UNDERSTANDING YOUR STAFFING

RATIOS – A PRACTICAL APPROACH TO

ANALYZING YOUR STAFF BY SITE

Eric S. Holzberg

ESH Services, Inc.

Goals of the session

• To provide the analytical capability to review site,

program, and departmental staffing ratios.

• To Discuss the staffing ratios and their reasonableness

• To provide training in using Microsoft Excel and its Pivot

Table to run reports off of a Staff, salary, and FTE.

• To provide guidance and information to Executive Team to

support operational staffing decisions.

Begin with the End in Mind

Lets get Started – Slow and steady

This must be in a Microsoft

Excel Spreadsheet.

Each column header must be in

one cell.

.

Where do you get the data

• Your payroll system should have the level of detail you

need.

• If not, some human resource systems collect the data

• This data should be obtainable. It is used to complete

cost reports, UDS, and to meet regulatory requirements.

• Regardless, you have to assign each of you employees to

a job type (discussed further in the presentation).

Key Terms

• Full Name is the standard name used for the employee in

the payroll system. Must be consistent • John Doe

• Eric S. Holzberg

• Smith, Steven

• Title is the title in their job description. Must be

consistent.

• CFO

• Chief Financial Officer

• Physician

• PA

• Nurses Aid

• Medical Attendant

Key Terms

• Physical Site is the location in which they do business.

Same site must be spelled and entered same way each

time used. Consistency here is absolutely critical.

• Downtown

• Uptown

• Lynch

• Port Chester

• Program can be used to cover funding sources,

departments, or higher level departments. For example,

program can be medical, dental, other. More on this later

Key Terms

• FTE – Full Time Equivalent. Number of hours worked over a period

of time divided by standard hours of full time employee during that

time.

Using 7/1/2011 to 6/30/2012 data

John Doe worked (including vacation, CME, sick, and Holidays) 1664

hours

Organization has established that a full time staff members works 2080

in a year.

John Doe’s FTE is 1664/2080 or .8

If he splits his time between Site a and Site b equally, he would be .4

FTE for Site a and .4 FTE for Site b.

Job Types

• Job Type – This is the most important for our analysis. Each

employee must be carefully reviewed and identified and placed in a

type.

• Admin – Provides a centralized role that does not include any direct patient

care. Usually includes Executive Team, QI, Finance, Infrastructure

managers, and Training.

• Bill or BillLocal – Includes all staff that are in a billing/practice management

role. Can include portions of front desk if they do cashiering or billing.

• ES – Enabling Service Providers including all services incident to a

physician visit that are not considered medical or dental services. This

could include translation, case management, and driving. Those services

that support improved health care

EVERY STAFF MEMBER MUST BE ASSIGNED A JOB TYPE

AND APPROPRIATELY ALLOCATED TO THE RIGHT SITE,

PROGRAM AND DEPARTMENT

Job Types

• Ops or OpsLocal – This includes all staff other than those involved in direct

patient care (i.e. nurses, nurses aids, Mas). It can include front desk staff,

site managers, medical records staff, local maintenance staff, and others. It

can be centralized or local

• Providers – These are the direct deliverers of care. I recommend the

following Job Types:

• P Physician

• D Dentist

• Mid Non Physician Billable Medical Provider

• DH Dental Hygenist

• BH Behavioral Health Care Provider

EVERY STAFF MEMBER MUST BE ASSIGNED A JOB TYPE

AND APPROPRIATELY ALLOCATED TO THE RIGHT SITE,

PROGRAM AND DEPARTMENT

Job Types

• DMS – Direct Medical Support. These folks have direct contact with the

patient and support directly the medical providers delivery of care. They can

include phlebotomists, nurses, nurses aides, medical attendants, Nurse

supervisors (as long as they also participate in patient care).

• DDS – Direct Dental Support. These folks have direct contact with the

patient and support directly the dental providers delivery of care. They are

most offten referred to as dental assistants.

• Anc – Ancillary Programs. This can include staff for your pharmacy, lab, and

or x-ray. If you have large programs you can break this out by program.

• SP – Special Programs. These are special programs that you want to

specificially break out. An example may include WIC (Woman Infant Children

Program or RW (Ryan White) Progams.

