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Evaluating a Healthcare Staffing Company's Processes

By Jeff on May 28, 2010 in Hospital Staffing

If the quality of the candidates is the lifeblood of a healthcare staffing company then their process is the heart. It is in the process that a lot of differentiation in companies takes place. There are three key process styles that companies tend to fall into and they really set the tone for how they are going to work with you and your hospital. They are: The Hands-On Approach to Healthcare Staffing, The High Volume Approach to Healthcare Staffing and The Multi-Tasking Approach to Healthcare Staffing.

The Hands-On Approach to Healthcare Staffing

A company with this approach is going to be structured in a way that allows them maximum contact with their customers, both hospitals and traveling healthcare professionals. That means they are more likely to be split between a recruiter and a hospital client manager. This lets each group focus on meeting the needs of those clients without having to split their time. This elevates the level of attention and expertise they are able to give to their customers and thus their service.

A company with this approach is also going to have a cautious approach to working with Vendor Management Systems (VMS) if it limits their ability to connect with their hospitals because that affects their ability to provide the best customer service they can. This can limit the number of jobs they have, but the trade-off is the service their clients do receive and the experience their travelers have at an assignment.

Companies with the hand-on approach are also going to want their recruiters to have smaller “desk sizes” or the numbers of travelers they will work with at any given time, so they can focus on individuals and not numbers.

The High Volume Approach to Healthcare Staffing

A high volume approach company is going to be structured to work with large numbers of clients and travelers. They are more likely to encourage larger desk sizes for their recruiters and ask them to also be the hospital contact. As a result they work with a large number of VMS, which aggregate companies to compete for a hospital’s jobs and take the work out of finding new customers for companies. Their structure allows them to process more travelers, but the level of customer service can suffer as a result of a lack of focus in one area.

The Multi-Tasking Approach to Healthcare Staffing

A company using a multi-tasking approach is going to ask their recruiters to also be the hospital contacts, which has the advantage of direct contact for the Nurse Manager of HR specialist with the same person talking to the nurse, therapist or tech. On the flip-side, however this set up usually means that the recruiters are assigned regions or states that they focus on. This can result in a disjointed experience for the traveler who has to switch recruiters if they want to work in a different part of the country, which affects the company’s ability to attract new travelers if they don’t feel a connection to a recruiter.

This type of company is also going to rely heavily on working with VMS in order to offset the amount of time that is required to recruit healthcare professionals. This means that they have to put a lot of focus on volume because the number of candidates submitted to hospitals through a VMS can be a large number.

Conclusion about Evaluating a Healthcare Staffing Company’s Processes

All of these approaches are different and which one is best for you really depends on your situation and how your hospital is structured. In the next post in this series we will look at evaluating a healthcare staffing company’s cost.

Are your healthcare staffing providers financially stable?

By Jeff on Apr 02, 2010 in Featured, Hospital Staffing, Working with Staffing Vendors

Awhile ago we looked at how to evaluate the healthcare staffing vendors you work with so you can make sure you can working with the best ones and getting the most value out of them. Well, in light of recent news of a major healthcare staffing company reporting that it may have to file for bankruptcy it made me think of one other thing you need to look at when evaluating travel nursing or travel allied companies, their financial stability.

The last thing you want to do is to become heavily dependent on one company only to have that company go out of business and leave you with the hassle of dealing with temporary nurses, therapists or techs who no longer have a company behind them. In addition if this were to happen to a company you were working with you may find yourself suddenly either scrambling to find a new healthcare staffing company or forced to working with an unfamiliar company that bought out your contingent staffing company.

This is not to say that you should only work with “big” travel nursing or travel therapy companies. Because being bigger does not necessarily mean more stable. Instead you need take a closer look at their financial standing. Here is a basic list of some of the actions you can take when you are looking at new companies to staff your hospital or skilled nursing facility:

If they are publicly traded visit their corporate website and check out their annual reports to see their balance sheet
If they are a private company look for recognized signs of growth like Inc 500 awards or fastest growing industry and area awards
See how many employees they have, it needs to be large enough to handle things like billing, doing background and reference checks and providing your hospital with the support it needs
Find out how long the travel nursing or travel therapy company has been in existence
Find out if they ever have payroll issues
Ask for references from other hospitals and healthcare facilities they work with

What about you? Do you have any other questions you ask to gauge the stability of a contingent staffing company?

Time to examine your healthcare staffing companies

By Jeff on Feb 20, 2010 in Featured, Hospital Staffing

In past posts we have discussed how effective temporary staffing can be at improving the quality of care, reducing costs and improving revenue at your hospital or healthcare facility if it is viewed as and made part of your overall staffing plan, rather than a last resort.

One aspect of this plan should be a formal vendor review process where you can rate the effectiveness of the staffing vendors your hospital works with. After all if you are not measuring it, how do you know how well or poorly it is meeting your needs?

Implementing this process, whether you work with many travel nursing companies, just a few or with a VMS will help you answer questions regarding the staffing companies’ quality, cost and efficiency. And help you make changes that maximize this resource for you.

A benefit of having this process in place, which we will discuss later in this post, is that it gives the healthcare staffing companies you work with an upfront set of expectations you believe they should meet and creates an equal playing field for all to start on.

