Flexible Staffing Research Articles

Enabling Your Radiology Business to Thrive Strategic Lessons Learned During the Initial and Subsequent Surges of the Covid-19 Pandemic

The Covid-19 pandemic surges of 2020 resulted in major operational, personal, and financial impacts on US radiology practices. In response, a series of strategic and intentional operational changes were implemented, varying by practice size, structure and model. In reviewing the many business lessons that we learned during the pandemic, it became clear that for a business to be successful, a host of additional supportive factors are necessary. In addition to timely expense reductions, optimizing revenue capture and close monitoring and management of cash and reserves available for use, we also consider effective leadership and communication strategies, maintenance of a healthy and adequately staffed team, support for a remote work environment and flexible staffing models. Other ingredients include effectively embracing digital media for communications, careful attention to current and new stakeholders and the service delivered to them, understanding federal and state regulatory changes issued in response to the pandemic, close collaboration with the Human Resources office, and an early focus on redesigning your future practice structure and function, including disaster and downtime planning. This review aims to share lessons to enable leaders of an imaging enterprise to be better prepared for similar and future surges.

Assessment of the flexibility of human resources in enterprise’s innovative projects

The article examines the actual problem associated, on the one hand, with increasing requirements for the flexibility of human resources and management systems in conditions of increased dynamism and uncertainty of environmental factors, and, on the other hand, with the lack of scientifically based and practical approaches to assessing the flexibility of human resources with its subsequent formation. The relevance of flexibility is enhanced in relation to the human resources of innovative project teams, which are characterized by an even higher level of uncertainty, unpredictability and variability of project environment factors. This determined the purpose of the study, which is formulated as the development of a methodological approach to assessing the flexibility of human resources of innovative projects. To achieve this goal, there were set tasks of defining the concept of flexibility of human resources of projects, flexibility criteria and principles of their evaluation. The author used methods of analyzing the provisions set out in scientific publications, as well as the method of expert survey, which helped to formulate the hypotheses of the study, and then test them in practice. Using this method, 155 project managers and specialists from 36 enterprises in Russian cities were involved in the study. All enterprises implement innovative projects. The main conclusions of the expert survey were the following: innovative projects require flexible staff, flexibility is reduced to the ability to quickly and efficiently update their competencies, enterprises need methods for evaluating and developing the flexibility of human resources in projects, staff flexibility can be provided with a flexible management system. These findings became the basis for the development of a methodological approach to the assessment of flexibility, which provides for the assessment of the flexibility of people in projects and the assessment of the flexibility of project human resource management. There were proposed criteria for assessing flexibility, which are related to the assessment of the speed, depth and scale of updating the competencies of human resources of projects. The proposed developments can be useful to project managers for their activities to ensure the flexibility of innovative projects and people in these projects.

Ramping Up a Pediatric Hospital Medicine Advanced Practice Provider Team Rapidly

Pediatric Hospital Medicine (PHM) is a growing subspecialty with a broad scope. The Covid-19 pandemic demands flexible staffing models. Advanced practice providers (APPs) can be a valuable addition to hospital medicine teams, although there is no established training program for APPs within PHM. The authors’ purpose is to describe how one institution rapidly established a PHM APP team by collaborating with experienced APPs working in other areas of the hospital. This APP team cared for 16% of the average daily census during the pilot period with no significant difference in length of stay compared to traditional teams.

Staffing decisions in a tele-ICU: dedicated versus flexible resources

In a tele-ICU center with flexible staff scheduling, interruptions to tasks with lower priority are common, often prolonging the processing time of these tasks. Dedicated staff scheduling, however, can reduce such interruptions. While dedicated staff scheduling is generally perceived to be less efficient than flexible systems according to traditional queueing theory, the reductions in interruptions call this result into question. To investigate when dedicated staff scheduling could be more efficient than flexible systems for tele-ICUs, we build a discrete-event simulation model to analyze the operational process of admissions and interventions at a real tele-ICU center. Our simulation results show that if the dedicated nurse (intensivist) can process admissions at least 31% (26%) faster than the flexible nurse (intensivist), the dedicated staff scheduling will be preferred. Thus, the tele-ICU administrators should choose the scheduling approach (flexible versus dedicated) based on how often interruptions are likely to occur and their anticipated effect on prolonging the medical staff’s processing times of the interrupted tasks. Our simulation model can also help tele-ICU administrators determine a suitable staffing level by providing the estimated waiting times of admissions and interventions under varying staffing levels.

