Staffing and Scheduling II

HCM 540 Operations Management

Part

Primary Objectives
1. Staff scheduling is a difficult, time 2. 3. 4. 5.
consuming managerial problem Many flavors of staff scheduling problems Staff scheduling inextricably linked with determining total amount of staff Tactical and operational staff scheduling Computerized staff scheduling systems

High Level Staffing Framework

Budgeting and Planning Annual or as needed Planned capacity Staffing/scheduling policies Operational staffing/scheduling Every 2-6 weeks Target staffing levels Create employee schedules for core staff
Staff schedule Budget, staffing plan, policies

Tactical Staff Scheduling Analysis

Realized shortages and surpluses

Daily allocation Ongoing Reacting to staffing variances Floating staff, overtime, contract staff, agencies
Adapted from Abernathy et. al. (1973), Hershey et. al. (1981), Warner et. al. (1991)

The Challenge of Staff Scheduling

1
45 40 35

Postpartum Staffing Needs

Nurses
30 25 20 15 10 5 0

Tue 12 am

Wed 12 am

Tue 12 pm

Wed 12 pm

Thu 12 am

Sat 12 am

Sun 06 am

Mon 06 am

Tue 06 am

Wed 06 am

Thu 12 pm

Thu 06 am

Sat 12 pm

Sat 06 am

Fri 12 am

Fri 06 am

Sun 06 pm

Tue 06 pm

Sun 12 am

Mon 06 pm

Wed 06 pm

Mon 12 am

So, how much staff is needed and how should they by scheduled? 2 Position Tour Type FTE Sun Mon Tue Wed Thu Fri Sat Tour Type Tot FTEs 3
1 2 3 4 5 6 7 (8 hrs, 5 days/wk) (8,5) (8,3) (10,4) (10,4) (12,3) (12,4) 1.0 O 1.0 O 0.6 O 1.0 O 1.0 O 1.0 O 1.0 7a-7p 7a-3p 3p-11p 8a-4p 7a-5p 7a-5p O 7a-7p 7a-3p 3p-11p 8a-4p 7a-5p 8a-6p 7a-7p O 7a-3p 3p-11p 8a-4p O 7a-5p 7a-7p 7a-7p 7a-3p 3p-11p O 7a-5p O O 7a-7p O 7a-3p 3p-11p O O O 7a-5p O 8a-6p O 7a-7p O O O (8,5) (8,3) (10,4) (12,3) 30.0 6.6 4.0 22.0 62.6

FTE = Full Time Equivalent (40 hrs/wk = 1.0 FTE)

Mon 12 pm

Thu 06 pm

Sun 12 pm

Sat 06 pm

Fri 06 pm

Fri 12 pm

Staff Scheduling - It s a Problem

Policies and practices affect total labor cost.


little tactical scheduling analysis done

Overstaffing increases labor costs while understaffing may impact quality of care or service Presents difficult combinatorial problems. Consumes costly managerial time and effort; ad-hoc methods are the rule. Bias often to favor employee over institutional needs. Large impact on employee dissatisfaction and turnover Not only in healthcare - police, fast food, call centers, airlines Computerized systems under-utilized and often require inputs which themselves are the solution to a difficult scheduling analysis problem.

Elements of Scheduling Environments

Planning cycle is the number of weeks in the scheduling horizon


1, 2, 4, 6, 8, etc. 15 minutes, half-hours, hours, 8-hr shifts staffing or coverage requirements by planning period
 where did they come from?  hard constraints vs. soft constraints (e.g. understaffing costs)

Each day is composed of planning periods

 

A shift has a start time, a day of week, and a length (8hr shift, starting Mon @ 7:30am)


allowable start times (8-5) is someone who works 5 8-hr shifts per week (12-3, 12-3, 12-4) works three 12-hr shifts for two out of three weeks and four 12-hr shifts for one of three weeks (12-3, 12-3 + 8-1) works three 12-hr shifts every week + one 8-hr shift every other week

Tour Types: (periods/shift-shifts/week)

 

