Patient Satisfaction Planner - Shift bidding: Hospitals see boost in staff morale

Lower vacancies result; substantial savings seen

A number of hospitals across the country have found they can drastically reduce the cost of staff salaries, while at the same time ensuring full nursing shifts, through shift bidding. This on-line vehicle also has been shown to boost staff morale while improving patient care and satisfaction.

While it varies from facility to facility, shift bidding basically works like an "eBay in reverse." Available shifts are posted on-line, and interested staff can bid for them.

A starting hourly salary is listed, and staff can bid a lower wage if they want, to win the shift.

"It has allowed us to communicate staffing needs much more clearly to staff, allowed staff to put in more time if they elect to do so, and to have more control over when they decide to do it," says Christine McCarthy, MSRN, nurse recruiter at St. Peter’s Hospital in Albany, NY, one of the recognized pioneers of shift bidding. "It also decreases frustration and anger levels, as there is no forced overtime."

"We see it as an enhancement of our ability to staff our units," adds Anne Davis, vice president of workforce at Sharp Healthcare in San Diego, which uses an outside vendor called BidShift to conduct its on-line auctions.

"We know our nurses pick up extra shifts outside of Sharp, so we’ve tried to find ways to keep staff within our company. If we have our own staff pick up an extra shift with us, they know our policies and procedures and how to take care of our patients better than anyone; there’s a whole lot less room for error," she notes.

Kathy Whelchel, RN, vice president of nursing at Spartanburg (SC) Regional Medical Center, sees another benefit. "We found a productivity issue with agency nurses," she asserts.

"They are not your employees, and they do just what they need to do to make it work. For the most part, they are not team players."

The whys and hows

St. Peter’s started its program in 2002, recalls McCarthy. "Like everyone else, we were looking at high vacancy, loss of staff to agencies, and travel because of perceived convenience and a higher pay rate; and the nursing shortage did not help replace people when they left. So we decided to look at how to keep our own staff here."

One of the hospital executives noted that he bought all kinds of things on-line by looking for the best price.

"So we decided to kick that idea around," she continues. "We have a very talented IT [information technology] department, so we had a webmaster and another individual work with nursing administration and human resources." After about a year, the program went live.

They began with their own staff, with managers providing information as to who was qualified for specific units, and then held informational sessions for staff.

"We fiddled around until we got a product that was easy to use on the manager’s part, easy to use on the nurse’s part, and finally developed a methodology to bring people in from the outside and put them through an orientation that met the same quality indicators as our staff; and they eventually came on staff themselves," McCarthy explains.

This helped to gradually enlarge staff, through newspaper ads and e-mail exchanges.

The St. Peter’s system works like this: The manager reviews the schedule, then decides to put shifts on the site to let people know there are openings.

People responding must meet the qualifications necessary to work on that unit (i.e., educational requirements, certifications).

If respondents are qualified, they are allowed to access the calendar. "We give them a salary range, and they put in what they want to make," McCarthy adds.

The negotiation starts between the manager and the nurse. For example, the manager can call and say, "I got your bid, but I also got three lower bids; do you want to stay in the game?"

Spartanburg Regional was another early adapter, after reading about the experience at St. Peter’s.

"Our COO and I were in a regular management interview; and he said, I wish we could do this to help get the agencies out,’" Whelchel recalls.

"We found out that what St. Peter’s was doing was proprietary, so we met with IS [information systems] and personnel, and the guy from IS got real excited," she says.

The programmer stayed up all that night and wrote the entire program for Spartanburg Regional.

The program is similar to St. Peter’s — nurses have to meet basic competencies to bid for a shift. It went live in August 2002 and proceeded very slowly at first. "We sent a letter to every RN’s home but only sold 12 shifts in the first three weeks; then, all of a sudden, it was up to 35 a week," Whelchel adds. "Now, we’ve sold as many as 250 a week."

Agency nurses are a thing of the past

There is no agency nursing left in the system today, although at one point, the facility was using up to 54 full-time equivalents through agencies.

