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Nurse & Staff Scheduling 2021
First Look at Workload Balancing

author - Niel Oscarson
Niel Oscarson
author - Emily Paxman
Emily Paxman
author - Ciera Walker
Ciera Walker
July 29, 2021 | Read Time: 18  minutes

As one of healthcare organizations’ largest operational costs, staffing is a top-of-mind concern. Though not yet widely used, workload balancing can provide insight into staffing gaps and help organizations make equitable assignments based on census data, patient acuity, and staff credentials. This report examines the customer experience of current workload balancing users to help organizations that are considering the tools understand the potential benefits and pitfalls and which nurse and staff scheduling vendors have experience with organizations of their size.

symplr ShiftSelect & HealthStream ANSOS Lead in Handling Complexity of Short-Term Analytics; Cerner Excels with Same-Day Data 

Short-term analytics (defined as predictive analytics for managing staffing needs one to eight weeks in the future) are notably more complex than same-day analytics because of the extended time frame and greater reporting requirements. symplr ShiftSelect customers using short-term analytics highlight the tool’s simplicity (compared to symplr’s Staffing and Scheduling product) and note that having good ongoing scheduling data enables leaders to make staffing decisions centrally. After years without significant development under Change Healthcare, customers of ANSOS Staff Scheduling—recently acquired by HealthStream—are adopting more functionality and feeling optimistic about recent changes. Most respondents agree the short-term analytics are most accurate up to four weeks out and provide good visibility to individuals at all levels of an organization. ShiftWizard was also recently acquired by HealthStream. Satisfaction with ShiftWizard’s analytics varies—customers who are able to put in the work or put pressure on the vendor to deliver the needed support derive high value; others feel getting to insights is more labor intensive than expected.

analytics to identify and predict needs/capacity across enterprise

Cerner’s strong census capabilities and insightful reports lead to high customer satisfaction with same-day analytics; users say they struggle to get good predictions beyond a few days. Use of the predictive analytics and workload balancing tools from Avantas has historically been low, but adoption has increased over the past year as Avantas has better enabled users to leverage the tools on their own. The system’s key strengths include automation, built-in suggestions, and accurate same-day analytics. Some reports can be cumbersome—customers recommend strong training or deliberate use of superusers.

Vast Majority See Positive Outcomes with Workload Balancing, Especially with Avantas & symplr ShiftSelect

Organizations that implement workload balancing are highly likely to achieve positive outcomes and to feel the tools are worth the investment. Avantas and symplr ShiftSelect customers are the most likely to report positive outcomes. Avantas’ workload balancing customers say the predictive tools are key, allowing them to look ahead several weeks or several months and achieve outcomes such as reduced overtime, improved staff satisfaction, and the ability to address incidental work time. symplr ShiftSelect customers say their analytics allow them to respond quickly to staffing needs, reduce overtime, and distribute talent effectively across the organization. HealthStream ANSOS and UKG (Ultimate Kronos Group) customers are least likely to report positive outcomes. Some HealthStream ANSOS customers say the potential for getting outcomes can be limited by manual processes. One UKG customer reported a negative impact, saying it is difficult to identify which shifts need staffing or to accommodate staged arrivals in the ER.

outcomes of workload balancing technology

Avantas Customers Report Significant Improvements to Training/Support

Adopting workload balancing can be a significant lift, so having the right training and ongoing support is key to achieving desired outcomes. In the past, Avantas customers have struggled to get this support. However, over the last year, Avantas has made notable strides in these areas (e.g., offering online training resources and webinars), and many customers now feel they have what they need to be successful. Customers describe support personnel as engaged. Support and training are also strengths for HealthStream ANSOS. Their support team is described as extremely responsive, and customers say it is easy to get in touch with people who can answer questions and resolve issues. Several UKG customers feel they would get more value from the tools if UKG provided better training and support. Customers say training is expensive and outdated and they have to proactively seek it out. Cerner’s initial training is often described as insufficient, but many customers say Cerner’s ongoing support is helpful and responsive when contacted. symplr ShiftSelect users don’t require much training due to the solution’s comparative simplicity. Support quality varies—while most customers report responsive, helpful support, some have encountered personnel who were unable to answer questions or resolve issues.

training vs phone/web support

Flexible Solution & Exceptional Support from HealthStream ANSOS Drive Customer Success with Workload Balancing

