# ![](media/image1.png){width="2.134027777777778in" height="2.0840277777777776in"}

# 

# 

##### Resource Requirements Methodology

**RRM2005**

# 

# 

# 

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**User's Guide**

January 2005

Office of Public Health Support

Division of Planning and Evaluation

Rockville, Maryland

#  

[An Overview of the IHS Resource Requirements Methodology
3](#an-overview-of-the-ihs-resource-requirements-methodology)

[I. INTRODUCTION 5](#i.-introduction)

[II. What You See 6](#ii.-what-you-see)

[III. USING RRM2005 7](#iii.-using-rrm2005)

[Loading RRM2005 7](#a.-loading-rrm2005)

[Scrolling -- Using Tabs 7](#scrolling---using-tabs)

[Protected Cells
......................................................................................................](../Protected%20Cells)7

[Saving Files 8](#saving-files)

[Formula Cells 8](#formula-cells)

[IV. Data Input -- FACILITY INFO INPUT WORKSHEET
9](#iv.-data-input-facility-info-input-worksheet)

[A. Display 10](#a.-display)

[B. General Description 10](#b.-general-description)

[Facility Space Estimates: 11](#facility-space-estimates)

[Population: 13](#population)

[V. Data Input -- INPATIENT WORKLOAD INPUT WORKSHEET
14](#v.-data-input-inpatient-workload-input-worksheet)

[A. Display 14](#a.-display-1)

[B. General Description 14](#b.-general-description-1)

[DAYS and Nursing Stations 15](#days-and-nursing-stations)

[VI. Data Input -- OUTPATIENT WORKLOAD INPUT WORKSHEET
17](#vi.-data-input-outpatient-workload-input-worksheet)

[A. Display 17](#a.-display-2)

[B. General Description 17](#b.-general-description-2)

**VII. Security
Staffing.........................................................................19**

[VIII. Deviations 21](#ix.-deviations)

IX\. Questions and
Answers...............................................................21

#   {#section-8 .unnumbered}

# An Overview of the IHS Resource Requirements Methodology 

###### Computer Program

The purpose of this manual is to provide persons using the Resource
Requirements Methodology (RRM) of the Indian Health Service directions
on how to complete the worksheets that link to the RRM formulas. The
instructions also inform the RRM user as to where needed information can
be obtained and other information that is useful when completing the
worksheets. Following the input instructions, in the appendix, is
information by discipline on the driving variables for the staffing
formulas.

The Indian Health Service (IHS) Resource Requirements Methodology (RRM)
is a computer spreadsheet program to assist with the preparation of
staffing estimates. The system is designed to automate the planning
process for a particular facility, population, or operating unit. In
doing so, essential workload information is gathered that provides the
driving variables for each discipline. The goal of the RRM 2004 program
is to help ensure the IHS provides appropriate, reasonable and quality
staffing information to Congress and Tribes. The main purpose of the RRM
model is to project staffing that will be used in the development of
Program Justification Documents (PJD), Project Summary Documents (PSD)
or tribal requests for technical assistance in the submittal of HUD
Block Grant proposals (or for justification to other funding sources).
The RRM is also a tool used by health administrators to analyze,
evaluate and plan staffing patterns for existing facilities or
population bases. In developing the computer program, experts in the
various disciplines have recommended staffing ratios based on various
workload factors. Many of the disciplines compared staffing ratios with
industry standards, as well as benchmark information from existing IHS
facilities.

In the late 70's, the IHS developed a standard system known as Resource
Allocation Criteria (RAC) to estimate staffing needs. In the 80's, the
process was automated and became known as the Resource Requirements
Methodology Needs Assessment (RRMNA). In the early 90's, several
disciplines updated their staffing criteria and the new criteria was
added module by module to the RRM program, culminating in the last RRM
version known as RRM6g. In addition to staffing estimates, the RRM was
an integral part of the national resource allocation formulas. The major
changes made from the RRM2003 to RRM2005 are: Security staffing was
added under General Services and Plant Operations; Public Health Nursing
can use either census or user population to project staff; Emergency
Medical Services is included in the RRM, not an appendix and; pooled
clerical staff was added for Physical therapy, Audiology, Eye Care,
Laboratory, Pharmacy and Imaging. Also FTE rounding was converted to be
by department.

The RRM2005 contains healthcare, administrative and support disciplines
(or modules) in four major groupings:

-   Inpatient and Ancillary

-   Ambulatory

-   Operations (Administration and Facility Management)

-   Community

The final tab in the RRM table is a summary sheet of the FTEs generated
by the RRM based on the information provided in the input tables.