A newly added module has self-scheduling for the flow pool. Managers post the schedule, and the person goes on-line and fills in when he or she wants to work.

"This has totally changed how we do the flow pool," Whelchel notes. "If a shift is not selected, it goes into auction. We put out six weeks of schedules at a time; so if a shift is not picked, the managers can know four weeks ahead if they need to bid it out."

Additionally, Spartanburg Regional now has a quick-pick module, through which nurses can guarantee they get the shift they want by immediately accepting the stated wage.

At Sharp, not only do nurses bid for shifts, but also nurse assistants, respiratory staff, and physical therapists.

Soon radiology staff will participate as well. Otherwise, the BidShift program, which was initiated in September 2002, is similar.

"The nursing units fill schedules as normal, and any open shifts not filled typically go to our large resource pool; those not filled are posted to BidShift," explains Angela Athis, director for the staffing resource network.

"Nurses have the ability to log on and view what is available. They see the wage we have posted, and they can take it, but then someone else can come on and take it for less," she says.

More money, more flexibility

The health care professionals using shift bidding cite a wide range of benefits, but perhaps the most significant is the boost in staff morale and the ability to make more money while saving the hospital money at the same time.

"There’s no mandatory overtime; people make choices," McCarthy points out.

And while the nurses can make more than they would on overtime, "the costs to the hospital are absolutely less than when they used temp nurses," she says.

"There’s probably a minimum 20% difference between agency fees and those bid on-line. We do expect the people bidding to make more than they would otherwise," McCarthy notes.

While agency use is way down at St. Peter’s, she stresses, "We want to keep good relationships with the agencies."

Nonetheless, it is an advantage to have the open shifts filled by your own staff, she says.

"They are on board with the mission and philosophy and how that is carried out in patient care. Someone from the outside may not know all the resources available to them; and if they feel frustrated, they may show that to patients and family.

"We have found that patient satisfaction has improved [since the system was implemented]." The vacancy rate also has vastly improved, McCarthy notes.

Athis has had similar experiences. "Before we went live, we conducted focus groups with our RNs," she recalls.

"To a person, they all said they preferred not to work with outside agency nurses, because it took time to orient them and then to follow up. We think this has been such a savings of time and has increased the quality of people who come to our unit," McCarthy explains.

As at St. Peter’s, the posted rate on bid shifts is higher than what all the nurses make on an hourly basis (about $10 an hour more), but less than Sharp would pay to outside registries. "

I know we have filled close to 3,000 shifts, and they would have gone to outside registries," Athis says.

Whelchel sees similar financial results. "Our average wage for an RN is around $23 an hour, and an agency nurse costs around $50. On shifts bid for, we average around $35 to $37."

She adds, however, that bids have gone as low as $27 for the more popular units and shifts.

Again, however, this is not the greatest benefit. "It completely changes how staff feel valued by the system," Whelchel notes.

"You give $50 to that agency, and they think you give that to the nurse, who they perceive as not working as hard, and that builds resentment. This takes them out of the equation, and lets our nurses choose when, where, and what to work. They came through for us and covered shifts, and we got the agency out," she says.

As for the hospital, "We are able to cover shifts with people who want to be at work," Whelchel explains. "And in terms of patient satisfaction, that is huge. You see it in demeanor at the bedside; if you want to be somewhere, you are happy, and it shows."

Vacancies go down and morale increases

In the past, she notes, even though the hospital never had mandatory overtime, "We had to beg, and people were tired."

Vacancies today are way down, she reports. "In 2002, our high might have been 104, and now we are probably at 30 today," Whelchel says. Other departments, she adds, have begged to be included in the program.

Davis sees another major benefit. "I sit on a lot of patient safety committees, and as we have our own staff working here, they will clearly know what those efforts are about, what our resources, policies, and procedures are; and that puts our patients at far less risk.

"It also unburdens the nurses on the unit, because when you have outside registry nurses, a lot of that burden falls on those nurses. So we now have a safer, less stressful environment, and that improves quality all the way around," she adds.