HealthStream ANSOS is used mostly by large organizations (>500 beds), who find it flexible for their complex environments. Customers of all sizes report high-quality support personnel who provide timely, effective help. Some customers struggle to integrate HR or EMR platforms. Hosted customers are highly satisfied, noting seamless, automatic upgrades that support their workload balancing efforts. Interviewed Avantas customers—who are all large organizations—report good vendor relationships and user-friendly functionality for staff. Customers say the product receives needed enhancements, though development can take a while and some updates are buggy or problematic. The functionality for non-inpatient settings could also be improved. ShiftWizard has the highest percentage of small customers (1–200 beds) in this sample. Two of these organizations report high satisfaction with relationships and value. The third reports dissatisfaction caused by functionality gaps. Overall, customer satisfaction varies—some customers say ShiftWizard is a partner who supports and guides them; others report buggy upgrades and system downtime.

score and bed size distribution

UKG Customers Say Success Is Mostly Self-Driven, Due in Part to Rocky Implementations

Cross-industry UKG is used by organizations of all sizes. Customers describe good technology but note that success with workload balancing is not guaranteed—several have had to drive their own success following rough implementations (e.g., insufficient implementation documentation, poor project follow-up, and personnel changes). Pricing is also a concern—there are costs associated with customization, upgrades, and the use of some functionality.

Customers of symplr’s lighter offering—ShiftSelect—report an extremely varied experience; some highlight positive relationships, while others report buggy upgrades, integration gaps, and challenging workload balancing functionality, especially for administrators. Several symplr Staffing and Scheduling customers feel relationships and the product road map have improved since symplr acquired the solution. Some say the solution is stable and helps them achieve desired outcomes; others note that its robustness leads to complicated or clunky workflows. Additionally, some customers report buggy updates and rigid reporting that hinders them from getting full value from the workload balancing. Large organizations over 1,500 beds are the least likely to be satisfied with the product or to feel they get the training or support needed for such a heavy lift.

Most Cerner Clairvia customers in this sample are Cerner EMR customers (though Clairvia is EMR agnostic). Some large organizations that have been live with Clairvia longer than five years report strong vendor partnerships. However, many customers say the solution is cumbersome and upgrades don’t deliver needed fixes. Customers have difficulty exporting data and struggle with inflexible reporting, especially for short-term analytics, limiting success with workload balancing.

Avoiding Common Workload Balancing Pitfalls—Advice from Current Users

  • Leveraging workload balancing can be time consuming, but organizations are more likely to see the value and outcomes they want if they put in the necessary time and data, especially for short-term predictive analytics.
  • Understand that while recent vendor acquisitions and mergers have led to notable improvements in support, development, and customer optimism, they have also led to some uncertainty. Your organization will likely need to be proactive about seeking out a vendor’s road map.
  • Administrative functionality is often complex or clunky and can require a lot of time. Ensure your organization receives adequate training.
  • Don’t cut corners in order to save costs. Understand which modules you will need to achieve your desired outcomes and get clarity about what those modules will cost.

Vendor Insights

Vendors ordered alphabetically

Avantas Smart Square

Caters to some of the largest health systems in the country but has comparatively small customer base in terms of unique contracts. 2014 acquisition by AMN Healthcare saw subsequent multi-year drop in customer satisfaction. Performance has improved recently, with customers citing better support, more training, and price adjustments. Analytics are a strong focus, but adoption and value have historically been low since customers had to rely on Avantas for success. However, recent changes have notably improved customers’ ability to more fully leverage Avantas’ analytics tools, and many customers report optimism for continued updates. Predictive tools help drive outcomes such as reduced overtime, improved staff satisfaction, and the ability to address incidental work time. Recent success has yet to translate into true market energy—Avantas was included in a handful of the buying decisions tracked by KLAS.

positive quote icon“With Smart Square, nurse managers can get their own reports in seconds. The product is incredibly easy to use; it is very intuitive. . . . It is so intuitive to nurses that the end-user training takes minutes. The training is even quicker with the enhancements we have made. There is just one worksheet and a tutorial. End users hardly have any questions on how to use the product.” —Manager

negative quote icon“There are a lot of modifications, reworks, and functionalities that we need that this product doesn’t have. An enhancement can just be logged as an enhancement request and never really be optimized. We have had issues because of the way we use the system. We need specific changes to the system, but that just hasn’t been done yet. Avantas has a lot of things that they need to support that they are not able to support. The scheduling tools that the vendor offers are more meant for clinics or hospital units. We are using a makeshift schedule as a workaround that doesn’t really work. There have been a lot of bugs. We have worked with Avantas a lot on that. The product is good for what it does, but the product is just not super intuitive in a lot of different ways. I don’t think the product is the most intelligent or intuitive scheduling system out there, but it works.” —Manager