The RRM2005 was developed jointly by the Area Planning Officers, the
Office of Public Health/Headquarters (OPH), Office of Environmental
Health and Engineering (OEHE)/Headquarters and senior clinicians and
administrative managers involved in providing and managing direct
patient care.

# I. INTRODUCTION

The Resource Requirements Methodology (RRM2005) is a spreadsheet
translated to the following computer formats:

• PC Formats:

\- PC Excel 2003.XLS

\- Office 2003.XLS

• Macintosh Formats

\- Excel 2003

> Later versions of Excel will be able to read any of the above formats.
> The user is given the flexibility to choose the appropriate format
> that is compatible with the software and hardware available at each
> site. All versions contain the same cell references and calculations.
>
> The comprehensive RRM2005 is used for facility planning purposes in
> conjunction with the Health System Planning (HSP) process. To properly
> use the RRM the user must have the latest version of the HSP as it
> provides the current user populations, work load estimates and space
> information that are needed for the RRM worksheets. For this reason
> the user must "run" HSP before they begin inputting data on the RRM
> worksheets. After the RRM staffing outputs are generated they must be
> transferred to the HSP to have the correct space needs calculated.
>
> To use the RRM for purposes other than facility planning, the user may
> or may not use HSP. To define existing staff needs, current population
> and workload for a given population can be used. To define projected
> staff needs it is best to run the HSP to get projected population and
> workload.
>
> The ***RRM2005 Reference Manual***, a companion to this guide,
> summarizes the assumptions that were made in developing the RRM2005
> and describes how the staffing is calculated. The ***RRM Users
> Guide*** is designed to describe the use of the RRM2005 computer
> program.
>
> Very basically, the RRM2005 will estimate the *staffing need* for any
> given facility, summarized by departments. The workload and active
> user counts are inputs needed to determine most of the staffing needs.
> Building size, number of quarters and ground area of the facility
> location are needed to determine facility support staff.

#  II. What You See

The RRM2005 computer model is organized into 8 major tabs within an
excel workbook. Most users will only be concerned about the first three
tabs.

-   *Fac* *Info*

```{=html}
<!-- -->
```
-   *INPT WKLD*

-   *OutPt WKLD*

-   

![](media/image2.jpeg){width="6.997916666666667in"
height="0.36736111111111114in"}

> The next four tabs are not intended for routine display or printing:

-   *INPATIENT & ANCILLARY -- FTE*

-   *AMB -- FTE*

-   *OPS_FTE*

-   *COMM -- FTE*

-   

![](media/image3.jpeg){width="6.997916666666667in"
height="0.36736111111111114in"}

These five tabs describe how the RRMNA criteria were used for each
position. These tabs will only be changed or revised by IHS
Headquarters. The only exceptions are the deviations that may be
proposed.

The final tab is the output of the RRM2005:

-   *FTE List*

-   

> ![](media/image4.jpeg){width="6.997916666666667in"
> height="0.36736111111111114in"}

In addition, there are several hidden sheets in the RRM2005 which are
used to provide the direct calculations and formulas used for each
position. The hidden sheets are not routinely displayed; however, the
user may wish to track individual formulas.

# III. USING RRM2005

##  A. Loading RRM2005

> Excel users can retrieve the spreadsheet from the Planning and
> Evaluation WEB site or a diskette (or hard disk) with the *File-Open*
> menu command or by *double-clicking* with the mouse on the RRM2005
> 12142004.xls file (either from the WEB site, the diskette or from the
> hard drive). **[Before]{.underline}** inputting any data, the RRM user
> should make a copy of the master program. The copy should then be
> saved under a different name, preferably under the Operating Unit's
> (OU) name. In this way, a blank master copy of the RRM200512142004.xls
> file will always be available. EXCEL users can use the *File-Save As*
> command to rename the file.

## Scrolling - Using tabs

> The user will need to scroll downward through the spreadsheet to
> access and view the pages to be printed. If a value made during data
> entry needs to be changed/corrected, scroll to it, delete it and enter
> the correct value. The output will change to the new staffing
> projection automatically. The tabs on the bottom of the spreadsheet
> can be clicked with the mouse to change from Fac Info to INPT WKLD,
> etc. The middle four tabs are used if deviations are being proposed.
> Section VIII of this manual discusses deviations. RRM2005 users can,
> however, tab and scroll through the work areas to analyze how the
> formulas work. Many of the cells are not subject to modification. If
> there are modifications to be made, IHS Headquarters will provide the
> revised computer programs to each Area.

