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ABSTRACTIn this article, we present strategies to help combat the U.S. nursing shortage. Key considerations include providing an attractive work schedule and work environment—critical issues for retaining existing nurses and attracting new nurses to the profession—while at the same time using the set of available nurses as effectively as possible. Based on these ideas, we develop a model that takes advantage of coordinated decision making when managing a flexible workforce. The model coordinates scheduling, schedule adjustment, and agency nurse decisions across various nurse labor pools, each of differing flexibility levels, capabilities, and costs, allowing a much more desirable schedule to be constructed. Our primary findings regarding coordinated decision making and how it can be used to help address the nursing shortage include (i) labor costs can be reduced substantially because, without coordination, labor costs on average are 16.3% higher based on an actual hospital setting, leading to the availability of additional funds for retaining and attracting nurses, (ii) simultaneous to this reduction in costs, more attractive schedules can be provided to the nurses in terms of less overtime and fewer undesirable shifts, and (iii) the use of agency nurses can help avoid overtime for permanent staff with only a 0.7% increase in staffing costs. In addition, we estimate the cost of the shortage for a typical U.S. hospital from a labor cost perspective and show how that cost can be reduced when managers coordinate.

ABSTRACTIn this paper we present a general model and solution methodology for planning resource requirements (i.e., capacity) in health care organizations. To illustrate the general model, we consider two specific applications: a blood bank and a health maintenance organization (HMO). The blood bank capacity planning problem involves determining the number of donor beds required and determining the size of the nursing and support staff necessary. Capacity must be sufficient to handle the expected number of blood donors without causing excessive donor waiting times. Similar staff, equipment, and service level decisions arise in the HMO capacity planning problem. To determine resource requirements, we develop an optimization/queueing network model that minimizes capacity costs while controlling customer service by enforcing a set of performance constraints, such as setting an upper limit on the expected time a patient spends in the system. The queueing network model allows us to capture the stochastic behavior of health care systems and to measure customer service levels within the optimization framework.

AbstractWe present an algorithm for solving a specially structured nonlinear integer resource allocation problem. This problem was motivated by a capacity planning study done at a large Health Maintenance Organization in Texas. Specifically, we focus on a class of nonlinear resource allocation problems that involve the minimization of a convex function over one general convex constraint, a set of block diagonal convex constraints, and bounds on the integer variables. The continuous variable problem is also considered. The continuous problem is solved by taking advantage of the structure of the Karush‐Kuhn‐Tucker (KKT) conditions. This method for solving the continuous problem is then incorporated in a branch and bound algorithm to solve the integer problem. Various reoptimization results, multiplier bounding results, and heuristics are used to improve the efficiency of the algorithms. We show how the algorithms can be extended to obtain a globally optimal solution to the nonconvex version of the problem. We further show that the methods can be applied to problems in production planning and financial optimization. Extensive computational testing of the algorithms is reported for a variety of applications on continuous problems with up to 1,000,000 variables and integer problems with up to 1000 variables. © 2003 Wiley Periodicals, Inc. Naval Research Logistics 50: 770–792, 2003.

ABSTRACTLegislators at the state and national levels are addressing renewed concerns over the adequacy of hospital nurse staffing to provide quality care and ensure patient safety. At the same time, the well‐known nursing shortage remains an ongoing problem. To address these issues, we reexamine the nurse scheduling problem and consider how recent health care legislation impacts nursing workforce management decisions. Specifically, we develop a scheduling model and perform computational experiments to evaluate how mandatory nurse‐to‐patient ratios and other policies impact schedule cost and schedule desirability (from the nurses' perspective). Our primary findings include the following: (i) nurse wage costs can be highly nonlinear with respect to changes in mandatory nurse‐to‐patient ratios of the type being considered by legislators; (ii) the number of undesirable shifts can be substantially reduced without incurring additional wage cost; (iii) more desirable scheduling policies, such as assigning fewer weekends to each nurse, have only a small impact on wage cost; and (iv) complex policy statements involving both single‐period and multiperiod service levels can sometimes be relaxed while still obtaining good schedules that satisfy the nurse‐to‐patient ratio requirements. The findings in this article suggest that new directions for future nurse scheduling models, as it is likely that nurse‐to‐patient ratios and nursing shortages will remain a challenge for health care organizations for some time.

Reducing the risks believed to be associated with product availability can be critical to increasing consumer retention rates. This study considers the role that perceptions of channel integration have on such beliefs and their impact on purchasing decisions. Surveys distributed to purchasers of specific goods both online and in-store provide data used in the analysis of these effects. The findings suggest that firms simultaneously managing both online and in-store channels should not only reassess the repercussions of availability failures but also consider efforts that encourage the transparency of channel integration.