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Staggered work shifts: a way to downsize and restructure an emergency department workforce yet maintain current operational performance

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  • David Sinreich
  • Ola Jabali

Abstract

Starting from the last decade of the twentieth century, most hospital Emergency Department (ED) budgets did not keep up with the demand for ED services made by growing populations and aging societies. Since labor consumes over 50% of the total monies invested in EDs and other healthcare systems, any downsizing, streamlining and reorganization plan needs to first address staffing issues such as determining the correct size of the workforce and its work shift scheduling. In this context, it is very important to remember that downsizing certainly does not mean a general cut-across-the-board. This study shows that a selective downsizing process in which each resource is treated separately (increasing the work capacity of some resources is also possible), based on its unique contribution to the overall ED operational performance, can approximately maintain current ED operational measures in terms patient length of stay (LOS) despite an overall reduction in staff hours. A linear optimization model (S-model) and a heuristic iterative simulation based algorithm (SWSSA) are used in this study for scheduling the resources’ work shifts, one resource at a time. The algorithm was tested using data that was gathered from five general hospital EDs. By leveling the workload of the different resources in the ED, SWSSA was able to achieve LOS values within −19 to 4% of the original values despite a reduction of 8–17.5% in physicians’ work hours and a reduction of 13–47% in the nurses’ work hours. Copyright Springer Science+Business Media, LLC 2007

Suggested Citation

  • David Sinreich & Ola Jabali, 2007. "Staggered work shifts: a way to downsize and restructure an emergency department workforce yet maintain current operational performance," Health Care Management Science, Springer, vol. 10(3), pages 293-308, September.
    • Handle: RePEc:kap:hcarem:v:10:y:2007:i:3:p:293-308
    DOI: 10.1007/s10729-007-9021-z
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    References listed on IDEAS

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    4. Niyirora, Jerome & Zhuang, Jun, 2017. "Fluid approximations and control of queues in emergency departments," European Journal of Operational Research, Elsevier, vol. 261(3), pages 1110-1124.
    5. Ran Liu & Xiaolan Xie, 2018. "Physician Staffing for Emergency Departments with Time-Varying Demand," INFORMS Journal on Computing, INFORMS, vol. 30(3), pages 588-607, August.
    6. Van den Bergh, Jorne & Beliën, Jeroen & De Bruecker, Philippe & Demeulemeester, Erik & De Boeck, Liesje, 2013. "Personnel scheduling: A literature review," European Journal of Operational Research, Elsevier, vol. 226(3), pages 367-385.
    7. Wang, Wen-Ya & Gupta, Diwakar & Potthoff, Sandra, 2009. "On evaluating the impact of flexibility enhancing strategies on the performance of nurse schedules," Health Policy, Elsevier, vol. 93(2-3), pages 188-200, December.
    8. Emir Hüseyin Özder & Evrencan Özcan & Tamer Eren, 2019. "Staff Task-Based Shift Scheduling Solution with an ANP and Goal Programming Method in a Natural Gas Combined Cycle Power Plant," Mathematics, MDPI, vol. 7(2), pages 1-26, February.
    9. Hainan Guo & David Goldsman & Kwok-Leung Tsui & Yu Zhou & Shui-Yee Wong, 2016. "Using simulation and optimisation to characterise durations of emergency department service times with incomplete data," International Journal of Production Research, Taylor & Francis Journals, vol. 54(21), pages 6494-6511, November.
    10. Azyyati Anuar & Rohaizah Saad & Rushami Zein Yusoff, 2018. "Operational Performance and Lean Healthcare in the Healthcare Sector: Review on the Dimensions and Relationships," International Journal of Academic Research in Business and Social Sciences, Human Resource Management Academic Research Society, International Journal of Academic Research in Business and Social Sciences, vol. 8(4), pages 276-292, April.
    11. Abo-Hamad, Waleed & Arisha, Amr, 2013. "Simulation-based framework to improve patient experience in an emergency department," European Journal of Operational Research, Elsevier, vol. 224(1), pages 154-166.
    12. Najmaddin Akhundov & Nail Tahirov & Christoph H. Glock, 2022. "Optimal Scheduling of Waitstaff with Different Experience Levels at a Restaurant Chain," Interfaces, INFORMS, vol. 52(4), pages 324-343, July.
    13. Erhard, Melanie & Schoenfelder, Jan & Fügener, Andreas & Brunner, Jens O., 2018. "State of the art in physician scheduling," European Journal of Operational Research, Elsevier, vol. 265(1), pages 1-18.
    14. Yong-Hong Kuo & Omar Rado & Benedetta Lupia & Janny M. Y. Leung & Colin A. Graham, 2016. "Improving the efficiency of a hospital emergency department: a simulation study with indirectly imputed service-time distributions," Flexible Services and Manufacturing Journal, Springer, vol. 28(1), pages 120-147, June.
    15. Ionut NICA, 2020. "Operational Research in the Emergency Medical System of Romania," Database Systems Journal, Academy of Economic Studies - Bucharest, Romania, vol. 11(1), pages 3-13.
    16. Miguel Angel Ortíz-Barrios & Juan-José Alfaro-Saíz, 2020. "Methodological Approaches to Support Process Improvement in Emergency Departments: A Systematic Review," IJERPH, MDPI, vol. 17(8), pages 1-41, April.
    17. Ludwig Kuntz & Sandra Sülz, 2013. "Treatment speed and high load in the Emergency Department—does staff quality matter?," Health Care Management Science, Springer, vol. 16(4), pages 366-376, December.

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