Overtime Reduction within a Multidisciplinary Ambulatory Cancer Center
A cancer center opened up in November 2013. A team of 37 team members across 8 departments work together to provide oncology patient care there.
Between September 1, 2014, and November 23, 2014, the cumulative overtime (OT) hours within the cancer center combined departments averaged 31 hours per week, which was above the goal of 10 hours per week which led to recurring budget variances.
Multidisciplinary oncology team members among all departments within the cancer center will reduce cumulative OT from an average of 31 hours per week to 10 hours per week by huddling to increase awareness of OT and generate additional time and cost-saving solutions by January 1, 2015:
- Frontline team members tracking OT transparently on all Level 1 huddle boards
- Frontline team members flexing time throughout the week in areas with variable daily patient censuses
- Identifying new staffing patterns in areas with high OT
- Adjusting all-team meeting times
- Identifying and correcting wasteful processes to reduce staff work time on non-value added work
Patient and Family Centeredness Implications
Benefits that directly or indirectly impact the patient or the patient’s family:
- Value-added care via the elimination of waste in work in care (that also reduces OT)
- A more satisfied healthcare team via autonomy in flex scheduling and authority via idea generation and implementation
Process Measures (Issues):
- Scheduled patient volumes in all departments
- Machine Downtime
- Reduce cumulative OT from an average of 31 hours per week to 10 hours per week
- Staff satisfaction
- Reduction in Adverse Events
Rapid Cycle Improvement: Cycle 1
Plan- The increasing OT issue was identified through budget variances and time card review. The scope of the project included all 8 departments within the cancer center, and the initial solution and evaluation plan was to utilize huddle board tracking and daily huddles to see all OT in all areas.
Do- Huddle board tracking was implemented first on the level 2 board and then on all level 1 boards a few weeks later. Leader OT goals were also added in between the tracking roll out. There were no unexpected issues.
Check- As soon as tracking was transparent and huddle discussions began, OT immediately started declining.
Act- After reviewing the results, the improvements were adopted and received well by all team members as they could see the benefits via leader tracking weekly and monthly via financial reports.
Rapid Cycle Improvement: Cycle 2
Plan- The next cycle of improvements came via frontline huddle idea generation and implementation, some of which escalated to the administration huddle for approval and spread. Team members flexed their time around patient care, offered solutions to avoid OT as a whole, and focused on eliminating waste in their areas to reduce OT in those areas.
Do- Implementation occurred in multiple phases across all departments. Unexpected issues were only that the issues resulting in OT were so diverse across departments/teams.
Check- OT continued to decline. It was learned that waste leading to OT was multifactorial and different for each team.
Act- Most huddle ideas focused on reducing OT were adopted after seeing an impact. These changes were well-received as they were generated directly from the team members.
The cancer center reduced weekly OT hours consistently falling below the stretch goal of 8 hours per week among all departments, resulting in reduction of average monthly OT expenses from an average of $5583/mo. to average of $2598/mo. (~53% reduction) while team member work satisfaction increased.
- OT reduction will continue to be a focus via huddle idea generation/implementation, ongoing managerial tracking focus, and continuous PRN training efforts.
- All OT per week continues to be tracked/reported on the cancer center Administration (level 2) huddle board. All departments continue to monitor frontline OT on all level 1 huddle boards. Metrics are discussed weekly in huddles.
- Process owners remain the lead team members on this project to ensure OT reduction work is hardwired. In addition, all cancer center team members maintain ongoing OT tracking and reduction responsibilities per previous rapid cycle improvement work.
- Continue hardwired OT tracking and reduction processes
- OT is extremely multifactorial
- Frontline team members are more than willing to reduce OT once educated and empowered
- Transparency is difficult at first but then reaches a “tipping point” that positively impacts all other tracking areas
- Entirely eliminating OT is not a realistic goal as there are instances in which OT is appropriate and necessary for patient care