##  Protected Cells

> Most cells of the RRM2005 are protected (locked) against accidental
> alteration. Cells requiring data entry by the user are not protected
> and are designated by the yellow color. The other unprotected cells
> are designated by a blue or turquoise color. The blue/turquoise cells
> provide the option to override the RRM calculation(s). If the RRM user
> decides to override the RRM calculation(s), then there must be
> sufficient justification attached that would enable the RRM validation
> committee to validate the RRM results.
>
> ***Notes on Input***
>
> The light green cells of the input sheets can be used by the user to
> make notes on the input for that variable. This is especially useful
> when there are changes in the standard value entered for that
> variable.

##  Printing

> To print the results of the RRM2005, use the print command within
> EXCEL on each TAB. The page breaks and Print Ranges have been preset
> to print only the result. If you desire to print the work areas, the
> print ranges and page breaks will need to be reset by the user using
> the commands on the EXCEL menus.

##  Saving Files

> After input of the data, the user may desire to save a copy of the
> completed spreadsheet. It is recommended that you save individual
> project RRMs with different names that indicate the date of any
> changes to prevent confusion over entry and output information. For
> purposes of a national IHS application of RRM, you will be given
> instructions regarding saving OU files.

##  Formula Cells

> Most cells with formulas are protected from changes. There are cells,
> however, that have formulas but are [not protected]{.underline}. In
> these cells, the user has two options: to let the formula provide the
> entry or to over ride the formula with the users' own entry. The cells
> have been left unprotected in order to allow the user to bypass the
> automatic calculations. IHS Headquarters will provide directions and
> updates to the formulas, including the data entry cells.
>
> USER NOTE: To delete any number in any cell use "delete" key or "0",
> [not]{.underline} space bar, because the spread sheets read a space
> bar as a text field and will not calculate.

# IV. Data Input -- FACILITY INFO INPUT WORKSHEET

> Prior to entering data into the RRM2005 computer program, the user
> must first gather the following information:

• workload

> \- Direct Inpatient Days
>
> \- Direct Inpatient Births
>
> \- Direct Surgical Cases

-   Admissions in Private Hospitals

-   Direct Primary Care Provider Visits

• user population

\- Active Users

\- Inpatient Population

\- Outpatient Population

\- Community Health Population

\- Census Population

> The data will need to be separated by Operating Unit (or Service Unit,
> or by facility or other designated service area being studied) and
> projected to the year of facility opening. The results from the Health
> Service Planning (HSP) system can be used since it automatically
> projects ten (10) years of workload obtained from the Data Center. The
> workload results from HSP are considered the official IHS numbers used
> for official reporting to Congress, facility planning, and other
> reports. RRM2005 users may use numbers other than from HSP, however,
> the results may or may not be certified by the IHS. If the HSP
> projections are not used, using the percentage change to the year of
> opening in the HSP to project approved numbers is suggested.

The *HSP output*, however, is recommended, since it will make it easier
for the RRM validation committee or other Headquarters staff to validate
the Area and OU population and workload figures.

If you intend to project EMS staff the information you need for this
page is:

###  

### IHS or Tribal (I/T) Services

-   Percentage of EMS runs provided using contract health service funds
    **(Percent I/T EMS runs purchased)**

