Excessive overtime is expensive in terms of salaries paid to staff at premium rates; reducing overtime expenses can be achieved in several ways. Performance can also suffer if employees become overtired or inattentive, exposing an organization to additional risks for errors and mistakes. These risks are a particular concern in a patient care environment like HHC, especially when staff are assigned to work multiple overtime shifts or consecutive days without a break. By placing limits on overtime shifts, and the number of consecutive days that employees can work without taking a day off, management can help ensure optimal performance by staff and promote patient safety.
HHC grants its individual facilities the discretion to establish many of the work rules that govern
staff scheduling. As a result, some facilities have developed additional procedures governing
overtime, while others have not. Two facilities, Coler-Goldwater and Bellevue, have rules that
limit staff to no more than three overtime shifts in a week. To determine whether this work rule
was being followed, we visited these facilities and examined overtime records and timesheets for
40 employees who worked significant amounts of overtime during a two-week period.
We found that 18 of the 40 employees worked more than three overtime shifts in one or both
weeks, in violation of the three overtime shift maximum. In addition, 11 of these 18 employees
worked 10 or more consecutive days in a row. For example, at Coler-Goldwater:
•
Seven of 20 employees worked between four and six overtime shifts during each of the
two weeks we reviewed, including a medicine surgery technician who worked six overtime
shifts in the first week and five overtime shifts in the second. In another case, a nurse’s
aide worked six overtime shifts during each of the two weeks.
•
Two other employees had worked more than the three-shift maximum during one of the
two weeks we reviewed. These two employees each worked five overtime shifts.
•
Four of these nine employees had worked between 13 and 20 consecutive days without
a full day off, including two medicine surgery technicians who had worked 19 and 20 days
in a row. We found similar issues at Bellevue, where:
•
Seven of 20 employees had worked between four and seven overtime shifts during both
weeks, including a pharmacy technician who worked six overtime shifts in the first week
and five in the second.
•
Two other employees exceeded the three-shift maximum during one of the two weeks;
one working four shifts and the other six.
•
Seven of these nine employees had worked between 10 and 20 consecutive days, including
the pharmacy technician who had worked 20 consecutive days.
Officials at these two facilities agreed with our findings and indicated they would monitor and
enforce these restrictions in the future. We believe that HHC should also adopt similar work rules
that would apply to all facilities and take steps to monitor compliance in an effort to reduce risk.
One way HHC can reduce the need for overtime by patient care staff is to increase its use of part-
time or temporary staffing. We noted that HHC has contracts in place with certain employment
agencies to provide staff, such as nurses and nurse’s aides, on a per diem or temporary basis.
However we found this option is not being fully used, even though HHC’s own staffing plans and
patient census analyses show certain units are understaffed. Officials explained that they would
rather schedule their own employees to work overtime than use temporary staff, in part because
it provides more certainty that staff have the necessary skills, but also because it ensures less
disruption and continuity of care for the patient.
While these concerns are valid, they may be less germane to some units or operations where
patients may have less complicated cases or experience shorter stays. Further, HHC needs to
weigh these goals against the additional risks posed by staff who may not be performing at their
optimal level due to fatigue or inattentiveness.
(In responding to our draft report, HHC officials advised that their workforce reduction has reached
2,500 positions and generates $200 million in savings annually. They project that these savings
will increase to $300 million annually by the end of fiscal year 2014 when the full reduction of
3,750 positions is achieved.)
Auditor Comment - HHC officials make several important points about their overall approach to
reducing personal service costs and the resulting impact on overtime expenses, particularly in
the clinical setting. They point out the significant cost savings that have been already achieved
through attrition and the specific steps they have taken to maintain patient care standards during
this process. We agree that this approach is sound, especially when viewed at the broadest
organizational level. Nevertheless, we believe opportunities still exist to better manage individual
incidences of overtime at a significant savings, especially in non-clinical areas. In fact, most of the
high overtime earners listed in Exhibit A to this report serve in facility maintenance and support
positions, rather than patient care.
Recommendations
1.
Actively explore, implement and manage ways to reduce HHC’s overtime costs, including
encouraging facilities to maximize the use of part-time and temporary staff before using full-
time staff when assigning overtime. Adopt the best practices of other HHC facilities when
deciding to use overtime.
2.
Review the extent that employees at all facilities are working multiple overtime shifts and
consecutive days. Establish and implement controls to prevent employees from working
excessive multiple overtime shifts and consecutive days.
3.
Set specific dollar or percentage overtime reduction goals for the facilities, monitor the facilities’
performance in achieving these goals, and take corrective action if the goals are not achieved.
