Simulation for Strategic Workforce Planning

Simulation for Strategic
Workforce Planning

SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com
Presenters
Claire Cordeaux
Executive Director, Healthcare SIMUL8
SIMUL8 Corporation
claire.c@SIMUL8.com
Brittany Hagedorn
SIMUL8 Healthcare Lead, North America
LEED AP
brittany.h@SIMUL8.com

Housekeeping
• Audio
• Q and A
• Recording available on
simul8healthcare.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

High Level
Planning for 24/7 primary care services to
support older people
• Likely demand for service?
• Capacity required?
• Impact on hospital beds?

Unscheduled Care Over 75s

In 5 years
0
50000
100000
150000
200000
250000
300000
350000
1 2 3 4 5
Increasing demand for unscheduled care for over 75s

In 5 years – if we bring in a Primary Care
Locality Hub – unscheduled care only
1 FTE utilized 30%
of time

Add Planned Care Activity

Before Locality Hub: Year 1-5
Emergency admission bed
utilization
Total bed utilization

After Locality Hub: Year 1-5
Emergency admission bed
utilization – average
occupancy dropped by 20
Total bed utilization dropped
7%

Staff Utilization
Year 1 – 1 FTE 84% utilized
Year 1- 5 – 1 FTE queue builds in
year 3

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MODELING OPERATIONS
Examples and Case Studies

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?

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

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

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.

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
PatientsinBeds
Minimum Average Maximum
Pre-Surgery Prep Beds Occupancy
0
1
2
3
4
5
6
7
NursesonDuty
Minimum Average Maximum
RNs to Handle Patient Load

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.

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.

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.

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.

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SIMULATING STAFF
Considerations in SIMUL8

Set Staff Availability
Select your
time block.
Flexible rotating schedule.
Factor in overlapping
shifts and breaks.

Option: Staff Behaviors
Specify how your staff will behave at the
end of their shift or when going on a break.

Option: Work to the Top of License
Select the most appropriate staff member for the task,
depending on which patient is needing attention.

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.

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

Interval Results: New for 2015!

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?

Using State Charts to Simulate Workforce

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?

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)

Simulation for Strategic Workforce Planning

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