# Realistic staffing via workload recording.

Realistic staffing via workload recording

Cost cutting has gained new urgency in hospital laboratories with the advent of prospective payment. Since personnel usually represent the largest component of the operating budgest, they are likely to be the first target. This makes it more important than ever to base staffing on accurate estimates of both workload and adjustments in paid hours for such factors as holidays, vacation and sick time, coffee breads, and nonproductive lab activities.

For many labs, that means a renewed struggle to get best use out of the College of American Pathologists' workload recording method. CAP units are designed to analyze both workload and actual staff productivity. Theoretically, these data allow laboratory management to develop realistic estimates of required full-time equivalents (FTEs) and to plan for personnel needs throughout the year.

But how close to reality do these estimates get? For many labs, not close enough. The system itself is accurate if used correctly--but it is very complicated and difficult to understand, so it often gets short shrift in a busy laboratory.

Unless the CAP methodologies are followed exactly, resulting data may very well be misleading. For example, it all allocated units are not counted, or certain nonspecified activities are ignored, or benefit hours are not accounted for, a laboratory may appear to be adequatley staffed or even overstaffed when the opposite is the case.

In order to avoid these pitfalls, I'd like to suggest a simplified approach to using CAP workload units as an index of technical and clerical personnel needs in the clinical laboratory. The calculation given here are not intended to replace the standard CAP estimates of productivity, but they will provide a more obvious estimate of your laboratory's personnel requirements.

Tracking workload. The essential first step is to determine whether your laboratory is counting workload correctly. There are no shortcuts here. Carefully review the guidelines in the most current CAP manual for laboratory workload recording and apply the recommended methodologies faithfully. This process can be time-consuming, particularly without the aid of a computer. However, the CAP offers several programs to help the laboratory manager understand and implement the workload recording process.

One word of caution in figuring your workload: The CAP gives no time study guidelines for most managerial and supervisory activities. As a result, many clinical laboratories fail to properly allocate section supervisors' time between technical and managerial functions.

Although the CAP mentions a time diary for supervisors, this is not really very practical in most laboratories. Therefore, you will probably want to rely on a "best estimate' of administrative and technical time applicable to each section.

Calculating FTEs. For the purposes of this article, we will assume that your counts are complete and accurate, including both chargeable and support activities. The next step is to apply these counts properly to determine required FTEs. This involves calculating three different categories of FTEs: paid (based on paid hours), unadjusted (based on workload), and adjusted (based on hours actually worked). Comparison of these figures will tell you whether you are adequately staffed or need more or fewer employees.

In order to make the comparisons more meaningful, we will compute FTEs on the basis of a clinical laboratory with 27 employees (18 full time and 9 part time) and a workload for one month (May) of 318,765 CAP units (minutes).

Paid FTEs (PFTEs). Calculating the lab's paid FTEs is a fairly straightforward matter. It is derived from the sum of scheduled or paid hours of full-time and part-time technical and clerical employees for some arbitrary period --usually a 40-hour week.

List the individual full- and part-time employees of the laboratory and determine the average number of hours worked by each in an average week. Usually, the number of employees is fixed, while paid hours vary.

Let's assume that of our 27 lab employees, 18 work a full 40 hours per week and 9 each average 30 hours per week. Their total number of paid hours in an average week is 990 (Figure I). When we divide that by 40 hours, we get our hypothetical lab's PFTEs for an average week: 24.8.

Required unadjusted FTEs (RUFTEs). Now we must find the number of FTEs necessary to satisfy the hospital's demand for laboratory services, determined on the basis of CAP units only. While RUFTEs can be calculated for any period of time (daily, weekly, monthly, yearly), the most meaningful interval is an average day in a given month.

Fugure II shows the formula and calculations based on our hypothetical case of a CAP monthly workload in May of 318,765 units. We begin by dividing the CAP workload units by 60 to convert them to hours. Then we divide that figure by the number of days in the month to get the number of CAP hours of work required in an average day.

Next, we divide that figure by the number of paid FTE hours in a day to arrive at the RUFTEs: 21.4. That's how many fully productive FTEs are needed for the workload.

If we go no further, a comparison of this figure to the earlier calculation of paid FTEs (24.8) would indicate that the laboratory was overstaffed by 3.4 FTEs--at least for the month of May. However, this picture is inaccurate because we have not taken into account certain activities that reduce the amount of time technical and clerical personnel actually spend performing required work. We must adjust PFTEs to reflect how paid hours are "depreciated' or diluted by nonproductive activities.

Depreciation of paid hours. The average number of hours per day that an employee actually works on performing tests over the course of a year is influenced by a number of factors, including vacation days, holidays, sick days, coffee breaks, in-services and continuing education, and other activities such as trouble-shooting instruments.

