The nurse rostering problem: from operational research to organizational reality?

The impact of electronic and self-rostering systems on healthcare organisations and healthcare workers: A mixed-method systematic review

AIM

To synthesise evidence from studies that explored the impact of electronic and self-rostering systems to schedule staff on healthcare organisations and healthcare workers.

DESIGN

Mixed-method systematic review.

METHODS

Studies were screened by two independent reviewers and data were extracted using standardised data extraction tables. The quality of studies was assessed, and parallel-results convergent synthesis was conducted.

DATA SOURCES

Academic Search Complete, CINAHL, ERIC, MEDLINE, PsycINFO and PsycARTICLES were searched on January 3, 2023.

RESULTS

Eighteen studies were included (10 quantitative descriptive studies, seven non-randomised studies and one qualitative study). Studies examined two rostering interventions including self-rostering (n = 12) and electronic rostering (n = 6). It was found that the implementation of electronic and self-rostering systems for staff scheduling impacted positively on both, healthcare workers and healthcare organisations. Benefits included enhanced roster efficiency, staff satisfaction, greater control and empowerment, improved work-life balance, higher staff retention and reduced turnover, decreased absence rates and enhanced healthcare efficiency. However, self-rostering was found to be less equitable than fixed rostering, was associated with increased overtime, and correlated with a higher frequency of staff requests for shift changes.

CONCLUSION

The impact of electronic and self-rostering systems to schedule staff on healthcare organisations and healthcare workers' outcomes was predominantly positive. Further randomised controlled trials and longitudinal studies are warranted to evaluate the long-term impact of various rostering systems, including electronic and self-rostering systems.

IMPLICATIONS FOR HEALTHCARE

Rostering is a multifaceted responsibility for healthcare administrators, impacting patient care quality, workforce planning and healthcare expenditure.

IMPACT

Given that healthcare staffing costs constitute a substantial portion of global healthcare expenditure, efficient and strategic resource management, inclusive of healthcare staff rostering, is imperative.

REPORTING METHOD

The 27-item Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) checklist.

PATIENT OR PUBLIC CONTRIBUTION

No Patient or Public Contribution.

Does a GP service package matter in addressing the absence of health management by the occupational population? A modelling study

OBJECTIVE

To assess the influence of supply and demand factors on the contract behavior of occupational populations with general practitioner (GP) teams.

METHODS

We employed a system dynamics approach to assess and predict the effect of the general practitioner service package (GPSP) and complementary incentive policies on the contract rate for 2015-2030. First, the GPSP is designed to address the unique needs of occupational populations, enhancing the attractiveness of GP contracting services, including three personalized service contents tailored to demand-side considerations: work-related disease prevention (WDP), health education & counseling (HEC), and health-care service (HCS). Second, the complementary incentive policies on the supply-side included income incentives (II), job title promotion (JTP), and education & training (ET). Considering the team collaboration, the income distribution ratio (IDR) was also incorporated into supply-side factors.

FINDINGS

The contract rate is predicted to increase to 57.8% by 2030 after the GPSP intervention, representing a 15.4% increase on the non-intervention scenario. WDP and HEC have a slightly higher (by 2%) impact on the contract rate than that from HCS. Regarding the supply-side policies, II have a more significant impact on the contract rate than JTP and ET by 3-5%. The maximum predicted contract rate of 75.2% is expected by 2030 when the IDR is 0.5, i.e., the GP receives 50% of the contract income and other members share 50%.

CONCLUSION

The GP service package favorably increased the contract rate among occupational population, particularly after integrating the incentive policies. Specifically, for a given demand level, the targeted content of the package enhanced the attractiveness of contract services. On the supply side, the incentive policies boost GPs' motivation, and the income distribution motivated other team members.

Interactive Nurse Scheduling

Repeatedly solving nurse scheduling problems is one of the most difficult and time-consuming tasks for nurse managers. Although software solutions exist to solve nurse scheduling problems automatically, they are limited to cases in which scheduling rules can be easily formalized and are relatively stable. In other cases, nurse scheduling problems must be solved manually. Thus, this article proposes a new general method for solving nurse scheduling problems that overcomes the limitations of existing methods by introducing human-computer interaction. The solution is based on not only the computer's algorithmic logic but also the nurse manager's knowledge and experiences. We tested the method in a large hospital. The results show that our method also can be used for cases in which fully automated nurse scheduling is not feasible and that it performs better than manual scheduling. In addition, the time spent on scheduling decreased by 80%, and nurse satisfaction with the schedule increased.