Elements of Scheduling Environments

Days-off Patterns
Su Mo Tu We Th Fr Sa 0 1 1 1 1 1 0
Su 0 1 Mo 1 1 Tu 1 1 We 1 0 Th 1 1 Fr 1 1 Sa 0 0 Su 0 0 Mo 1 1

1=working, 0=off So, how many different patterns are there for working 5 out of 7 days?
Tu 0 1 We 1 1 Th 1 1 Fr 1 1 Sa 1 0

2-weeks

A tour is a combination of days worked and shifts worked

 

workstretch - # days worked consecutively time between consecutive worked shifts e.g. 16 hours day, afternoon, midnight shift each shift for each day of the week can have unique staffing requirement multiple week issues
 covering off-shifts (permanent, rotation)  weekend rotation issues (A out of B weekends off)  some tour types, e.g. (12-3,12-3,12-4)

The standard 3-shift nurse scheduling problem

 

Elements of Scheduling Environments

Employee preferences for various schedule characteristics A challenge of scheduling problems is to balance schedule quality with coverage

Tactical vs. Operational Scheduling

Tactical
Not concerned with specific employees. Determine minimum staff needed to meet TOD/DOW staffing targets subject to various scheduling policies. Done periodically as part of planning or a special study. Done by department staff or operations analyst

Operational
Specific employees identified. Schedule current staff to meet TOD/DOW staffing targets subject to scheduling policies, staff preferences and availability. Done every two to six weeks.

Done by department staff.

Performance of Schedules
Overall scheduling efficiency
Total Hours Required Scheduling Efficiency ! Total Hours Scheduled

Distribution of under and overstaffing



usually more desirable to spread out under and overstaffing than concentrate it costs of understaffing

Schedule quality / implementability Fairness Ongoing manageability

Approaches to Solving Scheduling Problems

Trial and error + basic scheduling principles
 

self-scheduling within management set parameters Get a master cyclic schedule built and try to follow it making modifications as needed

Various specialized heuristics or algorithms have been developed for different versions of scheduling problems
 

lower bounds on staff size then build a schedule Website devoted to Excel based templates for scheduling

 http://www.shiftschedules.com/
Mathematical optimization models Artificial intelligence based techniques


suited for finding good solutions for problems with many complicated constraints

Many different commercial scheduling systems exist with widely varying capabilities and incorporating one or more of the above approaches

Classes of Scheduling Problems

Days-off scheduling


staffing specified at daily level (1 or more standard shifts per day) by DOW find min staff size to meet coverage and other constraints on weekends worked, workstretch, allowable patterns traditional nurse scheduling usually posed as a 1-day problem with staffing requirements specified by time of day (e.g. hourly) basically a combination of days-off and shift scheduling over some planning cycle (1 or more weeks)

Shift scheduling


Tour scheduling


Countless industry specific variations on all of these problems

Tactical Staff Scheduling Analysis

Used periodically as part of planning Concerned with capturing the essence of staff scheduling problems
    

TOD/DOW specific staffing targets allowable mix of tour types (shift lengths and # days worked per week) allowable shift start times and flexibility budget constraints days worked constraints (e.g. no 3 consecutive 12hr shifts)

Determine minimum staff size needed to meet coverage requirements subject to scheduling related constraints Quantify cost of scheduling policies

Example - Shift Length Flexibility All full time

8 hr 10 hr 12 hr Total FTEs

1 42

Scenario 2 28 10 38

3 23 10 4 37

42

Dantzig s Linear-Integer Programming Based Scheduling Optimization Model

N Minimize c j x j j!1 Subject to: N Aij x j u di j!1

(Total staffing cost)

c j ! cost of shift j x j ! # of people working shift j

(Staffing coverage in each period (e.g. hourly)) for i ! 1,2- P di ! demand for staff in period i
1 if shift j call for work in period i Aij ! otherwise

x j u 0 and integer, for j ! 1,2,- N

Provided basis for 35 years of scheduling research and practice. Many extensions: understaffing costs varying skill levels and productivity breaks and lunches industry specific side constraints

A Comment on Edies Traffic Delays at Toll Booths, Dantzig, G. (1954)