Cerner Clairvia

Developed by nurses before being acquired by Cerner in 2011. Development has continued, though customers do not view Cerner as a cutting-edge leader. Connection with Cerner EMR provides advantage when it comes to leveraging core clinical data to drive effective same-day analytics and good acuity tools (an area in which Cerner is seen as a leader). Most interviewed workload customers report positive outcomes, including staff satisfaction and decision-making visibility. Within the staffing market, Cerner primarily focuses on nurse and staff scheduling; KLAS has validated a few instances of the solution being used for physician scheduling.

positive quote icon“Cerner is technically a vendor because we are buying a service and a tool from them, but for our organization, I consider them my partners. When I reach out to Cerner through their ticketing process to work on issues that I can’t fix, the Clairvia support team is very responsive. Some of my issues get fixed within less than five minutes of me logging the ticket. All the tickets go through the vendor’s online portal, but if I need to, I can call them and talk to them directly. In addition, Cerner regularly asks us for our input to make the solution better because we are the end users and know how it is being used. They are very willing to make upgrades when we need them. Out of all the Cerner teams I have worked with, the Clairvia team is my favorite team.” —Analyst

negative quote icon“For Clairvia, Cerner hasn’t promised a whole lot. They keep talking about their innovations and changes, but I haven’t seen much. I don’t know that that is breaking a promise, so I guess Cerner keeps their promises, but they don’t really promise anything. I don’t see a lot of innovation from Cerner, so I just don’t know what tangible outcomes they are driving. We have been using Clairvia for several years now, and we have been trying to get onto a new platform to get some enhancements. But nothing has happened. I feel like Cerner is slow and on the low end of delivering new technology to us.” —Manager

HealthStream ANSOS Staff Scheduling

ANSOS solution has changed hands multiple times in recent years, moving from McKesson to Change Healthcare to (most recently) HealthStream. HealthStream acquisition seen as a positive by most customers, who are optimistic about HealthStream bringing innovation to previously slow development. Some say outcomes can be limited by manual processes. HealthStream’s broad offering spans the human capital management ecosystem and includes credentialing, talent management, patient flow, and scheduling solutions.

positive quote icon“We are happy with ANSOS Staff Scheduling. It works great and does everything for us. We don’t have any problems with the system. It is very stable; it sort of just hums along. It schedules everybody down to the day and interfaces with our time and attendance product. Our environment is very complex, and the system accommodates and keeps track of all our quirky rules. We record our census, and we have our EMR integrated with the scheduling system, so our census and acuity data are also recorded in ANSOS Staff Scheduling. The system tells us what our staffing should be. We can see who is at overtime and who is traveling. We can easily run reports, and we can clearly see who is who and how much the staffing will cost us. We aren’t getting rid of ANSOS Staff Scheduling because it is entrenched in our organization. I can’t see us doing the scheduling any other way.” —Director

negative quote icon“From an administration and account manager perspective, the solution makes my job very challenging on some days. I can’t apply a template of security settings to a group of users. I also can’t create all of the web scheduler accounts that I need in mass. I can’t copy settings from one employee to another. The accounts for each of the vendor’s products are separate. I am sure that there is some sort of strategy behind that. The vendor is making some progress toward making things more active and compliant.” —Analyst

ShiftWizard, a HealthStream Company Scheduling

Noted for strong focus on clinician experience (thanks to their nurse founders). Strong performance during the company’s early growth has earned increasing market interest. Has a history of focusing heavily on one-to-one relationships (e.g., dedicated account management and heavy customization). Reported outcomes include increased efficiency and staffing visibility. Recent growth has led to some growing pains as ShiftWizard works to scale their service. Was recently acquired into HealthStream’s broad portfolio. Customers are largely unsure how the acquisition will affect them.

