Workforce Mix Research Articles

’Did we do our best?’ Reviewing person-centred compassionate care at the end of life in an acute hospital in the United Kingdom, during the COVID-19 pandemic. An Appreciative Inquiry

ABSTRACT There is an outstanding task for all international healthcare organisations to understand how healthcare services learn from the COVID-19 pandemic. We sought to understand whether the treatment and holistic care received by each person who died with presumed nosocomial COVID-19 in our United Kingdom hospital was provided with kindness and compassion. A multi-professional team carried out a service evaluation underpinned by Appreciative Inquiry (AI) methodology. Our current Learning from Death data collection tool was supplemented by the addition of narrative analysis to augment our qualitative findings. We identified a total of 63/143 patients as dying from presumed nosocomial COVID-19 in our hospital. The deaths occurred in hospital between 15 April 2020 and 29 January 2021. We found evidence of individualised decision-making in complex medical situations, alongside the challenge of managing COVID-19, with appropriate management of deterioration and appropriate symptom control. A Learning from Death programme benefits from a multi-professional approach that utilises the skilled workforce mix that exists in our hospitals. The use of AI methodology and addition of narrative analysis is practical and adds valuable qualitative data to the scrutiny of deaths. Sharing the narrative of those who died during the COVID-19 pandemic has reinforced the evidence that healthcare professionals strive to do their best even in the most challenging circumstances and do so with compassion.

Against the tide: A case of industrial relations transformation in the Indian coal sector

AbstractAlthough the scholarly debate on industrial relations (IR) transformation is inclined toward the conclusion that the IR transformation is bound to take place with changes in the surrounding business environment, we observe a few exceptions in each economy. The current study investigates one of such curious IR contexts, that is, the Indian coal sector. We rely on the ‘logic of the action’ framework and the IR transformation measures to assess the sector at an aggregate and micro level. The coal sector in India consists of a mix of both permanent and informal workforce. With respect to the permanent workforce, we analysed the collective bargaining agreements spanned over five decades (1975–2021). For the informal workforce, we analysed the recommendations of the HPC on wages and working conditions, the provisions of relevant legislation, internal circulars of coal companies and important judicial pronouncements. Our analyses revealed vast differences in wages and working conditions between the permanent and informal workforce. Despite a significant decline in the permanent workforce, they could negotiate better terms as the growing size of the informal workforce was yet to form a collective bargaining mechanism for better wages and working conditions. These results are indicative of a paradox which needs to be explored further. Our study advances the thesis of adaptive state capitalism in the coal sector through functional and numerical flexibility despite a politicised multi‐union model in India.

An optimization approach for hybrid workflows in platform-enabled private service marketplaces

The future of work is likely to include private platform-enabled marketplaces which remain a new, fertile ground for research. This paper focuses on hybrid workflows which utilize the expertise of in-house (IH) and on-demand (OD) workers to perform complex knowledge intensive tasks under service constraints. Our primary contributions are in identifying and modeling an innovative application of OR in the new economy, proving its complexity and proposing a high-quality heuristic. We formulate a scenario-based mathematical programming model of a private talent marketplace for Knowledge Intensive Business Services (KIBS). This model considers uncertainty in task, worker, and OD marketplace characteristics. Problem complexity is illustrated. We develop a simplified queuing theory-based model of PKIBS to characterize the structure of the OD marketplace. Propositions from the queueing model inform IH workforce size, IH and OD workforce composition, and OD pricing decisions. A Tabu-based One Period Look Ahead heuristic based on propositions from the simplified queuing theory-based model is proposed. Heuristic performance is evaluated using a problem upper bound and MIP solution for small problems, and experiments based on a cyber security use case. Results illustrate the mix of OD and IH workforce and sophisticated hybrid workflows for different market conditions.

Employment Protection, Workforce Mix and Firm Performance

Abstract We measure the impact of employment protection reduction in an uncertain framework on firms’ hires and performance, exploiting the Italian 2015 Jobs Act. Results indicate that firms (1) stabilize workforce mainly through contract transformations of low-tenure and low-human-capital incumbent workers performing high-physical and low-intellectual tasks; (2) apply a cost-saving strategy that increases profits and decreases value added per-head. Effects are stronger among non-exporting and non-innovative firms. Our evidence casts doubts on the effectiveness of employment protection reductions in enhancing productivity in the long run.

