Position Justification Template Attach completed form to HR Position Management request

Section A: Position Information

Requestor: Alisha Kreider & Val Adams Date: 8/7/2014

Department: Supplemental Staff Cost Center: 3575

Position Job Title: PtCA FTE:

Salary Mid-Point: 13.21 Start date: Status: X Regular Casual

Entity: X LGH/WBH/Amb. LGMG The Heart Group Twin Rose

VP, SVP or EVP: Karen Oxler

X JD Attached Org Chart Attached

Benefit Realization Schedule (BRS) Attached (VMI only) Have you completed the business capital and planning process?

Yes XNo

Section B: Justification

Please categorize your new position request (check all that apply); avoid “Miscellaneous” when possible:

X Decrease OT/Agency Utilization EHR (Electronic Health/Medical Record) Expansion/Increase in Clinical Volumes Expansion/Increase in Non-clinical Volumes In-sourcing/out-sourcing Mission/Community New Services/Units X Physical Safety/Security

X Staffing Ratio Goals/Standards X VMI

Miscellaneous (explanation):

EXISTING SERVICES Data Thru:

FYTD Budget YTD Variance

from Budget (%) Prior YTD

Variance from PY (%)

Volumes * n/a

Gross Revenue / Charges * n/a

Total Non-Salary Expense

Total Salary Expense

Outsourcing Expense 0

FTEs

Overtime Hours

Above information is available from EPSI reports- hours are charged to the cost center in which the PtCA works.

* direct patient care areas only

Additional Justification

Please provide below any relevant information relative to the following items, if and as appropriate.

1. Clear explanation of the position and need. 2. Strategic fit and/or relationship to specific strategic initiatives. 3. Options considered other than filling position. Can the work be absorbed by existing staff? 4. Risks associated with not filling position. 5. Quantification of specific anticipated outcomes of filling position (e.g. $xx increase revenues, $xx decrease in expenses) 6. Internal, national or other benchmark data 7. Productivity metrics for position and trend data 8. Review of Span of Control Guidelines

o # Org Layers

Six (6) layers total from CEO/EVP to front-line associates

o % of Mgmt with 2 or less direct reports:

Less than 10% of associates in management roles should have fewer than 2 direct reports

o % of Mgmt at Director level or above:

Less than 20% of management team should be at or above the Director level. Accordingly, at least 80% of

the management team should be Manager or below

o Mgmt:Staff Ratio

Administrative support and non-clinical support functions should have a management span of control ratio ranging from 1:10 to 1:15 (FTEs)

Clinical / operational functions should have a management span of control ratio of 1:20 FTEs (1:40 headcount)

9. How are you funding this position? (ex: eliminating existing position, increased revenue from new services, elimination of outsourced services, etc)

1. PtCA positions are entry-level positions that are often used as a stepping-stone for advancement. These positions are heavily relied upon to assist in providing quality care to our patients. We continually struggle with the turnover of this position. PtCAs need to provide only a 2 week notice when resigning leaving a gap until positions can be posted, interviewed, hired, and on boarded. This timeline results in the nursing units not having the resources needed to efficiently provide patient care. The workload is absorbed by the remaining PtCAs working additional hours and possibly working overtime and professional nursing staff performing the tasks. This additional workload to the nurses decreases their productivity and often results in overtime from them staying late to complete their RN responsibilities that could not be completed during their scheduled hours. The nursing productivity committee completed a turnover analysis in collaboration with Human Resources. The turnover trend for those individuals leaving the organization continues to be around 20% or greater. This number does not include individuals who transfer to other positions within the organization or leave of absences that also impact patient care. Through this assessment, it has been identified that 10.0 FTEs of additional PtCA resources is needed to keep up with the current turnover levels and ensure a quality experience for patients.

2. This change has been identified as a supportive initiative for the nursing department to meet their VM financial target by decreasing contributing factors of incidental overtime of RN staff. The additional PtCAs will also help ensure that resources are available to meet the patient needs contributing to the organizational goal of patient satisfaction.

3. The additional workload will be absorbed by the RN staff. This will decrease RN productivity and increase costs.

4. Risks would include decreased patient satisfaction due to delay in meeting needs and negative financial impact on organization. Potential negative impact on nursing quality measures such as pressure ulcers and falls.

5. Improve patient satisfaction score related to needs being meet in a timely manner and improved staff satisfaction related to having enough staff to do their work.

6. According to the Advisory Board Company’s Staffing Benchmarks, organization’s that run a 1:4 or 5 RN:patient ratio should have .4 or.5 assistant per nurse. This is aligned with our staffing model of PtCA’s being a 1:9 PtCA:patient ratio.

7. Hours per patient day is the productivity measure that the nursing department utilizes to measure productivity for PtCA’s. We currently budget for 2.6HPPD on most units. FY14 averaged at least 10units per month being less than 2.6 indicating that the units ran with higher ratios than budgeted.

8. These are frontline staff positions. 4 organizational layers exist between them and Karen Oxler. This position will have no direct reports or management responsibilities.

9.These positions will be budget neutral. 4.3 RN FTE’s will be converted into a total of 10 PtCAs FTE’s.

