bams 580b workforce staffing and planning lecture 4
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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. - PowerPoint PPT PresentationTRANSCRIPT
BAMS 580B BAMS 580B Workforce Staffing and Planning Workforce Staffing and Planning
Lecture 4Lecture 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
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
BackgroundBackground
Workforce planning, training and regulation is thethe dominant 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)
B.C. RNs Employed in Nursing by Age (2001-2005)
0
1000
2000
3000
4000
5000
6000
<25 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65+
Age groups
Nu
mb
er o
f R
Ns
2001
2002
2003
2004
2005
Source: Canadian Institute for Health Information. (2006). Workforce Trends of Registered Nurses in Canada, 2005.
BackgroundBackground
Nursing Ratios or How Many Nurses Do We Need?
Impacts of Nursing Shortages
Delays for care in wards Emergency Department Treatment
Delays Medication Errors Poorer outcomes and increased
mortality rates
Key Tasks
Admit, Transfer and Discharge Patients Provide Meds Monitor Patients Respond to call requests Prepare patients for procedures
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
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.
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.
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
b
^
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
Long Term Planning
Planners RequirePlanners Require
PrecisePrecise 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 unifiedunified frameworks that apply to any workforce: Regional Provincial National Sub-specialty
A Commonly Used Approach to PlanningA 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
Lavieri-Puterman ApproachLavieri-Puterman Approach
A flexible computer-basedcomputer-based optimization model that provides a minimum cost health health human resource planhuman resource plan that achieves workforce targets over a multi-year planning horizon
Based on an operations research Based on an operations research optimization technique – linear programming optimization technique – linear programming (LP) (LP)
Excel based but requires an LP solverExcel based but requires an LP solver Key Input – Annual nursing demandKey Input – Annual nursing demand
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)
A Sample Plan A Sample Plan
Model OverviewModel Overview
Assumptions: Attrition rates Nurse/Pop. Costs
Run model: Minimum cost plan
Data: Nurse workforce size
Student body
Population projection
2003 RN Population
0
1000
2000
3000
4000
5000
6000
<25 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 >=65
Age
Pop
ulat
ion
Age distribution of student body
0
50
100
150
200
250
300
350
15
18
21
24
27
30
33
36
39
42
45
48
51
54
57
60
63
Age
Nu
mb
er
of s
tud
en
ts
Student(year 2) Student(year 3) Student(year 4)
BC Population projection
0.00
1,000.00
2,000.00
3,000.00
4,000.00
5,000.00
6,000.00
20
04
20
06
20
08
20
10
20
12
20
14
20
16
20
18
20
20
20
22
20
24
20
26
Year
Po
pu
latio
n
Outputs: Optimum costs
Yearly student population
Yearly workforce size
Practicing nurse population
05000
10000150002000025000300003500040000
2006
2008
2010
2012
2014
2016
2018
2020
Year
Wo
rkfo
rce
po
pu
latio
n Total practicingnurses
New immigrantpracticingnurses
Total Cost
$1,694,786,393 4%
$1,665,612,117 4%
$40,138,704,506
92%
Cost of training
Immigration cost
Annual salary
Yearly total student population
0
500
1000
1500
2000
2500
3000
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
Year
Stu
de
nt p
op
ula
tion
Student(year 1)
Student(year 2)
Student(year 3)
Student(year 4)
Model OverviewModel Overview
Assumptions: Attrition rates Nurse/Pop. Costs
Run model: Minimum cost plan
Data: Nurse workforce size
Student body
Population projection
2003 RN Population
0
1000
2000
3000
4000
5000
6000
<25 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 >=65
Age
Pop
ulat
ion
Age distribution of student body
0
50
100
150
200
250
300
350
15
18
21
24
27
30
33
36
39
42
45
48
51
54
57
60
63
Age
Nu
mb
er
of s
tud
en
ts
Student(year 2) Student(year 3) Student(year 4)
BC Population projection
0.00
1,000.00
2,000.00
3,000.00
4,000.00
5,000.00
6,000.00
20
04
20
06
20
08
20
10
20
12
20
14
20
16
20
18
20
20
20
22
20
24
20
26
Year
Po
pu
latio
n
Outputs: Optimum costs
Yearly student population
Yearly workforce size
Practicing nurse population
05000
10000150002000025000300003500040000
2006
2008
2010
2012
2014
2016
2018
2020
Year
Wo
rkfo
rce
po
pu
latio
n Total practicingnurses
New immigrantpracticingnurses
Total Cost
$1,694,786,393 4%
$1,665,612,117 4%
$40,138,704,506
92%
Cost of training
Immigration cost
Annual salary