-   Total Population served by EMS (**Total Population**)

```{=html}
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```
-   Total Area to be served (**Square Kilometers Served**)

-   Driving time and distance to nearest emergency room.

###  

> The data will need to be separated by Operating Unit (or Service Unit,
> or by facility or other designated service area being studied). The
> results from the Health Service Planning (HSP) system can be used
> since it uses current population data obtained from the Data Center to
> automatically project population and workload data to a specified
> planning year - usually 10 years in the future for facility planning.
> The workload results from HSP are considered the official IHS numbers
> used for official reporting to Congress on facility planning documents
> and reports. RRM2005 users may use numbers other than from HSP;
> however, if a different workload is used it must be submitted to IHS
> Program Statistics for verification and approval.
>
> The *HSP output*, however, is recommended, since it will make it
> easier for the RRM validation committee or other Headquarters' staff
> to validate the Area and Operating Unit (OU) population and workload
> figures.

## A. Display

The *Facility Information (Fac INFO)* is shown on the first tab of
RRM2005:

## B. General Description

Located at the top of the *Fac INFO*, the user will input facility or
operating unit information. There is no set format for entering this
data as it is used for informational purposes only.

The next step will be to input the OU (or facility) specific name,
population, workload and facility data as indicated. The following
instructions coincide with the line-number on the *printed* RRM
spreadsheet. The following instructions do not coincide with the *cell
number* of the excel spreadsheet. The input cells are in **yellow** and
the blue cells will override formulas.

> **Line No. 1: HSP Project Name:** Enter the name of the project as it
> is entered in the HSP program for this facility.
>
> **Line No. 2: Facility Name:** Enter the name of the facility, service
> unit or operating unit that will be using the RRM.

**Line No. 3: Contact:** Enter the name and phone number of the Area
Planner, person that prepared the RRM or other person that can answer
questions regarding the data input.

> **Line No 4: Area:** -- Name: Enter the name of the Area Office where
> the facility is located.
>
> **Line No. 5: Service Unit** -- Name: Enter the name of the IHS
> service unit or tribal operating unit where the facility is located.
> This name may be the same as line no. 1 above. The facility code is
> described in the Standard Code Book. Enter the four digit area and
> service unit code as identified in the IHS Standard Code Book.
>
> **Line No. 6: Facility -- Code**: Enter the two digit facility code as
> described by the Standard Code Book.
>
> **Type of Facility**: Select the type of facility being planned from
> the "drop down box". Health Stations are open less than five days per
> week. To qualify as a Health Center, the facility must be open at
> least five days per week with a minimum workload of 4,400 PCPVs. A
> general care hospital is one that provides services to the local
> population. Alternative Rural Healthcare (AHR) facility without
> birthing unit and ARH with birthing unit is a facility providing a
> broad range of ambulatory/clinical care and limited inpatient care
> including emergency room services and low acuity inpatient care.  The
> facility may also include low risk birthing services.  This facility
> does not provide Surgery, C-Sections or ICU services.  User population
> of 6,000 or more, with an inpatient ADPL of 2-12. A Medical Center is
> a large hospital that provides specialty care and has patients
> referred to it from other hospitals in the region. The RRM program is
> not suited for Medical Centers; however, it may be used on a limited
> basis.
>
> **Salary Estimated Budget Year:** In order to get the salary cost
> estimate for enter the year facility opening is planned.

## Facility Space Estimates:

The following section (Lines 7 thru 14) should be completed AFTER the
HSP has been completed.

> **Calculated Space Estimates:** The RRM requires space estimates to
> generate facilities personnel. Generally, this information comes from
> the HSP POR Building Area Summary Report, but since there are no space
> estimates available until a full-blown HSP is done, the OEHE provided
> a formula that projects preliminary estimates. Therefore, prior to the
> completion of the Program of Requirements (POR), the RRM will
> automatically estimate total GSF by the following formula: (0.8 x User
> POP + 200) x 10.76.
>
> **Line No 7: Inpatient Treatment Space:** Use the POR/Building Area
> Summary report for the Inpatient Department Gross Square Meters from
> HSP. If the HSP has not been completed, leave this space blank, the
> estimated formula in the calculated space estimate line above will be
> used.
>
> **Line No 8: Ambulatory Treatment Space**: Enter the building gross
> square meters less Inpatient Department Gross from the HSP
> POR/Building Area Summary Report. If the HSP has not been completed,
> leave this space blank, the estimated formula in the calculated space
> estimate line above will be used.
>
> **Lines No 9-10: Other**: Enter the building gross square meters of
> other facilities or buildings maintained by the maintenance staff
> beyond that required for the health care facility, such as an
> airstrip, heliport, or recreational facilities. (If these are new
> spaces/buildings they must be justified and approved in the PJD).
>
> **Line No 11: HSP Building Area less ambulatory and inpatient:** Enter
> gross HSP building area minus lines 7 and 8. (Generally not used.)
