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Optimal Nursing Home Workforce Planning Under Nonstationary Uncertainty
Employee staffing and scheduling are critical aspects of resource management in labor-intensive, customer-centric service organizations. This thesis investigates the optimal decision-making process for these critical tasks in the presence of non-stationary uncertainty, such as case-mix resident need, recommended staffing hours, and potential staffing turnover, a challenge prevalent in various domains, including healthcare and nursing home management.
The research begins predicting resident needs accurately. For this purpose, we present a novel Bayesian modeling approach to predict nursing home need-based resident census and staffing time. The resultant time series data of need-based resident census and staffing time are nonstationary with potential correlations between resource utilization groups. We thus propose Bayesian latent variable models with time-varying latent states to capture the dynamic patterns of resident service needs. We demonstrate the superiority of the proposed Bayesian prediction models by comparing their forecasting performance with several popular benchmark models, using historical assessment and aggregate staffing data from representative nursing homes.
The thesis further incorporates a rolling-horizon scheduling approach that integrates a periodically evolving Bayesian forecasting method into a series of stochastic look-ahead decision actions over multiple periods. To deal with the workforce scheduling with nonstationary demand uncertainty, we introduce a stochastic lookahead optimization framework that executes two-stage stochastic programming periodically along a rolling horizon to address the evolving non-stationary uncertainty. We obtain two-stage stochastic programming models to design effective work schedules, specifically assigning nurses to various shifts while balancing the staff workload and accommodating fluctuating resident needs.
We finally introduce the SNHSSO framework (stochastic nursing home staffing and scheduling optimizer), encompassing data modeling and addressing multi-period, multi-uncertainty, and multi-objective staffing and scheduling challenges. When the SNHSSO Optimizer is executed with the provided inputs, it generates recommended staffing decisions for longer planning horizons, as well as schedules and contingency plans for shorter planning horizons. These adapted decisions and adjusted parameters are archived for future reference, facilitating subsequent iterations of the process. SNHSSO optimizes caregiver assignments by taking into account probabilistic forecasts of service requirements, resident acuity, and staff turnover, all within two-stage stochastic mixed integer linear programs. Our approach leverages a scenario-based rolling horizon methodology to effectively solve the SNHSSO model.
The empirical foundation of this work is built on case studies conducted using Minimum Data Set (MDS) data spanning five years from 2014 to 2018 in Indiana nursing homes.
- Doctor of Philosophy
- Industrial Engineering
- West Lafayette