The following generally relates to workforce scheduling and is described with particular application to hospital nurse scheduling. However, it is also amenable to other hospital staff scheduling and/or non-hospital staff scheduling.
Staffing is a cost for hospitals, and aligning the staffing level with patient demand variation can be challenging. Hospitals have faced the dilemma of saving operating cost and maintaining a satisfactory patient to nurse ratio. However, sometimes there are more nurses scheduled than needed in a unit. This results in cost and staffing inefficiencies. Other times, e.g., to cover an unexpected increase in patient volume where there is not enough nurses, nurses (e.g., via overtime, agency, etc.) are added to make up for the deficiency. In this instance, the initial patient to nurse ratio may not meet the satisfactory patient to nurse ratio. In general, there is no workforce staffing golden rule. Instead, the staffing level and scheduling process depends on a nurse manager's personal experience and manual arrangement. Current scheduling software does not utilize an optimal combined resource for workforce or accommodate schedule pattern accordingly. Thus, there is an unresolved need for another approach to improve workforce scheduling.
Aspects of the present application address the above-referenced matters and others.
According to one aspect, a method includes receiving, in electronic format, a set of predetermined inputs, generating, using a stochastic model, a core-staff assignment, a float-pool assignment, and an overtime and agency cover for a hospital unit based on the set of predetermined inputs, generating a core-staff workings pattern and a float-pool working pattern for the hospital unit based on the core-staff assignment, the float-pool assignment, and a predetermined set of schedule rules, and employing the core-staff workings pattern and a float-pool working pattern to construct a workforce schedule in the electronic format for the hospital unit.
In another aspect, a computing system includes a memory device configured to store instructions, including a record integration module, and processor configured to executes the instructions. The processor, in response to executing the instructions: receives, in electronic format, a set of predetermined inputs, generates, using a stochastic model, a core-staff assignment, a float-pool assignment, and an overtime and agency cover for a hospital unit based on the set of predetermined inputs, generates a core-staff workings pattern and a float-pool working pattern for the hospital unit based on the core-staff assignment, the float-pool assignment, and a predetermined set of schedule rules, and employs the core-staff workings pattern and a float-pool working pattern to construct a workforce schedule in the electronic format for the hospital unit.
In another aspect, a non-transitory computer readable medium is encoded with computer executable instructions, which, when executed by a processor of a computer, cause the computer to: receive, in electronic format, a set of predetermined inputs, generate, using a stochastic model, a core-staff assignment, a float-pool assignment, and an overtime and agency cover for a hospital unit based on the set of predetermined inputs, generate a patient-to-nurse ratio distribution and a resource utilization for the hospital unit based on the core-staff assignment, the float-pool assignment, and the overtime and agency cover, generate a core-staff workings pattern and a float-pool working pattern for the hospital unit based on the core-staff assignment, the float-pool assignment, and a predetermined set of schedule rules, and employ the core-staff workings pattern and a float-pool working pattern to construct a workforce schedule in the electronic format for the hospital unit.
Still further aspects of the present invention will be appreciated to those of ordinary skill in the art upon reading and understand the following detailed description.
The invention may take form in various components and arrangements of components, and in various steps and arrangements of steps. The drawings are only for purposes of illustrating the preferred embodiments and are not to be construed as limiting the invention.
Generally, the instructions of the workforce optimization tool 108, when executed by the at least one processor 104, cause the at least one processor 104 to acquire historical hourly census of each unit in a hospital and process this data to create hourly patient arrival probability distributions, and then simulate a random patients' arrival based on this information using a stochastic workforce optimization model. Based on the incoming patients, the model computes the optimal core-staff, float-pool, overtime and agency staffing level at any hour, shift, day, week or season. These results reflect actual scenarios in a hospital. The core-staff assignment determines how the core-staff fulfills the schedule, and the float-pool, overtime and agency staffing level determine float-pool and overtime and agency on-demand arrangement. This information, e.g., is used to generate an actual patient-to-nurse (PTN) ratio distribution and a resource utilization level. The generated actual patient-to nurse ratio distribution is different from an input desired patient to nurse ratio, and can reflects if the desired ratio has been achieved and/or indicates the actual staffing situation, understaffed or overstaffed.
