Within Centegra Health System, Ill., relationship-based care-a model of care based on living the organization's core values-is the foundation for employee engagement.1 Nurse leaders found that providing this type of care was a daunting challenge when they used a manual scheduling system and needed to frequently hire agency staff. In addition, many of the nurses viewed the manual, paper-based scheduling system as inconsistent and inequitable. Compounding this challenge was the reality that agency staff didn't always share Centegra's vision of providing five-star services, nor did they always emulate the organization's core values of genuine respect, passionate caring, and demonstrating a joyful spirit. This situation posed an urgent call to action on the part of nurse leaders and provided a "burning platform" for change.

Creating balance

The manual scheduling of nursing employees was an inefficient, variable, and labor-intensive process. Unit leaders each had their own method for scheduling, which created inconsistencies in how employees took paid time off, made a switch, or traded a shift. Some employees felt the manual scheduling process wasn't equitable and fostered a culture of favoritism. Accurately tracking schedules was nearly impossible with the manual system, which didn't provide a system-wide view of the entire scheduling process. Also, the paper-based scheduling system resulted in the use of agency staff, totaling 2,000 hours monthly, equal to 10 full-time equivalents.

Moving to an automated scheduling solution would allow staffing and scheduling to support Centegra's five stars of performance excellence: 1) community (patients), 2) people (employees), 3) quality, 4) growth, and 5) financial stability. Nursing leaders hoped this move would promote higher levels of engagement of employees, provide a higher level of quality patient care, and align with Centegra's overall goal of being able to reinvest in the organization due to cost-saving efforts.

To achieve these goals, nurse leaders worked collaboratively to identify the primary reasons the current scheduling situation existed. Through their in-depth study of the situation, one message became clear: the more they used agency staff, the more the employees didn't feel part of a cohesive team. As the nursing shared governance council began to better understand the business of healthcare, it, in collaboration with nurse leaders, selected an automated scheduling solution. Serving as a unified group, members designed and facilitated an orientation for the new system, handled issues, articulated expectations, and eliminated antiquated pay practices. Shared accountability and the camaraderie created between the nurse leaders and charge nurses served as the framework to impress upon employees that automated scheduling was the right solution for improving both employee engagement and patient satisfaction.

The next step in the staffing and scheduling improvement initiative was the creation of one system-wide staffing office dedicated to providing staff for all patient care units. Employees in each area were given the opportunity to choose whether they would use block scheduling or self-scheduling. For units using block scheduling, regular staff is scheduled four weeks before float pool and registry staff can select their schedules. A two-week period is provided for the float pool or registry to respond and select work dates. This new system provides the autonomy they requested to determine their own schedules. The next step in the process is having the updated schedules available for regular staff to select additional work shifts. In the units using self-scheduling, full-time employees have two weeks to select their schedules before the float pool and registry staff make selections. Without the reliance on agency staff to fill open shifts, employees now enjoy the added benefit of picking up shifts and increasing personal earnings.

Nurse leaders facilitated training sessions to provide employees with the knowledge they need to use the automated scheduling solution. In addition, they made frequent rounds to ensure that employees understood how to use the system. Employees can access their schedules at home and have the ability to choose a schedule, as well as make necessary changes. Any change in the schedule can be made up to two hours prior to the start of a shift. This has allowed employees to adjust their schedules if unexpected demands arise, creating a valued work-life balance. Such situations can create the need for agility in schedule management.

As with implementing any new process, the path had a few bumps along the way. The leaders and team members, however, maintained a constant focus and communication plan, including the purpose of the change being excellent patient care and satisfaction. Having staff available to help those employees who struggled with the change or in actually using the system alleviated employees' concerns.

Increased staff satisfaction, improved patient care

Using an automated scheduling solution, employees now know they have the same opportunity as every other employee to create the schedule they want, make changes, and experience an equitable process. The result has been increased patient satisfaction and employee engagement. Evidence of the improved performance was noted through Centegra's 2010 annual associate satisfaction survey. In addition to a 14% increase in employee participation, the overall organizational results jumped from 81% to 87% for the question, "Taking everything into account, Centegra is a great place to work." Evidence of improved employee satisfaction has also been noted in a seven-point annual increase in the National Database of Nursing Quality Indicators nursing satisfaction survey. Nursing service employees are now more inclined to fill in and pick up extra shifts because they feel everyone is being treated equitably.

Evidence-based practice highlights the fact that positive employee satisfaction has a direct correlation to positive patient outcomes. Together, nurse leaders and employees of the Centegra organization have built a cohesive team that no longer needs to focus on addressing challenging staffing and scheduling issues. Today, this collaborative team works together toward the mutually important goal of providing the very best in five-star relationship-based healthcare.

In addition to bringing consistency to nurse leaders' practices, automated scheduling has given Centegra's managers real-time staffing visibility across the system. In the past, nursing supervisors were responsible for staffing and scheduling. Today, supervisors can focus their energy and efforts on patient throughput, keeping a vigilant eye on patient admissions and discharges. Every four hours these leaders communicate census information to the staffing office, making scheduling adjustments to meet the critical needs of patients. Employees in the staffing office can detect which employees are on the floor and identify those scheduled for the next shift. Having this "real-time" ability allows them to make changes to ensure the ideal staffing mix is in place to care for patients. Another great feature of the system is the staffing office's ability to identify employees who might be approaching overtime status, as well as those at premium pay status. If staffing adjustments are needed, the staffing office can swiftly initiate changes, using the system-wide float pool.

Living core values, reducing costs

More efficient scheduling of employees has enabled Centegra's nurse leaders to focus on their primary mission of caring for patients. In addition, the organization has been able to leverage the use of resources across the entire healthcare system. At the same time, Centegra has remained true to its culture, striking the right balance between saving money and having employees who are satisfied and engaged while delivering the best care to patients.

Centegra Health System is on a journey to Magnet(R) designation from the American Nurses Credentialing Center. Part of this journey is about fair and consistent staffing and living the core values of the organization. These elements are closely aligned with providing quality, relationship-based patient care. The initiation of an automated scheduling system has been a valuable tool in helping the organization continue on the Magnet journey.

Since moving to an integrated automated timekeeping and scheduling system, Centegra's nursing service has the real-time visibility to optimize the scheduling of employees and provide safe, quality care. Numerous benefits have been realized, including the ability to respond to fluctuating patient census, as well as align the workforce with relationship-based care and the core values of the organization. The new scheduling system has enhanced employee engagement and, ultimately, the delivery of personalized quality patient care. In addition, there's been a 30% decrease in overtime and the elimination of expensive agency staff, resulting in an overall annual savings of $1.6 million dollars.

Now, on Saturday at 10 p.m., Centegra's leaders can be confident that employees who share and demonstrate the organization's core values are caring for their patients.

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