EVERY STAFF MEMBER MUST BE ASSIGNED A JOB TYPE

AND APPROPRIATELY ALLOCATED TO THE RIGHT SITE,

PROGRAM AND DEPARTMENT

The more detailed the spreadsheet, the

better the analysis

Must Have Optional

Full_Name Title Physical Site Program FTE Job Type Department Annualized

Salary

Employee 1 CFO Admin Bldg Admin 0.75 Admin Admin 75000

Employee 1 CIO Admin Bldg Admin 0.25 Admin Admin 75000

Full_Name Title Physical Site Program FTE Job Type Department Annualized

Salary

Super Susan Medical Director Admin General 0.5 Admin Admin 160,000

Super Susan Medical Director Site a General 0.2 P Medical 160,000

Super Susan Medical Director Site b General 0.2 P Medical 160,000

Super Susan Medical Director Site b Homeless 0.1 P Medical 160,000

The more detailed the spreadsheet, the

better the analysis

Key Terms

• Department is optional and can be used to further clarify

multiple programs worked. For Example

• John Doe, who works .4 at Site a and .4 at Site b, works

the Homeless program when at Site b

THE SAMPLE WE WILL WORK WITH!

Full_Name Title Physical Site Program FTE Job Type

Employee 1 Dental Assistant Registered Site C Dental 1.00 DDS Employee 2 Medical Assistant Certified Site C Medical 1.00 DMS Employee 3 Lab Technician Certified Site D Medical 1.00 DMS Employee 4 Front Office Specialist Site E Dental 0.30 Ops Employee 4 Front Office Specialist Site E Medical 0.70 Ops Employee 5 Dental Hygienist Site E Dental 0.80 DH Employee 6 Dentist Offsite Dental Van 0.40 D Employee 7 Data Entry Specialist Administration Medical Admin 0.90 Admin Employee 8 Billing Specialist Administration Financial Services 1.00 Bill Employee 9 Clinic Nurse - LPN Site D Medical 1.00 DMS Employee 10 MI HEALTH PROGRAM Social Worker

BSW Site A MI HEALTH PROGRAM 1.00

MI HEALTH PROGRAM Employee 11 MI HEALTH PROGRAM Dietician Site B MI HEALTH PROGRAM 0.90

MI HEALTH PROGRAM Employee 12 WIC Dietician WIC WIC 0.30 WIC Employee 13 Medical Records Technician Site C Medical 1.00 Ops Employee 14 Dental Assistant Registered Site A Dental 1.00 DDS Employee 15 MI HEALTH PROGRAM Nurse Site C MI HEALTH PROGRAM 0.40

MI HEALTH PROGRAM Employee 16 Outreach Nurse - FAW Offsite Outreach 0.30 ES Employee 17 Physician Site C Medical 0.60 P Employee 18 Dental Hygienist Site C Dental 0.20 DH Employee 19 Dentist Site C Dental 0.40 D Employee 20 Medical Assistant Certified Site C Medical 1.00 DMS Employee 21 Dentist Site A Dental 1.00 D Employee 22 Health Center Manager Site C Dental 0.20 Ops Employee 22 Health Center Manager Site C Medical 0.80 Ops Employee 23 Outreach Worker Migrant Outreach

Site Outreach 0.07

ES

A COUPLE OF SIMPLE PIVOT TABLE

RULES

• CONSISTENCY CONSISTENCY CONSISTENCY

• NO BLANKS CELLS, COLUMNS, OR ROWS.

• YOU CAN ALWAYS DELETE IT, IF ITS NOT WHAT YOU

WANT.

• AT SHEET 10, ITS TIME TO CLEAN UP YOUR MESS,

• SAVE OFTEN

CREATING A PIVOT TABLE

AFTER PIVOT TABLE BUILDER COMES

UP • COLUMN LABEL GETS PHYSICAL SITE

• ROW LABEL GETS JOB TYPE

• VALUES GETS SOME OF FTE

• AND QUITE HONESTLY THE MAGIC IS DONE.

• WE HAVE WHAT WE NEED!

