Valley Hospital Aligns Staffing to Match Patient Volumes, Increase Efficiency

Guidehouse Partnership Helps to Reduce Labor Costs by 8 Percent While Maintaining High-Quality Care


The Valley Hospital, located in Ridgewood, NJ, is a 451-bed acute care hospital that has received three consecutive American Nurses Credentialing Center Magnet® designations. Like many hospitals across the country, Valley Hospital has experienced declining inpatient volumes and associated revenues as more care is delivered in outpatient settings. Recognizing these changes in the healthcare delivery system, hospital leadership sought an objective methodology to analyze their current staffing practices, redesign them to be as efficient as possible, and reduce unnecessary costs.

Hospital executives decided to take a bottom-up rather than a top-down approach. Instead of giving nursing, ancillary, support services, and other departments budget targets based on external benchmarks, executives asked unit and department leaders to develop optimal staffing plans based on analyses of:

  • Historical data and patterns
  • Current staffing plans and configurations
  • Existing practices and workflows

The purpose of the approach was to determine the optimal plans to staff to demand and improve overall efficiency by redesigning processes and workflows to reduce waste.

From the beginning of the initiative, Valley Hospital leaders made it clear that quality of care must not be jeopardized by any staffing changes and wanted to ensure the direct-care nursing hours per patient would not change. In addition, the hospital takes pride in its employee-friendly culture and Magnet status.


Valley Hospital partnered with Guidehouse to achieve its staffing goals by engaging its key leaders, managers, and frontline staff. The organization created design teams by functional area, and combined the following three solution sets to effectively manage labor costs:

  • Staffing Optimization: leaders wanted each area to determine the actual demand, on different days and at various times, and then adjust staffing plans to meet that demand.
  • Workflow Redesign: The second key strategy Valley Hospital used was workflow redesign. Staff worked with Guidehouse consultants to map out workflow steps for key processes and identify which steps might be combined, eliminated, or streamlined.
  • Management Tools: Management tools — including daily staffing calculators and automated position control — were created or streamlined to ensure that hospital leaders can more easily plan staffing budgets and track labor metrics, including costs and productivity.


Valley Hospital worked with Guidehouse to identify about 25 initiatives to improve staffing and workflow, for a projected total decrease of $7 million or 8% of nursing, ancillary, and support services labor spending. Most of the opportunities were identified in nursing, perioperative care, and support services. The savings included in Valley Hospital’s FY18 budget based on implemented value totaled $5.5 million.

In addition, leaders attained their goal without layoffs. Some positions were eliminated through staff attrition or migration. For instance, after the transport workflows were redesigned, leaders realized they did not need to fill two vacant positions. And, when nursing units reduced their staffing numbers, nurses were moved to a float pool or reassigned to another unit.

Most importantly, because staffing was reconfigured to match actual patient demand, Valley Hospital leaders are confident that quality of care will not be affected.


We were looking for data-based insights that could help our leaders better staff their departments to meet patient volumes. At the same time, we suspected that we could redesign certain processes to more efficiently deliver the same service and quality levels. With Guidehouse’s assistance, we are on track to accomplishing both objectives.

Ann Marie Leichman, RN
Senior Vice President of Patient Care Services and Chief Nursing Officer
Valley Hospital

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