What is Optimization?
In a business problem context
Loosely Finding the best solution to a problem More precise Finding the answer to a problem that minimizes (maximizes) some objective or goal of a decision maker while taking into account business constraints Mathematical version Finding the values of a set of decision variables that minimizes (maximizes) some objective function subject to constraints (equations or inequalities) on the decision variables

Some Optimization Concepts

A potential solution is feasible if it satisfies all the constraints we build in the model


a model is infeasible if no solution satisfies all the constraints

A potential solution is optimal if it is feasible AND it is better than all other feasible solutions in minimizing (or maximizing) our objective


a model is unbounded if we can make the objective as big as we want (assume we re maximizing) and still satisfy the constraints

So, how do we search among the (potentially huge number of) feasible solutions to find the optimal solution?


that s what optimization algorithms such as those built into the Excel Solver do

Linear Programming
Many useful, important problems can be formulated as:
Maximize Subject to c1x1 + c2x2 + a11x1 + a12x2 + a21x1 + a22x2 + am1x1 + am2x2 + + cnxn (objective function) + a1nxn e b1 (1st constraint) + a2nxn e b2 (2nd constraint) + amnxn e bm (mth constraint)

LP

xi u 0 , i=1..n, (decision variables)

The ci and aij are just numeric coefficients that are multiplied by the values of the decision variables (x ) LP=linear program i

Yet Another Observation

Many useful, important problems can be formulated as:
Maximize Subject to c1x1 + c2x2 + a11x1 + a12x2 + a21x1 + a22x2 + am1x1 + am2x2 + + cnxn (objective function) + a1nxn e b1 (1st constraint) + a2nxn e b2 (2nd constraint) + amnxn e bm (mth constraint)

MIP

xi u 0 , i=1..n, (decision variables)

Some of the xi must be integers MIP=mixed integer-linear program

So, what is different?

Some of the toughest mathematical problems solved routinely in business today are optimization problems

Example 1: Simple 1 week, days-off problem

Formulated model in Excel and we will solve it using Solver Goal 1: give flavor of optimization applied to scheduling Goal 2: illustrate fact that scheduling policies affect staffing needs Goal 3: real scheduling problems can lead to huge optimization problems

SchedulingDSS_Northpark.xls Scheduling_AdvancedDaysOff1.xls Scheduling_AdvancedDaysOff2.xls

Example 2: Simple 1 day, shift scheduling problems

Formulated model in Excel and we will solve it using Solver Goal 1: see difference between shift and days-off scheduling Goal 2: treat staffing requirements as both hard and soft constraints Goal 3: real scheduling problems can lead to huge optimization problems

ShiftSchedulingModel1.xls ShiftSchedulingModel2.xls

 Creating a sample schedule is good test of whether youve come up with an implementable solution Schedule can be reviewed by staff for undesirable characteristics, errors, other ideas for improvement Sample schedule helps sell scheduling policy changes because people can visualize the end product

Example 2-Week Schedule

Cyclic Schedules
Idea is to create a set of schedules that employees cycle through. Various mathematical methods, computerized and trial and error approaches to creating cyclic schedules Pros schedules can be specified well in advance, fair, once created relatively easy to manage for stable workforce Cons very rigid, difficult for mix of full/part time staff, difficult when varying shift lengths, difficult for 24/7 operations

http://www.shiftschedules.com/

Coverage Report Comparison of Targeted to Scheduled Staff Levels

Sched=Staff scheduled

Target=Min staff requirements +/- = Over/understaffing

FTE Summary # of Shifts Shift Worked in Length Two Weeks 12 hr Full Time 7 10 hr Full Time 8 8 hr Full Time 10 12 hr Full Time 6+one 8 hr 8 hr Full Time 10 8 hr Part Time 8 8 hr Part Time 6 8 hr Part Time 4 4 hr Part Time 10 4 hr Part Time 8 4 hr Part Time 6 Number of scheduled FTEs LDR Postpartum LDR+Postpart LDRP 2,150 Births 2,150 Births 2,150 Births 2,150 Births Const Flex Const Flex Const Flex Const Flex 16.8 12.6 16.8 14.7 33.6 27.3 27.3 23.1 3.0 3.0 6.0 2.0 6.9 4.9 7.8 2.9 14.7 7.8 12.0 6.9 2.0 3.0 3.0 5.0 3.0 3.0 3.0 0.8 1.6 0.8 1.6 1.6 0.8 3.2 0.6 0.6 0.6 0.6 0.6 0.8 1.2 0.4 0.8 1.2 2.0 1.0 0.5 1.5 0.5 0.4 0.4 0.4 0.6 0.6 1.2 0.6 27.1 24.1 29.6 27.3 56.7 51.4 43.7 39.7

