For grounds care, the median is 30,000 acres per FTE; 82 percent said they used outsourcing for to handle grounds care. As noted more than once in this report, VHA already captures extensive data about facilities, as well as the services it provides to veterans and the veteran population. SOURCE: Committee generated. A long-term strategic investment strategy may assist VHA with achieving sufficient funding to meet its infrastructure needs. These values could be compared with actual, known staffing levels for the VAMCs. Healthcare facilities must be prepared for potential staffing shortages and have plans and processes in place to mitigate these, including communicating with HCP about actions the facility is … The Facility Complexity Model provides output for each VAMC that is along a compendium of five possible options, known as the Clinical Complexity Index (1a, 1b, 1c, 2, 3). When considering a model, it is important to understand your organization’s unique needs. 3. Instead, it should be recognized that the model will be a living tool that is refined during annual review as these challenges get addressed. PRISON STAFFING. Staffing is a cornerstone of human resource management. Thomas J. Beauclair . The timing of the staffing model review should occur annually in time to provide defensible requirements to support the budget request to Congress. Director . They must respond to requests for information from HQ that require data pulls and analyses, which may not be done consistently across VAMCs or even between staff members at the same VAMC. The committee estimates that this review process will require 3 months. In larger or more complex organizations, each … Changes of infrastructure at the medical center level: Unique requirements or new requirements (i.e., traumatic brain injury or post-traumatic stress disorder care), Demographic population shifts (i.e., gynecological care for the growing number of female veterans), Leased status (i.e., community-based outpatient clinic locations and capacities). Develop contingency staffing and resident placement plans with neighboring facilities. An explanation is provided to describe how funding for Facilities Management (Engineering) staff could. RECOMMENDATION 5.5: The Veterans Health Administration (VHA) subject-matter expert task force should apply the VHA Facilities Management (Engineering) Staffing Methodology to determine and document all logic, justification, and calculations for the baseline, parameters, thresholds, and variances when building out the initial VHA Facilities Management (Engineering) Staffing Model. Define a clear vision that can help stakeholders understand what the organization is trying to achieve within the agreed time frame. Big data sources go well beyond spreadsheets and databases to include real-time capture and processing of e-mail, video, chats, and location-tracking information. (The median is the middle point in a set of data; half of the responses are above it and half are below it.). They could focus more on other important aspects such as working with their research teams, regulatory issues, taking care of equipment and consumables, and ensuring the health status and well-being of the animal models. The facility will enter into the Community Correction Staff System (database) the following staffing … For these purposes, it may be helpful to visualize an implementation process and sustainment cycle in the context of the fiscal year. Sign up for email notifications and we'll let you know about new publications in your areas of interest when they're released. The vast changes coming forward from the merger of many DoD medical services under a Defense Health Agency (DHA) umbrella, where they will be streamlined and consolidated, has the potential to impact the veteran population across the country. Property & Facilities Management staffing Your employees require a unique intersection of hard and soft skills to succeed in their roles. Operations and maintenance typically includes the day-to-day activities necessary for the building/built structurei, its systems and equipment, and occupants/users to perform their intended fu… To start, this chapter will begin with a description of how key staff element roles could be identified to tap into critical expertise for each of these three steps. The committee recognizes that the SME task force will need to deal with three major challenges that were described in the interim report and in previous chapters of this report, as follows: alternatives. IT Facility Management Services (Technology Staffing) We offer Facility Management Services on Service Level Agreement (SLA) Model, Cost+ and Manpower based support model. Last, all stakeholders should be able to see the logic behind the thresholds for each parameter and the logic or justification for the staffing variances for each threshold of each parameter. Based on the role and responsibilities of OCAMES, it would be logical that this office would continue to be the sponsor and provide oversight and management for all steps of the model. Chapter 4 described the context in which the Veterans Health Administration (VHA) Facilities Management (Engineering) Staffing Model will operate and a staffing methodology that starts with a baseline and then applies infrastructure complexity parameters to capture the specific factors that impact the three Facilities Management (Engineering) functions defined as in-scope by the study sponsor. The Facilities Management (Engineering) staff in the hospital is the critical link to make this happen. Facility Staffing Levels: Maintenance, Custodial, and Grounds Care, Survey: Facility Staffing Levels for Office, Educational, Government, and Health Care Buildings. The committee heard repeatedly that this is no small or easy task, but it certainly is a requirement for the staffing model to work. 4 step process of facility planning are; 1. For example, custodial services can be provided more efficiently, in terms of square feet covered by a