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Blue County Memorial Hospital (BCMH) is one of the largesthealth care organizations in eastern North
Carolina. It serves the eastern one-third of North Carolina andmaintains a 500-bed facility offering 24/7
acute medical and surgical care. The health care facility has over30,000 patient admissions a year, and
its average length of stay (LOS) is about four days.

The health care facility is organized by specialty and staffedwith qualified MDs, physician assistants
(PAs), nurses, and technicians. BCMH contains 12 operating rooms,all with state-of-the-art equipment,
numerous wards for postoperative care, and related ancillaryservices (rehabilitation, testing labs, etc.).
The operating room department has a large challenge in that it mustmanage and allocate equipment
and staff so that surgeries can be performed effectively but alsoin the most efficient manner possible.
In all, the assignment of equipment and staff is a difficultjob.

State regulations require threshold levels for nurse-patientratios, and not meeting these thresholds
may lead to underutilization of available capacity. In turn, thesize and mix of staff are critical decisions
for the workforce planners. Overstaffing, understaffing, orunbalanced staffing leads to issues with
quality of care and increased patient cost. BCMH meets its staffingrequirements with a mix of
permanent staff and an on-call group of part-time staff availableon short notice. There is also
temporary staffing that occurs for nurses with six-month toone-year contracts. Overall, the hospital’s
staffing needs have been met by 60 percent permanent staff, 35percent temporary staff, and 5 percent
on-call staff.

BCMH provides services to patients, and in turn those patients,either through insurance or by direct
payments, reimburse BCMH for services provided. Although manyservices are provided, surgery is one
area where BCMH adds value and garners profits. However, surgerydemands numerous resources,
including equipment and staff (surgeons, nurses, technicians,etc.). BCMH is also responsible for
preoperative care and postoperative care. Insufficient capacity inany area (surgery, postoperative
wards, etc.) can lead to surgical procedures being turned away orto higher costs if accepted when over
capacity.

Slotting is used for planning and scheduling purposes. Each areawithin BCMH is broken up in half-day
slots, meaning there are 14 slots per week. Slot planning andscheduling is conducted about once a
quarter (once every three months). A plan is developed inconsultation with surgeons; demand for
surgical procedures varies little from year to year, but the demanddoes have a seasonal component,
making some quarters busier than others. In addition, somespecialties have peak demands whereas
other specialties have very stable demand.

The slotting and planning process also encompasses the staffingof nurses. The labor cost of nurses for
surgery is one of the largest and most controllable operatingcosts. Nursing staffing plans are prepared
each month for a month’s time frame and two weeks in advance. Thenursing schedule is frozen one day
in advance and then resource requirements are matched based on theupcoming surgeries. This type of
planning is efficient for day-to-day operations but gives limitedflexibility in terms of the permanent
staff, temporary staff, and on-call staff. The nurse scheduler mustmany times rely on temporary staff or
on-call staff when demand changes occur in the short term.Subsequently, BCMH must meet its nursing
needs from outside, and in monetary terms the outside staff costsmore, as higher rates are paid to the
outside staff. In addition, the staffing in preoperative andpostoperative wards is done in a similar
fashion.

Q1: 1) What data items are to be collected, and how they areused in operational management of BCMH’s surgical
unit; Also Labor cost has gotten the attention of BMCH Leadership,and they want your team to come up with

options addressing nurse staffing. The team must come up with atleast three options for nurse staffing
to include outsourcing 100% of the nurses. What are theseoptions?

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Patrina Schowalter
Patrina SchowalterLv2
29 Sep 2019

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