Costs and consequences of using average demand to plan baseline nurse staffing levels: a computer simulation study

BackgroundPlanning numbers of nursing staff allocated to each hospital ward (the ‘staffing establishment’) is challenging because both demand for and supply of staff vary. Having low numbers of registered nurses...

Role of Pediatric Departments in Community Hospitals in Countermeasures against Measles Epidemics at Olympic Games Sites.

In preparation for the 2021 Tokyo Olympic/Paralympic Games, the Japanese government assessed the risks of infectious disease outbreaks and identified necessary preparations. This present study reviewed efforts made during a previous measles epidemic and describes the roles of hospitals. This descriptive study investigated the records of 198 children with measles. All children were treated at a general hospital during the period from January 1997 through February 1998. We also examined the actions of pediatricians during and after a measles outbreak in the community. Of the 198 children, 145 (73%) were hospitalized. The measles vaccination rate in the previous year was approximately 75%. Of the patients examined, 53% were younger than 2 years of age; mean age was 2.75 years. Pneumonia and gastroenteritis accounted for 46% and 30% of the complications, respectively. Issues requiring attention included the number of hospital beds located in a negative pressure room or private room with a window, the need for gamma globulin preparations with high measles antibody titers, the necessity of increasing vaccination opportunities, and extension of physician working hours. Visitors from other countries could cause measles outbreaks in Japan. Measures that might mitigate an outbreak were maintenance of high vaccination rates, ready availability of information on the location of negative pressure hospital rooms, knowledge of the status of the measle outbreak, and flexible medical staffing. There is a risk of measles outbreaks among infants and among those who do not have a measles antibody titer.

Gendered and generational inequalities in the gig economy era

Over the last few decades, there has been a radical transformation of Australia's labour market and education sector, with intersecting implications for gender and generational inequalities. First, the composition of the labour force has changed. There has been a significant increase in women's participation in paid work, which has been driven by the changing industrial landscape as well a significant expansion of higher education opportunities for women. At the same time, there has been a steady decline in full-time youth employment. Youth unemployment has become a persistent problem for governments since the late 1980s and 1990s and has only worsened since the global financial crisis (Denny and Churchill, 2016). Primary industry and the manufacturing sectors, once reliant upon unskilled labour, in particular young people who left school early, have waned and there has been a countervailing growth in service industries that require professional, skilled workers (Cuervo and Wyn, 2011). Not only has the composition of the labour market changed, so too has its characteristics. New jobs have different conditions to the old ones. The contemporary labour market is increasingly characterised by what Guy Standing (2011) calls precarious work. Precarious work is 'uncertain, unstable, and insecure and in which employees bear the risks of work (as opposed to businesses and government) and receive limited benefits and statutory protections' (Kalleberg, 2018: 1). It is often described as contingent or non-regular work, or referred to as 'alternative work arrangements' or 'flexible staffing arrangements' (Kalleberg, 2018: 12). Examples of precarious work include temporary work; contract work, including independent contractors; part-time work with a desire for more hours; work with irregular hours; casual work; and own-account self-employed workers (Kalleberg, 2018: 12). The growth in precarious work is a result of structural changes which have eroded the standard employment arrangements that emerged in the post-war period (Kalleberg, 2018). These changes have given rise to what is being termed 'the gig economy': a new way of organising economic activity, where workers are not hired on a permanent basis but for shorter or longer term 'gigs'. This reconfigures labour markets and can on the one hand be seen to encourage a new, digital form of entrepreneurship and provide new opportunities for flexible work patterns. However, especially in a flexible, deregulated economy like Australia, it also exposes individuals to greater financial risks and social insecurities which can deepen existing inequalities. Younger generations are arriving in a labour market in which 'work' has increasingly been replaced by 'gigs' and 'tasks', and this kind of highly casualised, non-standard employment is having a spill-over effect on their non-working lives, which are increasingly disrupted by these social changes. This is what we term the gig economy era. In many ways, it is an extension and continuation of the neoliberal forces which have created the 'new precariat' (Standing, 2011), for whom insecure and non-standard employment has become the norm. The introduction to this special issue, 'Gender and Generational Inequalities in the Gig Economy', begins by mapping the context and configurations that have led to this era and its impact upon young men and women, and introduces the articles contained in the issue. It concludes with a discussion of future avenues for research.

