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BAMS 580B Workforce Staffing and Planning Lecture 4

BAMS 580B Workforce Staffing and Planning Lecture 4. Dimensions of staffing. Shift Scheduling Determining best shifts Assigning staff to shifts to meet constraints Union Regulations Strategic scheduling Long Term Planning Demand Models Supply Models.

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BAMS 580B Workforce Staffing and Planning Lecture 4

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  1. BAMS 580B Workforce Staffing and PlanningLecture 4

  2. Dimensions of staffing • Shift Scheduling • Determining best shifts • Assigning staff to shifts to meet constraints • Union Regulations • Strategic scheduling • Long Term Planning • Demand Models • Supply Models

  3. BCNU Collective Agreement – Key Operational Sections • Article 11 – Employee Status • Article 13 – Seniority – Call ins • Article 19 – Layoffs • Article 25 – Work Schedules • 25.08 – Change in Schedules • 25.12 – Switching Shifts • Article 26 – Hours of Work, Meals and Rest Periods • Article 27 – Overtime • Article 28 – Shift Premium • Article 29 – On-Call, Call Back and Call In • Article 38 – Parental Leave • Article 39 – Paid Holidays • Article 45 – Vacation Leave

  4. Background Workforce planning, training and regulation is thedominant immediate and long term issue for policy makers, managers, and clinical organizations. Listening for Direction: A national consultation on health services and policy issues Registered nurses account for one-third of the health workforce. Today’s HR decision have long term implications. Decisions in the 1990’s: decrease education seats, decrease nurse leadership positions In 2001, the CNA president noted “Canada should be graduating about 10,000 nurses annually to replenish the workforce in the next 10 years”. Current Characteristics (CNA)

  5. Background Source: Canadian Institute for Health Information. (2006). Workforce Trends of Registered Nurses in Canada, 2005.

  6. Nursing Ratios or How Many Nurses Do We Need?

  7. Impacts of Nursing Shortages • Delays for care in wards • Emergency Department Treatment Delays • Medication Errors • Poorer outcomes and increased mortality rates

  8. Key Tasks • Admit, Transfer and Discharge Patients • Provide Meds • Monitor Patients • Respond to call requests • Prepare patients for procedures

  9. Nursing Ratios • Varies by unit type: • 8:1 Clinical Units • 1:1 Intensive care (ICU) • 6:1 California Legislation 2004 on general wards • Videos • Limitations • 6:1 is arbitrary • Doesn’t account for differences in need • Ignore size of unit • Ignore length of stay • Not based on service criteria

  10. Yankovic-Green • Questions Efficacy of Ratios • Should be based on actual needs • Propose finite source queuing model • Key limitation lack of good data • What data would be needed? • This is addressed in ARHQ grant referred to in the paper. • Paper goals • Develop planning tools for hospital managers • Determine factors that effect nursing levels needed to achieve high quality patient service. • Determine impact of nursing levels on ED congestion.

  11. Model • Models beds and nurses as finite resources • N Nurses • B Beds • Dynamics • Patient arrives to a bed • Nurse needed to admit • Generates multiple requests for nursing time • Nurse serves patient • Patient ready to be discharged • Nurse needed to discharge • Derives analytical results but also could simulate the system.

  12. Application Parameters • Base case • 42 bed surgical unit • Average LOS 4.3 days • Average occupancy rate ( )– 78% • Average service time – 15.3 minutes • Data weak here • Demand rate - .38 requests per hour • Waiting room for admission to ward – 3 beds • Service Criterion • Probability of delay > 1 or 5 minutes for care • Approach • Vary the number of nurses to achieve target service levels • Used simulation to evaluate quality of queueing model

  13. Yankovic-Green Results • See Figure 2 • The staffing ratio needed to insure a specific probability of delay increases with • the number of beds • Demand for nurses services • It is relatively insensitive to ALOS • High bed utilization impacts ED overcrowding

  14. Long Term Planning

  15. Planners Require Precise short and long term plans that provide the annual number of: nursing education seats nurses to recruit and at what level nurses and managers to promote Models: Inputs and assumptions can be varied and implications seen Flexible unified frameworks that apply to any workforce: Regional Provincial National Sub-specialty