single FTE, in a 500,000 square foot high rise than in a K-12 system that offers pre-kindergarten in a variety of small spaces. Last, it will offer areas for further study on issues the committee believes could impact the VHA Facilities Management (Engineering) staff, and thus the model, in the near future. To search the entire text of this book, type in your search term here and press Enter. Results of performance metrics and measures that occurred that year. The better the data, the more equipped leaders at every level will be for decision-making. The annual review should consider all model assumptions and estimation procedures (e.g., baseline staffing level, infrastructure complexity parameters, threshold values, and staffing variances). Successful change management is more likely to occur if the following steps are included: RECOMMENDATION 5.8: The Veterans Health Administration (VHA) leadership at the Deputy Under Secretary for Health for Operations and Management should actively supports the design, implementation, and sustainment of the VHA Facilities Management (Engineering) Staffing Model, including a deliberate annual review of the VHA Facilities Management (Engineering) Staffing Model. Once developed, the model output should provide a defensible Facilities Management (Engineering) staffing requirement to support annual budget requests and then inform staffing decisions to best manage risk at the medical center level based on actual funding. 2. A description of the budgetary implications of implementing the staffing model 4. This body would be integral in the design, coordinated review, implementation, and sustainment of the staffing model (see Figure 5.1). The VHA Engineering Staffing Model provides output (staffing requirements) that is specific if not unique to each VAMC based on the parameters, thresholds, and variances that represent that VAMC’s specific infrastructure complexity. care model and Lewin’s change theory were used to support the design of the new staffing model. Contracting for staffing various engineering program areas can be considered as an option to deal with the difficulty in hiring qualified staff. The third-party entity would review all data sources and logic algorithms. Analyzing. In order for the model to retain relevancy, there should be an audit trail of this aggregated model output, the percentage of funding requested by the department of the aggregated output and then the percentage of funding appropriated by Congress for the VHA Facilities Management (Engineering) staff of the aggregated model output. Tightened budgets are putting more pressure than ever on facilities leaders to strategically allocate their dollars, staff, and time. They were hired on a temp/term status, giving them the potential opportunity to become permanent employees. The FM … It is the starting point from which to add the infrastructure complexity parameters and thresholds to build out the staffing level, by function, for different configurations of infrastructure complexity across the 172 medical centers.1, Once the baseline is established, the SMEs will assess and agree on a set of parameters that best capture the most important infrastructure complexity characteristics that impact Facilities Management (Engineering) workload. At least once per year the facility, in collaboration with the Agency PREA Coordinator and the Assistant Deputy Commissioner for Secured Facilities, reviews the staffing plan to see whether adjustments are needed. Post-decision involvement may include briefing the union(s) on the resultant model and allowing the union(s) to request impact and implementation negotiations. The Joint Commission mandates 100 percent preventive maintenance on critical systems, such as HVAC for operating rooms. Because the model provides insight into the unique infrastructure attributes at the individual medical center, it becomes a powerful tool for each director to manage risk as he or she makes staffing level decisions for his or her Facilities Management (Engineering) department. The entity would then run scenarios for all 172 VAMC Facilities Management (Engineering) departments,2 taking care to exclude the functions that are not included in the model. facility management, i.e. In addition, VHA has opened outpatient clinics and established telemedicine and other services to accommodate a diverse veteran population and continues to cultivate ongoing medical research and innovation. A description of the quality metrics and other data that was used to determine the most appropriate staffing model 3. These further areas of study include but are not limited to the following: infrastructure investment; data collection, accuracy, and analytics; staffing approaches; integration in strategic and interdisciplinary planning; and leveraging big data, machine learning, and artificial intelligence. In addition to the Facilities Management (Engineering) SMEs, the task force should include appropriate “operators” such as physicians, nurses, laboratory technicians, and other key staff such as modelers (e.g., from the Manpower Management Office or the Office of Productivity, Efficiency, and Staffing [OPES]) that provide insight to the impact of infrastructure complexity parameters on their portion of the VHA mission. The facility must comply with Department of Juvenile Justice policy 8.1, Security Management section V.A-H, pages 3-4. Those three questions were: • What is your staffing level for maintenance in square foot per full time equivalent employees (sq.ft./FTE)? Evaluate lines of responsibility and accountability associated with various types of nursing care delivery models. At the request of the VHA, this study presents a comprehensive resource planning and staffing methodology guidebook for VHA Facility Management Programs by reviewing the tasks of VHA building facilities staff and recommending actions for the VHA to meet the mission goals of delivering patient care, research, and effective operations. Monitor