>
> **Line No 12: Number of Quarters:** Enter the estimated number of
> quarters at the facility. At this time this is an estimate and is not
> finalized until a Quarters PJD is approved.
>
> **Line No 13: Total Quarters Square Meters:** The cell shows the
> building gross square meters for quarters based on a general estimate
> that each quarter is 1,800 gross square feet. Cell 13E can be used to
> override Line 13 if the Quarters space is **known**.
>
> **Line 14: Parking Spaces:** These are the parking spaces for the
> facility and can be obtained from the Parking Summary section of the
> HSP.
>
> **Calculated Hectares:** This is the land area required for the Health
> Care Facility using a look-up table contained in the OEH Technical
> Handbook, Site Selection. This also includes land area required for
> staff quarters plus 5% for staff quarters recreational facilities.
> This cell is protected and no data entry is needed.
>
> **Line No 15:** Hectares of Ground (Over-ride): You can over-ride the
> calculated hectares on Line 17, however, the change must be
> documented. Enter only the amount of land that is *maintained* by the
> facility grounds keepers, not the total campus acreage. Entering an
> amount here is optional.

##  Population: 

> Smaller facilities may need to join with neighboring service areas to
> meet the minimum thresholds for various modules. The RRM allows you to
> pick and choose which modules you can combine with neighboring service
> areas. Indicate in the green space to the right the names of the
> service areas or communities that are being combined so that the
> populations can be validated. Indicate whether census or active user
> population is being used. The population figures come from the HSP PJD
> Report on User Population etc. Note: the combination of service areas
> must be consistent with the Area\'s Master Facility Plan (if
> available). Also, the user population is only entered for those
> services that will be provided at the proposed facility.
>
> **Line No 16: Inpatient Population**: Enter the Active User
> Population. This population may include an area larger than the
> surrounding facility or operating unit. Whatever inpatient population
> is used must be verifiable. The results from the HSP should be used
> since they represent the official IHS numbers.
>
> **Line No 17: Ambulatory Population**: Enter the Active User
> Population that will be using the ambulatory services. If a health
> station or field clinic is being staffed the workload from the health
> station can be combined with a neighboring operating unit or facility
> in order to justify a full-time staff position. The full-time staff
> would then provide itinerant service to the health station. The local
> service unit management has the discretion to divide the staff time
> among the facilities.
>
> **Lines No 18-26: Enter the Active User population that will be used
> for the particular services.** Some health centers may not have enough
> population to justify full time staff and may want to combine
> populations from neighboring operating units. If other operating units
> are added, please indicate the service units, operating units or other
> verifiable communities in the space provided. Again, the HSP numbers
> should be used. Note that in line 23, Public Health Nursing,
>
> the PHN module uses either the census population or active user
> population to generate staffing projections. Enter the population that
> is greater.
>
> **Line No 27: Emergency Medical Service Program:** If you are planning
> to provide EMS services, to receive the 0.2 FTE for the EMS Director
> that is located in the facility line 26 must be YES. There are
> overrides in the EMS worksheet that can be used to override the
> calculated work loads. There is also some additional cost information
> available in the EMS worksheet.
>
> **Line No 28: Percent of CHS Runs:** Enter the percent of EMS runs
> that are paid for with contract health service funds or by private
> resources.
>
> **Line No 29: Square Kilometers served by EMS:** The total area served
> by the proposed EMS program.
>
> **Lines No 30&31: Driving Time to Nearest Emergency Room:** Enter YES
> on the appropriate line 29 or 30 if an ER is planned. Select the line
> that describes the driving time to the nearest hospital with an
> emergency room. If the health facility exceeds the 100 km criteria or
> over 90 minutes criteria the staffing for ER will be generated if
> there are any ER/after hours PCPVs. If the health facility meets the
> 64 km or over 60 minutes criteria and there are more than 3000
> ER/after hours PCPVs ER staffing will be generated. Also on the
> Outpatient workload sheet the ER, line 5, the YES box needs to be
> selected.
>
> **Line No 32: Patron Rations:** Enter YES if the food services
> department prepares meals for staff and visitors.
>
> **Line No 33: Security:** Enter yes if 24/7 security is planned for
> the facility. If the facility is not providing healthcare 24/7, around
> the clock security services must be justified. Note: *Center with 24
> hour coverage uses building area, patient+ visitor + staff, and ER
> visits Health Center without 24/7 coverage uses area only without FTE
> for night security. Both can request additional staff via deviations
> for areas with high crime rates and special services.*

# V. Data Input -- INPATIENT WORKLOAD INPUT WORKSHEET

Prior to entering data into the RRM2005 computer program, the user must
first gather information from the HSP.

## A. Display

> The *INPATIENT WORKLOAD* worksheet (INPT WKLD) is shown on second tab
> of RRM2005.

## B. General Description

Located on the INPT WKLD, the user will input inpatient workload
information:

