Western State Staffing Deficit 2017

As we await to learn the fate of 65 million dollars in federal funding that may soon be lost after an inspection is carried out by CMS, I find myself compelled to comment on the progress of the preparation for the final inspection.


The Governor and DSHS has poured millions per year of taxpayer dollars into funding the most extensive expansion of Western State Hospital administration I have seen in over thirty years.  


If I were a legislator, I would demand a list of all administrative, administrative support, as well as Washington Administrative Services staff that were hired at Western State Hospital since January of 2017.  I ask that legislators look at the annual cost of all the added administrators and administrative support staff.  None of the taxpayer dollars that were spent on administrative and administrative support funding pertained in any way to direct patient care or in maintaining base staffing levels.  


I began my service with Western State Hospital as a Registered Nurse in 1984.  Within years I was promoted to a nursing supervisor position.  I have at one time or another supervised almost all civil wards within Western State.  I have also covered for unit managers during this 33 year period, thus am aware of most administrative functions.  I have served as the RN Union Chairperson on numerous occasions and have been involved in negotiations as well as  grievance procedures at all levels.  I have served on most Western State committees and co-chaired several.  While serving as the co-chair of the Joint Nurse Staffing Committee I created the first mathematical staffing model for Western State.  I created a staffing model that was NOT dependent on negotiation and subjective views…  Therefore my staffing model was not subject to “point of view” bias and was objective as it used (employer provided) statistical data to produce the exact number of staff that were required to provide safe direct patient care while nulling out overtime taking all factors into consideration including training.  The model would identify understaffing as well as overstaffing…  As a result, the RN union did not back the model as it could identify overstaffing and it would essentially end all staffing negotiations based on subjective data.  DSHS did not like the model because of sticker shock, the numbers produced indicated that DSHS had grossly understaffed Western State.  


Now lets look at where we are now with regard to safe staffing.


Less than half (far less than half) of the employees that were necessary to provide basic minimal safe staffing at Western State were requested by DSHS. This is because the staffing request was not based on any viable form of objective data.  


Now for the presentation of Western States’ own statistical data for the past (almost) four months…


All of the data that is being presented is from January 1, 2017 to April 20, 2017.  During this approximate four month (trimester) period, overtime and mandatory overtime use has been extensive and necessary for day to day operations. On may days, Western State does NOT meet base minimum staffing levels.    


Below is the amount of overtime used at Western State displayed in hours.  


OvertimeNum


Note that 81,345.8 hours of overtime was required in an attempt to provide base safe staffing levels.  It is important to state that base staffing levels for all wards is frequently not attained and staff often work entire shifts with inadequate base staffing.  It is important to note that the above numbers are IN ADDITION TO on-call part time personnel that are NOT part of the WSH budget.  There are 52 weeks in a year and a full time employee (except for WFSE employees) work an actual 40 hours per week, or 2080 hour per year.  From this almost four month period, if you don’t count the on-call and agency personnel costs or the time-and-a-half these overtime personnel earn, Western State could have funded an additional 39.875 full time direct patient care staff members (funded for the full year).  By any measure, this constitutes gross mismanagement of public funding.


The next question should be, is Western State understaffed every day of the week?  The answer is yes.  Below is a table of overtime used from 1/1/17 to 4/20/17 broken down into overtime use for days of the week.  


OvertimeDays


Please remember that the above data does not include on-call part time personnel utilized or agency personnel who come at a much greater cost.  


Now lets look an part time on-call personnel that are utilized daily at Western State.  On-call personnel are not part of the Western State staffing budget, therefore on-call data is often never presented to the legislature.  


OnCallNums


From 1/1/17 to 4/20/17 (an almost four month period) part time on-call were utilized for 81,537.4 hours.  So during the almost four month period this would have paid for the equivalent of an additional 39.2 full time employees (funded for the full year).


Now lets add the overtime full time positions that could have been funded for the full year to the on-call personnel use that would have funded full time positions for a full year.  


  • 39.875 overtime + 39.2 on-call = 79.075 full time positions to ALMOST meet base staffing for almost 4 months. 


Note that the 79.075 full time positions that could have been funded for an (ALMOST) single trimester (four month period) does not take into consideration the additional 19.94 full time positions that could have been funded by the overtime wages alone.  


The projection for the rest of the year cannot be made from the above numbers because this period of time is not when most annual leave occurs.  The overtime numbers will increase by at least a third over the next trimester.