A Novel Model for Flexible Staffing in Unionized Healthcare Foodservice Departments

develop a flexible staffing model for foodservice operations in both unionized and non-unionized healthcare facilities.

Taking the 'Alternative' out of Alternative Legal Service Providers: Remapping the Corporate Legal Ecosystem in the Age of Integrated Solutions

The word “alternative” is definitely trending in the legal zeitgeist. Beginning with the U.K. Legal Services Act and accelerating through the legal tech startup boom, discussion about the growing importance of Alternative Business Structures (ABS) and Alternative Legal Service Providers (ALSP) has become a cottage industry in the legal press, and increasingly in the legal academy as well. And yet, for all of the talk about the growing importance of these “alternatives,” the very discourse used to cast these new providers as the harbingers of impending dramatic changes in the market for legal services continues to marginalize and mask their true significance. In this Chapter, we argue that this characterization of the range of new providers competing for a share of the global corporate legal services market is fundamentally flawed. We do so by first reminding today’s lawyers and commentators that the large law firms and sophisticated in-house legal departments that we now consider to be the “traditional” standard against which all other legal service providers should be measured, were once considered radical “alternatives” posing a significant threat to the “core” values of lawyer professionalism. As market conditions changed, however, these marginalized forms of practice not only moved to the mainstream, but have become the very embodiment of professional excellence. Similarly, we argue, as corporate clients increasingly demand professional services that are “integrated,” “customized,” and “agile,” the parts of the market that are now considered “alternative” – e.g., technology, managed services, flexible staffing, and multidisciplinary practice – are also moving from the periphery to the core. At the same time, “traditional” law firms and in-house legal departments are under mounting pressure to demonstrate how the “core” services that they provide contribute to producing the kind of “integrated solutions” their clients need. We conclude by highlighting some of the challenges that this evolving “integrated solutions” model poses for other parts of the legal “ecosystem” such as legal education, legal regulation, and the rule of law, that either have not – or should not – change.

Flexible staffing of physicians with column generation

In Germany, around 40% of the hospitals do not generate an annual surplus. This leads to an increasing pressure on hospitals’ management to reorganize and restructure their processes and resources to decrease the upcoming costs and become profitable. Since personnel, especially physicians, generates a major part of the arising costs, assigning staff efficiently provides an opportunity to decrease associated costs. Up to now, experienced physicians create rosters manually which is cost and time intense due to the problem’s complexity and especially the fluctuation in demand. To circumvent this difficulty, it is our main aim to create a new mathematical modeling approach to implement additional flexibility in the rostering process to better match supply and demand. Therefore, we formulate the problem as mixed-integer programming model with the objective to minimize occurring labor costs of physicians over the considered planning horizon subject to coverage of demand to make flexibility monetarily evaluable. In our approach, full flexibility in terms of patterns of working days, shift types, and the placement of the break is provided. To solve the problem under consideration, a column generation heuristic is presented. In our experimental study, the performance of the provided solution approach as well as the effect of additional flexibility in the rostering process are evaluated using real life data. Results indicate the significant impact of implementing flexibility in the scheduling process on the salary costs of the number of required physicians and evidence the superior quality of our solution approach.

Abstract P5-13-05: Overcoming barriers to achieve a successful breast cancer patient recruitment: Professionals' views

