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Domain #4: Productivity

Many organizations (in a variety of industries) are challenged to bridge the paradigm between measuring productivity the "way everyone else measures it" and measuring productivity with the intent to actually understand and improve productivity. Productivity as a "cost measure" is only valid if the measure used incents the organization to change the way it operates. Doing the same work with fewer people IS NOT IMPROVING PRODUCTIVITY, it is in actuality merely INCREASING WORK BURDEN. "Changing what people do", IS improving productivity.

This section allows an organization to assess the level of performance is has achieved in understanding, measuring and improving productivity with the stated objective of reducing costs through the changing of processes so that less work is required to engender desired outcomes.

Components of the Productivity Self Assessment are listed below.


  • Have begun measuring hours of labor per volume
    The organization measures and tracks hours of labor per adjusted productive output (IE: worked nursing hours per adjusted patient day).
  • Have begun measuring "cost per hour of labor" per volume
    The organization has begun overlaying labor cost data to core productivity data making the final measure: cost-per-hour-of-worked-labor per adjusted productivity output) (IE: cost per worked nursing hour per adjusted patient day).
  • Flexing targets are based on customized volume measures
    The organization is using department based measures of work output (not just census, can include things like: # of billable procedures, # of scripts entered, square footage cleaned, etc…).
  • Volume measures are adjusted for work burden variances
    The organization has identified the unique factors of work burden for each department and uses them as a multiplier to adjusted productive output (IE: # of bed turns, # of admission, # of pharmacy consults, etc…).
  • Productivity is measured at least 3 times per day (not just on a midnight census)
    The organization measures productivity by shift rather than once per day.


  • Support departments have begun flexing
    No explanation needed.
  • Non-exempt staff are not being asked to flex
    No explanation needed.
  • Flexing is managed to avoid PTO pool exhaustion
    The organization has recognized and developed policies to avoid exhausting staff PTO by properly rotating "who flexes, under what conditions & when".
  • Flexing policy is reasonable and allows for "productivity make-up" if target is missed
    The organization's flexing policy is broad enough to allow a department who misses a productivity target during a single shift or day to make it up during the pay period.

Reporting & Performance

  • Shift by shift productivity reports are available for every department but only reported formally by pay period
    No explanation needed.
  • Productivity variance reports have been created and are required
    No explanation needed.
  • Cost of labor has been reduced through productivity
    The "cost per worked hour per adjusted productive output" has been measurably & sustainably reduced.
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