In this paper, we consider a two-stage call center staffing model. In the first stage, the interval staffing levels are set under arrival rate uncertainty. In the second stage, these initial staffing levels are corrected to the right value based on more precise arrival rate information. We show that this problem is of newsvendor type, where the costs are the initial staffing costs plus the second stage adaptation costs. We show that we should initially staff according to a quantile of the distributional forecast, rather than the mean. It is also shown that the errors in staffing are approximately linear in the forecasting errors. This leads to the conclusion that the weighted sum of errors should be the error measurement in call center forecasting, since minimizing, it minimizes the total staffing costs. In special cases where the costs are symmetric for over- and understaffing, this is equivalent to minimizing the weighted absolute percentage error.

In response to the coronavirus disease (COVID-19) pandemic, the State of Maryland established a 250-bed emergency response field hospital at the Baltimore Convention Center to support the existing health care infrastructure. To operationalize this hospital with 65 full-time equivalent clinicians in less than 4 weeks, more than 300 applications were reviewed, 186 candidates were interviewed, and 159 clinicians were credentialed and onboarded. The key steps to achieve this undertaking involved employing multidisciplinary teams with experienced personnel, mass outreach, streamlined candidate tracking, pre-interview screening, utilizing all available expertise, expedited credentialing, and focused onboarding. To ensure staff preparedness, the leadership developed innovative team models, applied principles of effective team building, and provided “just in time” training on COVID-19 and non-COVID-19-related topics to the staff. The leadership focused on staff safety and well-being, offered appropriate financial remuneration, and provided leadership opportunities that allowed retention of staff.

The Hospital Surge Preparedness and Response Index is an all-hazards template developed by a group of emergency management and disaster medicine experts from the United States. The objective of the Hospital Surge Preparedness and Response Index is to improve planning by linking action items to institutional triggers across the surge capacity continuum. This responder tool is a non-exhaustive, high-level template: administrators should tailor these elements to their individual institutional protocols and constraints for optimal efficiency. The Hospital Surge Preparedness and Response Index can be used to provide administrators with a snapshot of their facility’s current service capacity in order to promote efficiency and situational awareness both internally and among regional partners.

Ontario has the highest proportion of for-profit nursing homes in Canada. These facilities, which are known in Ontario as long-term care (LTC) homes, offer 24-hour custodial as well as nursing care to individuals who cannot live independently. Increasingly, they are also operating as members of multi-facility chains. Using longitudinal data (1996–2011) from the Residential Care Facilities Survey (n = 627), our analysis revealed discernible differences in staffing levels by profit status and chain affiliation. We found for-profit LTC homes – especially those owned by a chain organization – provided significantly fewer hours of care, after adjusting for variation in the residents’ care needs. Findings from this study offer new information on the impact of organizational structure on staffing levels in Ontario’s LTC homes and have implications for other jurisdictions where a growing presence of private, chain-affiliated operators has been observed.

This study examined how nursing home facility ownership and organizational characteristics relate to emergency department (ED) transfer rates. The sample included a retrospective cohort of nursing home residents in the Vancouver Coastal Health region (n = 13,140). Rates of ED transfers were compared between nursing home ownership types. Administrative data were further linked to survey-derived data of facility organizational characteristics for exploratory analysis. Crude ED transfer rates (transfers/100 resident years) were 69, 70, and 51, respectively, in for-profit, non-profit, and publicly owned facilities. Controlling for sex and age, public ownership was associated with lower ED transfer rates compared to for-profit and non-profit ownership. Results showed that higher total direct-care nursing hours per resident day, and presence of allied health staff – disproportionately present in publicly owned facilities – were associated with lower transfer rates. A number of other facility organizational characteristics – unrelated to ownership – were also associated with transfer rates.

We sought to estimate the incidence of long-term care (LTC) placement and to identify resident- and facility-level predictors of placement among older residents of designated assisted living (AL) facilities in Alberta, Canada. Included were 1,086 AL residents from 59 facilities. Research nurses completed interRAI-AL resident assessments and interviewed family caregivers and administrators. Predictors of placement were identified with multivariable Cox proportional hazards models. The cumulative incidence of LTC admission was 18.3 per cent by 12 months. Significantly increased risk for placement was evident for older residents and those with poor social relationships, little involvement in activities, cognitive and/or functional impairment, health instability, recent falls and hospitalizations/emergency department visits, and severe bladder incontinence. Residents from larger facilities, with an LPN and/or RN on-site 24/7 and with an affiliated primary care physician, showed lower risk of placement. Our findings highlight clinical and policy areas where targeted interventions may delay LTC admissions.

Hospitalization of nursing home residents can be futile as well as costly, and now evidence indicates that treating nursing home residents in place produces better outcomes for some conditions. We examined facility organizational characteristics that previous research showed are associated with potentially avoidable hospital transfers and with better care quality. Accordingly, we conducted a cross-sectional survey of nursing home directors of care in Vancouver Coastal Health, a large health region in British Columbia. The survey addressed staffing levels and organization, physician access, end-of-life care, and factors influencing facility-to-hospital transfers. Many of the modifiable organizational characteristics associated in the literature with potentially avoidable hospital transfers and better care quality are present in nursing homes in British Columbia. However, their presence is not universal, and some features, especially the organization of physician care and end-of-life planning and services, are particularly lacking.

In 2005, against a background of expanding radiotherapy services and increasing demands on therapy radiographers, the UK radiotherapy managers group were concerned about vacancies and low establishments impacting on service delivery, and lack of guidance on staffing establishments. They undertook a survey and work to develop a staffing framework, also to highlight the criticality of adequate radiographer staffing to radiotherapy, both in service delivery and treatment safety. The survey, of 2004 services and staffing, aimed to see if commonality existed in establishment size related to services delivered, and whether staffing levels correlated with activity levels.

Reasonable parity in the total number of funded WTE establishment for “core” services, per centre, per planned daily Linear Accelerator (linac) hour of service was shown. The resultant staffing formula for core services is 1.33 WTE per linac hour. This includes radiographers, assistants, helpers and others contributing to the core activities. The average linac day length was 8h. The average fraction time was 11min with a range of 1.7–5.7 fractions per hour, the variations in activity rate correlating with actual staffing levels. The formula was tested in three departments and example staffing models constructed to help in operationalising the four-tier career structure.