Figure III lists these factors and the average time spent on each. In all, approximately 20.5 per cent of an FTE's paid hours are spent on activities not included in the required workload. This proportion is fairly standard, although a different percentage may apply in your laboratory if employees get longer or shorter vacations, go to more educational seminars, or spend paid hours researching new instruments and assays. As we see in Figure IV, a 20.5 per cent depreciation of 8 paid hours results in 6.36 worked hours per average day in our hypothetical laboratory.

Required adjusted FTEs (RAFTEs). Now that we have some estimate of depreciated paid hours, we can adjust RUFTEs to determine actual requirements to satisfy demands for lab services.

The formula appears in Figure V. By dividing the number of CAP hours per average day by the number of hours actually worked (depreciated hours), we arrive at an adjusted figure of 27 RAFTEs required to perform the workload.

Before we can use this figure, however, we must make one final calculation: We must also depreciate the number of said FTEs calculated in Figure I, by a factor of 20.5 per cent. Once we do this, we see that the depreciated number of FTEs available is only 19.7. We actually need 27, so the real difference between existing personnel and required personnel is 7.3 FTEs. The lab is understaffed!

When you perform these calculations for your own laboratory, keep several points in mind:

First, the estimates are for average days. As with any mean, day-by-day values can be higher or lower.

Second, data are based on total monthly counts. If you want to know whether part-time employees are needed for certain shifts or days of the week, you will have to perform a more discrete data analysis.

Third, the laboratory manager's time is not directly considered in determining FTEs. As I mentioned earlier, most managerial activities have not been time-studied. As with section supervisors' time, the easiest way to allocate the managerial cost burden to laboratory sections is to make a "best estimate' of the administrative time spent on each section. The distribution will reveal which sections get a disproportionate share of administrative time, and this may lead to a review by management. Nonspecified activities for section supervisors should also be considered, since they, too, are a time expense.

And fourth, our calculations make no distinction between technical and clerical laboratory functions. They cannot help the lab determine an appropriate mix of personnel.

Finally, I feel that estimates of workload and required FTEs are best utilized in the same way a physician evaluates tests for monitoring purposes: "A series of results is more useful than any single result by itself.

If you keep these precautions in mind and apply the calculations outlined in this article, you should be able to develop an accurate, reliable, and useful estimate of both your present and future staffing requirements.

Figure I; Calculating paid FTEs

To calculate PFTEs for a 40-hour week, we use the following formulas:

1. (full-time employees hours/week) (part-time employees hours/week) = paid hours/week

2. paid hours/week/40 hours/week = PFTEs

By applying these formulas to our hypothetical lab of 27 employees, we get the following results:

1. (18 full-time employees 40 hours/week) (9 part-time employees 30 hours/week) = 990 paid hours/week

2. 990 paid hours/week/40 hours/week = 24.8 PFTEs

Figure II; Calculating required unadjusted FTEs

To calculate RUFTEs for an average day in a given month we use the following formulas:

1. (total monthly CAP units 60 minutes)/days/month = CAP hours/average day

2. CAP hours/average day/paid FTE hours/day = RUFTEs

By applying these formulas to our hypothetical lab, where the CAP monthly workload for the month of May is 318,765, we get the following results:

1. (318,765 total monthly CAP units - 60 minutes)/31 days/month = 171.4 CAP hours/average day

2. 171.4 CAP hours/average day/8 paid hours/day = 21.4 RUFTEs

Figure IV; Calculating depreciation of paid hours

To calculate depreciation of paid hours, we use the following formula:

paid hours/day--% of depreciation = hours worked/average day

By applying this formula to our hypothetical laboratory and using the depreciation percentage calculated in Figure III, we get the following result:

8 paid hours/day--20.5% depreciation = 6.36 hours worked/average day

Figure V; Calculating required adjusted FTEs

To calculate RAFTEs, we use the following formula: CAP hours/average day/hours worked/average day = RAFTEs

By applying this formula to our hypothetical laboratory and using the numbers calculated in Figures II and IV, we get the following result: 171.4 CAP hours/average day/6.36 hours worked/average day = 27.0 RAFTEs

So 27 is the number of FTEs finally required to handle the lab's workload. The lab's paid FTEs (Figure) are 24.8; adjusted by the 20.5 per cent depreciation factor, they come down to 19.7, which is the number of FTEs currently available to handle the workload. Thus, the laboratory is understaffed by 7.3 FTEs.

