Show Me the Money! Decreasing Incremental Overtime

Abstract

Background:

Incremental overtime was identified as having a major financial impact on a respiratory department. Incremental overtime (IOT) is defined as 15 to 30 min beyond a 12-hour shift. During the second half of fiscal year 17/18, the total hours of incremental overtime resulted in a financial impact of $6,000 per month. A goal of IOT reduction by 50% was established.

Methods:

To identify the primary causes of IOT, a sign-off tool was developed to complete when IOT was accrued. This allowed the supervisory team identify opportunities to reduce IOT. Analysis of data found three primary reasons for IOT: Barriers to giving and receiving report, clocking in late and therapist arriving to the unit for report late. Obstacles for giving and receiving report were: geography of institution, reporting to multiple therapists and having a completed hand-off. By providing coverage to therapists that were assigned to multiple areas, a reduction in late reports were seen. The second barrier, clocking in late, had a strong correlation to IOT accrual. Consistent reminders to staff of work time attendance policy and providing verbal feedback to repeat offenders had a significant impact. The third identified barrier was therapists arriving late to assigned units. Resolution of the two above causes directly affected this third area, by correcting the first two causes staff were able to arrive to their assigned areas on time.

Results:

By identifying the most impactful causations, incremental overtime was reduced by 75% in the first half of the fiscal year. The three barriers impacting staff were identified as receiving/giving report to multiple therapists, clocking in late and arriving to assigned work areas late. Solutions were developed to reduce these barriers resulting in exceeding the goal.

Conclusions:

The goal was to decrease the frequency of IOT accrued by 50%. An action plan was made to; identify the root causes for the incremental overtime and made a resolution plan for the causes. For fiscal year 17/18, we have seen a reduction of incremental overtime by 75%. This equates to $8,000 a month. The overtime tool is an effective tracking mechanism which has helped narrow the reasons for overtime accrual. Due to the work environment, there will remain a percentage of unavoidable incremental overtime that is deemed acceptable if related to patient care. It is vital for leadership to follow through with staff who are repeat offenders of IOT to maintain these results.