positive quote icon“When we are using ShiftWizard’s system, there are always things that we could imagine being done differently, but ShiftWizard is very good about listening to us. ShiftWizard has grown with us through the years. In the past, we didn’t have centralized staffing; we were very siloed. We then moved to a particular model where we send staff all over the organization, so ShiftWizard had to be able to change the functionality of the system to meet our needs.” —Director

negative quote icon“ShiftWizard Scheduling is a great-looking product and works, but the bugs in the system keep ShiftWizard from being a five-star company. There have been so many bugs over the years. The message center doesn’t work anymore. At one point, we were getting upgraded to new software without being notified, so we had to quickly ask for more notifications about big things like that. There are a lot of change-control issues. Additionally, every month, we get a notice that ShiftWizard Scheduling is down and that nobody can access it. There was a time when the system went down for two days. Sometimes the vendor sends us the schedules so that we can see them when the system is down, but we can’t make any changes to the schedules. There is no contingency plan for when the system is down. To my knowledge, there is no backup site. I have asked about that several times, and I don’t think that the vendor has a backup. The frequency of downtime is a problem. We don’t see other vendors’ systems going down all the time; other vendors seem to be handling the traffic a little better than ShiftWizard does.” —Analyst

symplr ShiftSelect (formerly API Healthcare)

Less robust than Staffing and Scheduling, but also a lighter lift in terms of deployment and speed-to-value. Acquired by GE Healthcare in 2014, Veritas Capital in 2018, and then symplr in 2019. GE’s hands-off approach initially allowed former API staff to maintain good relationships and generally high satisfaction. However, development was stagnant, and relationships declined over the last two years due to staff turnover. Customers report that symplr—who offers a broad portfolio of credentialing, time and attendance, data management, ERP, and nurse and staff scheduling solutions—has revived development and provides a more hands-on approach to account management. Analytics allow customers to respond quickly to staffing needs, reduce overtime, and distribute talent effectively across the organization. Market energy has waned over the last 18 months, with ~20% of customers saying they would consider a more functionally robust solution.

positive quote icon“The solution has had a significantly positive effect on our organization in two ways. First off, it has allowed nursing leadership to distribute the talented nurses across the facility in a very efficient manner. Recently, the system has been critical in distributing personnel across our facilities for COVID-19 response. COVID-19 has required us to mobilize almost anybody that qualifies to help for COVID-19. We have been able to quickly take that pool of people and get them into ShiftSelect so that they can respond to and help our caregivers. This last year has been phenomenal.” —Director

negative quote icon“In the last year or so, symplr has tried to integrate ShiftSelect into their API Healthcare suite better. In doing so, they have made huge changes to how the fundamental process worked. That has made things extremely hard on the administrative side. I hear from the users and administrators about how tough the system is to use. Those people have a really hard time getting a response from somebody to help them when there is an issue. We have consistent upgrades all the time, and getting upgrade notes is hard because we have to log in to the health system and search. Our administrators have a hard time keeping up with what is going on. Recently, API Healthcare combined the end-user side with the administrator side, and that made things difficult. Every time API Healthcare does an upgrade, we find that we weren’t informed well enough about a change that has happened, and that is unfortunate. I really haven’t seen any upgrades that have actually given us something.” —Analyst

symplr Staffing and Scheduling (formerly API Healthcare)

Solution offers broad tools, but training gaps and a clunky interface prevent some customers from getting full value. Acquired by GE Healthcare in 2014, Veritas Capital in 2018, and then symplr in 2019. GE’s hands-off approach initially allowed former API staff to maintain good relationships and generally high satisfaction. However, development was stagnant, and relationships declined over the last two years due to staff turnover. Customers report that symplr—who offers a broad portfolio of credentialing, time and attendance, data management, ERP, and nurse and staff scheduling solutions—has revived development and provides a more hands-on approach to account management. Existing customer base is more stable than ShiftSelect’s—almost all interviewed Staffing and Scheduling customers say the solution is part of their long-term plans. Reported outcomes include increased visibility, especially related to staffing budgets.

positive quote icon“API Healthcare has new ownership, and service is a higher priority to them. API Healthcare has gone through quite a few different hands over the last several years, and that has been a little bit unsettling, but things are starting to level off now. The vendor has client forums that we are allowed to participate in. The vendor listens to our direct feedback now compared to before when we had to go through an enhancement process that was horrible because we were 1 of 400 people that made an enhancement. But now we are a more manageable group of large clients that have similar vested interests, and we are able to participate in that committee and have some leverage as to how the application is grown. That has been really good.” —Analyst

negative quote icon“The end product is good; it just takes some time to get it there because the build is not intuitive. On the build side, there is some simplification that could occur to make building the schedules more intuitive, and there could perhaps be some better training guides or programs for our builders. Sometimes I don’t know whether it is our organization that hasn’t bought or paid for some things or whether those things are not offered. Sometimes that is hard to know, but I do know it is very difficult to learn to build the schedules and become good at that. If people have a very standard, easy schedule, the system is easy to use. However, outside those circumstances, things are harder. We have a very centralized, staff-empowered scheduling system. We have shared governance, and staff members get to make their own rules. That gets complicated. The learning curve is steep for all the bells and whistles that API Healthcare has to support a varied scheduling system or scheduling process.” —Manager