Abstract Accurate recruitment in performing clinical trials is crucial to avoid delays in the availability of potential beneficial treatments for patients. However, optimal strategies to improve it remain elusive and highly variable. The aim of this study was to identify the factors affecting recruitment from a multi-professional approach. Methods: A convergent mixed method study was used, including key informant in-depth interviews (n=13), 5 focus groups (n=40) and a 209-item Likert-scale survey for the measurement of a whole array of variables of interest (i.e. job attitudes, job satisfaction, job stressors and social status). A purposive sample of professionals from thirty-three clinical trial sites in Spain were targeted. Qualitative data were analyzed alongside quantitative data to document patterns and modifiers of recruitment performance. Audio material was recorded, transcribed verbatim and analyzed using the framework method. Findings: Pattern observed in qualitative data was confirmed in quantitative analysis. A total of 32 key barriers to successful patient recruitment were identified and clustered in three categories. The most commonly reported barriers and facilitators regarding a multifactorial approach were: System/organization: Counting on experienced recruiters and having a strong team-workforce awareness (92,3%); automated recruitment software, scientific culture, recruiting philosophy, adequate workload demands (88%); high stimuli and interprofessional trust (84%). However, lack of time devoted to clinical research in favor of assistance demands, excessive workload and bureaucratic tasks were the most salient stressors to fulfill professional research and recruitment responsibilities (54%). Working team conditions: Insufficient workforce support as well as high employee turnover contributed to emotional exhaustion and depersonalization and to a lower personal accomplishment (15%). Interpersonal relations affected not only motivation and performance but professionalism satisfaction with outcomes. Professional recruiter characteristics: Professionals with a high level of expertise and academic specialization (>5 years), greater active involvement in relevant clinical trials just as interprofessional prestige and recognition showed a greater satisfaction. Consequently, they were prompted to intensify their efforts to fulfill recruitment. The more effective clinical research settings were those better aligned with attributes for becoming high recruiters and with better multi-professional articulation. Suggestions to improve recruitment included providing professionals with devoted time for research, setting up collaborative research agreements, building a clinical research network, collaborative tumor registries, clinical trials data sharing resources, multidisciplinary functional units and committees, flexible staffing models and empowering oncologists/managers leadership. Conclusions: This study provided useful understanding of how to maximize patient recruitment at clinical research sites. Strong team-workforce and adequate workload were the most important identified factors for achieving it. Results will be used to inform professionals and stakeholders of the next steps needed and to engage them to fulfill accurate recruitment. Citation Format: Casas A, Gonzàlez X, Capelán M, Morales J, Fabián M, Ciruelos E, Gabriele G. Overcoming barriers to achieve a successful breast cancer patient recruitment: Professionals' views [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P5-13-05.

329 Using Digital Health to Enhance Medical Screening Exam in the Emergency Department

Surges in patient arrivals put stress on emergency department (ED) resources contributing to increased time-to-provider, increased walk-outs and decreased patient satisfaction. A medical screening exam (MSE) performed by a Provider-in-Triage (PIT) has been shown to both aid in early identification of seriously ill patients as well as those with non-critical illness. PIT assessments are frequently encumbered by interruptions as the provider navigates through the physical space of the ED. Research suggests that so-called “task switching” causes disruption in the primary task and may contribute to error. We sought to enhance our MSE process by incorporating digital health / telemedicine during peak hours. Specifically, we compared the Provider-In-Triage (PIT) model to a remote Telemedicine medical screening exam (TeleMSE) which had the enhanced capability to quickly navigate between 3 patient triage stations without interruption in work flow. Our hypothesis was that TeleMSE would improve time-to-provider and patient satisfaction while decreasing walk-outs. We conducted a retrospective observational study at a single urban academic tertiary care center, with an annual ED census of 96,000 visits. All 3 processes (PIT MSE, single-station TeleMSE and multi-station TeleMSE) were launched sequentially. The following metrics were analyzed: 1) time-to-provider (initial and full) and 2) total number of patients screened per hour. Initial time-to-provider was defined as the time to the PIT MSE or TeleMSE encounter during which the patients had a brief assessment done by a provider who placed necessary orders to initiate care. Full time-to-provider was defined as the time patients saw a local provider who determined the need for further work-up and disposition. Data on ESI (Estimated Severity Index) level, sex, and age were collected to assess for potential confounding. Data were abstracted from March 1, 2017-May 31, 2017; June 1, 2017-September 14, 2017 and September 15, 2017-December 10, 2017 for PIT MSE, singles station TeleMSE and multi-station TeleMSE respectively. PIT had an average of 3.7 patients per hour MSE encounter, with a median time-to-provider initial evaluation at 21 minutes and a full evaluation at 61.8 minutes. Single-station TeleMSE performed an average of 3.12 patients per hour, with a median time-to-provider initial evaluation at 10.8 minutes and a full evaluation at 30.6 minutes. Lastly, the multi-station TeleMSE model performed 4.8 patients per hour, with an initial time-to-provider evaluation of 15 minutes and a full evaluation at 48.6 minutes. Walk out rates were 4.3%, 4.3%, and 4.1% for PIT, single-station tele MSE and multi-station TeleMSE respectively. Initial results suggest that the TeleMSE process is associated with decreased time-to-provider in comparison to the PIT model. This may be due to decreased interruptions and streamlined work flow. With remote access it also allows for flexible staffing increases during surge and peak times. Multi-station TeleMSE was associated with increased rate of patients seen per hour in comparison to single station TeleMSE. The TeleMSE model has the potential to positively impact the Medical Screening Exam process and patient care.