There are some basic things you will want to keep in mind as you build your Staffing Vendor Evaluation Program:

You need to build a system that allows smaller providers to be represented fairly alongside larger ones
You should include both qualitative discussions about the candidates and quantitative measurement tools about the staffing company
You will want to include a tool that measures the overall quality of the healthcare staffing companies

To put this plan in place for your hospital, skilled nursing facility or ambulatory care center, let’s take a look at these three areas.

How do you build a system that allows small providers to compete with the larger ones?
This can be accomplished by looking not at how many submittals a company provides but what is their rate of success. You can determine this by first establishing a baseline level of success your hospital expects from a healthcare staffing company. So if you believe that one out of every eight candidates should be interviewed and one out of every 20 candidate submitted should be placed for larger staffing companies, then it would be reasonable to expect that same rate of success from a smaller travel nursing company, just at a smaller scale.

How do you measure quality of candidates?
This is where great internal communication at your hospital or healthcare facility comes into play. If you are at a smaller to midsized hospital where you are both the hiring manager and nurse manager working with the contingent nurse or therapist then this is simple as asking yourself how well they worked out, would you hire them again, etc. However if you are at a larger hospital with a hiring manager responsible for hiring for many different units you will want to make sure you have a formal process in place that includes both a standard list of questions or survey that gauge performance that the manager completes and a direct feedback session between the department using the staff and the hiring professional.

How do you evaluate the overall quality of the staffing company?
This should happen during some sort of set direct feedback meeting and be at least quarterly meeting where you evaluate the companies you are working with and determining their status for the next quarter. Whatever the schedule is, during the meeting and evaluation process should be a thorough evaluation of the travel healthcare companies or VMS you are working with that looks at them from a holistic view and evaluates them based on a set list of criteria that includes items like:

Bill Rates – This measures how competitive they are in comparison to their competitors and in relation to their quality
Fill Rate – This looks at how many jobs they fill versus the number of chances they have to fill them
Candidate Quality – This should be completed by the unit manager and looks at the overall quality of the candidates submitted
On the Job Performance – This should be completed by the unit manager and looks at the ability of the past hired candidates to do the jobs they were hire for
Time to Fill – This evaluates the speed a healthcare staffing company or VMS can fill your open positions
Response Rate – This is the number of requests for staff by your hospital divided by the responses the company provides
Number of Submittals – This is a measure of how many nurse resumes did they send in for each open job
Accounts Receivable – This is looking at how fast invoices are received from the travel nursing company or VMS

By using all these variables in a scorecard type of format you will make sure you don’t have tunnel vision on the value of one company over another. For example, from a hiring manager’s point of view this can help avoid focusing on one vendor who may be easy to work with, but provides bad candidates. Or from a nurse managers point of view it can prevent falling in love with a company that provides great candidates, but takes forever to fill needs and is even slower to bill you. By aggregating all these scored categories in one area you will get a complete view of the healthcare staffing companies you are working with and give yourself a starting point to improve them.

How can you use this scorecard to improve the healthcare staffing companies you work with you ask. Simply share the information with them, both before you work with and after each evaluation. Most, the good ones anyway, want to improve their service to your hospital, so sharing their results with them gives them a snapshot of their performance for your hospital and alerts them to areas to improve on. This will only improve the quality of your relationship as well as saving you money.

The next step is to formalize the follow up of this process. After you share a healthcare vendors score with them you should designate a reasonable time-frame for them to improve on their score, however if no improvement is made you need to add that vendor to a Do Not Use List. This is where this process will save you time and money in the long run.

What about you? What type of evaluations tools do you use?

Are healthcare staffing companies a haven for bad nurses? Follow-up.

By Jeff on Dec 23, 2009 in Featured, Hospital Staffing, Travel Nurses

In my last post I talked about an article in The Los Angeles Times on Sunday, Dec. 6th called, Temp Firms a Magnet for Unfit Nurses, that discussed the quality, or lack of it, of nurses working through staffing firms. My point in my last post was that the article placed a lot of the blame on the staffing agencies and not the nurses themselves or hospitals that don’t check on the agencies they work with. I also talked about research that showed that temporary nurses are as, if not more, qualified than permanent nurses. But one area I did not fully address was what could be done about it.

Well in a recent article titled “Union: Healthy Environments, Better Orientation Can Solve Temp Nurse Issue” at HealthLeadersMedia, Media Rebecca Hendren discussed the article with some nurse executives from the new National Nurses United union who brought up some great points in response to the Los Angeles article including:

Acknowledging that in some circumstances travel nurses can be a real blessing for hospitals, but focus should still be on building a stable long-term workforce
Not supporting a national nurse registry and instead letting the state associations and licensing boards handle it
Illustrates a need to focus on a healthy working environment to improve retention and recruitment of permanent nurses, which in turn will reduce the need for temporary and travel nurses
Better orientation of travel nurses is important because even a good nurse who does not know the system and procedures of her new hospital will have a hard time with little orientation
California’s nurse to patient ratio had little to do with the problem and in fact has brought more nurses back to work in the state

These points really make me think about travel nursing orientation, and the role it plays in the overall quality of healthcare provided by travel nurses and in the experience of the travel nurses themselves. Stay tuned for a post dedicated to it.

