Workforce Planning in the public Health Sector

Quoting figures of year 2012:

No of Hospitals (beds) 1163 (214’548)
public hospitals (beds) 542 (65’524)
accredited private hospitals (beds) 621 (149’024)
local health authorities (ASL) 145
government health care spending €113 billions

The government seems willing to close all small hospitals and focus its expenditure in big centers with 1'000-2'000 employees.

In this scenario one would expect a widespread use of workforce management tools in order to plan and control the employees. But this is not the case.

Nothing of all this happens: very few public hospitals use workforce management tools.

On one side, the management does not see a problem here. Every months the rosterings are prepared by medical doctors and nurse leaders: why should one spend money for something one already has?

On the other side, unions are always very suspicious with all systems that promise “productivity”: won’t it be a way to make the members’ work harder?

Both parts err through ignorance.

A workforce management tool - in fact - gives benefits to both managers and employees.

Lets see the benefits:

Effectiveness: get a correct and objective planning

Saving: save thousands of work hours spent for planning and get an optimal use of workforce

Consistency: get a consistent, fair and objective rostering policy

Trasparency: get objective widely accepted rules implemented in planning. Get the workload fairly shared and get rid of main causes of conflict between the staff

Control: use real time metrics to immediatly get aware of possible critical issues re the use of human resources

Staffing Levels

The staffing levels for health care personnel should be a function of the workload, what can be foreseen from historical data.

Stiff decision-making habits in the public sector cause the staffing levels not to change according to the fluctuating workload.

The weekly staffing levels (SUN-MON) do not change during the year, other than in 2 periods: Chistmas holidays and summer holidays.

During Christmas and during the summer the staffing levels are reduced. This is not due to a smaller workload, but to the need of guaranting the due number of leave days to the personnel .

In the same way, the weekly staffing levels keep constant during regular days and are reduced during the weekend. This is not (always) due to a smaller workload during SUN-SAT, but to the need of guaranting a monthly number of free weekends to all employees.

The usual staffing levels of health care personnel is done like this:

shift SUN TUE WED THU FRI SAT MON
E 3 5 5 5 5 3 5
L 4 4 4 4 4 2 2
N 2 2 2 2 2 2 2

where

E=early

L=late

N=night

The planned staffing levels of medical doctors is more complex because:

  • several activities exist (Doppler, UTIC, Ergometry, etc) that can be performed by a small group of doctors
  • doctors are not avaiable each day of the week (many of them work in private clinics)
  • doctors are often away for education and meetings

The Planning

Once nurses used to work along the repeating schedule (or rota) ELNFF (“early-late-night-off-off”).

Such a fixed rota can be easily repeated month after month using Excel and Copy/Paste function.

But this was long time ago.

Nowadays things are harder than that.

Full time nurses are a (small) part of the supplied personnel. Different contracts limit the total number of work hours and the availability during the day: horizontal part-time, vertical part-time, fixed term contracts at X hours, temporary worker, etc.

Several employees can have special constraints : no night work, caring for disabled children, maternity leave, etc

The rostering is now a complex un complicato jigsaw puzzle. Nurse managers can spend 80% of the time to prepare and maintain a rostering, with high company costs and low personnel satisfaction.

The sudden absence of one or more nurses is often a serious problem. A monthly rostering is a hard task (you need to put together a complex clockwork of N parts). But you have several days to complete it. Fix a sudden absence means to build most of the same clockwork (with some parts missing)...and you have no time for that. You need to fix the schedule now and with the utmost urgency!

Often nurse leaders are not aware that the personnel they have at hand is by no means enough to cover the required level of care. And get discouraged by their inability to square the circle.

Often you hear the funny story of the peasant who goes to the fair. He has 2 dimes and wants to buy 1 dime worth of rope, 1 dime worth of nails and 1 dime worth of seeds: albeit he tries several purchase combinations, he finds (astonished and disappointed) that he is always short of 1 dime.

This often happens in hospital wards. Nurse leaders have poor staffing skills and cannot perform the basic controls of compliance between what is required (minimal care standards per census) and what is avaiable (the total number of work hours of the supplied personnel).

The menagement (by cunning or ignorance) hands the hot potato off to nurse leaders...

When using a workforce management software the personnel shortage would be automatically pointed out, so it is better NOT to use such a software!

A few years ago a salesman of our company called an italian hospital at latitude 40°N. He talked with a manager and tried to explain the benefits of a workforce management software.

Manager: “We have no scheduling problem here”

Salesman: “Great! You must be a centre of excellence! Which method do you use in order to resolve all scheduling problems?”

Manager: “Every morning in the departments the nurses count themselves. Depending on the number of nurses at work we decide what to do”

I am afraid that this is the idea of “planning” in many hospitals.

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