The instructions of the scheduling optimization tool 110, when executed by the at least one processor 104, cause the at least one processor 104 to process the core-staff assignment and float-pool assignment from the workforce optimization tool 108 along with scheduling rules to create a core-staff and float-pool working patterns. The working patterns indicate the number of staff needed on each shift on each day of the week for every hospital unit and a specific arrangement to each tentative roaster. The core-staff working patterns are made available for core-staff nurses from each unit to pick according to work rules, weekends worked in the past, and their seniorities. The remainders (position vacancies due to nurse turnover, absence due to family medical leave act (FMLA) and part of the non-productivity related absence) become holes in the overall schedule and will be added to float-pool assignment and covered by shared float-pool nurse.
In one instance, the workforce optimization tool 108 and/or the scheduling optimization tool 110: (1) reduce staffing cost and avoid understaff in changing patients demand by using simulation-based stochastic optimization in workforce optimization tool; (2) generate working patterns based on optimal staffing level so every nurse could choose their patterns at the beginning of the scheduling cycle; (3) adapt different hospitals' requirements by having flexible and/or optimized shift design (the traditional 12 hour per shift results, 12 plus 8 hour combined shift, etc.); and (4) generate expected results under optimal workforce strategy to have the actual resource status like patient to nurse (PTN) ratio distribution. Furthermore, the tools 108 and/or 110 can optimize the workforce level further using flexible shift starting time and/or flexible shift length (4 hours, 8 hours, and 12 hours). This can save the total FTE amount, especially for units with large patient census variations. It is also suitable for hospitals with different starting time and shift length requirements.
Furthermore, the tools 108 and 110 described herein require less memory and/or faster computation time, while improving scheduling results, relative to other scheduling tools.
In this example, the training and output generation modules 202 and 204 receive, as input 200, one or more of the following, and/or additional and/or alternative data:
The modules 202 and 204 generate, as output 208, 214 and 216, one or more of the following, and/or additional and/or alternative data:
The training module 202 employs a stochastic workforce optimization model 206 (which is described in detail below) to determine an optimal combination of staffing levels such as the number needed for each shift for a day for core-staff, float-pool nurse, overtime nurse and agent nurse. Core-staff are responsible for the major level of patients, while the float pool, overtime nurse and agency nurse should cover patient volume variation and core-staff absences. A float-pool nurse is a relatively cheaper and flexible resource, which is shared by several related hospital units where similar skill sets are required. An overtime nurse is a core-staff nurse working overtime hours. The overtime wage, in one example, is 1.5 times the non-overtime wage. A float-pool nurse's wage is less than 1.5 times, but higher than regular core-staff wage. An agency nurse is the most expensive resource, but may be needed for unexpected vacancies. The stochastic workforce optimization model 206, in one instance, assigns resources based on their wages to save total operating cost.
The output generation module 204 processes the output of the training module 202 and generates the actual PTN ratio distribution 214 and the resource utilization 216, and/or other performance factors. The number of core-staff nurse on duty on each shift on the day of week is based on the core-staff assignment, and the number of float-pool nurse on duty on each shift on the day of week is based on float-pool assignment. However, the real number of float-pool nurse, which has been assigned to every unit changes according to patient volume variation. Therefore assigning a float pool nurse to each unit is designed to satisfy those high unexpected patients' volume units first, which may cause different levels of understaff for other units or overall overstaff sometimes. The output generation module 204 simulates the working space under optimal strategy and would reflect more realistic PTN ratios distribution and resource utilization level.
By way of example, in the beginning of the scheduling cycle, core-staff first picks the working dates to cover the majority of the demands, and they pick according to their seniority level, depending on the rules and conventions for each unit. Then, a portion of the known absent working dates will be added to the float-pool working pattern and will be covered by float-pool. The other part will be covered by core-staff themselves. The remainder will be covered by over-time or agency nurse. The float-pool working pattern is from the needed department by float-pool assignment. The float-pool assignment is to cover patient variations in iterations for each unit, which becomes the first part of float-pool use. Based on other historical absence ratios like FMLA ratio, other part of float-pool use is predicted for the coming year. The total float-pool needs from the shared units are determined by adding them together and used to generate float-pool working patterns.
From above, the training module 202 employs the stochastic workforce optimization model 206 to determine an optimal combination of staffing levels, including the number needed for each shift for a day for core-staff, float-pool nurse, overtime nurse and agent nurse. The following provides a non-limiting example of the stochastic workforce optimization model 206.