Demystifying healthcare staffing: How can hospitals make sure they are staffed appropriately in a nursing shortage?

By Jeff on Dec 04, 2009 in Demystifying healthcare staffing, Featured, Hospital Staffing

When it comes to staffing your hospital it important that you have a plan in place. You want to make sure that you have enough nurses in place to deal with things like seasonal fluctuations, the opening of new units or wings, unexpected and expected staff vacancies and illnesses just to name a few. That part you already know, the hard part is how you develop that plan.

For starters it needs to be a plan that takes of long-term and short-term staffing shortages. Like anything in life it is easier to plan for something if you know what to expect, which is why being able to look at some historical factors to predict just what your staffing needs are going to be is an important first step of creating a plan to make sure your unit always has a safe level of nurses for the number of patients you are going to have. Some factors to include in this are:

Your hospitals past census levels
Your staffing budget
Your accepted nurse to patient ratios

Conversely one thing you want to avoid is being overstaffed because it can be very costly to a hospital on a tight budget. Ultimately you want a plan that at least helps your unit break even, but even better you want it to help your hospital make money.

So when you look at staffing your hospital or unit, temporary staffing can be a good part of your staffing plan. You will often hear from the C-Level when money gets tight that temporary staff is one of the most costly budget items and easiest to get rid of, but if the use of travel nurses is part of a plan, not a quick reaction to unexpected census changes then they should not be seen as an expense, but as a revenue generator. A few factors to keep in mind when looking at the cost of temporary nurse staff as part of your staffing plan are:

How many patients are you not seeing because your nurse numbers are too low?
What is your average revenue per patient?
What percent of your FTEs are being covered by internal float pools and how long will that last?
What are average nurse turnover rates?
How much are your recruiting cost for a full-time staff?
What is your annual salary for a full-time nurse?

When you put together your staffing plan don’t just look at the immediate weigh what your nurse needs will be through the course of the year and determine the times when you will need both full-time staff and temporary (travel or per diem) staff. Not only will you be able to ease the burden on your full-time staff, plan for the temporary staff’s orientation better, help your hospital make more money and most importantly, treat more patients.

Demystifying healthcare staffing: When should my hospital or facility consider temporary staffing?

By Jeff on Oct 23, 2009 in Demystifying healthcare staffing, Featured

Using temporary healthcare staffing is a great strategy anytime your hospital, skilled nursing facility or other healthcare facility is faced with a need that is either difficult to fill or is just short-term in nature, like a maternity leave for instance. In situations like this you can turn to healthcare staffing companies that provide temporary or travel nurses, travel therapists or techs. You can also look to Per Diem staffing agencies if the needs are very short-term.

Additionally, because of challenges to your hospital like fluctuating census and a lack of nurses resources, forecasting your staffing needs can be difficult and if you are off even a little it can have a big impact on your hospital’s financial and clinical operations. Carrying excess nursing staff when you don’t need it means you are also carrying costs that affect your hospital’s financial strength. At the same time not having enough staff can end in patient diversion and lost revenue. This is why your hospital’s staffing plan should always have a proper ratio of perm to travel staff that can fill the gaps on a temporary basis. What the mix is depends on your particular hospitals factors, like location, age of surrounding population, etc. But it is something every hospital should be at least discussing.

Temporary staffing can also be a key strategy at your hospital in situations like:

Maintaining staffing ratios
Improving patient care
Opening new units
Census spikes
Computer Conversions
ANCC Magnet Certification

Demystifying healthcare staffing

By Jeff on Oct 16, 2009 in Demystifying healthcare staffing, Featured, Hospital Management, Hospital Staffing

Over the next several weeks we are going to be bringing you a new series that tackles some of the common questions about temporary healthcare staffing.

On the schedule right now are the following questions:

How can hospitals make sure they are staffed appropriately in a nursing shortage?
Why should I use one company over another to meet my healthcare staffing needs?
How do healthcare staffing companies recruit healthcare professionals?
How do healthcare staffing companies screen healthcare professionals?
How quickly can healthcare staffing companies find healthcare professionals for my hospital?
What is the first step I should to take if my hospital has staffing needs?
When should my hospital consider temporary staffing?
Why would a healthcare professional want to work on a temporary basis?
Can a hospital extend a temporary assignment? Or turn it into a permanent hire?
Whose responsibility is it to provide a temporary healthcare professional with living accommodations?
Whose responsibility is it to provide for a temporary healthcare professional’s liability insurance?
What types of nurse staffing do healthcare staffing companies provide?
What special skills or competencies do healthcare staffing companies require for travel nurses?
What about Vendor Management Services (VMS)?
Do healthcare staffing companies provide staffing for ambulatory surgery centers?
Do healthcare staffing companies help recruit permanent staff too?
Do healthcare staffing companies only provide temporary staffing to hospitals?
Can healthcare staffing companies provide staffing for home health needs?
What should I look for in a healthcare staffing company?
Isn’t temporary staff expensive?