UKG (Ultimate Kronos Group) Workforce Scheduler 

Kronos and Ultimate Software merged in 2020 to form UKG (Ultimate Kronos Group). Kronos portfolio includes a broad suite of products, covering aspects of ERP, time & attendance, and scheduling (for both physicians and nurses/staff). Thanks to this breadth and Kronos’ name recognition outside healthcare, UKG has significant market share. A cross-industry vendor, UKG’s lack of healthcare-specific resources means healthcare customers frequently feel they don’t get the support, training, or partnership they need. Technology is praised as stable and robust, and customers who can manage the complexity and lack of support feel they get value. Not all customers report achieving their desired outcomes. Despite the challenges, most customers say UKG is part of their long-term plans because of the convenience and integration of working with fewer HCM vendors.

positive quote icon“I would say that this solution has had a positive effect on my organization. It allows us to match nursing skills with patients so that the right nurse will take care of the right patient. We do this by putting all of our nursing staff members’ skills into the system. Then if we need a nurse who can handle a special piece of equipment or do a special dialysis, we can go to Workforce Scheduler to find which nurses have the skills to safely care for that patient. I assume that our patients are much better cared for now that we have this solution.” —VP

negative quote icon“We initially had a bad implementation, but we have brought the system to where we need it to be, and we are using it. Kronos is not proactive in any sense. There is very little that we have with Kronos. We have a client success person, but we barely hear from that person. We are supposed to have regularly scheduled meetings, but that person brings nothing to the table. The meetings aren’t productive.” —Manager

About This Report

Each year, KLAS interviews thousands of healthcare professionals about the IT products and services their organizations use. For this report, interviews were conducted over the last 12 months using KLAS’ standard quantitative evaluation, which is composed of 16 numeric ratings questions and 4 yes/no questions, all weighted equally. Combined, the ratings for these questions make up the overall performance score, which is measured on a 100-point scale. The questions are organized into six customer experience pillars—culture, loyalty, operations, product, relationship, and value.

customer experience pillars software

To supplement the client satisfaction data gathered with the standard evaluation, KLAS also created a supplemental evaluation to delve deeper into several questions specific to workload balancing. This evaluation asked respondents to rate their solution’s (1) same-day and short-term analytics and (2) impact on outcomes.

Sample Sizes

Sample sizes displayed throughout this report (e.g., n=16) represent the total number of unique customer organizations interviewed for a given vendor or solution (the exception to this is distribution data, which necessarily shows the total number of respondents). However, it should be noted that to allow for the representation of differing perspectives within any one customer organization, samples may include surveys from different individuals at the same organization. Ratings from these individuals are aggregated in order to prevent any one organization’s feedback from disproportionately impacting a solution’s score. The table below shows the total number of unique organizations interviewed for each vendor or solution as well as the total number of individual respondents.

It should be noted that some respondents choose not to answer particular questions, meaning the sample size for any given vendor or solution can change from question to question. When the number of unique organization responses for a particular question is less than 15, the score for that question is marked with an asterisk (*) or otherwise designated as “limited data.” If the sample size is less than 6, no score is shown. Note that when a vendor has a low number of reporting sites, the possibility exists for KLAS scores to change significantly as new surveys are collected.

about this report
author - Elizabeth Pew
Elizabeth Pew
author - Jess Wallace-Simpson
Jess Wallace-Simpson
author - Natalie Jamison
Project Manager
Natalie Jamison
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This material is copyrighted. Any organization gaining unauthorized access to this report will be liable to compensate KLAS for the full retail price. Please see the KLAS DATA USE POLICY for information regarding use of this report. © 2024 KLAS Research, LLC. All Rights Reserved. NOTE: Performance scores may change significantly when including newly interviewed provider organizations, especially when added to a smaller sample size like in emerging markets with a small number of live clients. The findings presented are not meant to be conclusive data for an entire client base.

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