Patient Care Assistant Profile

Details

Profile of the currently employed Patient Care Assistants, as of 8/9/2013

Profile of Patient Care Assistants that terminated in FY13

Under 1 year25%

1.0 to 3.026%

3.1 to 5.07%

5.1 to 7.014%

7.1 to 1011%

10.1 to 158%

15.1 to 20.03%

over 20.16%

Years of Service for Currently Employed Patient Care Assistants as of 8/1/2013

19 and under7%

20-2942%

30-3920%

40-4915%

50-5913%

60-693%

70 and over0.3%

Age of Patient Care Assistants as of 8/1/2013

Asian4%

Black9%

Hispanic12%

Native Hawaiian or Pacific Islander

0.3%

Two or More Races

3%White72%

Race of Patient Care Assistants as of 8/1/2013

Female86%

Male14%

Gender of Patient Care Assistants as of 8/1/2013

Under 1 year47%

1.0 to 3.027%

3.1 to 5.06%

5.1 to 7.010%

7.1 to 106%

10.1 to 152%

15.1 to 20.01%

over 20.11%

Terminations by Length of Service (in years) FY13

Involuntary14%

Voluntary86%

Terms by Type of Reason-FY13

19 and under4%

20-2961%

30-3916%

40-4912%

50-593%

60-694%

Terms by Age at Termination- FY13

Other Employment33%

Personal 28%

Moved18%

Education11%

Top 80% of Voluntary Reasons for Separation- FY13

Asian1% Black

7%

Hispanic12%

Two or more races2%

White78%

Terms by Race Code (FY13)

Female79%

Male21%

Terms by Gender- FY13

Summary

Majority of Patient Care Assistants Currently Employed

Length of Service 1-3 years

Age 20-29

Race White

Gender Female

Majority of Patient Care Assistants Terminated in FY13

Length of Service less than 1 year

Involuntary or Voluntary Voluntary

Reason for Leaving Other Employment/Personal

Age 20-29

Race White

Gender Female

Patient Care Assistants:

A Review and Analysis of Turnover

8/9/2013

Agenda

• Turnover data

• Transfer data

• Market data, practices, and trends

• Profile of Patient Care Assistants

• Summary of Findings

• Cost of Turnover

• Recommendations

Turnover data- Yearly Turnover of Patient Care Assistants

•Average headcount of employees in the Patient Care Assistant job

title is decreasing each year.

•In FY13 the Patient Care Assistants turnover was slightly lower

than the previous years.

90-Day Turnover

Patient Care Assistants have been among the top five positions with the

highest 90-Day Turnover for the past 3 fiscal years.

Terminations within 90-days of hire account for 13.8% of the total

terminations of employees in the Patient Care Assistant role for

FY13 and 17.6% of FY12.

Positions with highest turnover within the first year of service

Patient Care Assistants are also in the top four positions that have the highest

number of terminations within the first year of service.

Terminations within the first year of service account for 50.8% of the total

terminations of Patient Care Assistants in FY13 and 59.5 % in FY11.

Market data

•Data was collected from 6 salary surveys.

•The average of the 50th percentile of those surveys was $12.96.

•The mid-point of LG Health’s salary range is $12.96.

Local Organizations- hiring rates and ranges

•Pinnacle, Hershey, and Reading hire their staff based on their previous job

experience.

•Pinnacle and Reading have slightly higher salary ranges than LG Health, however,

both organizations sited this role as one with high turnover and that most of their

staff are within the first quartile of the salary range.

Profile of a Patient Care Assistant

The accompanying packet creates a profile of the Patient Care Assistants within the

LG Health organization that either terminated their employment with LG Health in

FY13 or are currently employed with LG Health. Below is a summary of the findings.

Summary of Findings

• The overall headcount of employees in the Patient Care Assistant job title is

decreasing each year.

• Turnover has been above or close to 20% for FY13 and FY12 and FY11.

• Turnover within the first 90 days of employment is 12-17% of total yearly turnover of

Patient Care Assistants.

• Turnover within the first year of employment is 28-50% of total yearly turnover for

Patient Care Assistants.

• Market data indicates that our salary range is in line with current market rates.

• Profiles of terminated Patient Care Assistants reveals that the highest turnover is

seen among white, females, aged 20-29, employed for less than one year.

Turnover Costs

Soft and Hard Costs include:

• Separation Processing

• Advertising and administrative time

• Reference checking and drug testing

• Interviewing time

• Orientation

• Co-worker burden

• Potential Overtime

• Learning curve productivity of new employee

• Lost productivity of departing employee and eventual vacancy

• Increased workload of employees – slower productivity

ASSUMPTIONS

• Turnover costs approximately 50% of the cost of the salary of the position.

• Having overfills and “ready employees” can reduce the cost of turnover by 50% by

minimizing learning curves, decreased productivity, and overtime.

Estimated Overfills and Potential Costs Avoidance

Example: Estimating using 22.3% Turnover Rate

Estimated Overfills and Potential Costs Avoidance

Example: Estimating using 15.0% Turnover Rate

Ideas and Considerations• Consider overfill strategy of 4-6 Patient Care Assistants

• Consider leveling (Patient Care Assistant I, Patient Care Assistant II). This option

would require a detailed examination of the various areas where Patient Care

Assistants are utilized. A methodology would be drafted in order to “rank” those

positions based on carefully chosen criteria.

Ideas Put Into Action in May 2013• LG Health has begun to hire based on experience rather than hiring every employee

at a set rate regardless of their previous experience within LG Health or elsewhere.

• The hiring rate, for non-experienced employees, was raised to $11.00 rather than

$10.50.