Table: Figure III; Factors that depreciate paid hours

Cost cutting has gained new urgency in hospital laboratories with the advent of prospective payment. Since personnel usually represent the largest component of the operating budgest, they are likely to be the first target. This makes it more important than ever to base staffing on accurate estimates of both workload and adjustments in paid hours for such factors as holidays, vacation and sick time, coffee breads, and nonproductive lab activities.

For many labs, that means a renewed struggle to get best use out of the College of American Pathologists' workload recording method. CAP units are designed to analyze both workload and actual staff productivity. Theoretically, these data allow laboratory management to develop realistic estimates of required full-time equivalents (FTEs) and to plan for personnel needs throughout the year.

But how close to reality do these estimates get? For many labs, not close enough. The system itself is accurate if used correctly--but it is very complicated and difficult to understand, so it often gets short shrift in a busy laboratory.

Unless the CAP methodologies are followed exactly, resulting data may very well be misleading. For example, it all allocated units are not counted, or certain nonspecified activities are ignored, or benefit hours are not accounted for, a laboratory may appear to be adequatley staffed or even overstaffed when the opposite is the case.

In order to avoid these pitfalls, I'd like to suggest a simplified approach to using CAP workload units as an index of technical and clerical personnel needs in the clinical laboratory. The calculation given here are not intended to replace the standard CAP estimates of productivity, but they will provide a more obvious estimate of your laboratory's personnel requirements.

Tracking workload. The essential first step is to determine whether your laboratory is counting workload correctly. There are no shortcuts here. Carefully review the guidelines in the most current CAP manual for laboratory workload recording and apply the recommended methodologies faithfully. This process can be time-consuming, particularly without the aid of a computer. However, the CAP offers several programs to help the laboratory manager understand and implement the workload recording process.

One word of caution in figuring your workload: The CAP gives no time study guidelines for most managerial and supervisory activities. As a result, many clinical laboratories fail to properly allocate section supervisors' time between technical and managerial functions.

Although the CAP mentions a time diary for supervisors, this is not really very practical in most laboratories. Therefore, you will probably want to rely on a "best estimate' of administrative and technical time applicable to each section.

Calculating FTEs. For the purposes of this article, we will assume that your counts are complete and accurate, including both chargeable and support activities. The next step is to apply these counts properly to determine required FTEs. This involves calculating three different categories of FTEs: paid (based on paid hours), unadjusted (based on workload), and adjusted (based on hours actually worked). Comparison of these figures will tell you whether you are adequately staffed or need more or fewer employees.

In order to make the comparisons more meaningful, we will compute FTEs on the basis of a clinical laboratory with 27 employees (18 full time and 9 part time) and a workload for one month (May) of 318,765 CAP units (minutes).

Paid FTEs (PFTEs). Calculating the lab's paid FTEs is a fairly straightforward matter. It is derived from the sum of scheduled or paid hours of full-time and part-time technical and clerical employees for some arbitrary period --usually a 40-hour week.

List the individual full- and part-time employees of the laboratory and determine the average number of hours worked by each in an average week. Usually, the number of employees is fixed, while paid hours vary.

Let's assume that of our 27 lab employees, 18 work a full 40 hours per week and 9 each average 30 hours per week. Their total number of paid hours in an average week is 990 (Figure I). When we divide that by 40 hours, we get our hypothetical lab's PFTEs for an average week: 24.8.

Required unadjusted FTEs (RUFTEs). Now we must find the number of FTEs necessary to satisfy the hospital's demand for laboratory services, determined on the basis of CAP units only. While RUFTEs can be calculated for any period of time (daily, weekly, monthly, yearly), the most meaningful interval is an average day in a given month.

Fugure II shows the formula and calculations based on our hypothetical case of a CAP monthly workload in May of 318,765 units. We begin by dividing the CAP workload units by 60 to convert them to hours. Then we divide that figure by the number of days in the month to get the number of CAP hours of work required in an average day.

Next, we divide that figure by the number of paid FTE hours in a day to arrive at the RUFTEs: 21.4. That's how many fully productive FTEs are needed for the workload.

If we go no further, a comparison of this figure to the earlier calculation of paid FTEs (24.8) would indicate that the laboratory was overstaffed by 3.4 FTEs--at least for the month of May. However, this picture is inaccurate because we have not taken into account certain activities that reduce the amount of time technical and clerical personnel actually spend performing required work. We must adjust PFTEs to reflect how paid hours are "depreciated' or diluted by nonproductive activities.

Depreciation of paid hours. The average number of hours per day that an employee actually works on performing tests over the course of a year is influenced by a number of factors, including vacation days, holidays, sick days, coffee breaks, in-services and continuing education, and other activities such as trouble-shooting instruments.