Sample summary report from a tactical scheduling analysis

FTE implications of Constrained vs. Flexible scheduling policies Summary of FTEs and # of positions These solutions were derived from user specified scheduling policies and a scheduling optimization model Note also the variance pooling effect that an LDRP gives

Mil Mil Mil Civ Civ Civ Civ Civ Civ Civ Civ

FTE 1.05 1.00 1.00 1.00 1.00 0.80 0.60 0.40 0.50 0.40 0.30

Mil Mil Mil Civ Civ Civ Civ Civ Civ Civ Civ

Position Summary # of Shifts LDR Postpartum LDR+Postpart LDRP Shift Worked in 2,150 Births 2,150 Births 2,150 Births 2,150 Births Length Two Weeks FTE Const Flex Const Flex Const Flex Const Flex 12 hr Full Time 7 1.05 16 12 16 14 32 26 26 22 10 hr Full Time 8 1.00 3 3 6 2 8 hr Full Time 10 1.00 12 hr Full Time 6+one 8 hr 1.00 7 5 8 3 15 8 12 7 8 hr Full Time 10 1.00 2 3 3 5 3 3 3 8 hr Part Time 8 0.80 1 2 1 2 2 1 4 8 hr Part Time 6 0.60 1 1 1 1 1 8 hr Part Time 4 0.40 2 3 1 2 3 5 4 hr Part Time 10 0.50 2 1 3 1 4 hr Part Time 8 0.40 1 1 1 4 hr Part Time 6 0.30 2 2 4 2 Number of scheduled employees 28 28 30 31 58 59 43 42 ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ?

Mil Benefit Factor Civ Benefit Factor Civ Benefit Factor

Full time Part time

Number of FTEs on Staff

Sample Applications
Surgical nurses/techs Communications operators Appointment scheduling clerks Short stay unit nurses Recovery room nurses Medical transcriptionists Radiation oncology technicians Obstetrical nurses How much staff needed? Can current staff absorb increased demand through rescheduling? What are the potential savings from increased flexibility in shift lengths and start times? By how much can we improve customer service through scheduling changes?

Isken, M.W. and W.M. Hancock, 1998, Tactical Staff Scheduling Analysis for Hospital Ancillary Units, Journal of the Society for Health Systems, Vol. 5, No. 4, pp. 11-23.

Comments on Tactical Scheduling

How do shift start times and shift lengths match the work flow of the department?


can t make general statements that certain shift lengths or scheduling practices are good or bad look for opportunities to smooth workload to ease the scheduling burden

Pay attention to policies and procedures regarding the definition of OT



>40 hrs/week vs. >80 hrs/pay period don t assume what people will and will not like

Schedule desirability can vary widely by employee



Important to involve staff in analysis of scheduling policies

 

easy for them to undermine intangibles not captured by scheduling models

Another Link between staffing and scheduling

Time of day staffing targets are really decision variables, Simultaneous solution of staffing targets and schedules may lead to better solutions from cost, service, and schedule quality perspectives. Preliminary experimental results are promising. Considers workload smoothing, buffering, and scheduling schemes. Operational setting drives the model building process (Lab and Transcription). Challenge is resulting problems more difficult to solve (research ongoing)
16 14 12 10 8 6 4 2 0 16 14 12 10 8 6 4 2 0

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8: 00

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:0 0 20

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:0 0

Operational Personnel Scheduling

The ongoing process of creating and managing staff schedules Balancing system needs with staff availability and preferences Several methods:
  

computerized scheduling systems self-scheduling manual scheduling done by committee or manager it s like doing a really hard jigsaw puzzle

A difficult, time consuming process



Nurse Scheduling Challenges

24/7 coverage needed Workload varies by shift by skill level by unit Rotation to off-shifts? Multiple skill levels (RN, LPN, aide, etc.) Covering weekends Shortage of personnel Dealing with daily fluctuations in supply & demand


OT, agency, part-time, float on/off unit, contingent, send home, call-in

ANSOS

Typical architecture of Computerized Personnel Scheduling Systems

External Human Resources System Personnel Module Workload Module External Service Delivery Support System Workload Data Workload

HR Data Personnel

Staffing Targets

Identification Availability Preferences

Automated Scheduling

Schedules

Supports day to day scheduling of current staff.