Low-Value Care De-implementation: Practices for Systemwide Reduction

Summary Despite a growing body of evidence documenting the problem of low-value care, our understanding of how to effectively reduce or eliminate it remains limited. Through semistructured interviews with U.S. health care organizations with demonstrated experience and success in low-value care reduction, the authors sought to elucidate how different stakeholders across the system approach low-value care de-implementation in practice and the key strategies and actions used. The analysis identified four key phases of low-value care de-implementation: (1) plan and assemble, (2) identify and assess, (3) de-implement, and (4) evaluate and disseminate. De-implementation is an iterative, multiphased, multicomponent process marked by ongoing learning and feedback loops. Each organization approached low-value care de-implementation with a strong orientation toward experimentation and continuous improvement and as a central tenet of a broader organizational mission to improve health and health care value. To combat the complex drivers that facilitate and sustain low-value care provision, organizations adopted a range of strategies, resources, and tools to inform, implement, and drive their de-implementation efforts. Such features included, but were not limited to, senior leadership support and aligning low-value care initiatives with unifying organizational values and priorities; physician leadership and empowerment; de-implementation infrastructure supports across people, data, and technology; education and engagement opportunities for providers, patients, and staff; data-driven techniques to measure and track low-value care, benchmark performance, and embed or link de-implementation targets within payment, network design, and care pathways; and ongoing relations with internal teams and external stakeholders and partners to disseminate and scale de-implementation best practices. While health care organizations are complex and unique — with their own culture, workforce mix, resources, and priorities — these identified experiences and practices from organizations successful in de-implementation can inform and empower others across the health care landscape to act, innovate, and move the needle on systemwide low-value care reduction.

Nurses’ Role in Taking Care of Gestational Diabetes Mellitus Patients: A Qualitative Study

Introduction: Gestational Diabetes Mellitus (GDM) is becoming one of the major public health problems. It is important to screen the GDM and for the case to be managed by nurses. Nurses are needed to care for pregnant women with GDM, and the work experience of nurses is directly related to the assistance and quality of care provided. However, nurses face some barriers in understanding the GDM and providing good management thereof. This study explored the experiences of nurses of caring for GDM patients.Methods: This study was a phenomenological approach qualitative research. Participants were 10 nurses who provide care for pregnant women with GDM selected by purposive sampling technique with sampling criteria. Data analysis used the Colaizzi method.Results: There were five categories, e.g. empathy, inspiration to find ways to treat patients very well, feeling of ambivalence, self-preservation to develop potential, and the impact on the nurses of caring for GDM.Conclusion: Sustaining the nursing workforce and improving their working experiences are essential to meet the care needs of pregnant women with GDM. Nurses should understand to promote empathy, and there is a need to improve the job satisfaction and morale of nurses. At the institutional level, policy makers should make efforts to improve the nursing clinical practice environment, increase the nursing management role, the maternity nursing education and training, achieve a proper skill mix of the health workforce, and, overall, attract, prepare and sustain nurses regarding caring for pregnant women with high risk GDM.

Registered nurses\u2019 role experiences of caring for older stroke patients: a qualitative study

BackgroundWith China’s population ageing rapidly, stroke is becoming one of the major public health problems. Nurses are indispensable for caring for older patients with acute and convalescent stroke, and their working experiences are directly linked to the quality of care provided. The study aims to investigate registered nurses’ experiences of caring for older stroke patients.MethodsA qualitative descriptive design was adopted. Data were collected via semi-structured interviews with 26 registered nurses about their lived experiences of caring for older stroke patients. Thematic analysis was used to analyze the data.ResultsTwo main themes were identified. First, the nurses identified an obvious gap between their ideal role in elderly care and their actual practice. The unsatisfactory reality was linked to the practical difficulties they encountered in their working environment. Second, the nurses expressed conflicting feelings about caring for older stroke patients, displaying a sense of accomplishment, indifference, annoyance, and sympathy. Caring for older stroke patients also affects nurses psychologically and physically. The nurses were clear about their own roles and tried their best to meet the elderly people’s needs, yet they lack time and knowledge about caring for older stroke patients. The factors influencing their working experiences extend beyond the personal domain and are linked to the wider working environment.ConclusionsSustaining the nursing workforce and improving their working experiences are essential to meet the care needs of older people. Understanding nurses’ lived working experiences is the first step. At the individual level, nurse mangers should promote empathy, relieve anxiety about aging, and improve the job satisfaction and morale of nurses. At the institutional level, policymakers should make efforts to improve the nursing clinical practice environment, increase the geriatric nursing education and training, achieve a proper skill mix of the health workforce, and overall attract, prepare and sustain nurses regarding caring for older people in a rapidly aging society.

