Earlier this summer, the Auditor of State conducted a performance audit on the Ohio Department of Mental Health and Addiction Services (OMHAS), and in particular, a review of nursing staff levels at Ohio’s 6 regional psychiatric hospitals. According to State Auditor Keith Faber, the auditors in the state of Ohio determined “that by adjusting the staffing model and updating scheduling practices, OMHAS could replace between 10% – 40% of its overtime hours with regular hours, through the use of intermittent or temporary labor pools, saving $250,000 – $1 million annually”.  Auditor Faber also believes that mandated overtime is one “that leads to poor morale, increased turnover, disjointed care for patients, and as our performance audit indicates, unnecessarily high costs”.  This week Ohio Auditor of State Keith Faber submitted a letter of support for House Bill 144, which aims to prohibit the use of nurse mandatory overtime.

 

The following the content from Mr. Faber’s support letter of HB 144.

 

Dear Representatives,

As the House Committee on Commerce and Labor considers House Bill 144, I would like to express my support for the bill and share some results of a recent performance audit conducted by the Auditor of State, which focused on the Ohio Department of Mental Health and Addition Services (OMHAS) and in particular, our review of nursing staff levels at Ohio’s six regional psychiatric hospitals.

Like other hospitals across Ohio, state psychiatric hospitals currently mandate that nurses and direct care employees work overtime in order to provide appropriate levels of care. Our auditors performed a detailed analysis of the staffing model developed by OMHAS Hospital Services and found that the model should be adjusted to reflect historical operational needs. Doing so, in addition to updating scheduling practices, would reduce mandated overtime and help save OMHAS up to nearly $1 million annually.

The OMHAS nursing model analyzed is intended to calculate minimum staffing requirements of nurses and therapeutic program works for each hospital, taking into account the occupational need of the hospitals leave time, occupational injury leave, sick leave, vacation leave, and personal leave. Additionally, the model calculated the minimum numbers of hours needed to cover hospital shift operations. Both are calculated using a multiplier. Our analysis compared the minimum staffing and hour calculations with the actual hours worked in each hospital and found that nurses and therapeutic program workers were working more hours than the model’s calculations called for at all six hospitals. This suggests that the model is not accurately estimating the number of hours needed by these positions. The multiplier could be adjusted to accurately estimating the number of hours needed by these positions. The multiplier could be adjusted to more accurately reflect the current operating environment of the hospitals. If more regular staff are available for work and shift scheduling is adjusted, hospitals could replace overtime hours with regular hours. Doing so would result in a reduction in overtime needed as well as reduce mandated overtime.

These changes would save hundreds of thousands of dollars each year. In fiscal year 2018, OMHAS spent $9, 366,799 on overtime costs. Our auditors determined that by adjusting the staffing model and updating scheduling practices, OMHAS could replace between 10%-40% of its overtime hours with regular hours, through the use of intermitted or temporary labor pools, saving $250,000-$1 million annually.

While these number do not depict the staffing issue of all hospitals in Ohio, only the six state psychiatric hospitals tested, I am confident that these staffing recommendations would be useful across the Buckeye State and help advance the goals of House Bill 144. I encourage you to read through our recommendations in the copy of our OMHAS performance audit. If you have any questions, the Auditor of State’s office will gladly provide any support necessary.

Finally, I would like to thank Representative Don Manning for his leadership on House Bill 144. The issue of unanticipated, mandated nurse overtime is one that leads to poor morale, increased turnover, disjointed care for patients, and as our performance audit indicates, unnecessarily high costs. Reducing mandated overtime as much as possible, while preserving the option for overtime in truly unusual circumstances, will not only increase the quality of care at our hospitals, but make them more efficient and cost effective as well. I hope you will join me in supporting House Bill 144.

Very truly yours,

Keith Faber