implementation and adjust it as necessary. It is important to note that if the model estimates do not closely align with the current, actual staffing levels, this does not automatically mean that the initial model is “wrong,” because current actual staffing levels may not be optimum. Last, the chapter provides thoughts on areas for further study that could impact the facility operations and Facilities Management (Engineering) staff in the near future. Register for a free account to start saving and receiving special member only perks. Staffing helps in placing right men at the right job. That’s why we tailor our time-tested onsite staffing solutions to fit your organization’s unique needs. For example operating room suites are a crucial element of hospitals. Any organization of the size of VHA also has the potential to capture and make use of big data. We don’t believe in cookie-cutter strategies. FIGURE 5.2 Design process and timeline. There could also be opportunities to increase shared skill sets with local agencies. Incorporating Infrastructure Complexity Parameters into a Baseline Staffing Model. A strategic infrastructure investment strategy should consider the following issues (including, but not limited to): The output of an infrastructure investment strategy could also be a key factor in the annual review of the VHA Facilities Management (Engineering) Staffing Model in the context of how it may inform, with longer lead time. This shared skill set concept could be further developed and overseen by the CEFAC. Our Vision To support the diverse membership of the Greater Seattle Chapter of IFMA and encourage each member’s growth in all areas of facility management. To provide one data point for that analysis, we asked facility managers to tell us staffing levels for maintenance, custodial, and grounds care workers in terms of square feet or square acres per full time equivalent (FTE) employees. The staffing plan for our example unit, Med-Surg 2 South, is complete if this unit is only open 5 days per week. The chief benefactor of the model is the medical center director who serves as the primary champion of the model to ensure adequate resources are dedicated to its development and sustainment. RECOMMENDATION 5.9: After the model is through the design and validation phase, the Veterans Health Administration should issue a policy for implementation and sustainment of the model, including the annual review. Some publicly available data (see. Sustainment of the model is paramount and should be done on an annual basis and must have support at the medical center director level. One area, in particular, where it would be important to have a chief engineer, perhaps a member of the CEFAC, attend would be the Department of Defense (DoD) Defense Health Agency planning meetings. This process will mirror some of the scenarios likely enacted in Phase 2, but the difference is that the third party has no vested interest in how closely (or not) the model outputs match current Facilities Management (Engineering) staffing levels. Throughout the workshops and meetings, the committee gained an understanding of the pivotal role of the medical center director in prioritizing resources to successfully accomplish the VA mission at his or her medical center level and also heard directly from a panel of medical center directors themselves. As such, the committee encourages VHA to conduct an independent third-party validation of the Engineering coordinated working model by an entity with expertise in. The baseline is the level of staff that the least infrastructure intensive medical center would require. This is a prudent measure to identify issues such as hire lag or funds migration. Companies should form a team that includes the COO, CIO, a facilities management leader, a strategic sourcing leader (for facilities management or innovation), and a project management office leader, among others. and Support (OCAMES) (Broskey, 2018, 2019). Based on similar staffing model efforts, such as the National Academies report on the FAA Systems Specialists in Aviation, as well as committee experts, the estimated design time of approximately 30 months is an ambitious but reasonable timeline given the extensive data already available and preliminary analyses that have already been conducted on this topic (NRC, 2013). This should include the reasons for the change, the benefits of successful implementation, as well as the details of the change. Noted throughout the meetings and workshops was the challenge of effectively collecting accurate facility data across the VAMCs. Shift presence, maintenance, and vendor support are the areas that support … It may be helpful to have human resources support and advice on the communications to ensure that appropriate information is included to answer anticipated personnel action questions. Assess modeled staffing requirements against funding, Prioritize staffing actions to mitigate risk, Initiate prioritized hiring/contracting staffing actions within budget, Begin strategic communications to workforce, Submit modeled staffing requirements for Year 2 budget request, Review priorities for midyear funding realignments, Monitor progress on hiring/contracting staffing actions, Host town halls; provide updates to workforce, Conduct initial model review/update, and identify changes to data inputs, Identify any hire lag, retention concerns, or contracting issues, Host sensing sessions if needed; provide updates to workforce, Gather data inputs for model and performance metric data, Review priorities for end-of-year funding realignments, Work with human resources on hiring solutions and contracting on award actions, Continue consistent communication and updates to workforce, Run the model, assessing output against performance metrics, Assess Year 1 funding execution trends and risk mitigation issues, Update prioritized staffing actions using model and assessments, Continue prioritized hiring/contracting staffing actions within budget, Provide