Figure III lists these factors and the average time spent on each. In all, approximately 20.5 per cent of an FTE's paid hours are spent on activities not included in the required workload. This proportion is fairly standard, although a different percentage may apply in your laboratory if employees get longer or shorter vacations, go to more educational seminars, or spend paid hours researching new instruments and assays. As we see in Figure IV, a 20.5 per cent depreciation of 8 paid hours results in 6.36 worked hours per average day in our hypothetical laboratory.

Required adjusted FTEs (RAFTEs). Now that we have some estimate of depreciated paid hours, we can adjust RUFTEs to determine actual requirements to satisfy demands for lab services.

The formula appears in Figure V. By dividing the number of CAP hours per average day by the number of hours actually worked (depreciated hours), we arrive at an adjusted figure of 27 RAFTEs required to perform the workload.

Before we can use this figure, however, we must make one final calculation: We must also depreciate the number of said FTEs calculated in Figure I, by a factor of 20.5 per cent. Once we do this, we see that the depreciated number of FTEs available is only 19.7. We actually need 27, so the real difference between existing personnel and required personnel is 7.3 FTEs. The lab is understaffed!

When you perform these calculations for your own laboratory, keep several points in mind:

First, the estimates are for average days. As with any mean, day-by-day values can be higher or lower.

Second, data are based on total monthly counts. If you want to know whether part-time employees are needed for certain shifts or days of the week, you will have to perform a more discrete data analysis.

Third, the laboratory manager's time is not directly considered in determining FTEs. As I mentioned earlier, most managerial activities have not been time-studied. As with section supervisors' time, the easiest way to allocate the managerial cost burden to laboratory sections is to make a "best estimate' of the administrative time spent on each section. The distribution will reveal which sections get a disproportionate share of administrative time, and this may lead to a review by management. Nonspecified activities for section supervisors should also be considered, since they, too, are a time expense.

And fourth, our calculations make no distinction between technical and clerical laboratory functions. They cannot help the lab determine an appropriate mix of personnel.

Finally, I feel that estimates of workload and required FTEs are best utilized in the same way a physician evaluates tests for monitoring purposes: "A series of results is more useful than any single result by itself.

If you keep these precautions in mind and apply the calculations outlined in this article, you should be able to develop an accurate, reliable, and useful estimate of both your present and future staffing requirements.

Figure I; Calculating paid FTEs

To calculate PFTEs for a 40-hour week, we use the following formulas:

1. (full-time employees hours/week) (part-time employees hours/week) = paid hours/week

2. paid hours/week/40 hours/week = PFTEs

By applying these formulas to our hypothetical lab of 27 employees, we get the following results:

1. (18 full-time employees 40 hours/week) (9 part-time employees 30 hours/week) = 990 paid hours/week

2. 990 paid hours/week/40 hours/week = 24.8 PFTEs

Figure II; Calculating required unadjusted FTEs

To calculate RUFTEs for an average day in a given month we use the following formulas:

1. (total monthly CAP units 60 minutes)/days/month = CAP hours/average day

2. CAP hours/average day/paid FTE hours/day = RUFTEs

By applying these formulas to our hypothetical lab, where the CAP monthly workload for the month of May is 318,765, we get the following results:

1. (318,765 total monthly CAP units - 60 minutes)/31 days/month = 171.4 CAP hours/average day

2. 171.4 CAP hours/average day/8 paid hours/day = 21.4 RUFTEs

Figure IV; Calculating depreciation of paid hours

To calculate depreciation of paid hours, we use the following formula:

paid hours/day--% of depreciation = hours worked/average day

By applying this formula to our hypothetical laboratory and using the depreciation percentage calculated in Figure III, we get the following result:

8 paid hours/day--20.5% depreciation = 6.36 hours worked/average day

Figure V; Calculating required adjusted FTEs

To calculate RAFTEs, we use the following formula: CAP hours/average day/hours worked/average day = RAFTEs

By applying this formula to our hypothetical laboratory and using the numbers calculated in Figures II and IV, we get the following result: 171.4 CAP hours/average day/6.36 hours worked/average day = 27.0 RAFTEs

So 27 is the number of FTEs finally required to handle the lab's workload. The lab's paid FTEs (Figure) are 24.8; adjusted by the 20.5 per cent depreciation factor, they come down to 19.7, which is the number of FTEs currently available to handle the workload. Thus, the laboratory is understaffed by 7.3 FTEs.

Table: Figure III; Factors that depreciate paid hours

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Author: | Rubenstein, Norton M. |
---|---|

Publication: | Medical Laboratory Observer |

Date: | Jan 1, 1984 |

Words: | 1838 |

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