'Box system' improves staff scheduling

Author's note: Some months ago this column discussed support staff labor. This month we take the discussion to the next level.

The cost of support labor is going up. I think we all discovered this reality when the 2001 final expense listing hit our desks.

And so while we are just a few months into 2002, we can make some adjustments to improve productivity while controlling labor costs in the next 12 months.

The solution exists in a staff scheduling system called the "box system." We will work through it step-by-step to illustrate how to calculate and manage support labor costs.

In the box system, one hour of support staff labor equals one "box." (Table 1,2).

Tables 1 and 2

1. List the gross support labor costs and percent, including all benefits, for 2001 $________,_______%

(For this illustration we invent a number of gross support labor costs to be 23 percent for 2001, but we can find the actual percent from looking at our own 2001 profit and loss statement.)

2. Add up and list the total hours worked by the support staff in 2001 _______.

3. To get gross labor costs per hour divide gross support labor costs by total hours worked by the support staff in 2001. This gives the practice the gross hourly cost of support labor for 2001: ____________.

(Practices typically will get a number like $10 per hour, but it is likely that your number will be different.

4. Set a support staff labor percent target for the year 2002 ________ (This number should include all costs, employer and employee shares of Medicare, Social Security, benefits and bonuses.)

5. Now set anticipated gross revenues for the next 12 months _____.

It is reasonable to decrease the annual labor costs by 3 percent without unseating the office chemistry, morale and work ethic.

(So for this discussion, we wanted, arbitrarily, to achieve 20 percent for the next 12 months, dropping the cost of labor by 3 percent for next 12 months.)

So we do the following calculations to determine how much the practice can afford in support labor costs to achieve the 20 percent goal.

We plan for labor to be 20 percent by using the following:

6. Anticipated gross for the next 12 months $ ____ x 0.20 = Annual Labor Budget, $______.

(For this illustration we will use an anticipated gross of $500,000, times 0.2 (20% = $100,000).

7. We need to now calculate hours available for the year:

We know from the previous that our actual gross hourly cost of support labor for 2001 was $____.

(But for this illustration we will use $10 per hour).

8. Annual Labor Budget (gross) ____ divided by gross hourly cost of support labor = ____.

(Or $100,000 divided by $10 = 10,000 hours per year are available to staff the clinic while keeping the labor cost at 20 percent.)

9. We need now to get the annual 10,000 hours into weekly units:

To get the annual number into weekly we divide total annual hours by 52 weeks (or 10,000 divided by 52 weeks = ______hours per week. In this illustration, 10,000 divided by 52 = 192 hours per week.)

10. We now divide by five days per week to get the number of hours available for each day.

So 192 hours per week divided by five days per week gives us 38 hours per day.

(Five days per week is for a simple work week, for 24/7 practices and other practices, "box system" calculation adjustments must be made to fit each practice's available hours.)

11. The box system works like this: each hour is a "box" and in this illustration we need 38 boxes to be filled in the daily work schedule to keep the clinic appropriately staffed.

In this illustration we end up with 192 hours per week and 38 hours per day.

When we create the work schedule, first we fill the open hours boxes, then we fill the busiest times of the week.

Then we go back and flesh out, or fill in 38 hours per day for the rest of the week.

12. The box system works great to adjust hours to fit practice needs.

In this illustration, Table 2, we moved three hours from Tuesday afternoon to Wednesday afternoon to cover a time of "peak business activity."

The placement of staff where they are needed, during times of "peak business activity" improves health care, decreases stress, keeps clients and staff happier and improves productivity which permits the practice, in the long run, to increase staff remuneration.

Using the anticipated gross for the year puts the appropriate number of staff in the office in advance of the anticipated need, thus improving health care.

To improve productivity run the hours lean, cut the available "boxes" per week by running under budget by 5 percent of the anticipated hours (for this illustration 192 x 5 percent = 9.5 hours, so cut the weekly hours to 183.

If you want to improve client service run the hours 5 percent more than budget and focus on extroverts in the front office (For this illustration 192 plus nine hours provides 201 "boxes.")

Please note that, in general, improved client service increases gross revenues.

13. Some added thoughts:

Looking at the support staff to veterinarian ratio will determine if you need more DVMs or support staff. Four support staff per veterinarian would mean hiring more support staff; six support staff per veterinarian would necessitate hiring another veterinarian.

Type needed

The type of support staff needed can also be determined by the box system.

In previous work it has been shown that the typical traditional practice needs about one support staff handling clinical duties with patients (hands-on time) for each one support staff handling clerical duties (soft-time).

We have arbitrarily labeled hands-on time as the T-Team and the soft-time staff as the F-Team.

Thus, if we have 60 percent of the boxes filled with hands-on staff, T-Team, the clinic is likely to be needing more soft-time clerical help, F-Team, to handle billing, telephone, customer service and medical records issues. Hire F-Team folks.

And one last thought. Multi-tasking is a hot buzzword these days; using the box system is but one of the ways to staff the clinic appropriately to begin training and improving the on-the-job multi-tasking issues.