• What Is SDM 2002™?
• Why Are Today's Staffing & Scheduling Practices Unsatisfactory?
• What Are The Objectives Of SDM 2002™?
• How Does SDM2002™ Stop The Census Roller Coaster?
• What Technology Supports SDM 2002™?
• How Does SDM2002™ Allow More Nurses To Be Brought To The Bedside At No Additional Cost?
• How Does SDM2002™ Enhance Continuity Of Care?
• How Are The Departments That Support The Nursing Units Affected?
• How Is SDM2002™ Different?
• What Is Meant By Aggregation?
• Our Hospital Is Organized Into Specialty Units. Doesn't The Aggregation Concept Interfere With This Specialty Focus?
• How Is SDM2002™ Any Different Than Nursing Unit Consolidation?
• The Patient Census In Our Hospital Varies Widely From One Day To The Next & Even From One Shift To The Next. In Addition, We Experience Significant Seasonal Census Fluctuation. How Does SDM2002™ Take This Into Consideration?
• Doesn't SDM2002™ Assume That Staff Is Moveable Or Already Cross-Trained?
• Won't Patient Transfers Become Necessary When The Variable Unit Is Open & There Are Discharges From The "First-To-Fill" Units?
• We Have Already Redesigned Our Care Delivery Models. Why Do We Need SDM2002™?
• Will SDM2002™ Leave Us With AUnit That Opens & Closes All The Time?
• We Run Fairly Full Units. Why Do We Need SDM2002™ & Its Decision Rules?
• This Sounds Great, But Won't The Nurses Oppose SDM2002™?
• Don't Low Census Days Become Much More Common With SDM 2002™?
• How Can Staff Be Maintained On A Variable Unit? Won't They Be Subjected To Excessive Low Census Days?
• How Does SDM2002™ Differ From Float Pools In The Attempt To Lower Premium Pay?
• Does SDM2002™ Require Computer Hardware Or Software Purchases?
• What Is The Typical Time Frame For Implementing SDM2002™?

SDM2002 is a systems thinking approach that enhances care delivery. It builds a predictable work environment by minimizing census variation and stabilizing patient ratios. SDM2002™ maintains high levels of productivity and allows schedules to be set at the top quartile of the aggregated census distribution. It eliminates premium pay labor and lessens recruitment needs.

This methodology is built around several important but often over looked observations:

• Census variation is a major driver of labor cost
• Census level is a major determinant of patient care ratios and productivity. Care teams are given an assignment based on patients not the HPPD target
• It is more important to manage labor cost than hours of care
• Efficiencies can be produced in aggregate that are not available to units independently

In the past, traditional patient care workloads had flexibility that allowed for the assignment of an additional patient. However, current ratios, some of which have nearly doubled, leave care teams without the ability to assume these additional patients.

The primary objective is to stop the census roller coaster and preserve nurse to patient ratios. In most hospitals, patient care units operate such that census varies significantly making the workload unpredictable from hour to hour. A typical unit may start with 20 patients at 7:00am, progress to 30 patients at 2:00pm, and then by 8:00pm, have decreased to 24 patients. Staff is expected to meet the needs of patients despite daily census that may vary by 40% or more.

In addition to preserving nurse to patient ratios, SDM2002 allows hospitals to:

• Diminish vacancies and lessen recruitment needs
• Meet financial imperatives without laying off staff or changing skill mix
• Allow more nurses to be brought to the bedside at no additional cost

SDM2002™ controls the number of units that experience day-to-day variation by applying a technique called "economic sizing" to determine the optimal census levels at which the various nursing units should be operating. Patient placement rules are used to keep units at these predefined, optimum levels. As a result, census variability is all but eliminated, thus ensuring that care teams always work at the desired patient care ratios.

In addition, the reduced census variation makes it possible to schedule staff at the top quartile of the aggregated census distribution, (rather than the average).

Economic sizing employs a proprietary optimization technology, developed over the last six years, to identify optimal aggregated patient placement solutions that minimize census variability and total labor cost. Used in connection with a highly interactive consulting process, our supporting technology analyzes:

1. Census levels at which care is delivered most cost effectively,
2. Historical hourly and daily census distributions to identify how patients can be assigned across units so that census levels can be maintained at the low cost levels, and
3. Potential units to be aggregated.

All of the support areas like lab, pharmacy, environmental services, food services, etc. benefit from the stabilized census.

For example, the food services department knows that 4 South has a consistent census of 28. This predictability results in more efficient use of the food services department.

• Caregivers deliver care to the exact number of patients called for by care models
• Paid time off (vacations and holidays), on-going education needs, orientation and attrition rates are built into schedules
• Staff is scheduled at the top quartile of the aggregate census distribution
• Bed placement rules fill beds on units to predetermined, optimum census levels, which minimizes census variation
• Focus is on paying straight time at all times while maintaining high levels of productivity; overtime is reduced, and agency help eliminated
• Excellent patient coverage is available at higher census levels
• Systems thinking approach and technology of SDM2002™ requires the aggregation of related units into patient centers so that patients can be placed in ways that lower overall costs

Aggregation refers to a collection of two or more nursing units into a patient care center or "mini hospital". The scope of RN practice that exists on each unit is used to help determine which units can form the mini hospital. For example, the following units could be considered a mini hospital if the staff on all three units have a comfort level caring for the medical population:

By organizing into a mini-hospital, SDM2002™'s optimal patient placement rules and scheduling schemes can be implemented to produce savings due to economies of scale and avoidance of premium (overtime and agency) dollars. These savings are not available to nursing units operating independently.

While, SDM2002™ depends on some form of patient aggregation to maximize productivity SDM2002™ will preserve core specialties and build around these specialties through the development of optimal patient placement rules.

In figure 1, all pulmonary patients will be placed on 4N; all renal patients will be placed on 4S and all oncology patients will be placed on 5E.

If your hospital has a critical mass of a particular kind of patient, it is likely that your patient care centers are already arranged accordingly.

While cost-effective unit consolidation requires optimal patient placement rules, optimal patient placement rules may not necessarily lead to unit consolidation. There may be other options for placing patients that are both more feasible politically as well as more cost-effective for the hospital. Also, unit consolidation implemented without optimal patient placement decision rules does not guarantee that the units remaining open are being filled in the proper sequences to the census levels that will enable productivity to be maximized in aggregate.

No, patient transfers are not necessary. There will be hours and days when the units will not be operating exactly at the census levels targeted by the optimal patient placement rules. SDM2002™ develops optimal patient placement rules after a thorough analysis of the hourly and daily census swings of the aggregated units over a one-to-two year period and these temporary variances from the targeted census levels are expected.

No. After our analysis we present several different scenarios. Some scenarios may support that a particular unit is open a portion of the year. Other scenarios will support having all the units open all of the year. Each one of these scenarios renders a different dollar savings. We encourage all of our clients to choose the scenario that is the most implementable.

Contrary to common believe even units that run fairly full, experience significant census variations. This is because they lack a census target and overall placement rules. SDM2002™ optimization technology economically sizes each unit and provides the necessary placement rules to keep the units at this target all the time.

SDM2002™ is a major benefit for all caregivers. By implementing SDM2002™ rules and staffing, census variation is reduced significantly. As a result caregivers are able to provide care to a predictable number of patients. This eliminates the need for caregivers to ever take on excessive patient assignments.

No. The number of low census days actually decreases.

There are a number of ways that staff can be scheduled to support the variable unit. These scheduling options range from the variable unit maintaining it's own staff to having the variable unit supported with staff from the mini hospital.