This chapter provides highlights of the final workshop session, which Cheryl Paullin (committee member) began by recapping some of the key points from the earlier sessions. As an aid to the final discussion, Paullin presented a list of potential themes on which she encouraged participants to comment. The recap and discussion resulted in the identification of six themes of the workshop: accurate and reliable data, model simplicity and practicality, continual updating, understanding implications and risk, unique characteristics, and change management. Workshop participants then offered their views on the various topics related to the development of budgeting and staffing methodologies for the Veterans Health Administration (VHA) facilities management function.
Several workshop participants discussed the importance of basing a staffing model on solid, credible data about workload requirements. Brian Norman (Compass Manpower Experts, LLC) stressed that clear, consistent labeling of equipment, cost centers, and labor processes is a prerequisite to accurate data collection. Norman also noted that the implementation of a robust, appropriate computerized maintenance management system can drive the effective collection of workload data. John Poulos (CBRE) cautioned, however, that the usefulness of data obtained from a work order system relies on the accurate and consistent entering of data by employees.
In their presentations, Joe Crance (consultant, medical facilities staffing) and Neal Schmeidler (Grant Thornton) had described the various techniques available for collecting work measurement data as a prerequisite for building a manpower model, emphasizing that these techniques have varying levels of accuracy. Crance had noted that engineered work measurement techniques provide the most accurate data; historical record data are less dependable. However, as discussed by Schmeidler, engineered tools are the costliest, and analytic work measurement tools, such as judgment estimating, can often provide good data if performed properly. Both Norman and Bill Strickland (member, Committee on Assessment of Staffing Needs of Systems Specialists in Aviation) cautioned against taking historical data at face value, noting that such data need to be reviewed for accuracy before being used.
Poulos, Ed Ricard (JLL), and Seth Sinclair (Plan4 Healthcare), who had discussed outsourcing options for facilities management, also stressed the importance of quality data. Sinclair noted that current workload data from VHA facilities are extremely variable. Poulos specified that effective workforce planning requires accurate tracking of various metrics, including preventive maintenance, overtime, and tech utilization rate. Ricard noted that JLL regularly collects facilities data on many factors, including employee productivity, uptime, and response times, to
create performance indicators that can improve facilities management functions. Steve Plotner (Gordian) described RSMeans as a powerful marketplace tool that can provide much of the data necessary for workforce modeling.
Fred Switzer (committee member) and several of the presenters noted that accurate, reliable data are costly to obtain, and Schmeidler reiterated that budget constraints need to be considered in the choice of appropriate data collection techniques. However, Oleh Kowalskyj (VHA) responded, there is also a cost associated with the absence of data, and a balance must be struck between the two. The VHA, according to Switzer and Kowalskyj, needs to be aware of the costs involved in either choice. Norman said that he thinks that data collection is worth the up-front investment, explaining that, in addition to providing a basis for workforce planning, collection of accurate data is also a powerful business practice that can aid in day-to-day task management, execution, and planning. Accurate workload data can also help to create a business case to bring to leaders when changes are needed, he argued.
Crance and Norman had each noted in their presentations that the data collection techniques applied as part of workforce planning need to be practical and straightforward so that they can be easily followed by all users. In his description of the study performed for the Federal Aviation Administration (FAA), Strickland had acknowledged that data collection can be time intensive, and if the data collection process has a negative impact on employees, data might not be collected appropriately, if at all. Therefore, the committee that wrote the earlier report recommended that the FAA’s chosen model not place an unacceptable burden on data providers.
Anshul Sheopuri (IBM) emphasized that validated user research should be performed to assess the effects of new tools and technologies on employees, managers, and business leaders. He noted that such research helped IBM to successfully implement various artificial intelligence tools. Sheopuri also explained that employees may not initially have the skills necessary to use new technologies, so an upskilling effort may be necessary. Ricard also emphasized that employee training is key to the effective utilization of newly implemented technology.
On the issues of simplicity and practicality, Steven Broskey (VHA) discussed the risk of beginning with a complicated model that cannot be supported by the kinds of data currently being collected by the VHA. David Alvarez (VHA) stressed that to avoid any model becoming “shelf-ware,” beginning with rough benchmarks rather than a more complex, theoretical model will likely provide the best chance of success.
Robert Anselmi (committee member) noted that although the focus of much of the discussions and presentations was centered on the maintenance aspect of facilities management, other aspects of facilities staffing, such as project and construction work and engineering administration, are also important. He cautioned that, since each aspect involves different types of work, to be of practical use different models, rather than one overarching model, might be needed.
In his presentation, Alex Manganaris (consultant, public-sector human capital) had stressed that effective workforce planning models rely on a strategic business plan that takes into account any foreseeable changes in technology, business practices, systems, and legislative policies. In presenting an example of work performed for the Internal Revenue Service, he had described how workforce models can be used to help organizations transition through various kinds of changes.
In response to Strickland’s presentation on the FAA modeling study, Colin Drury (committee chair) had noted that the situations of the FAA and VHA are similar in that both organizations were attempting to develop models in the face of major high-level changes in their respective industries—the transition to NextGen technology in the case of the FAA and the transition from inpatient to outpatient care in the case of the VHA. Strickland had explained in his presentation that workforce planning models are not static. Even appropriate models should be reviewed and updated regularly to enhance their accuracy.
