We were praised by one of our clients (the head of a state health and human service agency) for our work helping the agency rethink both its staffing levels and business processes. We refer to this work as a “staffing study”. The director stated that our work was not only valuable in its own right but for the impact it had on starting the agency examining and redesigning its business processes and even its business model. Here is an overview:
- The project was authorized by the State Legislature to find a more precise way than client to staff ratio to determine the number of staff needed to provide services (although truth be told they really wanted to prove that the agency had too many staff) and to identify process improvements and other cost savings (who wouldn’t want that).
- We studied Food Stamp and Medicaid Eligibility, Adult Protective Services, Case Management in Long Term Care and TANF, Vocational Rehabilitation Counseling and Employment Related Day Care and Medicare Part D.
- Our methodology was rather innovative. Historically staffing or workload studies are often done to determine federal reimbursement and use Random Moment Time Studies where workers carry a beeper and record what they are doing when the beeper goes off. This produces a lot of data but only quantifies what workers are doing now – not what has value or what could be done differently and how much time could be saved. We developed a “triangulation” method – using multiple sources to quantify workload and improvement opportunities. We typically used site visits with staff interviews, direct observation and process mapping (much of the site visits protocols we now use were developed here); electronic surveys of all program staff (with “reasonableness” checks); best practice searches, and focus groups.
- Our results were presented as high level process maps that showed tasks, how long each task took, and how often the task would be done each month. For example, we calculated how many minutes it takes to process a food stamp application multiplied by the expected number of applications and divided by the number of minutes available per worker to give us a staffing level. We could demonstrate the savings in time and dollars if tasks were done differently. We also proposed some major changes in the model for doing case management and vocational rehabilitation counseling – using the case manager as a team leader with para-professionals doing tasks that did not require case management credentials and expertise.
- Much to the delight of the legislature -we showed the expected cost savings for process improvements. For example, one of the easiest process improvements recommended and subsequently implemented was to synchronize eligibility redeterminations for clients. Clients were typically receiving multiple services from the agency (Food Assistance, Medicaid, etc.) but the time periods for re-determining eligibility for each service was different. Agency staff would review the same information for a client for one service and then later review the same information for the same client for a different service. By synchronizing the time periods for these reviews the agency could save approximately 2.6 million dollars per biennium (one-half of which was the state’s share).
We have used this methodology in both large (as noted above) and small studies as well such as a study of clerical services for a county senior services office and found equally successful results.