But, lets be conservative and falsely state that the above numbers would hold for the next two trimesters.  Agency use numbers do not appear in the above figures, thus the RN numbers will be skewed.  But lets follow through…  If we were to replace the overtime and on-call numbers with permanent full time positions, the projection using the above data would indicate we could fund an additional 79.075 x 3 = 237.225 full-time direct patient care staff members with the amount of overtime and on-call wages that are projected to be paid for the rest of the year.  This is the actual full time number of staff that would be required to operate for a full year if overtime use remained static.  The addition of 237 additional full time staff would be required to null out overtime and on-call use based on the almost four months of  statistics.  As stated the true number will actually be more when actual summer vacation data is included. 


The numbers are staggering due to gross mismanagement by DSHS.  I am sure that the public is not aware that DSHS does not even record unscheduled absence into permanent records (only type of leave that was utilized).  Thus DSHS is unable to produce any productivity data DSHS-wide.  I had the pleasure of being included on the Scheduler program committee which provided Western State with a program that for the first time tracked unscheduled absence, although unscheduled absence numbers do not get recorded on any DSHS permanent record.  


The numbers do NOT include training as WSH does not currently provide any additional coverage for staff for training that does not exceed four hours.  In short, WSH works without its advertised base staffing when training is provided currently.  


From 1/1/17 to 4/20/17 the following are the nursing department records for unscheduled absence.  It is important to note that nursing is the only department within the hospital that is tracked for unscheduled absence.  If the other departments were tracked, the use of unscheduled absence would FAR EXCEED that of the nursing department.


AbsenceRep


From the above data, nursing administration, MNC, employee health, organizational development, and PERT data needs to be subtracted as they are not considered full time direct patient care providers.  For nursing direct patient care providers, the amount of hours of unscheduled absence used from 1/1/17 to 4/20/17 is 53,961.4 hours or the equivalent of 25.94 full-time positions for one trimester or 77.83 full time positions if the statistics remain static for the rest of the year.  


Decreasing the amount of unscheduled absence can reduce the above numbers by less than a quarter at most.  This can be accomplished through the implementation of a permanent unscheduled absence recording and payroll system like Kronos.  I would recommend the initiation of biometric timekeeping systems for all DSHS facilities as well as the implementation of a DSHS-wide attendance policy that includes a published progressive discipline approach for unscheduled absence abuse.  DSHS has no true DSHS-wide attendance policy at this time nor does DSHS even record unscheduled absence in any permanent record.  Any such implementation would require that ALL employees within DSHS be monitored for unscheduled absence, not just nursing personnel.  When you consider the numbers saved in wages, the Kronos system would more than pay for itself. 


So from the projections from the above provided data (if conditions remained static) we can conclude that to null out overtime we would require funding for an additional 237 full time positions (of which 78 would cover for unscheduled absence use alone).  Thus 159 additional full time staff members would be required to just meet minimal base staffing levels, excluding any coverage of unscheduled absence.  As stated the numbers will not remain static as we head into vacation season.  


The numbers are here for everyone to see.  These numbers indicate why Government transparency is so important.


For Western State, I recommend the following:


  1. Administration must be FORCED to allow for diversity of opinions and views without retaliation for the culture to change.  Currently, open honest communication courts rapid and violent retaliation.  Conversely, being a “yes person” courts administrative appointment and raises as well as inclusion into the group think.
  2. All administrative and administrative support positions created after 1/1/17 should be audited and discontinued if the audit indicates administrative redundancy.  
  3. All funding from those administrative and administrative support positions should be diverted to direct patient care positions in order to null out overtime use and provide base staffing levels.
  4. Maintain an objective statistics based staffing model to recommend staffing.  Discontinue subjective models.  Follow state law pertaining to the Joint Nurse Staffing Committee and its role.


For DSHS, I recommend the following:


  1. Discontinue the HRMS Payroll system as it does not record unscheduled absence, only the type of leave used.  Implement a system like Kronos which does permanently document unscheduled absence use and other productivity data.
  2. Implement biometric time clocks for attendance due to their decreased infrastructure costs of implementation.  Example: No lost time cards or clocking other staff in. 
  3. Implement the first DSHS-Wide Attendance Policy which includes a written progressive discipline process that can be automated through the Kronos timekeeping system. 
  4. Standardize a base staffing model for all DSHS facilities which is objective and based on statistics for the facility in question.
  5. DSHS, for oversight purposes as well as maintaining accreditation, should license all its facilities through the Department of Health.  Thus Western State would become a “Hospital” under state law for the first time.



© Paul Vilja 2017