Employment Protection, Workforce Mix and Firm Performance

We measure the impact of employment protection reduction in an uncertain framework on firms' hires and performance, exploiting the Italian 2015 Jobs Act. Results indicate that firms (1) stabilize workforce mainly through contract transformations of low-tenure and low-human-capital incumbent workers performing high-physical and low-intellectual tasks; (2) apply a cost-saving strategy that increases profits and decreases value added per-head. Effects are stronger among non-exporting and non-innovative firms. Our evidence casts doubts on the effectiveness of employment protection reductions in enhancing productivity in the long run.

Legacy of COVID‐19 – the opportunity to enhance surgical services for patients with colorectal disease

The COVID-19 crisis has undoubtedly taken a toll on the care of patients with colorectal disease. Elective services, be that face to face contact, endoscopy or operating all but ceased during the pandemic.

A stochastic location model for designing primary healthcare networks integrated with workforce cross-training

Health posts aim to elevate the level of public health by providing primary health services. The effectiveness of a health post network depends on factors such as the number and location of health posts. The service quality in such networks can be improved by controlling the amount of congestion at the facilities. An important policy for decreasing operational cost of these networks is to consider a workforce mix of flexible and dedicated servers. This paper integrates the network design with workforce cross-training in the presence of congestion, where the queuing system at each health post is modeled by a set of multi-class M/G/m queues offering multiple service types. The problem is formulated as an integer nonlinear programming model, and a linearization method is used to solve it. A hypothetical case study illustrates how the model can be used, and interesting managerial insights are presented.

Access to Primary, Mental Health, and Specialty Care: a Comparison of Medicaid and Commercially Insured Populations in Oregon.

To describe how access to primary and specialty care differs for Medicaid patients relative to commercially insured patients, and how these differences vary across rural and urban counties, using comprehensive claims data from Oregon. Cross-sectional study of risk-adjusted access rates for two types of primary care providers (physicians; nurse practitioners (NPs) and physician assistants (PAs)); four types of mental health providers (psychiatrists, psychologists, advanced practice NPs or PAs specializing in mental health care, behavioral specialists); and four physician specialties (obstetrics and gynecology, general surgery, gastroenterology, dermatology). 420,947 Medicaid and 638,980 commercially insured adults in Oregon, October 2014-September 2015. Presence of any visit with each provider type, risk-adjusted for sex, age, and health conditions. Relative to commercially insured individuals, Medicaid enrollees had lower rates of access to primary care physicians (- 11.82%; CI - 12.01 to - 11.63%) and to some specialists (e.g., obstetrics and gynecology, dermatology), but had equivalent or higher rates of access to NPs and PAs providing primary care (4.33%; CI 4.15 to 4.52%) and a variety of mental health providers (including psychiatrists, NPs and PAs, and other behavioral specialists). Across all providers, the largest gaps in Medicaid-commercial access rates were observed in rural counties. The Medicaid-commercial patient mix was evenly distributed across primary care physicians, suggesting that access for Medicaid patients was not limited to a small subset of primary care providers. This cross-sectional study found lower rates of access to primary care physicians for Medicaid enrollees, but Medicaid-commercial differences in access rates were not present across all provider types and displayed substantial variability across counties. Policies that address rural-urban differences as well as Medicaid-commercial differences-such as expansions of telemedicine or changes in the workforce mix-may have the largest impact on improving access to care across a wide range of populations.

A dental workforce strategy to make Australian public dental services more efficient

BackgroundDental services can be provided by the oral health therapy (OHT) workforce and dentists. This study aims to quantify the potential cost-savings of increased utilisation of the OHT workforce in providing dental services for children under the Child Dental Benefits Schedule (CDBS). The CDBS is an Australian federal government initiative to increase dental care access for children aged 2–17 years.MethodsDental services billed under the CDBS for the 2013–2014 financial year were used. Two OHT-to-dentist workforce mix ratios were tested: Model A National Workforce (1:4) and Model B Victorian Workforce (2:3). The 30% average salary difference between the two professions in the public sector was used to adjust the CDBS fee schedule for each type of service. The current 29% utilisation rate of the CDBS and the government target of 80% were modelled.ResultsThe estimated cost-savings under the current CDBS utilisation rate was AUD 26.5M and AUD 61.7M, for Models A and B, respectively. For the government target CDBS utilisation rate, AUD 73.2M for Model A and AUD 170.2M for Model B could be saved.ConclusionAn increased utilisation of the OHT workforce to provide dental services under the CDBS would save costs on public dental service funding. The potential cost-savings can be reinvested in other dental initiatives such as outreach school-based dental check programmes or resource allocation to eliminate adult dental waiting lists in the public sector.

