Report 2009-608 Recommendation 3 Responses

Report 2009-608: High Risk Update—State Overtime Costs: A Variety of Factors Resulted in Significant Overtime Costs at the Departments of Mental Health and Developmental Services (Release Date: October 2009)

Recommendation #3 To: State Hospitals, Department of

To ensure that all overtime hours worked are necessary, and to protect the health and safety of its employees and patients, Mental Health should implement the Legislative Analyst's suggestion of hiring an independent consultant to evaluate the current staffing model for Mental Health's hospitals. The staffing levels at Mental Health should then be adjusted, depending on the outcome of the consultant's evaluation.

Annual Follow-Up Agency Response From October 2017

The Automated Staff Scheduling and Information Support Tool (ASSIST) has been deployed at all Department of State Hospitals (DSH) facilities.

The DSH is currently conducting a clinical staffing study to assess staffing methodologies and staff to patient ratios within core clinical functions. This assessment will review current staffing standards to determine appropriateness; propose new population driven methodologies to adequately support our current populations; assess current relief factors to ensure they continue to reflect our coverage needs; and review staffing levels within core clinical functions. The following is the current status of the staffing study which will focus on the following areas:

Forensic Departments

- Preliminary Findings: Completed October 2015

- Validation: Completed February 2016

- Final Report: Completed September 2016

24-Hour Care Nursing Services

- Preliminary Findings: Completed August 2016

- Validation: Completed February 2017

- Final report: Currently underway, tentative completion November 2017

Protective Services

- Preliminary Findings: Completed February 2017

- Validation: Currently underway; tentative completion October 2017

- Final Report: Not yet initiated; tentative completion December 2017

Treatment Planning and Delivery

- Preliminary Findings: Currently underway, tentative completion September 2017

- Validation: Not yet initiated, tentative completion June 2018

- Final Report: Not yet initiated; tentative completion July/August 2018

  • Estimated Completion Date: 2018

California State Auditor's Assessment of Annual Follow-Up Status: Pending


Annual Follow-Up Agency Response From October 2016

The Automated Staff Scheduling and Information Support Tool (ASSIST) has been deployed at all Department of State Hospitals (DSH) facilities.

The DSH is currently conducting a clinical staffing study to assess staffing methodologies and staff to patient ratios within core clinical functions. This assessment will review current staffing standards to determine appropriateness; propose new population driven methodologies to adequately support our current populations; assess current relief factors to ensure they continue to reflect our coverage needs; and review staffing levels within core clinical functions.

The initial phase of the staffing study will focus on the following areas: Hospital Forensic Departments, 24 Hour Care Nursing Services, Protective Services and Treatment Planning and Delivery. As each staffing study is completed it will be validated. The staffing study and validation will be completed by December 31, 2018.

  • Estimated Completion Date: December 31, 2018

California State Auditor's Assessment of Annual Follow-Up Status: Not Fully Implemented


Annual Follow-Up Agency Response From September 2015

The Automated Staff Scheduling and Information Support Tool (ASSIST) has been deployed at all Department of State Hospitals (DSH) facilities and is currently in the process of retiring paper-based scheduling methods and transitioning to paperless schedule management. Plans are in place to transition to Maintenance and Operations by September 30, 2015. Future enhancements may be continued as post project enhancements.

The DSH is currently conducting a clinical staffing study to assess staffing methodologies and staff to patient ratios within core clinical functions. This assessment will review current staffing standards to determine appropriateness; propose new population driven methodologies to adequately support our current populations; assess current relief factors to ensure they continue to reflect our coverage needs; and review staffing levels within core clinical functions.

The initial phase of the staffing study will focus on the following areas: Hospital Forensic Departments, 24 Hour Care Nursing Services, Protective Services and Treatment Planning and Delivery. On August 26, 2016 DSH entered into a contract with the Cooperative Personnel Services (CPS) to provide an independent review and validation of DSH's staffing study efforts. As each staffing study is completed it will be validated by CPS. The staffing study and validation will be completed by September 2016.

  • Estimated Completion Date: September 2015

California State Auditor's Assessment of Annual Follow-Up Status: Not Fully Implemented


Annual Follow-Up Agency Response From October 2014

As previously indicated, the Department of State Hospitals has the in-house expertise to evaluate its current staffing models. The Department has launched its staffing study project with an initial focus on the nursing classifications and anticipates completion of this phase in fiscal year 2015-16. As an update to the Department's complement IT project, the Automated Staff Scheduling and Information Support Tool (ASSIST), the first round of User Acceptance Testing was completed on October 9, 2014 and Department-wide implementation is scheduled to be completed in the spring of 2015.

  • Estimated Completion Date: 2015-16

California State Auditor's Assessment of Annual Follow-Up Status: Not Fully Implemented


Annual Follow-Up Agency Response From November 2013

As noted in last year's annual follow-up response to this recommendation, the Department of State Hospitals believes it has the in-house expertise to identify the classifications that use the highest amounts of overtime, identify the key drivers of overtime use and propose solutions to reduce the amount of overtime used DSH staff. The DSH has identified the key classifications that incur the highest overtime usage, psychiatric technicians, registered nurses and hospital police officers. The DSH has tasked in internal unit to identify look at the staffing model and relief factors to determine if those reflect our true operating need and look at other potential drivers of overtime. After the staffing models have been refined and drivers identified, DSH will implement administrative remedies and propose other solutions to address high overtime usage.

As a complementary step, the Department is undertaking and IT project, ASSIST (Automated Staff Scheduling and Information Support Tool), that is expected to help the department reduce its overtime usage. Specifically, ASSIST will do the following:

- Provide an automated scheduling tool to deal with the complexities of appropriately staffing 24/7 mental health hospitals;

- Reduce the need for level-of-care staff in the scheduling function;

- Provide data to enable root cause analysis of staffing issues such as excessive use of overtime;

- Optimize staff scheduling to reduce overtime usage;

- Enable the department to schedule lower cost staff where clinically appropriate to meet treatment needs.

The ASSIST tool will be deployed in the fourth quarter of 2014.

  • Estimated Completion Date: July 2017

California State Auditor's Assessment of Annual Follow-Up Status: Not Fully Implemented


Annual Follow-Up Agency Response From September 2012

The Department intends to comply with this finding in an alternate manner than that recommended by the Legislative Analyst's Office. The DSH has the in-house expertise to conduct the evaluation of state hospital staffing models. Within the next 90 days, the DSH will be conducting an internal review of clinical staffing models in the state hospitals using DSH staff that have expertise in DSH hospital staffing and operations. During the course of the department's evaluation, if it is determined additional expertise is required, the department may contract for outside expertise. As an outcome of this evaluation, we expect this evaluation to inform the DSH as to whether the existing use of overtime in the state hospitals is appropriate. Since 2009, DSH has taken action to reduce the use of overtime in the state hospital system. In September 2011, the DSH convened a group of fiscal mangers and retired annuitants with fiscal expertise to make recommendations to reduce hospital costs including overtime expenditures. This group of experts was known as the 'Transition Team.' The Transition Team made a series of recommendations to reduce costs at the hospitals that were implemented in December 2011. Implementation of these recommendations by the hospitals resulted in overtime reductions of $11.4 million in FY 2011-12 and projected to be $26 million in FY 2012-13.

California State Auditor's Assessment of Annual Follow-Up Status: Will Not Implement


All Recommendations in 2009-608

Agency responses received after June 2013 are posted verbatim.


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