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Matching care supply and demand in the women's and children's inpatient clinic : The value of flexible nurse staffing

Winkelhuijzen, S.A.J.E. (2013) Matching care supply and demand in the women's and children's inpatient clinic : The value of flexible nurse staffing.

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Abstract:BACKGROUND As a result of the pressure on hospital budgets, the Academic Medical Center Amsterdam (AMC) is forced to reorganize the operations of inpatients’ services during the upcoming years. In the Women’s and Children’s Inpatient Clinic (WCC) of the AMC, an area for improvement is matching patient demand and supply of care. Currently, the number of nurses staffed in a shift is not aligned with the number of patients on a ward. Performance measurement indicates that this frequently led to over- and understaffing of nurses in 2012. As a result of frequent understaffing, nursing coverage guidelines set by the AMC were not reached and quality of care was not guaranteed. In the AMC, two mathematical models are developed to improve nurse staffing: the hourly bed census (HBC) model (Kortbeek et al. 2012a) and the nurse staffing (NS) model (Kortbeek et al. 2012b). The HBC model predicts the number of occupied beds (bed census) based on the surgical schedule and arrival patterns of acute patients. The NS model determines efficient nurse staffing levels while guaranteeing nurse coverage for two staffing policies: staffing on bed census predictions and staffing on bed census predictions with the deployment of flexible nurses. The models are developed for the surgical inpatient care units of the AMC. To get insight whether these models are widely applicable to other wards to minimize over- and understaffing, we research the application of these models to the wards of the WCC. Therefore, the research objective is: Research the potential of applying the available mathematical models, which are developed for flexible nurse staffing for the surgical inpatient care units of the AMC, to minimize overstaffing and understaffing in the Women’s and Children’s Inpatient Clinic APPROACH To research the potential of the models, we required data of the WCC to use the methods of the HBC and NS model. The available data of our case study differed from the data of the surgical inpatient care units, which led to several limitations while applying the models. We encountered the limitation that the HBC model is not able to work with a surgical schedule from which patients of one surgery block can be admitted to various wards. This is the situation in the WCC and results in the inability to calculate bed census predictions based on an upcoming surgical schedule. Although the HBC model cannot be used to predict bed census in the future, we decided to manipulate historical surgical schedules in such way that the HBC model can be applied. The results of the application indicate which improvements are possible when the HBC model is usable for all surgical schedules. RESULTS This study resulted in insight in the limitations of the HBC and NS model. The main limitation is that the HBC model cannot be applied as a prediction tool for all surgical schedules. We were not able to overcome this limitation and use the HBC model as a prediction tool. Therefore, we decided to perform experiments with the HBC and NS model based on a historical surgical schedule and historical data. We used three wards of the WCC: Teenagers, Older Children, and Pediatric Surgery iii and Infants. Results showed that the two staffing policies resulted in a consistent high coverage and that a reduction in the number of FTEs is possible. RECOMMENDATIONS We recommend to research the possibilities how to make the model usable for all surgical schedules. A method must be developed to use the HBC model in situations where patients from one surgery block can be admitted to various wards. If the model can be adapted to these situations, the HBC and NS models can be used as prediction tools in the WCC. We were unable to predict the required nurse staffing levels for the future to minimize under- and overstaffing with the HBC and NS model. Therefore, we recommend the AMC’s WCC to start with structurally analyzing the historical bed census of the wards. We analyzed the situation in 2012 where a fixed number of nurses is staffed from Monday to Friday while the week patterns in historical bed census show large fluctuations. Therefore, we recommend to analyze the week patterns of 2013 and determine what improvements are possible in adapting nurse staffing levels for 2014 based on these patterns. In this way, wards can improve the alignment of care supply and patient demand.
Item Type:Essay (Master)
Clients:
AMC, Amsterdam
Faculty:BMS: Behavioural, Management and Social Sciences
Subject:85 business administration, organizational science
Programme:Industrial Engineering and Management MSc (60029)
Link to this item:http://purl.utwente.nl/essays/64563
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