> **Line 1: Admissions:** This is an override box. It should be filled
> in unless there is a justification for not using the bed days from the
> HSP that are placed in lines 8-20 that are used to calculate
> admissions.
>
> **Line No 2: Projected \# of Deliveries**: Input projected births from
> the HSP workload summary sheet. The number of births for small
> birthing centers (which are part of a sub-acute care unit) may not
> show up on the HSP in which case you need to input your own
> number...but it must be verifiable.
>
> **Line No 3 \# Inpatient General Surgical Cases:** Input the projected
> surgical cases from the HSP Workload Summary Sheet.
>
> **Line No 4: \# Inpatient Gynecological Surgical Cases:** Input the
> projected GYN surgical cases and identify the source of information.
>
> **Line No 5: Total Number of Beds:** Input the total number of beds in
> the facility, including ICU/CCU. Use the number given by the HSP
> unless there is HQ approval to use another number.
>
> **Line No 6: Total Number of ICU/CCU Beds:** Enter the number given by
> the HSP (4) unless there is HQ approval to use another number.
>
> **Line No 7: Staffed Observation Beds:** These are for patients placed
> for evaluation of status pending decision for admission or to receive
> additional treatment not available during ambulatory or emergency
> visit. Such beds require availability of nursing staff for monitoring.
> DO NOT use outpatient observation beds in this total as they are
> included in the outpatient work load section.

### DAYS and Nursing Stations

> **Line No 8: General Medicine:** In column E, enter the number given
> by the HSP. In column F, enter the number of separate GM Nurse
> Stations. In column I**, Staffed Beds-Override (cells in blue):** If
> there are no validated number of beds, then leave this column blank.
> Otherwise, input the number of beds for which nursing staff is
> available rather than the number of constructed beds. In the absence
> of a validated number, the formula of ADPL + 25% is used as shown in
> column H.
>
> **Line No 9: Obstetrics/Gynecology (OB/GYN):** In column E, enter the
> Postpartum and Antepartum days given by the HSP. In column F, enter
> the number of separate OB/GYN Nurse Stations. In column I**, Staffed
> Beds-Override (cells in blue):** If there are no validated number of
> OB beds, then leave this column blank. Otherwise, input the number of
> beds which nursing staff is available rather than the number of
> constructed beds. In the absence of a validated number, the formula of
> ADPL + 25% is used as shown in column H.
>
> **Lines No 10-13:** In column E, enter the On-Site Days from the HSP
> and nursing stations (if applicable) for each particular service. The
> blue cells in Column I are used to override the projected beds. Do not
> enter the total number of constructed beds, but rather the number of
> beds where nursing staff is available. As stated above in Line 11, in
> the absence of a validated number, the formula of ADPL + 25% will be
> used as shown in column H.
>
> **Line No 14: Step-Down Unit (also called "sub-acute care"):** In
> column E, use the sub-acute bed days from the HSP and nursing stations
> (if applicable.)
>
> **Line No 15: Operating Room (OR)**: In column F, enter the number of
> OR Nursing Stations. Look at the template(s) in the HSP for each
> medical service.
>
> **Line No 16: Psychiatric**: In column E, enter the number of
> Psychiatric Days: Use the number given by the HSP.
>
> **Line No 17: Ambulatory Care**: In column F, enter the number of
> Ambulatory Care Nurse Stations. Look at the template(s) in the HSP.
>
> **Line No 18: Birthing Units**: In column E, enter the number of
> Birthing Unit Days: Use the number given in the HSP (Inpatient Tab 12,
> Low-Risk Birthing Unit).
>
> **Line No 19: Sub Acute:** In column E, enter the number of sub acute
> bed days.
>
> **Line No 20: Other**: Enter the number of days and/or nursing
> stations that do not fit into the categories listed above. In the
> yellow cells under column D, enter the name of the approved service.
>
> **Line No 21: Nursery: Bassinets**: If Nursery is planned, enter the
> number of bassinets. These can be determined by running the Labor and
> Delivery equipment list generated by the HSP.
>
> **Line No 22: Remote Location:** From the drop-down menu select if
> this is a remote location. The criteria for being considered a remote
> location is that the proposed facility be located in Alaska.
>
> **Line No 23: Does Inpatient Nursing Provide Respiratory Services?**
> Data Source: Director of Nursing at the Hospital or Area Nursing
> Consultant.
>
> **Line No 24: Does Inpatient Nursing Provide EKG Services?** Data
> Source: Director of Nursing at the Hospital or Area Nursing
> Consultant.
>
> **Line No 25: Yearly Patient Escort Hours (Inter-facility):** refers
> to the journeyman level nurse with broad clinical skills required to
> address nursing care needs of a patient being transferred by surface
> vehicle or aircraft from the facility to a referral facility. Use
> PROJECTED hours based on ACTUAL experience. Submit log or something
> similar for validation.

# VI. Data Input -- OUTPATIENT WORKLOAD INPUT WORKSHEET

Prior to entering data into the RRM2005 computer program, the user must
first gather the information from the HSP and other information, if
applicable, as shown below.

## A. Display

> The *OUTPATIENT WORKLOAD* worksheet (OutPt WKLD) is shown on tab 3 of
> RRM2005.

## B. General Description

Located on the *OutPt WKLD worksheet*, the user will input outpatient
workload information:

> **Line No 1: Primary Care Provider Visits (PCPVs):** Data Source: Use
> the HSP Workload Summary - Primary Care visits being sure that