Yearly total student population
0
500
1000
1500
2000
2500
3000
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
Year
Stu
de
nt p
op
ula
tion
Student(year 1)
Student(year 2)
Student(year 3)
Student(year 4)
Model OverviewModel Overview
Assumptions: Attrition rates Nurse/Pop. Costs
Run model: Minimum cost plan
Data: Nurse workforce size
Student body
Population projection
2003 RN Population
0
1000
2000
3000
4000
5000
6000
<25 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 >=65
Age
Pop
ulat
ion
Age distribution of student body
0
50
100
150
200
250
300
350
15
18
21
24
27
30
33
36
39
42
45
48
51
54
57
60
63
Age
Nu
mb
er
of s
tud
en
ts
Student(year 2) Student(year 3) Student(year 4)
BC Population projection
0.00
1,000.00
2,000.00
3,000.00
4,000.00
5,000.00
6,000.00
20
04
20
06
20
08
20
10
20
12
20
14
20
16
20
18
20
20
20
22
20
24
20
26
Year
Po
pu
latio
n
Outputs: Optimum costs
Yearly student population
Yearly workforce size
Practicing nurse population
05000
10000150002000025000300003500040000
2006
2008
2010
2012
2014
2016
2018
2020
Year
Wo
rkfo
rce
po
pu
latio
n Total practicingnurses
New immigrantpracticingnurses
Total Cost
$1,694,786,393 4%
$1,665,612,117 4%
$40,138,704,506
92%
Cost of training
Immigration cost
Annual salary
Yearly total student population
0
500
1000
1500
2000
2500
3000
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
Year
Stu
de
nt p
op
ula
tion
Student(year 1)
Student(year 2)
Student(year 3)
Student(year 4)
ScopeScope
Registered Nurses in British Columbia 20 year planning horizon Decisions made once each year Ages 17 – 65+ Full time equivalent basis
Workforce FlowchartWorkforce Flowchart
Student(year 2)
Student(year 4)
Student(year 1)
Student(year 3)
Direct Care Nurse
Entry Level Management
Senior Level Management
Cost of educationDo other work/retireNew students/recruits
ModelModel
Decision Variables:
In each year
How many to admit
How many to recruit
How many to promote
Students(year 1) Students(year 1) Students(year 3)Students(year 3)
Direct care nurses Direct care nurses Entry level managementEntry level management
Direct care nurses Direct care nurses Entry level managementEntry level management
Decision Variables AgainDecision Variables Again
of age i that are in the system in year j
s(1)s(1)i,j i,j
s(2)s(2)i,j i,j
s(3)s(3)i,j i,j s(4)s(4)i,ji,j
n(1)n(1)i,ji,j
n(2)n(2)i,ji,j
n(3) n(3)i,ji,j
ModelModel
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.
Model InputsModel 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)
Cost of training
Recruitment cost
Annual salary
Necessary resources
Balance students
Recruit vs Canadian nurses
Promotion rules
Outputs – Baseline
Practicing nurse population
0
5000
10000
15000
20000
25000
30000
35000
40000
20
06
20
07
20
08
20
09
20
10
20
11
20
12
20
13
20
14
20
15
20
16
20
17
20
18
20
19
20
20
Year
Wo
rkfo
rce
po
pu
latio
n
Total practicingnurses
New immigrantpracticingnurses
Outputs – Baseline
Entry level management population
0
500
1000
1500
2000
2500
20
07
20
08
20
09
20
10
20
11
20
12
20
13
20
14
20
15
20
16
20
17
20
18
20
19
20
20
20
21
Year
Wo
rkfo
rce
po
pu
latio
nTotal entry levelmanagement
Newly recruited entrylevel management
Newly promotedentry levelmanagement
Yearly total student population
0500
10001500200025003000350040004500
20
07
20
08
20
09
20
10
20
11
20
12
20
13
20
14
20
15
20
16
20
17
20
18
20
19
20
20
20
21
Year
Stu
de
nt p
op
ula
tion
Student(year 1)
Student(year 2)
Student(year 3)
Student(year 4)
Outputs – Baseline
Nurse manager population
0
500
1000
1500
2000
2500
3000
3500
4000
20
06
20
07
20
08
20
09
20
10
20
11
20
12
20
13
20
14
20
15
20
16
20
17
20
18
20
19
20
20
Year
Wo
rkfo
rce
po
pu
latio
n Total nursemanagers
New immigrantnurse managers
New promotednurse managers
Senior nurse manager population
0
50
100
150
200
250
300
350
400
20
06
20
07
20
08
20
09
20
10
20
11
20
12
20
13
20
14
20
15
20
16
20
17
20
18
20
19
20
20
Year
Wo
rkfo
rce
po
pu
latio
n
Total seniornurse managers
New promotedsenior nursemanagers
Possible Scenarios for “What if?” AnalysisPossible 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 …
Outputs – Comparing ScenariosOutputs – Comparing Scenarios
Number of Students Admitted per Year
0
500
1,000
1,500
2,000
2,500
3,000
3,500
4,000
2007 2009 2011 2013 2015 2017 2019 2021
Year
Num
ber
of S
tude
nts
Adm
itted
Student(year 1) admitted:
Scenario 1 (Baseline)
Scenario 2 (School Attrition)
Scenario 3 (Nurses to Manager Ratio)
Scenario 4 (Maternity Leave)
Scenario 5 (Nurses to Population Ratio)
Student(year 3) admitted:
Scenario 1 (Baseline)
Scenario 2 (School Attrition)
Scenario 3 (Nurses to Manager Ratio)
Scenario 4 (Maternity Leave)
Scenario 5 (Nurses to Population Ratio)
Comments 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.