Indices and sets: N1 set of staff types (RN, PCT); i ∈ N
Parameters:
Decision variables:
Mathematical formulation: Minimizeα1Σi,jcixij(1+u*p1)+α2Σj,wqwcizijw+α3(Fi+Σi,jcixi,j((1−u)p1+p2))+(α3−α1)Σi,jcixi,jp3+α4Σj,wqwciβijw. Regular nurse FTE cost+Extra nurse FTE cost (includes fulltime nurses' overtime, budgeted float nurses and agency nurses, α1=1, and α1<α3<α2<α4. Where the above is subject to:
In one instance, the objective of the stochastic workforce optimization model is to save cost and arrange float-pool effectively. The total cost equals the summation of core-staff regular time cost, core-staff overtime cost, budgeted float-pool cost and the agency nurse cost in FTE terms. A heuristic approach is applied in the model to search for the combination of the optimal number of core-staff nurse, float-pool nurse, overtime nurse and agency nurse.
The following provides a non-limiting use-case in connection with
In this example, the input 200 is from human resources (HR) and operational data. Historical hospital hourly census data is converted into two datasets: 1) average hourly census and 2) standard deviation hourly census so it can follow a normal distribution.
The core-staff assignment and the float-pool assignment 208 are input to the scheduling optimization tool 110, along with the schedule rules 304, which must be satisfied. Example schedule rules 304 include the following; 1) maximum consecutive working days should be less than or equal to four; 2) maximum working hours per week should be less than or equal to forty; 3) day shift nurse can only work day shift, night shift nurse can only work night shi; 4) during weekends, one nurse should take all the weekends shifts for one week, and take the all the second weekend shifts off, etc. Other soft rules may also apply including: use less part-time nurse as possible, reduce the inequality in schedules by rotating patterns and so on.
It is to be appreciated that the ordering of the acts in the methods described herein is not limiting. As such, other orderings are contemplated herein. In addition, one or more acts may be omitted and/or one or more additional acts may be included.
At 1302, a set of predetermined inputs are retrieved, as described herein and/or otherwise.
At 1304, the training module 202 processes the set of inputs using the stochastic workforce optimization model 206, and generates a core-staff assignment, a float-pool assignment, and an overtime and agency cover, as described herein and/or otherwise.
At 1306, the output generation module 204 processes the core-staff assignment, the float-pool assignment, and the overtime and agency cover, and generates an actual PTN ratio distribution and a resource utilization, as described herein and/or otherwise.
At 1308, the scheduling optimization tool 110 processes the core-staff assignment and the float-pool assignment and a schedule rules, and generates a core-staff workings pattern and a float-pool working pattern, as described herein and/or otherwise.
The above may be implemented by way of computer readable instructions, which when executed by a computer processor(s), cause the processor(s) to carry out the described acts. In such a case, the instructions can be stored in a computer readable storage medium associated with or otherwise accessible to the relevant computer. Additionally or alternatively, one or more of the instructions can be carried by a carrier wave or signal.
The tools described herein quantitatively determine float pool size, unit-specific budget, and arrangement towards each shift and unit, as well as the optimal staffing mix of core staff, float pool, core staff overtime, and agency nurse. The float pool alleviates the core staff overtime usage during unexpected surge in patient volume. The non-productivity, vacancy and Family and Medical Leave Act (FMLA) absence ratio of core staffs have been also considered in calculating the optimal results to have these occasions covered in plan. The tools can optimally schedule nurses to fulfill the required staffing levels for different nurse types and can show how the shift designs change will result in operating cost change is able to be compared for the hospital. One example shows that 12 hour plus 8 hour shift combination results overall have lower cost than the traditional 12 hour shift.
The integration between workforce and scheduling optimization: workforce model results could show the optimal number of each resource in each shift for different departments, and based on which the working patterns could be generated. The model can be adjusted to accommodate any scheduling rules required by hospital administrator and detailed working patterns are made available (e.g. Full-time Nurse A should work on Monday, Tuesday and Thursday's 12 hour day shift for week 1) for each staff in every unit in a scheduling cycle. In summary, the solution mechanism, which includes analyzing the optimal workforce and generating working pattern accordingly, meets the hospital needs and has minimized the gap between research and practice. Stochastic simulation makes the patient variation be taken in to account, which can provide more robust and confident results.
The invention has been described herein with reference to the various embodiments. Modifications and alterations may occur to others upon reading the description herein. It is intended that the invention be construed as including all such modifications and alterations insofar as they come within the scope of the appended claims or the equivalents thereof
Filing Document | Filing Date | Country | Kind |
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PCT/IB2016/056672 | 11/7/2016 | WO | 00 |
Number | Date | Country | |
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62260738 | Nov 2015 | US |