> specialty care visits are not included with them as specialty care is
> entered on a separate line. Do not include the visits contracted out.
> In column E, enter the % of the PCPVs that are Indian active users. If
> the PCPVs are less than 6450 use of the RRM is not appropriate and you
> must use the Small Ambulatory Facility Criteria or consult with the
> Area Planning Office.
>
> **Line No 1a: Visits for Physical Therapy ONLY:** Data Source: Use the
> HSP Workload Summary for both outpatient and inpatient. Enter the
> number of projected Physical Therapy visits from the HSP. This figure
> may combine the visits from neighboring service areas in the HSP run.
>
> **Line No 1b: Total Specialty Visits (TVS) for specialty care:** Enter
> the total number of specialty care visits but do not include the
> visits that are contacted out. Specialty care work load is gotten from
> HSP.
>
> **Line No 1c: CHP Ambulatory Encounters:** Community Health
> Practitioner/Aids are only used in Alaska as an optional means of
> meeting ambulatory care needs in small isolated villages to small to
> warrant a regular facility CHP visits are necessary to determine
> additional support programs; ie., pharmacy, health records, laboratory
> and imaging.
>
> **Line No 2: Outpatient visits (OPVs):** If left blank, a
> RRM-calculated OPV figure will be given based on IHS average rates for
> Hospitals and Health Centers. The OPV can be overridden by entering a
> value in line 2. An override requires a justification.
>
> **Line No 3: Outpatient Surgery**: This input is for larger hospitals
> only! The number comes from the HSP.
>
> **Line No 4: ER PCPVs**: Use the number generated by the HSP.
>
> **Line No 5: Emergency Room**: Select level of emergency room that is
> planned at the facility. This is the based on JCAHO rating with 1
> being the lowest level ER and 4 being the highest. Since the IHS does
> not go beyond a level 3 emergency room this is as high as provided in
> the drop down table. Select **[No]{.underline}** if no emergency room
> is planned. This input is needed so that if an emergency room is
> justified by the variables that drive one, ER staff will be allocated
>
> **Line No 6: \# Patient Escort Hours, if provided:** Patient escorts
> are only for when RNs are required to be present. Escort trips are
> normally from the health center/hospital OPD to a higher level care
> facility. This does not include patient transport from the home to the
> health center or hospital OPD. Input the total number of hours per
> year to do all RN-accompanied trips. Usually this information is
> provided by the facility nursing department. It can be projected to
> the planning year based on the population growth rate in the HSP.
>
> **Line No 7: \# of Observation Beds, if provided by the clinic**: this
> applies to ambulatory clinics only. Inpatient observation beds are
> addresses in INPATIENT modules. Don\'t put a number in here until it
> gets approved by OPH.
>
> **Lines No 8-10**: Click on one of the following:

-   Part Time PHN School Services?

-   Full Time PHN School Service?

-   No PHN School Service

> **Line No 11: Discharge Planning by PHN?** The Calculation for
> discharge planning will only be used in areas served by free standing
> health centers, contract hospitals and/or IHS hospitals without
> discharge planning services. To prevent duplication, this service will
> not be estimated where existing discharge planning services are
> provided.
>
> **Line No 12: \# of Weekly One Hour PHN Managed Clinics:** Examples of
> PHN-managed clinics are: screening, well child, family planning,
> chronic disease and communicable disease and others. By inputting 1
> hr/week, the RRM planner is stating that 52 hours in a year are
> committed to specialty clinics.
>
> **Line No 13: \# of CHRs Supervised**: If the IHS operates the PHN
> program, in most cases the entry will be zero. If tribally operated,
> enter the number of CHRs being supervised by the PHN. Enter a number
> only if PHNs are supervising CHRs.
>
> **Line No 14: Are Interpreter Services Required?** This entry requires
> justification: What\'s required to justify? Use census reports that
> have the number of non-English speaking people.
>
> **Line No 15: Percent of Population Requiring Interpreter Services:**
> The RRM TAC has recommended no more than 5% of the User Population
> will require Interpreter Services. Percentages higher than 5% will
> require justification.
>
> **Line No 16: Target Minutes Per Dental User**: The Target Minutes can
> be obtained from the HSP.
>
> **Line No 17: \# of CHS PURCHASE ORDERS:** Enter the yearly total of
> CHS purchase orders, obtained from the Area CHS office. They can be
> projected to the planning year by using the HSP population growth
> rate.
>
> **Line No 18:** This figure is provided by the Area Office of
> Environmental Health.

# Security Staffing

Healthcare facilities present their own unique set of security
challenges when they seek to ensure the safety and security of the staff
and patients at the facility. The following functions are required of
the facility security staff:

**Physical Security**: Protection of the clinic including electronics,
locks, and closed security surveillance systems is a primary function of
the security service. Security officers control the flow of visitors,
conduct escorts for troubled patients, and conduct investigations of
incidents. Officers observe for a variety of safety hazards, which could
cause injury to patients, staff and visitors. They also provide
assistance with patina restrains and patient watch.

**Workplace Violence:** Security staff provides prevention education and
intervene when there is violence in the facility.

