Scheduling In Hospitals

Abstract

Decisions relating to hospital nurse staffing and scheduling are among the most important decisions made in hospitals today. Staffing and scheduling choices must be made which will result in timely and high-quality care to patients. These choices are complicated by the requirement for round-the-clock staffing in many hospital nursing units, a severe nursing shortage, and an outcry from many quarters to cut costs of health care. In general, patients today are kept in hospitals only if they are in need of highly skilled nursing care. In this paper we present a review of some of the issues in health care currently influencing the hospital nurse staffing and scheduling environment. In addition, we review the literature that illustrates nurse manager's concerns, and approaches taken in the past by operations researchers to address those concerns. We present some data from a recent study of nurse managers in 31 hospitals for qualitative parameters that illustrates the complexity of the issues. We define acuity mathematically, for an individual patient using quantitative parameters as the number of nurses in the unit needed by one patient during one shift. We represent the number of nurses needed in the unit during the shift as a multiplicative model of mean patient acuity, number of patients, and the mean rate of change in patient acuities. We show that changes in these factors can interact to cause wide swings in the number of nurses needed to staff the next shift. We derive conditions needed for level staffing under certainty, then introduce changes in those conditions in order to study the effect on the number of nurses required. Finally, a simulation model enables us to study the stochastic interaction between the alternative experimental factors for patient acuity, number of patients, and the rate of changes in acuity.

Table of Content

Introduction4

Background6

Literature review6

External pressures on the hospital industry6

Internal concerns of hospital nursing managers11

The role of operations management researchers in hospital nurse scheduling15

The problem setting20

Qualitative Parameters21

Quantitative Parameters26

The model26

Analytical results32

A simulation experiment36

Concluding remarks39

References40

Scheduling In Hospitals

Introduction

Hospital nurse staffing and scheduling decisions have interested researchers for several decades, and that interest is not likely to wane as an ever-changing environment surrounds the context in which these decisions must be made. In this study we review research specifically related to health care, the hospital industry, and hospital nurse staffing and scheduling. The purpose here is to give a flavor of the external environment driving decisions in health care, and to show how this has affected research interests in hospital nurse staffing and scheduling. An attempt is made to cofivey the enormous number of diverse factors impacting hospital nurse staffing and scheduling issues.

The provision of hospital nursing services is perpetually a difficult problem for a number of reasons. First, hospital nursing services exhibit almost all characteristics of 'pure' services. These services, for the most part, must be continuously available, 24 hours a day, 7 days a week, with no breaks for weekends or holidays. Output cannot be inventoried, demand is highly time-dependent, and there is a great ...