Q&A: CDI shift length
Q: At our institution, we currently operate under an eight-hour workday for five days a week. We are looking to change this status to possibly a 10-hour workday for four days a week. Are there any programs out there that currently operate a 10-hour workday for four days a week? Are there any programs out there that have both eight- and 10-hour workdays in their program?
Response #1: At my facility, we trialed four 10-hour days; however, the data failed to show that we were more productive. In those two additional hours, no extra assignments were accomplished; so, now, we are back to five days a week. I am flexible if a staff member needs paid time off and, if there is none available, they can work a weekend day.
Response #2: We have recently discussed opening up weekends for experienced CDI staff that do not require supervision or assistance. We feel as though this might help increase our total number charts because we often miss short stay cases over the weekend. We would still require them to do five eight-hour shifts, but they could be done during any of the seven days. Our staff frequently requests 10-hour shifts, but we have always been wary of productivity burn-out.
Response #3: Our CDI specialists are salaried and work five days per week. We have had a CDI specialist work a four day a week schedule; however, that did not work well. Productivity dropped and our follow-ups with providers were impacted negatively, as we do not hand off case coverage for routine days off. Additionally, many CDI specialists have told us that focusing for 10 hours a day is very taxing.
Response #4: We don’t have a “fixed” number of hours per day, but most staff work more hours on Monday and Tuesday since we do not have weekend coverage; on Friday, most are done with their day by noon. We still want to include Friday, so we don’t have a slew of missed admissions. What most of them do is flex off to avoid going overtime (unless the overtime is approved). I’ve done it this way for my last three facilities. One hospital was already running like this when I was hired, and I implemented the protocol at the other two. To my knowledge, the team prefers it this way.
Response #5: My team works in eight-, nine-, and 10-hour shifts. At my organization, it seems like this model makes employees much happier and, as a result, they are more flexible in terms of covering for each other. When the different hour shifts were offered, the team understood the minimum I needed each day and adjusted their time off accordingly.
Response #6: We have a mix of both on our team. Most of our caregivers work eight-hour shifts with a few working 10 hours. We also provide the flexibility for caregivers to work on the weekend, so that they can take a day off during the week for doctor’s appointments, etc. Caregivers who work 10-hour shifts typically have Wednesday or Thursday off so there isn't a three-day gap with follow-ups. This allows the team to feel like the eight-hour shifts are not so restricting. The team feels like they have a voice with respect to how many days they work, which really does help with employee satisfaction.
Response #7: We have a mixed model: once they are off orientation and meeting our productivity targets, a full-time team member can choose between five eight-hour shifts or four 10-hour shifts. Our productivity targets are based on the number of hours worked, so there is no “loss” in productivity going to a 10-hour shift.
The expectation is one initial review per hour worked and that subsequent reviews are 1.5x the number of initial reviews. Team members’ total weekly productivity is still based on a 40-hour week, which then rolls into their monthly totals.
There is some strategy in scheduling the 10-hour staff. Since we are a Monday-Friday shop without weekend coverage, our census is much higher on Monday, so we generally do not allow Monday to be a regularly scheduled day off (it is only approved if a team member takes PTO). Fridays off are also rotated equally. The 10-hour/four-day team members are typically given a scheduling pattern that repeats every two weeks or so. This allows them to know when their future days off will be for planning needs.
We also have a corporate program that allows a full time 1.0 FTE to reduce to a 0.8 FTE if the leadership and/or department can support it with respect to business needs. If they go to a reduced FTE, they can move back to a full FTE without HR or upline approval. These team members work four eight-hour shifts with the same productivity expectations and scheduling parameters stated above. Both staffing models have improved employee satisfaction and give team members greater autonomy in terms of how they manage their work/life balance. For those on the 10-hour or four-day model, it uses less PTO for weekday appointments (etc.), allowing team members to use their PTO for vacation time.
Editor’s note: This question was answered by members of the ACDIS CDI Leadership Council and originally appeared in the CDI Leadership Insider, the monthly newsletter for members of the Leadership Council. For the purposes of this article, all Council member answers have been deidentified.