Wide range of system capabilities and cost. Healthcare, retail, police, fire/EMS, telesales, tech support, fast food, banking

Active Schedules

Stored Schedules

Schedule Editor

Schedules

Schedules and Management Reports

ANSOS

Per Se Technologies

ANSOS - One Staff

Created in 1970s by Warner, tested at UMMC The standard for nurse scheduling software Staffing requirements, scheduling policies, and nurse preferences optimization model based Integrates with 3rd party PCS Numerous add-on modules See Automated nurse scheduling by Warner et al that was passed out last time

Shift centric as opposed to time of day centric Extent of use varies widely among institutions glorified typewriter vs. sophisticated auto-scheduler

A few scheduling packages

ANSOS - http://www.per-se.com/forhospitals/h_onestaff.asp ActiveStaffer - http://www.api-wi.com/products/activestaffer.asp AtStaff - http://www.atstaff.com/Products/Products.htm AcuStaf - http://www.acustaf.com/ Pathways Staff Scheduling - http://www.hboc.com/ Shiftwork Solutions - http://www.shift-schedules.com/ ShiftMaker - http://www.vastech.com/24-7/solutions/vastech247/247modules.htm ESP eXpert - http://www.total-care.com/ InTime - http://www.intimesoft.com/ VSS Pro - http://www.abs-usa.com/index.epl Kronos - http://www.kronos.com/ ScheduleSource - http://www.schedulesource.com/content/scheduling/default.asp
ORBIS - http://www.sieda.com/features_e.htm Various packages - http://www.hr-software.net/pages/217.htm StaffSchedule.com - http://www.staffscheduling.com/schedule.htm


web based scheduling

Evaluating Computerized Scheduling Systems

How are staffing requirements specified (TOD or Shift)? Auto-scheduling or just a schedule manager? Schedule editing Support for self scheduling? Single vs. multiple weeks Easy access to emp. data Employee requests and preferences Skeleton rotation patterns Archive past schedules Reporting built in and ad-hoc capabilities Does it handle YOUR scheduling environment?

Can be integrated with 3rd party workload systems? Can be integrated with 3rd party timekeeping, payroll, and/or HR systems? Cost and licensing


consulting, installation, training, sofware, hardware, maintenance, add-on modules

Tech support Strong user base Hardware and software requirements How applicable to multiple departments within the same institution?

Flexible Scheduling Ideas

Mix of different shift lengths
 

>8 hr shift gives more days off per week easier to match fluctuating workload easier to match fluctuating workload more complex to manage; rotation issues part-timers can provide invaluable flexibility in dealing with vacations, odd shifts, absences, workload variation by day of week and time of day

Increase number of allowable start times

 

Mix of full and part-time tour types



Flexible Scheduling Ideas

Float pools (internal agency)
  

cross training sufficient voluntary floaters ? How big should the pool be? How should the core staffing levels be set? pay a premium for staff on demand issues with integration with permanent staff usually from the employees perspective

Temp agencies
 

Contingent


On-call Forced TO (time-of) and Forced OT



not a super staff satisfier

Miscellaneous issues
Circadian rhythms


researchers study effect of shift work communication improvements 334, 3334, 33-1, 2-12 2-8 cost and scheduling implications need to have a good staffing plan and set of scheduling policies

Shift overlap


12hr tour types

 

Self scheduling


Learning More
Professional association trade journals and academic journals


 

Nursing Management, Medical Laboratory Observer, Nursing Times, and numerous other Interfaces Search Medline for staff scheduling

Google it healthcare staff scheduling Introduction to Employee Scheduling: Issues, Problems, Methods Nanda and Browne