What factors are associated with dental general anaesthetics for Australian children and what are the policy implications? A qualitative study

BackgroundDental general anaesthetics undertaken on young children are amongst the most common of all potentially preventable hospitalisations of children in Australia. They are costly for families and the community and entail some risk. The aim of the study was to explore the views of stakeholders about factors associated with children’s dental general anaesthetics in Victoria, Australia and to identify policy implications.MethodsInterviews with stakeholders were used to develop a framework of factors. Interview data were subject to qualitative analysis, informed by Interpretative Phenomenological Analysis.ResultsEight themes that encompassed 30 main factors were identified through focused discussions with 16 stakeholders. While the safety of dental general anaesthetics has improved and mortality rates are low, side effects are common. Push factors for children’s dental general anaesthetics include a perceived greater ‘child-focus’; preferred models of care; low oral health literacy; parent guilt; convenience; and some dentists reluctance to treat high needs children in the clinic. Factors that may decrease the prevalence of dental general anaesthetics include: prevention of dental caries; using alternative approaches; an appropriate workforce mix; enhancing oral health literacy; and development of guidelines.ConclusionThe prevalence of hospitalisation of children to treat dental caries is increasing. Many factors influence the prevalence of paediatric dental general anaesthetics - relating to the child, parent, oral health professional, financial impact, health risk, and accessibility to facilities. There are quality of care and convenience benefits but also high costs and possible health risks. Family, workforce and health system factors have been identified that could decrease the prevalence of paediatric dental general anaesthetics.

Shaping the police workforce: a state-of-the-art literature review

PurposeThe purpose of this paper is to review the evidence about the factors shaping the police workforce, commissioned by the Scottish Police Authority and Scottish Institute for Policing Research.Design/methodology/approachThe paper uses the theory of strategic fit to assess the available evidence relating to reshaping the police workforce and brings together the most relevant recent reviews of police organisations and empirical studies on these issues. The use of the theory enabled the strategies that have been adopted by police agencies in recent years to be evaluated in relation to the current political and economic environment.FindingsThe authors find that here is considerable uncertainty and while there has been previous discussion on the benefits of larger or smaller forces there is not robust evidence that a particular force size is optimal for either efficacy or efficiency, although very small forces may struggle in some ways. There is also mixed evidence about whether increasing police organisation resourcing to allow more officers to be employed reduces crime levels, and there is a relative lack of evidence about the impact this has on the other areas of community life in which police are involved.Research limitations/implicationsThere are major weaknesses in research relating to police organisational reform: there is no accepted theory of police reform, no accepted method as to how such a reform should be evaluated nor have there been any comparative studies of earlier police civilianisation programs (Braithwaite, Westbrook and Ledema, 2005).Originality/valuePrevious work on this topic often focuses on which organisational structure – whether in terms of workforce mix or size – is most efficient or effective. This research takes an alternative perspective and argues for a shift in the research agenda to take account of the friction involved in processes of organisational change, both in order to build a stronger research understanding of these important aspects of change and to more effectively inform policy. The paper provides a basis for the development of theories for understanding police reform in general – and workforce restructuring in particular – alongside appropriate methods for researching it.

Strategies of health workforce retention in rural areas of seven countries of francophone Africa.

Many countries face challenges in terms of number, skill mix, quality and distribution of the health workforce. This paper provides an overview of interventions focusing on retention adopted over the last decade in seven countries of francophone Africa. We assessed these interventions with respect to WHO guidelines and evaluated the extent of application of these recommended policies. This study was conducted according to a comparative multiple case-study design and comprised two phases. First, seven country reports were consulted to provide a mapping and preliminary analysis of the interventions. Secondly, an analytic synthesis was prepared by systematically and deliberately comparing and contrasting country cases in order to draw higher-level conclusions. This comparative analysis indicated that some WHO guidelines are introduced less often than others and HRH retention policies are rarely envisaged within coherent ?bundles' of interventions. This analysis identifies the efforts to develop local (informal) strategies tailored to the context, while official policy-making often remains a standardized exercise, which does not take context-specific features into account. Moreover, little information is available on the implementation and effectiveness of existing policies. The study stresses the importance of two key issues for the design of effective policies: the availability of sound data, as well as monitoring and evaluation structures, and the creation of a supportive and coherent political environment, focused on country-driven, realistic policy-making based on contextual problem identification and actual needs. This paper also suggests that good practices are often the result of local adaptations, rather than the close adoption of standardized guidelines. Therefore, in order to be effective, international guidelines must be complemented by locally acquired and fully appropriated knowledge.

