Staggered work shifts: a way to downsize and restructure an emergency department workforce yet maintain current operational performance

Starting from the last decade of the twentieth century, most hospital Emergency Department (ED) budgets did not keep up with the demand for ED services made by growing populations and ageing societies. Since labor consumes over 50% of the total monies invested in EDs and other healthcare systems, any downsizing, streamlining and reorganization plan needs to first address staffing issues such as determining the correct size of the workforce and its work shift scheduling. In this context, it is very important to remember that downsizing certainly does not mean a general cut-across-the-board. This study shows that a selective downsizing process in which each resource is treated separately (increasing the work capacity of some resources is also possible), based on its unique contribution to the overall ED operational performance, can approximately maintain current ED operational measures in terms patient length of stay despite an overall reduction in staff hours. A linear optimization model and a heuristic iterative simulation based algorithm are used in this study for scheduling the resources' work shifts, one resource at a time. The algorithm was tested using data that were gathered from five general hospital EDs.