How DPA Helped a Hospital’s Engineering Department Set Its Maintenance Staffing Requirements
By Steve Mueller, Daniel Penn Associates
Engineering departments in healthcare facilities keep the building and equipment operationally and cost-effective. They also support hospital staff in their efforts to create an environment of care.
Maintenance tasks that may be low priority outside a health care setting become far more important to patients in a hospital room. To respond more appropriately to ever-changing service demands from the hospital, maintenance departments must be proactive in the management of their resources, including periodic staffing level assessments.
DPA recently helped a large medical school-affiliated hospital reassess the staffing requirements for its engineering department’s shops and administrative functions.
DPA compared a prioritized workload demand to the department’s capacity, aka the supply of labor available to do the work.
On the demand (hours of work required) side of the staffing equation, we measured three areas.
Protect scheduled preventive and predictive maintenance (PM/PdM) hours. Why? PM/PdM tasks must be completed as planned to protect the hospital’s investment in the equipment and infrastructure that supports its environment of care.
Estimate labor hours for emergency work requests. In hospitals, a First Response Crew stationed in various locations can be dispatched quickly to triage urgent problems and take appropriate first steps.
Estimate the hours required for backlog relief. These are labor hours planned for non-critical routine maintenance tasks, scheduled projects, and other lower-priority work requests.
Paid hours per week
– Average weekly indirect hours (vacation, training, sick days, meeting time, cleanup etc.)
Direct hours available to work
Planned and Unplanned Work Workload
DPA was provided with a database of all work orders issued in 2018. This included more than 21,000 work orders for Preventative Maintenance (PM) and 49,000 work orders for work requests Data for requested work included actual labor hours. While this was helpful in forecasting future requirements, the hospital’s PM work orders did not include the usual estimates of labor hours that are normally used for defining requirements. Instead, the department staff developed averages for each PM procedure based on the actual labor reported against the PM work orders. This was used to forecast each shop’s PM labor requirements for the future 12 months. DPA was unable to determine if the reported hours reflected a reasonable level of performance since there was no original estimate for comparison.
The hospital calculated work request staffing workload (unplanned work) by summing the labor hours reported against various work order priority classifications for each shop, then calculating a weekly average. Our key assumption was that the near future is likely to resemble the recent past for work requests and therefore the department should be prepared accordingly.
In hospitals, a significant portion of work requests address normal wear and tear on the hospital facility caused by visitors, staff, and patients. Since there is every reason to expect this to be the case in the near future, each shop’s staffing should be set to accommodate this level of work.
Supervisors and Planner/Schedulers
The generally accepted rule of thumb for a supervisor’s span of control is 1:15 supervisors to workers. DPA determined that the department should add two additional supervisors to improve the department’s supervisory span of control to the 1:15 level.
Planner/schedulers should be allocated in a ratio of about 1:20 planner/schedulers to workers. This hospital had no planning or scheduling roles in operations. To relieve supervisors of planning and scheduling responsibilities and improve the department’s overall level of service, DPA recommended that the hospital create three planning and scheduling positions.
The engineering department’s administrative staff works primarily as a Call Center to receive and respond to the hospital’s requests for maintenance work. The engineering department receives requests from 7:00 a.m. to 3:00 p.m.; off-hours are handled by a control center.
On a typical day, the department receives more than 100 requests for service. Seventy-three percent of requests come in by telephone – one every 7.3 minutes. DPA found that calls from hospital staff are 1.5 – 2.0 minutes long with at least another couple of minutes of after-call work to finalize the work request, send it to the appropriate shop and/or dispatch it to a maintenance worker, then follow up to confirm that service was provided. Using an Erlang-C based Call Center Calculator, we found that at least two people were required to provide a basic level of service (80% of the calls answered within 30 seconds). As staff also performed a variety of general office administrative tasks for the 60+ members of the department, DPA recommended that no changes be made to staffing levels for the four administrative staff.
The PM and unplanned work that was contracted out (mostly for elevators and safety doors) was not the type that could be readily brought in house. Therefore, DPA did not recommend making any changes.
- Add five workers (across several shops)
- Add two supervisors
- Maintain administrative staff level which had recently grown from two to four.
Implement a planning and scheduling function
- Adding a planning and scheduling function enables more effective and efficient maintenance work order management.
- Adding this function frees up supervisors to spend more time supervising, which is their primary responsibility.
- A target ratio of planner/schedulers to workers is 1:20. This client had no planner/schedulers at all so DPA recommended having at least 2 and perhaps 3, depending on the true volume of “emergency” work, which was unclear given the hospital’s tendency to call for service (intended for urgent requests) instead of using the online system.
Balance the PM workload and create a dedicated PM crew
- DPA recommended balancing (aka ‘level loading’) the PM workload across 52 weeks for all shops with a PM workload.
- A balanced PM schedule can eliminate the end of the month PM crunch and support a dedicated PM crew.
- A dedicated PM crew makes it easier to focus on the required training, problem-solving, and process improvement needed to continuously improve PM performance.
- A dedicated PM crew and a balanced PM schedule ensure there is sufficient staff to complete all PMs on time every month.
Show Estimated Hours on PM Work Orders
DPA recommended strongly that all planned work orders include estimated hours so that everyone understands the work effort required.
Reduce Work Request Call Volume
Over 70% of work requests came in by telephone, well above the ASHE average of 40%.
- If every request becomes an “emergency”, the department’s ability to respond to true emergencies becomes diluted.
- The department can end up with excess staff to provide a level of service that is not required.
- DPA recommends working with the hospital departments to encourage greater use of the web system for making work requests instead of calling.
- DPA suggests regularly communicating the department’s response time to show how well you are serving the hospital’s needs. This could support the effort to use other channels for work requests and reduce the workload for dispatch.
Daniel Penn Associates senior consultant Steve Mueller provides an adept analysis of work and information flow, as well as the assessment of management and work procedures. Steve has additional expertise in developing staffing and resource requirements models and is accomplished in delivering management skills training and one-on-one coaching.