Airport ground workforce planning with hierarchical skills: a new formulation and branch-and-price approach

We address the problem of strategic workforce planning for airport ground staff. The goal is to find a minimum workforce mix that satisfies a target coverage rate with respect to a given demand profile. Based on the classical tour scheduling problem, we propose a new formulation with hierarchical skills in which staff with higher level skills is permitted to cover demands of lower levels. A branch-and-price approach is proposed to solve the model. Numerical experiments based on real-world demand data demonstrate that our approach can efficiently produce near-optimal solutions to the model.

Clinical nonlicensed personnel in U.S. hospitals: Job trends from 2010 to 2015

BackgroundDespite the large numbers in health care industry, little is known about the clinical nonlicensed personnel (CNLP) in U.S. hospitals and how their staffing has changed over time. PurposeThe purpose of this analysis is to better understand the conformation and recent trends in CNLP staffing in U.S. hospitals from 2010 to 2015. MethodsUsing Premier's OperationsAdvisor database, we examined trends in staffing of 25 CNLP jobs and graduate nurses (GNs) in U.S. hospitals and by hospital units, including medical–surgical units, outpatient units, and emergency departments, from 2010 to 2015, based on their skill levels. We measured CNLP and graduate nurse staffing using the average number of full-time equivalents (FTEs) in each hospital. We performed statistical analysis to compare the changes in the number of FTEs between 2010 and 2015. DiscussionOver the 6-year period from 2010 to 2015, we observed declining trends in the average number of high-skill and middle-skill CNLP FTEs by 22% and 7%, respectively, and increases in the average number of low-skill and graduate nurse FTEs by 38% and 117%, respectively. This skill mix shift appears to be most pronounced in emergency departments. ConclusionChanges in staffing levels and the skill mix of the hospital workforce warrant further study to understand both the reasons behind the observed changes and their effects on health outcomes. Although labor efficiency is an important goal, it is also critically important to assess whether reductions and/or the skill mix shifts among support staff impact nurse workload and, by extension, patient safety.

The structure of nursing: a national examination of titles and practice profiles.

To identify the practice patterns of the Australian registered nurse workforce according to position title and to map these disparate titles across all jurisdictions of the country. Effective nursing workforce planning can contribute to improved patient care and increased effectiveness and efficiency of healthcare systems. The prevailing approach to nursing workforce planning focuses on number of nursing staff needed in relation to the number of patients. The level of expertise and skill mix of registered nurses as a variable in workforce planning is rarely considered. A national cross-sectional electronic survey of registered nurses in Australia was conducted using the validated Advanced Practice Role Delineation tool developed from the Strong Model of Advanced Practice. The study involved a sample of 5599 registered nurses. Sixty-six nursing position titles nationally were mapped using cluster analysis technique and gave rise to seven clusters of equivalent Australian jurisdictional nursing position titles and practice profiles. Effective workforce policy and planning is reliant upon access to reliable evidence. This research is an international first in that it has provided comprehensive knowledge of the clinical level and practice profiles of a national nursing workforce. Effective, patient-centred workforce planning must consider both the numerical and expertise mix of a nursing workforce. This research provides Australian health service and policy planners with evidence-base knowledge of the nursing workforce. Internationally, this research establishes a platform from which to develop validated tools and established processes to support replication of this research.

Comparing trends in the job mix of the health workforce in Europe

Comparing trends in the job mix of the health workforce in Europe

Mathematical models and solution approach for cross-training staff scheduling at call centers

Call centers face demand variations over time across multiple service categories and typically employ a cross-trained workforce with flexible schedules to hedge against these fluctuations. In practice, it is often impossible to cross-train agents in each category, thus partial and limited cross-training are the norm. This adds another layer of complexity to determine the optimal mix of cross-trained workforce (on top of the shift and tour schedules) and has created a challenging problem in the optimization of staff schedules.To solve this problem to its fullest extent, an integer program that addresses cross-training, shift schedule, days off and break assignments across multiple service categories is proposed. The model is hard to solve and a two-phase sequential approach is developed. The first phase is to find the optimal mix of the workforce, i.e., the categories to be cross-trained and the time periods in which they are to be deployed; the second phase is a smaller staff scheduling model to find the composition of the workforce and to construct their weekly tours. For all the test cases, which are of practical sizes, the two-phase sequential approach provided better solutions than the solution of the original model with a state-of-the-art commercial solver subject to imposed time limits.Experimental results with data from a call center with nine categories clearly demonstrate the significance of cross-training. In fact, partial limited cross-training, where 30% of staff is cross-trained with two skills or 10% of staff is cross-trained with three skills, could result in considerable cost savings; however, these savings could diminish quickly with the increase of efficiency loss in secondary skills. Experiments also suggest that cross-training could be a more effective approach than part-time shifts to hedge against fluctuations across service categories.