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Work week of four 10-hour days is a hit with CMs
Staff can choose their own days off
At Davis Memorial Hospital, case managers work 10-hour shifts, four days a week, often choosing their own days off.
Since the shift from five-day work weeks in 2000, staff satisfaction has improved, and Tod Thorpe, RN, CPC-H, director of case management for the 90-bed hospital, has seen less staff burnout.
"The staff loves the 10-hour days. Case management is a tough job, and the staff likes the four-day work week. They end up being at work nine to ten hours anyway," he says.
The case management staff includes seven full-time-equivalent (FTE) employees and .38 FTE clerical staff. The staff typically work from 7 a.m. to 5:30 p.m. Monday through Friday. One case manager covers the entire hospital on Saturdays.
Six case managers work primarily in inpatient case management. One outpatient case manager covers the emergency department, same-day surgery, and surgery preadmissions. Two inpatient case managers are cross-trained to fill in on the regular outpatient case manager's day off.
Some of the staff work one particular block of cases all the time. Others who are more amenable to change pick up different areas when another case manager has a day off.
"We try to keep as much consistency as we can to see that all the beds are always covered," Thorpe says.
It was a challenge to choose the staff who work in various areas, Thorpe says.
"It takes a special kind of person to jump around from caseload to caseload. I had to look at the staff and see who needed the structure of a permanent caseload and who can pick up another caseload from time to time," he says.
Under the new arrangement, the department is staffing the hospital for more hours a week with the same number of FTEs. The arrangement gives the case manager more access to the physician. Some members of the medical staff do rounds in the morning; others do rounds in the evenings.
"With 10-hour shifts, we are catching more of the doctors when they are in the hospital. With an eight-hour shift, the case managers were missing a lot," Thorpe says.
Because Davis Memorial is in a rural area, many physicians work in clinics that are a good distance from the hospital, and they do rounds at odd hours.
Lack of consistency in working with the families is one drawback of the new program, Thorpe says.
"When a case manager gets to know a family and establishes a comfort level with them, it is hard for someone else to pick up the case," he adds.
His solution was to design business cards with a listing of all case managers' names and a check box beside each name. If a case manager is going to be off the next day, the case manager checks off the name of the person covering his or her caseload and informs the patient and family.
"Things are moving so fast in the hospital that typically, if a family member needs to talk to a case manager and asks the clerk, they'll just be told that the case manager is off that day. This way, they know who to ask for if they need something," Thorpe says.
The schedules are set monthly, and staff have an opportunity to choose their days off.
"The staff loves the self-scheduling. They know that not everybody can take Monday and Friday off, but it gives them the flexibility to take time off when they need it," Thorpe says.