Planning process

Workload determination

Belgian hospitals get recognition from the government for a number of beds per type (e.g. surgery, intensive care, internal nursing, etc.). The hospitals get nancing from the government based on that number of beds, and each type of bed (dependent on the discipline) gets dierent nancing. Therefore, the hospitals need to register all kinds of data whereupon the government bases itself to allocate the number of beds. These data are called the MZG (Minimale Ziekenhuisgegevens) and are formed by the registration of dierent activities performed in the hospital. The MZG are split up in MKG (Minimale Klinische Gegevens) and MVG (Minimale Verpleegkundige Gegevens). The MKG are about intensity of care: how seriously ill are the patients and how much care do they need. The MKG are determined based on ICD-codes (International Statistical Classication of Diseases and Related Health Problems). The government looks what the average number of hospitalisation days is for each classication. This average is used as a standard to grant compensations for a hospital. The MVG reect the number of nurses and the amount of nursing activities in a hospital. Those numbers are matched with the MKG: the required number of nurses is dependent on the intensity of care.

The concept of MZG registration implies that the number of beds per type is xed for the hospital and thus out of their control. The nancing of the hospitals is as such determined by the MZG: based upon the number of beds allocated, they will get nance for a number of FTEs. In addition, the MZG serves as a control mechanism for the government: if they nance x number of FTEs, the nancing should eectively be spent on x number of FTEs as well. The government imposes a minimal occupation rate for the dierent type of beds as well. If this minimum is not reached for a certain bed type, the government will decrease the awarded number of beds of that type. Hence the hospital strives for an as high as possible occupation rate.

Stang requirements

At the level of the dierent wards, the xed number of beds together with the bed occupancy determines the number of FTEs needed. The minimal coverage requirements are more or less based on the MVG and the intensity of care. In the past, the hospital made use of predened

norm determinants which indicate how many early, late and night shifts were needed for each ward. These norms could only be adapted mid-term. The system of norm determinants is abandoned since a couple of years. The determination of minimal coverage requirements is in fact quite subjective and is dependent upon the feedback from the personnel as well. That is why there is a periodic review of the coverage requirements.

Roster generation

The hospital works with a cyclical roster, with a variable period. There are three shifts: early, late and night. Each ward has its own planner. Based on the current occupation (shortages or surpluses), an existing pattern is used or a new pattern is built to ll in the schedule. The procedure to build a cyclical roster is determined on the strategic level. When the planner builds a new cyclical roster - a new pattern in fact - it is rst checked by the personnel department for conformity with the working time legislation. Next, the roster needs to be approved by a committee consisting of the hospital board and the labour unions. Once approved, the roster can be unrolled in SP-Expert and can be used permanently. So, only when adaptations are made to a certain cyclical roster, it needs to go back to the committee for verication. Adaptations can be made to the work roster itself or due to, for instance, a change in employment of a certain nurse. The planner has however some room to do modications within a 100% roster. For instance, an approved cyclical roster of 8 weeks for one FTE can be switched to a cyclical roster of 16 weeks for two half-time workers, in which case one works while the other does not. This procedure also implies that it is up to the planner to build a cyclical roster. The software does not automatically generate a roster. The planner therefore relies on simulations and trial and error to see the impact on the roster and to nd a good solution.

Objectives and contraints

There is no automatic optimisation, since the roster is generated by the planner and not by the software. This means that no objectives are incorporated in the software. The objectives are either strategically determined or pursued by the planner. Strategic decisions are to hire qualied nurses to maintain a high service level and to have a oating unit of nurses in order to avoid temporaries and in this way to reduce cost. The planner will of course try to minimise understang and overstang. Each planner will also try to take nurse preferences into account, but is allowed to do this in his own way. In order to achieve fairness, there are counters in the

system that keep track of the number of early, late and night shifts per nurse. The planner tries to divide the shifts equally among the nurses.

The dierent rules and constraints are incorporated in the software. There are however no hard constraints, which means that the system will indicate a rule violation but will not prevent it. Most rules and constraints are due to labour legislation, hospital rules, the contract type and the skills of each nurse. Examples of constraints are the minimum and maximum shift length, minimal duration between two shifts (forward rotation), breaks during the shift, and so on. Of course, the stang requirements count as a constraint as well. An example of a hospital rule is the two minute rule. The working time can only start each quarter of an hour, but up to two minutes after the quarter of an hour is seen as working time too.

The actual scheduling and follow-up

The planning is entirely done in a manual way. Nurses are given a function and are assigned to a ward. Per shift or function, the planner enters the minimal coverage. The roster generated by the planner is entered in SP-Expert. There are two lines for every nurse: the planned line and the actual line. The actual line fed by the clocking system. Every night, the clocking times of the past 24 hours are read by the system. This way, the planner is notied when a nurse did not perform the shift as planned. For instance, a certain code appears when a nurse that had to work did not show up or when someone who should be at home came to work.

Via the web terminal module, a nurse can enter shift preferences. These shift preferences are signalled in SP-Expert, where the planner can unfold a third line (besides the planned and actual line) to see the preferences. The nurses know the required coverage for each shift in their ward and they can see how much early, late or night shifts are already planned. In this way, they will only ask for a certain shift or for a day o if they see that it will t the overall schedule. The planner will only accept these preferences if it ts the overall schedule, and it becomes visible in the web terminal whether the preference is accepted or rejected. This tool is thus very useful for the nurses, as they can easily ask for certain shifts as well as see their roster for a certain period. Furthermore, nurses can ask to take (annual) leave via the web terminal as well.

To deal with shortages, the hospital disposes of several oating units. First, there is a oating unit per sector which can stand in when necessary. Second, there is a central oating unit to deal with short term shortages. These people are thus very exible; for instance when someone

calls in sick, a nurse from this team has to stand in and will only know this the morning itself. These people work cross-sector but have to propose a preference for two sectors. Third, there is a reserve team for long term absentees. Those people will replace others for long periods, like six months.

When nurses do overtime, they have to indicate that when clocking out. It is up to the ward responsible to approve the overtime or not, in order to make sure nurses do not abuse the overtime system.

Reporting

SP-Expert generates some standard reports. The reports can easily be exported to Excel, which makes it very easy to analyse certain data. Examples of reports are the leave card, performance list, sick leave, overview of compensations, and so on. There is also a counter in the system that keeps track of some data, for instance the balance of leave, overtime, recuperative leave, and so on. Several reports are also visible for the employees in the web terminal, for example the performance list of the employees (so every employee can see when and how much he or she has worked), the leave card, their leave right, duty roster, and so on.