Paullin said that an important point made in the earlier presentations could be summarized rather simply: “There should be a way, through the modeling process, to explain to decision makers the implications and risks of not meeting the recommended staffing standards.” As Crance had outlined in his presentation, when the budget received does not meet 100 percent of the staffing requirements, corporate decisions should be made to reduce the levels of service provided and decrease workload in order to mitigate risk. He had further noted that unfunded requirements should be defined and kept in view because they are a key aspect of risk. Robert Anselmi (committee member) stressed that even in the presence of accurate data about the work being performed, the risk of failure is not mitigated if the model does not account for work that should be, but is not being, done.
Strickland noted that the ability to predict risk was also one of the recommendations for the FAA’s staffing model. He explained that a model that can account for risk can also provide justification for budgeting requests related to staffing. Norman reiterated that some organizations object to investing in facilities management because this function is seen as a cost instead of a part of the organization’s mission. He explained that this view in itself is a risk because the cost of inadequate staffing of facilities management work centers—investing in useful models to properly estimate the FTE requirement and then stepping up to properly fund and fill these requirements—is essential to the overall VHA mission. VHA facilities management is a true “mission partner” with the medical professionals taking care of the patients.
In its statement of task, the committee was asked to identify and address the unique characteristics of the VHA that might influence the development of budget and staffing methodologies for the agency’s facilities management. While presenters acknowledged the challenge that some of these variables bring, some also noted that although the VHA has some unique characteristics, the same is true of many other organizations, and several of the methods commonly used in staffing modeling are also applicable to the VHA. In his presentation, Crance had explained that the creation and implementation of labor standards in medical settings have been done successfully in the past, and Ricard had noted that hospitals share enough similarities with other types of properties, such as Class A office buildings and hotels, that JLL believes it is possible to use a similar approach for hospitals. Ricard reiterated that the important point is “that everybody knows and understands that the ultimate goal is the patient experience.” Drury had also pointed out several similarities between the FAA’s situation and the situation at the VHA, including the stochastic nature of the work, the specialized training required, the variability between worksites, and the development of staffing models in the face of major changes in the industry.
In terms of handling these unique characteristics in a model, Norman noted that it is common practice to begin the modeling process using simple techniques, like ratios of full-time-equivalent staff per square foot. Even though it is known that these figures will not be accurate in every setting throughout an organization as diverse, decentralized, and nonlinear as the VHA, Norman said they provide a starting point from which benchmarking can be performed. A more refined model can then be built incrementally on the basis of the specifics of each facility, such as whether snow removal is needed or whether historical preservation is required. Poulos and other presenters acknowledged that it can take a significant amount of time to build a highly robust model for diverse organizations like the VHA, but they reiterated that ratios and other simple techniques can be used as a baseline while a more accurate model is being researched and constructed. One participant noted that one of the risks of staffing deficiently or ineffectively is the cost burden, and thus the VHA may not be saving the money it thinks it is saving when understaffing a facility or understaffing overall.
In his presentation, Robert Motion (Raytheon) had stressed that change management is a very large part of successful workforce planning, potentially more important than the technical workforce planning solution itself. Employees have to be educated on the reasons for the planned changes so that they are motivated to accept them.
Ricard had also emphasized that successful change can be challenging, and he reminded participants of the study that found that 70 percent of change programs fail, largely due to employee resistance and lack of management support (see Chapter 4).
In their presentations, Crance and Schmeidler had emphasized incrementalism as a useful change management approach, noting that the implementation of small, discrete steps can reduce resistance and aid with the successful implementation of standardized data collection processes and subsequent workforce modeling. Norman summarized this approach: “Rather than go for some cosmic model, realize there are steps in between that run parallel or at least on converging tracks.” He emphasized that such incremental steps are, in themselves, healthy management practices.
Motion had discussed the concept of “building an army” to manage change through an understanding of all the stakeholders involved in the change process. Schmeidler and Ricard had also emphasized the importance of stakeholder support, including strong backing by management. In Ricard’s words: “If we’re going to make a change, make sure we’re all buying in, and that we know where we’re going, and that we’re all behind it, and that we have a clear vision and plan of how we’re going to change.”
One point repeatedly stressed throughout the presentations and in the final discussion was the need for standardization within and across VHA sites, to allow for the data collection and subsequent comparison across facilities necessary to drive successful modeling. In his presentation, Poulos had noted that, in his experience, centralization plays a large role in CBRE’s success in effective workforce planning. Norman had emphasized that prior to developing a model, common systems for functions that are shared across facilities should be implemented by the VHA, such as standardized labeling and barcoding of equipment, common labeling of cost centers and centers associated with different types of labor, and a common computerized maintenance management system to collect and process work orders.
Norman also noted that implementation of standard labeling across facilities will enable future data collection and the continued success of a model beyond just the work measurement phase, and he stressed that if data are not continually available to maintain the model, it could easily become “a one-shot deal.” Ricard had explained that one of the best practices promoted by JLL involves standardization of general ledger codes and equipment definitions, which allows accurate comparisons among facilities. James Smith (committee cochair) noted that the need for a standardized business model at the VHA is beyond the current task of the committee. He suggested that the VHA ultimately needs to decide how much of the workforce modeling process will be centralized and how much will be decentralized.
To conclude the workshop, the committee cochairs thanked all of the presenters and other attendees for their participation, and they noted that other workshops related to the committee’s statement of task (see Appendix C) will be held over the next few months and are detailed on the project’s website.
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