but excludes the workload impact of Other patient events.

Summary of Calculations

Demand Manager calculates Target Demand Staffing for each skill in real-time as the unit census changes and as actual and projected patient activities increase or decrease. This means if the configuration changes, such as a change to ADT-Adjusted HPPD or time of day variability, Demand Manager updates the target staffing for all patients based on the effective date of the configuration. The application calculates and recalculates each patient’s future staffing needs each time it processes an event for the patient for the length of their assigned Progress Pattern.

The result is a Demand Management Staffing methodology that:

• Produces overall staffing levels that are budget neutral (the ADT events being added back in when they occur, neutralizing the fact that they were subtracted earlier).
• Recognizes the need for additional workload associated with patient activities while keeping the overall staffing budget neutral.

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