strategic communications and updates to workforce, Submit modeled staffing requirements for Year 3 budget request, Continue to provide communication forums and consistent updates for the workforce, Conduct model review/update and idenfify any changes to data inputs, Review performance metrics and identify any changes, Host sensing sessions, if needed; provide updates to workforce. Leadership from each level of the VHA chain of command will need to ensure the integration of this model review into their planning processes with the actual review being overseen by the model sponsor and supported by the CEFAC. This likely involves to some extent a culture shift. The outcome was a clear need for a staffing model for residential care, which includes an average of 4 hours and 18 minutes of care per day for each resident (up from the current average of 2.84 hours per day) and a minimum skills mix of Registered Nurses (RN) 30 per cent, Enrolled Nurses (EN) 20 per cent and Personal Care Worker (PCA) 50 per cent, according to the ANMF. The phases consist of an initial design (12 months); a coordinated review of the initial design that results in a coordinated working. Returning To Normal: Learning From Universities », FM Guidebook for Fire Alarm Inspection, Testing and Maintenance », FM Guidebook for Fire Alarm Inspection, Testing and, http://www.facilitiesnet.com/resources/editorial/2018/a17471-CollegeCampus.jpg, NFMT - Facilities Education and Conference. Many organizations are gaining new insights into their products and services using such techniques that heretofore were based primarily on human experience, judgment, and intuition. According to the International Facilities Management Association (IFMA), facility management is an interdisciplinary practice that “considers the coordination of people, place, process, and technology.” Broken down, this means that a facility manager is responsible for the success of the all facets of the facility, including organization, safety, security, and maintenance, along with the key, everyday operational practices. Model (NCSM) have very specific duties that do not vary by facility. The committee is not aware of the specific relationships that VHA has with its union(s) and has not reviewed any associated collective bargaining agreement(s). In the FAA staffing studies (NRC, 2007, 2013), an independent third-party validation was a recommended step in the review and validation of the staffing models. Facilities specific to VHA fulfill clinical, operational, research laboratory, and administrative functions. Coordinating with multiple staffing agencies is error-prone and inefficient. (4,8)Published information on how one facility’s staffing level compares to another’s is lacking. With support from the medical center directors and CEFAC, the SME task force should then use a coordinated review process to have all medical center directors and chief engineers vet the initial model. For example, new construction coming online could impact the outputs of the VHA Engineering Staffing Model, because the workload for Facilities Management (Engineering) staff will be impacted. Adoption of process changes described in the section “Areas for Further Study” later in this chapter. It would be effective to have the SME task force present its initial model to this senior expert team to ensure that it is appropriately aligned with agency goals and strategic vision. Facility management is a challenging job, and it’s one that grows increasingly complex as technology advancements reshape old processes into newer, streamlined approaches. Incorporating common outsourcing practices added to the complexity of the survey. Historically, facility management services have been provided on a campus by campus basis or separated into acute care and outpatient programs. © 2021 National Academy of Sciences. It should also consider the emerging factors that could impact those assumptions and estimation procedures, such as programmed facility investment or changes in Joint Commission requirements. Attention to data accuracy, performance metrics, and consistent policy will directly enhance the accuracy of the model. The facility management team to include the PREA Manager will prepare the facility’s staffing plan. One is the level of cleaning that is acceptable in the space; the definition of “clean” varies among different organizations. To this end, the model should inform the decision maker, not replace them. In patient care, it is usually recognized that provision of quality and safe patient care by clinicians is expected to be perfect. Unintended Retained Foreign Object (URFO) = 27 out of 40,370 surgical procedures (error rate = 0.00066). 3… The SME task force would then use the remaining 2 months in Phase 2 to incorporate additional feedback and produce a coordinated working model, assuming that there is general support from reviewers about how the model works and the output it produces. Oversight of the annual review and sustainment of the model will require the expertise of experienced chief engineers in a collective body formed as the CEFAC. Once the design phases are complete and VHA leadership is ready to proceed, the implementation may begin. The committee heard in discussions the importance of having the chief engineer represented in major planning efforts with interdisciplinary teams as well as strategic-level planning (NASEM, 2019a,b,c). 