When flexible staff face inflexibility

When flexible staff face inflexibility

When Is the Root of All Evil Not Money? The Impact of Load on Operational Risk at a Commercial Bank

Operational risk has been among the three most significant types of risks in the financial services industry, and its management is mandated by Basel II regulations. To inform better labor decisions, this paper studies how workload affects banks’ operational risk event occurrence. To achieve this goal, we use a unique data set from a commercial bank in China that contains 1,441 operational risk events over 16 months. We find that workload has a U-shaped impact on operational risk error rate. More specifically, the error rate of operational risk events decreases first, as workload increases, and then increases. Furthermore, when workload is low, employees tend to make performance-seeking risks; however, when workload is high, employees tend to exhibit quality degradation due to cognitive multitasking. Based on the causal relationship between workload and operational risk events from the empirical analysis, we discuss staffing policies among branches aimed at reducing operational risk losses. We find that employing a flexible staffing rule can significantly reduce the number of operational risk events by more than 3% under different scenarios. In addition, this significant performance improvement can be achieved by adding even a little bit of flexibility to the process by allowing employees to either switch their business lines in the same branch or switch branches within the same business lines on a quarterly basis.

Examining the reach of a brief alcohol intervention service in routine practice at a level 1 trauma center

The American College of Surgeons requires Level I and II trauma centers to provide brief intervention services to traumatically injured patients who screen positive for alcohol. Despite evidence supporting substantial cost savings and reduced re-injury associated with these services, brief interventions may not be uniformly delivered owing to a variety of demographic, clinical and operational characteristics. To inform service adjustments that may improve the reach of such services, we compared trauma patients who did and did not receive brief alcohol intervention services during their hospitalizations. Electronic medical records of injured patients admitted to a Level I trauma center between September 27, 2013 and March 11, 2014 with a positive blood alcohol concentration (N=189) were coded for demographic and clinical variables. Records of those who did not receive a brief intervention during their admission were reviewed for possible reasons why interventions were not delivered. Of the total sample, 115 patients (60.8%) received brief interventions. Patients who did and did not receive brief interventions did not differ on age, sex, race, blood alcohol concentration at admission, or mechanism of injury, indicating that patient characteristics were unlikely to bias service delivery. Instead, common features of patients who were referred but did not receive SBIRT interventions included admissions lasting fewer than two working days (12.7%) and persistent cognitive impairment following injury (9.0%). These findings align with previous studies suggesting that service reach could be improved by promoting dedicated and flexible staffing and adapting services to allow for SBIRT delivery in follow-up care settings.

Many‐server loss models with non‐poisson time‐varying arrivals

This article proposes an approximation for the blocking probability in a many-server loss model with a non-Poisson time-varying arrival process and flexible staffing (number of servers) and shows that it can be used to set staffing levels to stabilize the time-varying blocking probability at a target level. Because the blocking probabilities necessarily change dramatically after each staffing change, we randomize the time of each staffing change about the planned time. We apply simulation to show that (i) the blocking probabilities cannot be stabilized without some form of randomization, (ii) the new staffing algorithm with randomiation can stabilize blocking probabilities at target levels and (iii) the required staffing can be quite different when the Poisson assumption is dropped. © 2017 Wiley Periodicals, Inc. Naval Research Logistics 64: 177–202, 2017

Colombia: Review Under the Flexible Credit Line Arrangement-Press Release and Staff Report

Colombia: Review Under the Flexible Credit Line Arrangement-Press Release and Staff Report

The flexpatriate psychological contract: a literature review and future research agenda

Since the 1980s, research on international assignments (IA) has principally focused on traditional long-term expatriates. However, due to pressures to reduce long-term expatriate assignments and the emergence of a portfolio of more flexible staffing options, there has recently been a growing focus on the deployment of alternative forms of IA. This paper focuses on one form of alternative IA, flexpatriation, where employees undertake frequent international business trips without relocating. More specifically, we critically examine the flexpatriate employment relationship by applying psychological contract theory to yield insight into both the employer and the employee perspectives, which has been neglected in previous research. The article also examines some of the key HR challenges in managing flexpatriates and contributes to both the IHRM and psychological contract literature by presenting an agenda for future research in this area.