Mining context-aware resource profiles in the presence of multitasking

Healthcare organisations are becoming increasingly aware of the need to improve their care processes and to manage their scarce resources efficiently to secure high-quality care standards. As these processes are knowledge-intensive and heavily depend on human resources, a comprehensive understanding of the complex relationship between processes and resources is indispensable for efficient resource management. Organisational mining, a subfield of Process Mining, reveals insights into how (human) resources organise their work based on analysing process execution data recorded in Health Information Systems (HIS). This can be used to, e.g., discover resource profiles which are groups of resources performing similar activity instances, providing an extensive overview of resource behaviour within healthcare organisations. Healthcare managers can employ these insights to allocate their resources efficiently, e.g., by improving the scheduling and staffing of nurses. Existing resource profiling algorithms are limited in their ability to apprehend the complex relationship between processes and resources because they do not take into account the context in which activities were executed, particularly in the context of multitasking. Therefore, this paper introduces ResProMin-MT to discover context-aware resource profiles in the presence of multitasking. In contrast to the state-of-the-art, ResProMin-MT is capable of taking into account more complex contextual activity dimensions, such as activity durations and the degree of multitasking by resources. We demonstrate the feasibility of our method within a real-life healthcare context, validated by medical domain experts.

An Overview of Hospital Capacity Planning and Optimisation

Health care is uncertain, dynamic, and fast growing. With digital technologies set to revolutionise the industry, hospital capacity optimisation and planning have never been more relevant. The purposes of this article are threefold. The first is to identify the current state of the art, to summarise/analyse the key achievements, and to identify gaps in the body of research. The second is to synthesise and evaluate that literature to create a holistic framework for understanding hospital capacity planning and optimisation, in terms of physical elements, process, and governance. Third, avenues for future research are sought to inform researchers and practitioners where they should best concentrate their efforts. In conclusion, we find that prior research has typically focussed on individual parts, but the hospital is one body that is made up of many interdependent parts. It is also evident that past attempts considering entire hospitals fail to incorporate all the detail that is necessary to provide solutions that can be implemented in the real world, across strategic, tactical and operational planning horizons. A holistic approach is needed that includes ancillary services, equipment medicines, utilities, instrument trays, supply chain and inventory considerations.

Management practices impacting on the rostering of medical scientists in the Australian healthcare sector

Purpose

This study examines the management rostering systems that inform the ways medical scientists are allocated their work in the public healthcare sector in Australia. Promoting the contributions of medical scientists should be a priority given the important roles they are performing in relation to COVID-19 and the demand for medical testing doubling their workloads (COVID-19 National Incident Room Surveillance Team, 2020). This study examines the impact of work on medical scientists and rostering in a context of uncertain work conditions, budget restraints and technological change that ultimately affect the quality of patient care. This study utilises the Job-Demands-Resources theoretical framework (JD-R) to examine the various job demands on medical scientists and the resources available to them.

Design/methodology/approach

Using a qualitative methodological approach, this study conducted 23 semi-structured interviews with managers and trade union officials and 9 focus groups with 53 medical scientists, making a total 76 participants from four large public hospitals.

Findings

Due to increasing demands for pathology services, this study demonstrates that a lack of job resources, staff shortages, poor rostering practices such as increased workloads that lead to absenteeism, often illegible handwritten changes to rosters and ineffectual management lead to detrimental consequences for medical scientists’ job stress and well-being. Moreover, medical science work is hidden and not fully understood and often not respected by other clinicians, hospital management or the public. These factors have contributed to medical scientists’ lack of control over their work and causes job stress and burnout. Despite this, medical scientists use their personal resources to buffer the effects of excessive workloads and deliver high quality of patient care.

Originality/value

Findings suggest that developing mechanisms to promote sustainable employment practices for medical scientists are critical for the escalating demands in pathology.