  16. A Commonly Used Approach to Planning • Develop a plan • Project or simulate • Determine if needs are met • Revise and repeat • Limitations • Tedious • Sub-optimal • Not suitable for “what if?” analyses

  17. Lavieri-Puterman Approach A flexible computer-basedoptimization model that provides a minimum cost health human resource plan that achieves workforce targets over a multi-year planning horizon Based on an operations research optimization technique – linear programming (LP) Excel based but requires an LP solver Key Input – Annual nursing demand

  18. Projecting Nursing Workforce Demand • US Health Resources Service and Demand Model • Method – Regression analysis of demand rate on explanatory factors on log scale (Exhibit 19)

  19. A Sample Plan

  20. Model Overview • Data: • Nurse workforce size • Student body • Population projection • Outputs: • Optimum costs • Yearly student population • Yearly workforce size • Run model: • Minimum cost plan • Assumptions: • Attrition rates • Nurse/Pop. • Costs

  21. Model Overview • Data: • Nurse workforce size • Student body • Population projection • Outputs: • Optimum costs • Yearly student population • Yearly workforce size • Run model: • Minimum cost plan • Assumptions: • Attrition rates • Nurse/Pop. • Costs

  22. Model Overview • Data: • Nurse workforce size • Student body • Population projection • Outputs: • Optimum costs • Yearly student population • Yearly workforce size • Run model: • Minimum cost plan • Assumptions: • Attrition rates • Nurse/Pop. • Costs

  23. Scope Registered Nurses in British Columbia 20 year planning horizon Decisions made once each year Ages 17 – 65+ Full time equivalent basis

  24. Workforce Flowchart Cost of education Do other work/retire New students/recruits Student(year 1) Student(year 2) Student(year 3) Student(year 4) Direct Care Nurse Entry Level Management Senior Level Management

  25. Model Decision Variables: In each year How many to admit How many to recruit How many to promote Students(year 1) Students(year 3) Direct care nurses Entry level management Direct care nurses Entry level management

  26. Decision Variables Again of age i that are in the system in year j s(1)i,js(2)i,j s(3)i,js(4)i,jn(1)i,jn(2)i,jn(3)i,j

  27. Model Minimize: Cost of training + Recruitment cost + Salary In order to: Have sufficient resources (FTEs) to achieve quality of care targets. Achieve balance of “recruited” and BC educated nurses. Only promote nurses after they have been in their position a specified number of years.

  28. Model Inputs Costs: Education: Student (annual) (1) Management training (one shot) (1) Recruitment and turnover cost(2) Salaries (by level) (3) Continuation and attrition rates: Attrition rates (4), (5) Age distribution (6), (7), (8) Probability of continuing the degree (6), (9) Probability of passing the RN exam (7) Probability of leaving BC after graduation (7) FTE per full time person per age per experience time in position (7) Initial Conditions: Distribution of current workforce by position (8) Ratio of RN to population (8) BC population projections (11) (1)Ministry of Advanced Education (2)Weber (2005) (3)BCNU (4) Kazanjian (1986) (5) O’Brien-Pallas et al. (2003) (6) UBC School of Nursing (2006) (7) CRNBC (2005) (8) CIHI (2005) (9) Pringle and Green (2005) (10) CIHI (2005) (11) BC STATS (2006)

  29. Cost of training Recruitment cost Annual salary Necessary resources Balance students Recruit vs Canadian nurses Promotion rules

  30. Outputs – Baseline

  31. Outputs – Baseline

  32. Outputs – Baseline

  33. Possible Scenarios for “What if?” Analysis Vary nurse to population ratio Vary proportion of students that continue the program after each year of study Vary nurse to manager ratios and nurse attrition rates Change maternity leave policies Change demand for nurses Change attrition rates …

  34. Outputs – Comparing Scenarios

  35. Comments We have developed a tool for decision makers to examine HHR planning in the broadest context The modeling approach extends to other healthcare professionals or levels of granularity References Application - Using Operations Research to Plan the British Columbia Registered Nurses' Workforce, Mariel S. Lavieri, Sandra Regan, Martin L. Puterman and Pamela A. Ratner, Healthcare Policy, 4(2) 2008: e117-e135 Methods - Optimizing Nursing Human Resource Planning in British Columbia, Mariel S. Lavieri and Martin L. Puterman, Health Care Management Science. 12:119-128:2009.

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