Meeting Education Needs of Flexible Staffing: Begin With the End in Mind

In our multicenter organization, we prepare personnel to practice at consistent levels of excellence. Centralized orientation programs facilitate sharing best practice and collective vision. When acute needs for care delivery occur, traditional orientation is not feasible. Regardless of staffing model or training methodology, performance at the bedside must be equal. J Contin Educ Nurs. 2016;47(9):390-392.

Factors Determining Medical Staff Configurations in Community Health Centers: CEO Perspectives

INTRODUCTIONWith the expansion of coverage and preventive care facilitated by the Affordable Care Act, primary care facilities are facing increased demand for services. At the same time, new payment incentives linked to patient-centered medical homes (PCMHs) are encouraging the adoption of team-based care (Auerbach et al., 2013; Bitton et al., 2012). Team-based care may help contain costs and improve productivity and patient outcomes primary care facilities (Altschuler, Margolius, Bodenheimer, & Grumbach, 2012; Bodenheimer & Smith, 2013; Ku, Frogner, Steinmetz, & Pittman, 2015). However, most studies of primary care teams examine team-based care or teamwork as a variable associated with certain outcomes, with little attention given to the question of how leaders of primary care facilities determine the composition of primary care teams and the configurations that best serve patient populations given their local policy and market contexts (Chen & Bodenheimer, 2011; Chesluk & Holmboe, 2010).Understanding how leaders make configuration decisions the context of the current system transformations is important because it may help build knowledge about how ground-level choices primary care facilities mediate policy outcomes. In addition, such information may help inform national and state health workforce planners as they grapple with the challenge of projecting demand for different types of healthcare workers, some of whom have overlapping roles. Such projections have traditionally measured supply and demand for just one profession, but interest is increasing more sophisticated models that consider alternative team configurations (Auerbach et al, 2013). Furthermore, organizations such as the Association of American Medical Colleges are particularly interested identifying variables that can be used to develop local workforce planning tools (Dill, 2015).Researchers have argued for a complexity perspective on primary care, with greater attention given to how leaders manage competing goals and values, leam from their environment, and create emergent organizational forms (Felix-Bortolotti, 2009; Sweeney, 2006). In this study, we use a qualitative approach to explore how leaders of community health centers (CHCs) make complex medical staff configuration choices their role as safety-net providers for 22 million low-income patients the United States (Health Resources and Services Administration, n.d.). CHCs are a good venue for studying complexity primary care because they require leaders to use tightly constrained resources to provide high-quality primary care to patients, regardless of their ability to pay (Rosenblatt, Andrilla, Curtin, & Hart, 2006). CHCs are seen as in the vanguard of flexible staffing because their leaders make tradeoffs and adapt to the environment to maximize resources a difficult funding environment (Ku et al, 2015).METHODSParticipantsWe used the 2012 Uniform Data System (UDS), an annual administrative reporting system for CHCs that receive federal funding (Section 330 grantees), to identify a maximum variety sample (Patton, 1990) of CHCs with unusually high proportions of advanced practice providers (APPs) (i.e., nurse practitioners [NPs], physician assistants [PAs], and certified nurse midwives), nurses (registered nurses [RNs] and licensed practical nurses [LPNs] or vocational nurses), medical assistants (MAs), case managers, and community health workers. We selected three to five sites from each of these ftve categories for variety with regard to urban versus rural location, NP scope of practice (SOP), Medicaid expansion states versus Medicaid non-expansion states, and large versus small. We determined size (the last variable) on the basis of whether they reported more or less than 9,844, the median number of patients. This maximum variety sampling approach allowed us to analyze a wide range of ideas pertaining to (Patton, 1990). …