Compliance with Recommendations on Work Schedule for Shift Nurses in South Korea

Background

A well-designed shift schedule has been reported to have a positive effect on improving health problems associated with shift work. This study aimed to identify compliance with the 17 recommendations on work schedule (WSRs) for shift nurses and related factors.

Methods

The descriptive study was conducted with 182 nurses who worked in three shifts for more than 1 year at superior general and general hospitals in three regions. Data were collected with self-administered questionnaire and 13-week work schedule tables, and analyzed with both person- and cycle-based compliance.

Results

Person-based compliance was 11.77 among 17 items in total. However, no one completely complied with WSRs of “no work on weekends” and which showed the lowest cycle-based compliance (22.3%). Compliance with some WSRs was related to hospital type, proportion of nurses in school and having standards on work schedule at institutional level.

Conclusion

Compliance with WSRs of shift nurses in Korea is still unsatisfactory, and one day off after night shift and work on weekend are quite common. Hospitals should keep the standards on work schedule, monitor compliance with standards, and try to introduce modified shift systems to improve the current problems.

Staff unavailability and safe staffing: are headroom allowances 'realistic'?

BACKGROUND

'Hours per patient day' (HPPD) is an internationally recognised resourcing metric used to measure direct nursing care hours. However, hospitals often underestimate indirect time (unavailability) and specify unrealistic targets for planned unavailability ('headroom').

AIMS

To investigate the disparities between planned unavailability ('headroom') and actual staff unavailability.

METHODS

Data were collected from the e-rostering systems of 87 NHS trusts. This was compared with published data from 35 roster policies.

RESULTS

Many hospitals use headroom as a key performance indicator (KPI) and set targets for its components in their roster policies. This research highlights large variations in unavailability (15.8% to 33.6%) and lower variations in headroom (16-26%).

CONCLUSION

Hospitals operationalise headroom around an idealised 'target' value. This may be detrimental. Compelling a unit with unavailability of between 28% and 30% to adopt an institution-wide headroom of 22% (for example) may, at best, increase spending on bank/agency staff, or, at worse, jeopardise patient safety.

NHS managers’ use of nursing workforce planning and deployment technologies: a realist synthesis

Background

Policy and reviews of health-care safety and quality emphasise the role of NHS managers in ensuring safe, good-quality patient care through effective staffing. Guidance requires that NHS managers combine professional judgement with evidence-based workforce planning and deployment tools and technologies (WPTs). Evidence has focused on the effectiveness of WPTs, but little is known about supporting their implementation, or the impact of using WPTs across settings.

Objectives

The review answered the following question: ‘NHS managers’ use of workforce planning and deployment technologies and their impacts on nursing staffing and patient care: what works, for whom, how and in what circumstances?’.

Design

A realist synthesis was conducted. A programme theory was formulated and expressed as hypotheses in the form of context, mechanisms and outcomes; this considered how, through using WPTs, particular conditions produced responses to generate outcomes. There were four phases: (1) development of a theoretical territory to understand nurse workforce planning and deployment complexity, resulting in an initial programme theory; (2) retrieval, review and synthesis of evidence, guided by the programme theory; (3) testing and refinement of the programme theory for practical application; and (4) actionable recommendations to support NHS managers in the implementation of WPTs for safe staffing.

Participants

NHS managers, patient and public representatives and policy experts informed the programme theory in phase 1, which was validated in interviews with 10 NHS managers. In phase 3, 11 NHS managers were interviewed to refine the programme theory.

Results

Workforce planning and deployment tools and technologies can be characterised functionally by their ability to summarise and aggregate staffing information, communicate about staffing, allocate staff and facilitate compliance with standards and quality assurance. NHS managers need to combine local knowledge and professional judgement with data from WPTs for effective staffing decisions. WPTs are used in a complex workforce system in which proximal factors (e.g. the workforce satisfaction with staffing) can influence distal factors (e.g. organisational reputation and potential staff recruitment). The system comprises multiple organisational strategies (e.g. professional and financial), which may (or may not) align around effective staffing. The positive impact of WPTs can include ensuring that staff are allocated effectively, promoting the patient safety agenda within an organisation, learning through comparison about ‘what works’ in effective staffing and having greater influence in staffing work. WPTs appear to have a positive impact when they visibly integrate data on needs and resources and when there is technical and leadership support. A collaborative process appears to be best for developing and implementing WPTs, so that they are fit for purpose.