MAGIC! Sum of FTE Column Labels

Row Labels Administration HI Parentiing Migrant Outreach Site Offsite Site A Site B Site C Site D Site E WIC Grand Total

Admin 41.71666667 2 43.71666667

Bill 19.25 19.25

D 0.4 2.8 1.4 3 1.4 1 10

DDS 2 4.9 2 7.1 3.7 2 21.7

DH 1 2.1 1 2.2 1.2 0.8 8.3

DMS 28.15 11.35 17.55 6.7 7.9 71.65

ES 3.16 9.19 2 0.5 0.5 15.35

HI Parentiing 1.7 1.7

MI HEALTH PROGRAM 6.3 7.4 7 5.4 26.1

Mid 10.05 1.85 1.1 0.5 1 14.5

Ops 20.8 7 12.1 7 15 61.9

P 7.05 2 3.6 1.9 2 16.55

WIC 2.61 36.5 39.11

Grand Total 63.57666667 1.7 3.16 12.59 86.15 34 54.15 22.4 35.6 36.5 349.8266667

THIS PIVOT TABLE GIVES YOU A VALUABLE TOOL FOR ANALYZING

YOUR STAFFING RATIOS

EACH CELL IS AVAILABLE FOR DRILL DOWN!

SIMPLE RATIOS THAT TELL YOU A LOT

Sum of FTE Column Labels

Row Labels Administration HI Parentiing Migrant Outreach Site Offsite Site A Site B Site C Site D Site E WIC Grand Total

Admin 41.72 2.00 43.72

Bill 19.25 19.25

D 0.40 2.80 1.40 3.00 1.40 1.00 10.00

DDS 2.00 4.90 2.00 7.10 3.70 2.00 21.70

DH 1.00 2.10 1.00 2.20 1.20 0.80 8.30

DMS 28.15 11.35 17.55 6.70 7.90 71.65

ES 3.16 9.19 2.00 0.50 0.50 15.35

HI Parentiing 1.70 1.70

MI HEALTH PROGRAM 6.30 7.40 7.00 5.40 26.10

Mid 10.05 1.85 1.10 0.50 1.00 14.50

Ops 20.80 7.00 12.10 7.00 15.00 61.90

P 7.05 2.00 3.60 1.90 2.00 16.55

WIC 2.61 36.50 39.11

Grand Total 63.58 1.70 3.16 12.59 86.15 34.00 54.15 22.40 35.60 36.50 349.83

DMS TO MEDICAL PROVDERS 1.65 2.95 3.73 2.79 2.63 2.31

DMS

PHYSICIANS AND

OTHER MED PROVIDERS

Does the organization have a standard ratio.

Why is each site so different?

How do we compare site to site?

Compare Site C to Site A just an example

Its only the beginning…. Sum of FTE

Column Labels

Row Labels

Administ

ration Offsite WIC Site C Site D Site E Site A Site B

Migrant Outreach

Site HI

Parentiing Grand Total

Admin 41.7 2.0 43.72

Bill 19.3 19.25

D 0.4 3.0 1.4 1.0 2.8 1.4 10.00

DDS 2.0 7.1 3.7 2.0 4.9 2.0 21.70

DH 1.0 2.2 1.2 0.8 2.1 1.0 8.30

DMS 17.6 6.7 7.9 28.2 11.4 71.65

ES 9.2 0.5 0.5 2.0 3.2 15.35

Mid 1.1 0.5 1.0 10.1 1.9 14.50

Ops 12.1 7.0 15.0 20.8 7.0 61.90

P 3.6 1.9 2.0 7.1 2.0 16.55

WIC 2.6 36.5 39.11

HI Parentiing 1.7 1.70

MI HEALTH PROGRAM 7.0 5.4 6.3 7.4 26.10

Grand Total 63.6 12.6 36.5 54.2 22.4 35.6 86.2 34.0 3.2 1.7 349.83

DMS to Medical Providers 3.73 2.79 2.63 1.65 2.95 2.31

DDS to Dental Providers 1.37 1.42 1.11 1.00 0.83 1.19

OPS TO Medical and Dental Providers 1.22 1.40 3.13 0.95 1.12 1.25

Billers to Medical Providers 0.39

Total Staff to Providers (Does not include ES, Hippy, MIHP, or WIC) 4.42

Enabling Services to Providers 0.31

More advanced data analysis

• Include a column for Total Salary and Annualized Salaries

and compare staff salaries from site to site, within a site.

• Find the average DMS salary Cost per Provider FTE

• Add Billable Visits for Providers and you can do analyses

as to Cost per Visit by site, program and department

• The more creative you are the more this tool can do!

Questions and More Examples of How to!