Introducing a Powerful New Tool to Benchmark and Manage Productivity

HFS has developed an innovative method for understanding productivity in California hospitals. With it, we are able to measure productive hours per unit of service in any department, for all hospitals in the State. Our source data comes from the Office of Statewide Health Planning and Development (OSHPD) Annual Financial Disclosure Reports. OSHPD is one of 13 departments within the California Health and Human Services Agency.

The Annual Financial Disclosure Report is submitted by all 448 California acute care hospitals. It is approximately 134 pages and contains thousands of data elements regarding financial and operating conditions. Within the last year or two, OSHPD has inaugurated a web site where one can view and download an entire report in a .pdf file format.

Many hospitals have discovered this website and use it to view operating conditions at other hospitals. Since the number of productive and registry hours is identified for each department (California hospitals use a uniform accounting methodology), it is a relatively straightforward process to divide total hours by the corresponding unit of service statistic. However, it is a cumbersome process, and most accounting departments only investigate their immediate competitors.

As one of our service offerings, HFS Consultants prepares and issues OSHPD reports on behalf of client institutions. On occasion, we have been asked to produce custom analyzes using OSHPD data, and used the same methods as others to obtain the information. This involved downloading the file off the website, printing the reports, and then paging through to find the necessary information, which was often transcribed onto an Excel spreadsheet.

What HFS has accomplished is to develop a methodology that can download every report from the OSHPD website, and then convert each and every data element into readily accessible records. As we have designed this process to be completely automated, we can ensure the integrity of the data is 100% accurate. For the purpose of measuring productivity, we can conduct an analysis that compares a department’s performance not only with a select peer group, but with virtually every hospital in the State.

For example, we have determined that there are 390 adult medical surgical (med/surg) nursing units in California hospitals. By adding registry hours to unit productive hours, and dividing through by the number of reported patient days, a comprehensive profile of statewide performance can be developed.

Figure 1

From experience, we know for certain that a properly staffed med/surg department must accumulate approximately 8.20 hour per patient day (HPPD) to comply with the nurse to patient ratios. This figure includes all unit staffing, and includes the manager, unit secretary, and certified nurse assistants. When spreading the data, we recognize that certain results derived from OSHPD are not correct (please note statistical outliers). Out of 351 hospitals, 3 simply submitted improper data, and another twelve hospitals on the low end either submitted improper data or are not in compliance with state of California nurse to patient ratios. The remaining 336 hospitals run HPPD’s that range from the low eights to greater than 25 hours per patient day. As noted in figure 1 above, the 50^th percentile results are 11.31 HPPD. The 25^th percentile, which includes over 80 hospitals, have HPPD’s between 8.20 and 10.10.

Figure 2

Similarly, clinical laboratory productivity can be examined using the same techniques (see figure 2 above). The spread of data for 341 California hospital laboratories reveals the 50^th percentile is 0.17 hours per billed test. The best performance is obtained by nearly 100 hospitals and ranges between 0.08 to 0.14 hours per billed test. We also know that any performance less than 0.08 is either a statistical outlier, or from a lab that generates unexpected performance.

The capabilities of this system are extraordinary. We now have the capacity to generate relevant cost per unit of service data as the system automatically updates with each new report added to the system. As a result, cost data does not outdate, as it is continually refreshed. For peer review, data can be adjusted using case mix index, or regional wage indexes.

We can access virtually any data element on the OSHPD report, and summarize it in any manner, using powerful data base and statistical management software. For a complete explanation of our benchmarking and peer review capabilities, please contact Rich Parsons at ext. 241.