Limitations

The evidence, predominantly from acute care, often lacked detail on how managers applied professional judgement to WPTs for staffing decisions. The evidence lacked specificity about how managers develop skills on communicating staffing decisions to patients and the public.

Conclusions and recommendations

The synthesis produced initial explanations of the use and impact of WPTs for decision-making and what works to support NHS managers to use these effectively. It is suggested that future research should further evaluate the programme theory.

Study registration

This study is registered as PROSPERO CRD42016038132.

Funding

The National Institute for Health Research Health Services and Delivery Research programme.

Does longer roster lead-time reduce temporary staff usage? A regression analysis of e-rostering data from 77 hospital units

AIMS

Use of temporary nursing staff is contentious and expensive. Using e-rostering data from 77 hospital units, this research investigates whether longer roster lead-times reduce temporary staff usage.

BACKGROUND

It is commonly assumed that longer roster approval lead-times, the time from when a roster is approved, to when it is worked, result in better, more cost-effective rosters. Consequently, many hospitals target lead-times of 6 weeks, a figure recommended for the UK National Health Service in a recent governmental review. This contrasts with the minimum lead-time advocated by New South Wales Ministry of Health, which advises a shorter lead-time of 2 weeks. Using data from 77 hospital units, this paper explores this assumed relationship.

DESIGN

Using data extracted from the e-rostering system of an NHS Acute Foundation Trust, this study uses linear regression analysis to explore the relationship between roster approval lead-time and temporary staff usage. The data were captured over a period of 9 months from 15 February 2016-23 October 2016, a total of 693 rosters.

RESULTS/FINDINGS

This research suggests that late roster approval may contribute to as much as 37% of temporary staff usage, while approval 4-6 weeks prior to the roster being worked reduces this to approximately 15%. However, this is only relevant under specific conditions. Importantly, this should be considered before mandating lead-times across all units.

CONCLUSIONS

This research implies that the optimum approval lead-time lies between 4-6 weeks; however, given other challenges, achieving this in practice may prove difficult.

e-Roster policy: Insights and implications of codifying nurse scheduling

Following a decade of dissemination, particularly within the British National Health Service, electronic rostering systems were recently endorsed within the Carter Review. However, electronic rostering necessitates the formal codification of the roster process. This research investigates that codification through the lens of the 'Roster Policy', a formal document specifying the rules and procedures used to prepare staff rosters. This study is based upon analysis of 27 publicly available policies, each approved within a 4-year period from January 2010 to July 2014. This research finds that, at an executive level, codified knowledge is used as a proxy for the common language and experience otherwise acquired on a ward through everyday interaction, while at ward level, the nurse rostering problem continues to resist all efforts at simplification. Ultimately, it is imperative that executives recognise that electronic rostering is not a silver bullet and that information from such systems requires careful interpretation and circumspection.

Facilitators and barriers to the increased supervisory role of senior charge nurses: a qualitative study

AIMS

To explore the experiences of senior charge nurses provided with 'increased supervisory hours'.

BACKGROUND

Designated supervisory time is essential for senior charge nurses to provide effective clinical leadership. It is important to explore the impact arises of such an increase.

METHODS

An online questionnaire collected exploratory data from senior charge nurses (n = 60). Semi-structured interviews gathered in-depth qualitative data (n = 12). Findings were analysed for common themes associated with implementation of the increased senior charge nurse supervisory role.

RESULTS

The majority of senior charge nurses were unable to use their full allocation of supervisory time. They struggled to accomplish leadership goals because of managing staffing levels, increased workload, time constraints and limited support. Factors that facilitated the role included preparation and support, adequate staff capacity, effective leadership skills and availability of supervisory time. The senior charge nurses took pride in providing clinical leadership, promoting staff development and delivering patient care. Support, in terms of preparation, capacity building and ongoing mentoring, was a key factor for achieving senior charge nurse goals.

CONCLUSION

Senior charge nurses should be supported to maximise supervisory time through the provision of an induction programme, formal coaching and ongoing training and development.

IMPLICATIONS FOR NURSING MANAGEMENT

Preparation and support is essential for senior charge nurses to deliver enhanced clinical leadership through increased supervisory time.