**Fire Safety:** Security staff ensures accessibility to fire protection
equipment, conduct fire drills, inspect fire extinguishers, observe for
unattended flammable liquids and accumulation of trash and other
potential fire hazards.

The RRM security staffing module estimates the requirements for security
supervisors and staff to provide physical security services to the
facility, grounds and staff quarters. The workload parameters that are
the key variables in the staffing estimation are square meters of
facility space, patients and staff using the facility, parking lot size,
staff quarters and hours of operation.

Deviations that will be considered for additional Security staff at a
location are:

**Community Crime Profile:** For reservations this is available from the
BIA. For urban locations the local police department has it. Since these
numbers may be difficult to obtain and not be comparable across Indian
country the planner will be required to provide a justification as to
where the crime profile was obtained and why it is sever enough to
require more security staff. Documentation will need to be submitted
when the RRM for the facility is validated.

**Serious Security Incidence:** Examples of serious security incidence
are: 1. When there was a call for assistance "Code Strong", 2. The local
police are called to the facility, 3. An incident involving a weapon
occurs, 4. There is vandalism and or gang activity on campus, 5. There
is a burglary. Logs of these are kept at most facilities by the Building
Security Office. For a new facility, as opposed to an existing one, this
data can be based on information for the next closest facility. If this
information is not available it can not be used to request Security
staff. Documentation will need to be submitted when the RRM for the
facility is validated.

**Service Request:** These are requested services involving Security
Personnel outside of their normal duties. They are activities such as
sitting with a patient or escorting a patient to a referral facility.
This is measured in hours of time Security Personnel spend on such
request. Logs of these are kept at some facilities. For a new facility,
as opposed to an existing one, this data can be based on information for
the next closest facility. Documentation will need to be submitted when
the RRM for the facility is validated

# IX. Deviations

> Modules, services or disciplines not contained in the RRM can be
> included as a deviation. The location of the input is shown in yellow
> at the bottom of the worksheets entitled:

-   Inpt-Anc (Inpatient & Ancillary modules)

-   AMB (Ambulatory modules)

-   COMM HLTH (Community Health modules)

-   OPS (Facilities & Administration modules)

> The descriptions listed are only examples and are used as
> placeholders. Some of them have been used in previous RRM submittals
> as deviations to the RRM. For example, *Birthing Center, Traditional
> Healing, or Tribal Programs.* Simply, write over the placeholder and
> enter the FTE that is being proposed. Deviations require prior
> approval from OPH (Area and HQ) before being included as a part of the
> RRM.

**XI. Questions and Answers**

**Can the RRM2005 program be used to estimate staffing for health
stations?**

ANS: Most health stations do not have sufficient workload to meet the
threshold for full time staff for the various disciplines. The computer
program can be used to generate staffing for health stations under two
circumstances.

1.  The workload from the health station can be combined with a
    neighboring operating unit or facility in order to justify a
    full-time staff position. The full-time staff would then provide
    itinerant service to the health station. The local service unit
    management has the discretion to divide the staff time among the
    facilities; or

2.  The thresholds in the computer can be set to 0. The resulting
    fractions of positions could be used to identify part-time positions
    where appropriate.

**Can the RRM2005 program be used to estimate staffing for medical
centers?**

ANS: The RRM2005 was designed for medium sized hospitals (50 beds or
less) and health centers with over 6,450 primary care provider visits.
Several disciplines did take into account staffing needs for medical
centers; however, in general, use of the RRM2005 for medical centers can
only be used on a limited basis only. Most medical centers have
specialty services not covered by the RRM2005 and the RRM does not take
into account economies of scale that may or may not impact a particular
discipline. There is also a question counting the correct workload as a
referring facility and whether or not the active user count from outside
service units can be counted.

**Are Service Units restricted to the staffing projections from approved
RRMs?**

ANS: The RRM2005 is used to estimate staffing prior to construction or
funding. Once construction is completed and funding is received, the
local service unit management staff has the discretion on what staffing
will be hired. In most cases, only 85% of the estimated staffing is ever
funded by the Congress under new construction.

**What is a validated RRM?**

ANS: A RRM that has been reviewed by a committee of area and
headquarters staff and approved in writing by the OPCS Office of
Clinical and Community Services.

**What is a documented deviation?**

ANS: A deviation that is approved in writing by the OPH Office of
Clinical and Preventive Services.

**What is a justifiable deviation?**

ANS: A deviation with supportable information to warrant approval by the
OPCS Office of Clinical and Community Services. Se Section VIII above
for instructions on including deviation calculations.

**What is verifiable data?**

ANS: Data from an approval or published source that can be readily
retrieved and/or replicated.