Aligning Staffing to Match Patient Volumes, Increase Efficiency

Valley Hospital’s Ann Marie Leichman, RN, and Guidehouse’s Vamshi Gunukula, for Becker's Hospital Review

Similar to many hospitals across the country, Valley Hospital, a 451-bed acute care hospital located in Ridgewood, NJ, has experienced declining inpatient volumes and associated revenues as more care is delivered in outpatient settings.

Recognizing these changes in the health care delivery system, hospital leadership sought an objective methodology to analyze their current staffing practices, redesign them to be as efficient as possible and hence, reduce unnecessary costs.

Valley Hospital was looking for data-based insights to help leadership better staff departments to meet patient volumes. At the same time, hospital leaders believed the organization could redesign certain processes to more efficiently deliver the same service and quality levels.

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 the fact that it has received three consecutive American Nurses Credentialing Center Magnet® designations.


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 cost:

Staffing optimization: Valley Hospital had previously relied on nationally available staffing and productivity benchmarks, but leaders were not confident that these benchmarks accurately reflected their staffing needs or patient population. Instead, 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.

By analyzing historical data on patient volumes and visits, procedure logs, lab draw times, and other factors, actual demand could be determined for different departments and units. As part of this analysis, predictive algorithms developed by Guidehouse sort through the data to identify patterns at different days, times, and seasons.

Using these insights, almost all units at Valley Hospital have reconfigured their staffing plans and FTE targets to reflect the actual day-to-day reality in their hospital. The updated plans enabled reductions in labor budgets, leading to cost savings.

Workflow redesign: The second key strategy that 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.

Take, for example, how workflow has been optimized in the transport department. To identify why the department was not successfully scheduling and fulfilling transport requests, Guidehouse experts observed transport staff for a few weeks. They mapped the entire transportation workflow and determined peak days and times for transport requests.

This led to full-blown redesign of the transport workflow to better capture transport requests from various departments, including radiology and the ED, and schedule staff more appropriately to match the number of transporters actually needed. Now the department is successfully fulfilling a higher number of transport requests with two fewer FTEs.

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. Managers and directors are also now equipped with continual analytics on volumes and the optimal staffing plans to match the volumes. Owners for each initiative were identified and implementation documentation worksheets were developed in conjunction with the initiative leads to assign tasks, timelines, and impact.


Valley Hospital identified about 25 initiatives to improve staffing and workflow, for a projected total decrease of $7 million or 8% of the organization’s nursing, ancillary, and support services labor spend. 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.

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