Workforce Optimization Using PROSPECT Data

No matter how you sliced the data, Seattle Children’s Hospital costs were higher than many of its peer organizations.

With clinics spread throughout the Pacific Northwest and Alaska, geography could explain some of the reasons the hospital’s wages and case mix index-adjusted cost per adjusted patient day were higher than peers. Even so, hospital leaders wanted to determine if they could lower costs without impacting quality.

“When we looked at this data, we were forced to ask the question, ‘How are our peers providing the same high-quality care but at a lower cost?’” said Danielle Pagliaccetti, Seattle Children’s budget and financial analysis supervisor.

Benchmarking with PROSPECT data

In February 2023, hospital leaders looked to workforce optimization for savings, focusing on a key metric: Worked Hours Per Unit of Service (WHPUOS). The measure of productivity is calculated using volume and labor hours. Each department’s or unit’s WHPUOS was then benchmarked against peer hospitals using data from PROSPECT, Children’s Hospital Association’s (CHA) financial and operational data program.

Seattle Children’s identified a group of benchmark hospitals with a similar case mix index and organizational structure. Managers who felt the benchmark hospitals didn’t offer appropriate comparisons could ask for exceptions.

“It's the leaders’ responsibility to reach out directly to peers to find support for their benchmark data so they can speak more specifically to why their worked hours per unit of service metrics may be different from our benchmarks goals,” Pagliaccetti said.

PROSPECT training and accessibility

More than 400 managers received training on the PROSPECT benchmarking tool. The budget team developed step-by-step guides for using the system and interpreting the data.

Pagliaccetti said a Tableau dashboard also allows managers to quickly see their cost center’s percentile goal, upper and lower quartiles, and side-by-side comparisons of identified peer hospitals.

“Instead of having to go into PROSPECT and run reports, they can go into the dashboard and see where they stand. We wanted to make sure we were not gatekeeping this data,” she says.

Filling new and vacant positions

When a position becomes vacant or a hiring need arises, managers must first review their PROSPECT benchmark data. If their department’s WHPUOS meets or exceeds goals, the manager can submit a job requisition to human resources. If the WHPUOS goal isn’t met, the manager must submit the request to the hospital’s Workforce Optimization and Management Council (WOMC).

WOMC was created in 2023 to help the hospital achieve cost savings. Executive leaders serve on the council and review hiring requisitions weekly. Managers attend council meetings and explain why the position should be filled, but WOMC is not intended to be punitive.

“The council has really evolved since we since we started it. In the beginning, it was a group that decides yes or no to these requisitions. It has become a touch point between our executive and operational leaders. It allows them to brainstorm solutions to operational challenges rather than just moving forward as we always have,” Pagliaccetti said.

Early results

In the first year of the initiative, Seattle Children’s:

• Asked departments that were performing above the 60th percentile to improve budgeted FTEs by 5%.
• Restructured some management positions using PROSPECT benchmarks.
• Aligned volume allowances to support increases in productivity.

While it’s too early to determine if the changes influenced the hospital’s wage-adjusted cost per patient day, Pagliaccetti says as a result of this work, around 260 fewer FTEs were budgeted in the fiscal year 2024 budget planning process.

“Over the past year in this process, leaders have become more intentional with the requisitions they submit. Instead of just filling roles as they become vacant, they're really having to be more thoughtful. As a result, we've seen the number of requisitions come through HR decline,” she said.