Healthcare

Workforce Management in Healthcare 

In the healthcare sector, 40,000 nursing positions were unfilled across Germany in 2022. This is why the legislature has taken action: With the new Nursing Staff Regulation (PPR 2.0) and the Nursing Staff Lower Limits Regulation (PpUGV), the German Federal Ministry of Health is providing hospitals with a tool to relieve the burden on nursing staff while increasing the quality of care. Software with time management and staff scheduling functions enables healthcare organizations to manage duty rosters in accordance with these new regulations while taking the interests of patients and staff into account.

Best-of-Breed HCM

An important cornerstone for the performance of a workforce management solution is the technical ability to integrate it with existing ERP systems. In healthcare, the connection to hospital information systems (HIS) is also highly relevant. As part of a healthcare partner initiative, SAP has therefore created a modular best-of-breed approach based on the SAP Business Technology Platform (BTP).

The aim is to supplement standard ERP processes with special solutions and thus increase the added value for the clinics. Depending on individual needs, clinic-specific solutions can be integrated via SAP or S/4 Hana, for example for patient-related processes such as admission, diagnostics and therapy, or business processes such as purchasing, logistics or accounting. In the area of personnel management, the certified partner solutions include the modular Atoss Medical Solution with the functions time management, personnel requirements planning and personnel resource planning. Via standardized interfaces, data relevant for duty scheduling and payroll accounting as well as important personnel requirement drivers such as current and prognostic patient occupancy are validly available. 

Employee-oriented duty scheduling 

As the only supramaximal care provider in Rhineland-Palatinate, Mainz University Hospital has to cope with a highly fluctuating patient volume. For this reason, the hospital has been planning the working hours of its approximately 8,700 employees, including physicians, special and functional staff, nursing staff, technology and administration, with the Atoss Medical Solution for many years. The workforce management software integrates seamlessly into the entire clinical care process and the existing IT system landscape.

In order to make intelligent use of daily updated data relating to duty scheduling and working time management, the solution must communicate with a number of other systems. For example, master data and information on employee qualifications are imported from personnel information and education management systems. Staffing requirements drivers such as patient numbers flow into duty scheduling from the hospital information system. And the wage types for accounting for the services performed, including statutory working time and collectively agreed bonuses, are also transferred to the payroll system with cost center accuracy.

The Atoss Medical Solution also has a standard interface to hospital-wide SAP Time Management. Planning-relevant data from Time Management and SAP ESS is available to the planner at all times in an up-to-the-minute format. For example, employee requests are transferred directly to duty scheduling after they have been entered in Self Service. Balances including traffic light function, recorded absences such as vacations and also availabilities as well as entries and departures of employees are available in real time. The planning data is automatically transferred back to SAP Time Management. 

In addition, the duty rosters are visible in SAP ESS for doctors and nurses and are exported to Inpuls, a system for measuring staffing requirements in intensive care units. In this way, key figures regarding nursing workload can be generated. The seamless exchange of data between these systems and a holistic digitization strategy enable Mainz University Hospital to plan economically while at the same time focusing on employees and ensuring a high quality of care. 

Make workload visible

The new nursing staff regulation PPR 2.0 came into force on January 1, 2023. The instrument for measuring staffing requirements is now to be established in inpatient care by 2025. Using this assessment tool, every hospital must be able to demonstrate a shortfall concept that ensures regular staffing and prevents nursing staff from being overworked. Soon, there will even be the threat of sanctions if the defined values are permanently undercut. Against this background, Mainz University Hospital and Atoss have jointly developed a solution to digitally map the PPR 2.0. This objectifies the workload on the wards through measurements and makes the duty planning process more transparent and efficient. At the same time, it enables the implementation of the specifications from the in-house collective agreement on relief.

Patient data flows from the SAP I.S.H.med. hospital information system into the workforce management software. The workstations are stored there in accordance with the specifications from PPR 2.0 and assigned time values. Based on the number of patients and the service indicators corresponding to the treatment, the personnel requirements are calculated and displayed directly in the duty roster. Deviations from the target values are indicated to those responsible for planning. In this way, it is possible to calculate exactly with which staffing levels shifts need to be filled. 

In addition, the load can be made visible in accordance with the collective relief agreement (TV-E). Target specifications have been defined for the operating units, which replace the specifications of PPR 2.0. Based on these specifications, the clinic determines exactly when employees are working understaffed shifts. If a shift falls below target staffing levels, an automatic record is made and documented in the software. "We link the PPR 2.0 data to the Atoss software, giving us a kind of weather report for the load on our workforce. This allows us to be even more proactive in preventing overload," explains Christian Elsner, CFO of Mainz University Hospital. 

Planning reliability and compliance

Duty scheduling in the healthcare sector must manage personnel capacities dynamically and flexibly, while at the same time giving employees the greatest possible influence on their working hours. Transparency is necessary in order to consistently comply with legal regulations on working hours and collective bargaining agreements, such as those stipulated by the TVöD, TVÄ, TV-E, TV-L, the AVR or the BAT. At Mainz University Medical Center, for example, exceeding the statutory maximum weekly working hours is reported directly during the planning process. For the observance of Sundays off per year, a counter is set up in the Atoss Medical Solution, which restarts on January 1 of each calendar year. Spontaneous assignments that are subject to surcharges ("get out of free time" or a duty swap within six days) are automatically checked by the software directly during entry, so that times relevant to payroll are also correctly transmitted to payroll. 

The PpUGV is also displayed transparently directly in the planning process - as are the figures for PPR 2.0 or TV-E. For this purpose, the patient occupancies from the midday and midnight statistics are imported from SAP I.S.H.med. into the workforce management solution and displayed as demand in the duty roster - either broken down as a time value or as a personnel value (FTE). In this way, the more than 700 employees of the Mainz University Medical Center who are authorized to plan can do so efficiently on their own, while complying with the regulations. They also have the option of specifying desired services in SAP ESS, which are then in turn displayed in real time in the duty scheduling.

This makes it possible to organize working time individually in the individual departments. The individual time sheet is available on a daily basis - including generated time bonuses and days worked under load. As a further and next flexibility instrument, it is planned to provide medical clinic staff with direct access to the Atoss app and shift swap exchange via SAP ESS. The flexibility and transparency achieved through workforce management has a measurable positive impact on employer attractiveness and the employer brand in Mainz.