The basic human-resources management tenets of attract, retain, and motivate the best practitioners remain at the core of management focus; however, time standards, volumes, staffing variables, and flexible budgets are concepts that have become increasingly important in managing respiratory care departments. Labor productivity is one of the most important priorities of any business, and labor is the largest expense for healthcare organizations. Labor typically represents more than 60% of a respiratory care department's total costs. 1 The justification of resources and equitable work-load distribution require formal productivity reporting systems and established staffing strategies. Considering the month-to-month, day-to-day, and even hour-to-hour variability in work demand, and having systems in place that are sensitive to work-load fluctuations provides a data-driven approach to adjusting labor hours scheduled. Essential for successful respiratory departments is the development of systems and strategies that ensure adequate numbers of qualified personnel to meet the patients' needs at all times.

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In order to determine, document, and communicate the value of respiratory therapists performing respiratory care procedures, the respiratory care profession needs to position itself to capture and report both time and value standards that can be applied in allocating respiratory care resources.To do this, we propose a new metric called value-efficiency. If we wish to use value-efficiency as a metric to justify respiratory care activities and support labor budgets, there are three key considerations: (1) What value does respiratory care add to the health care organization? (2) Are the interventions provided necessary and of clinical value? (3) What is the value of the respiratory therapist in the delivery of these services? Significant challenges are facing the respiratory care profession and a focus on value-efficiency is a direction the profession must pursue. This approach is a practical response to the increasing demands of payers, administrators, consultants, and patients.