Simulation for Strategic Workforce Planning

SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com

Presenters

Claire CordeauxExecutive Director, Healthcare SIMUL8 SIMUL8 Corporationclaire.c@SIMUL8.com

Brittany HagedornSIMUL8 Healthcare Lead, North AmericaLEED APbrittany.h@SIMUL8.com

SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com

Housekeeping

• Audio

• Q and A

• Recording available on

simul8healthcare.com

SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com

• How simulation can help plan and effectively deploy workforce

• Case studies from UK and US• “How to?” useful software features which can

help

“How do I know the workforce I need?”

Planning for Workforce

•Population demand

•Activity requirements

•Workforce capacity

•Cost

High level

•Managing hour by hour operations

•Matching competence to task

•Staff shifts and availability

Operational• Current workforce

• Forecasting leavers and joiners

• Matching to demand

• Planning and commissioning education and training/recruitment to meet needs

Workforce availability

SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com

High Level

Planning for 24/7 primary care services to support older people

• Likely demand for service?• Capacity required?• Impact on hospital beds?

SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com

Unscheduled Care Over 75s

SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com

In 5 years

0

50000

100000

150000

200000

250000

300000

350000

1 2 3 4 5

Increasing demand for unscheduled care for over 75s

SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com

In 5 years – if we bring in a Primary Care Locality Hub – unscheduled care only

1 FTE utilized 30%

of time

SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com

Add Planned Care Activity

SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com

Before Locality Hub: Year 1 -5

Emergency admission bed

utilizationTotal bed utilization

SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com

After Locality Hub: Year 1 -5

Emergency admission bed

utilization – average

occupancy dropped by 20

Total bed utilization dropped

7%

SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com

Staff Utilization

Year 1 – 1 FTE 84% utilized

Year 1- 5 – 1 FTE queue builds in

year 3

Click to edit Master title styleClick to edit Master title style

SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com

MODELING OPERATIONSExamples and Case Studies

SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com

Typical Questions

Evaluate Changes– What would happen if we changed the duration of a shift?– What will happen if we modify a protocol?– How do we need to staff as our volumes change?

Roles & Responsibilities– What is the ideal skill mix for the new unit?– Who should be responsible for tasks that a variety of different

people could perform?

Manage Costs– How can I minimize the overtime staff have to work?– At what point do we need to call in extra support?

SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com

How do we model staffing at an operational level?

First approach: Model activity and use that to estimate staffing needs.

Model the Process Examine Results

3.0 FTE

Determine Needs

SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com

How do we model staffing at an operational level?

Second approach: Staff availability constraints the process and impacts throughput.

Set Availability and Assign Tasks Examine Results

SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com

Example: Staffing Ratios

• Environment – Operating Room.• Pain point – Patients can’t get in, but the operating rooms

themselves are frequently sitting idle.• Key inputs – OR schedule, Prep and recovery beds, Staffing ratios.• Key results – Patient delays & OR utilization.

Approach: Model the patient flow process and then use the simulation’s results to determine how many staff are needed, based on standard patient-to-nurse ratios.

SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com

Example: Staffing Ratios

In this case, we didn’t have to model the staff directly. Because we knew that we could call in staff if we needed them, we assumed a staff-to-patient ratio of 4:1 and used bed occupancy as a proxy.

0

5

10

15

20

25

Pa

tie

nts

in

Be

ds

Minimum Average Maximum

Pre-Surgery Prep Beds Occupancy

0

1

2

3

4

5

6

7

Nu

rse

s o

n D

uty

Minimum Average Maximum

RNs to Handle Patient Load

SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com

Example: Staffing Utilization

• Environment – Outpatient clinic.• Pain point – Nurses are “never available” when needed.• Key inputs – Schedule and skill mix.• Key result – Utilization.

Approach: Since we believed the nurses were a constraint on patient throughput and were causing delays in care, they were modeled directly as a “resource” in the simulation. This resource was required in order to complete specific activities.

SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com

Example: Staff Utilization

The simulation showed that less than 30% of nurses’ time was utilized for clinical tasks.

Validation was required in order to find out where the discrepancy was. After further interviews and observation, it turned out that the model was correct – BUT they were regularly getting pulled into low priority tasks and so were not readily available when needed.

SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com

Example: Staffing Model

• Environment – Procedure clinic.• Pain point – Need to handle 2x the number of patients without

adding any new FTEs.• Key inputs – Patient process, Staff skill mix.• Key result – Throughput.

Approach: Lay out the individual tasks that need to be completed and then test various combinations of task assignments, in addition to anticipated Lean improvement efforts. Continue testing until desired throughput is achieved.

SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com

Example: Staffing Model

Through an iterative process, many combinations of roles and responsibilities were tested. The tasks that needed to be completed were assigned to either specific skill levels (LPN, RN, CRNA) or to the pool of staff as a whole.

Click to edit Master title styleClick to edit Master title style

SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com

SIMULATING STAFFConsiderations in SIMUL8

SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com

Set Staff Availability

Select your

time block.

Flexible rotating schedule.

Factor in overlapping

shifts and breaks.

SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com

Option: Staff Behaviors

Specify how your staff will behave at the

end of their shift or when going on a break.

SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com

Option: Work to the Top of License

Select the most appropriate staff member for the task,

depending on which patient is needing attention.

SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com

Pooling: Shared Responsibilities

Sometimes, there are multiple individuals who

could perform the same task, or who act as

“back up” when the day gets really busy.

SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com

Key Operational Results

• Staff utilization• Time spent traveling• Average/Max number of busy individuals• Staffing costs

SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com

Interval Results: New for 2015!

SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com

Workforce Planning: typical questions

• Are the right skills available to meet demand when I need them?

• How many nurses should we train now to ensure skills are available in 5 years?

• Do we need to recruit from another region?

SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com

Using State Charts to Simulate Workforce

SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com

Matching Demand and Supply

• What if all providers decided to adopt the Primary Care Locality Hub Concept in a 5m population?

• How many specialist nurses would we need in 5 years time?

SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com

QUESTIONS

Please forward any topics you would like to see covered to claire.c@simul8.com

Continue the discussion on SIMUL8 in Health – LinkedIn Group

April Workshop: Tue April 28, 11am (ET)