2. Recommended to you based on your activity and what's popular • Feedback Ideally, the Facilities Management (Engineering) Staffing Model can help medical center directors adequately address risks to timely, safe health-care delivery based on the unique infrastructure requirements of their medical centers. National survey provides benchmarks for FTEs per square foot. The basis of staffing function is efficient management of personnel. Auditability of this funding request, appropriation, distribution, and execution is helpful to identify systemic issues such as hire lag or funds migration and provide fundamental insight into the applicability of the model. The Facilities Management (Engineering) SMEs will provide institutional knowledge and insight on the estimated workload associated with key tasks for their function. The Resident Centered Staffing care model has improved our overall quality of care and resident satisfaction as each resident has only two certified nursing assistants in … The conventional wisdom is that staffing models are all about the numbers. Implementation of this staffing model will require an investment that should be transparent in both the budget request and the distribution and execution of the appropriated funds. MyNAP members SAVE 10% off online. In many cases, these programs have been limited to plant operations, which are segregated as an individual support service and function in a silo environment. This forum could be referred to as the Chief Engineer Facility Advisory Council (CEFAC), and VHA should consider convening the CEFAC on a recurring basis, potentially quarterly. The best facility managers understand exactly how to balance smart technology investments that boost efficiency while minimizing risks (e.g., fiscal and safety risks) for a positive influence on the bottom line. It would also support OCAMES in overseeing annual reviews of the VHA Facilities Management (Engineering) Staffing Model. Due primarily to organic growth or mergers and acquisitions, healthcare systems often find themselves managing their facilities in a bifurcated manner, with individual hospitals operating more or … Along the way, the SME task force may do some reality checking by profiling a few VAMCs on the initial model infrastructure complexity parameters and using the thresholds and variances to calculate recommended Facilities Management (Engineering) staffing levels for those VAMCs. (2015) conducted research to create a predictive model The defining properties of big data include the volume of data that can be captured, the variety of data that can be captured, and the velocity or speed of processing data. Both implementation and sustainment will be most effective if they are synchronized with the organization’s budget cycle. Provide support in the way of training, education, or skills upgrading that is consistent with the change that is required by stakeholders. Not likely for an inpatient unit! Over time as these opportunities are pursued and implemented if appropriate, they may streamline parts of the facility staff workload and help offset areas of the facility mission that may cause an increase in Facilities Management (Engineering) staff. Ready to take your reading offline? Care Management As we have discussed previously, Care Management in the hospital setting is generally composed of Care Coordination, Discharge Planning, Utilization Review and Denial Management. In any case, VHA should consider union(s) concerns regarding staffing methodology and model development. Because of the criticality of the Facilities Management (Engineering) staff to overall hospital safety, the VHA Facilities Management (Engineering) Staffing Model should be kept up to date with all major decisions in hospital operations. Nationally, the median number of square feet per FTE for the maintenance staff is 50,000; 22 percent of respondents reported that they outsourced the function. Therefore, 100 percent HVAC preventive maintenance by engineering staff is required. VHA should consider union involvement, both timing and extent, to ensure smooth implementation of the staffing methodology and any resultant staffing model. With Staffing Considerations for Special Populations. Click here to buy this book in print or download it as a free PDF, if available. Among others, it could include an experienced chief engineer from each Veterans Integrated Services Network (VISN) to foster representation and communicate with an entire region. This coordinated review should include a few examples of actual VAMC Engineering Staffing Model outputs. A second objective of this research was to derive a ratio of FM staff to square footage managed. Changes in Joint Commission or other compliance requirements. Data support multitudes of decisions and, of course, are central to deriving useful output from the VHA Facilities Management (Engineer) Staffing Model. The committee has noted a few issues that warrant consideration for further study as they could have a significant future impact on the effectiveness of facility operations and thus impact Facilities Management (Engineering) staff. In addition, the documentation should facilitate an annual review where the baseline, parameters, thresholds, and variances can be reevaluated for relevancy and adjusted, added to, or eliminated as circumstances change. Leadership commitment is especially important to sustain the model in order to preserve its relevancy and acknowledge the importance of the facility engineering staff to the overall VHA mission. One way to evaluate whether a facility management department is understaffed is to look at the staffing practices of comparable organizations. Nothing motivates more than success, particularly from those closely involved in the change process. It will follow with a discussion of resources, to include leadership engagement—necessary to implement and sustain the model—as well as a summary of sustainment considerations to support a recurring update of the model. However, the strongest action to galvanize organizational support will be consistent communication from leadership as they begin to take actions based on the model output that may change the status quo. Critically, the data on which the estimates are based and the expertise of the SMEs who made judgments should be apparent to eliminate concerns that the model is based on more than just the intuition of a few Facilities Management (Engineering) staff members. There are many reasons that staffing levels differ from one organization to another. 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