An interdisciplinary team at IMT Atlantique is currently working on a project to develop an innovative tool for managing hospital staff schedules, including socio-organizational conditions. The aim is to improve not only the satisfaction of care teams, but also the quality of care.
In the current hospital debate, one subject has tended to fly “under the radar”: the management of care team schedules - and in particular those of the 700,000 or so nurses and care givers. Yet these schedules play a key role in hospital operations. A team from IMT Atlantique is looking into this issue, as part of a research project called OptiHSoins (Optimisation plus Humaine des plannings des établissements de Soins - more humane optimization of scheduling in healthcare establishments). The aim is to develop an innovative software tool that facilitates the management of these schedules, by integrating not only the practical constraints encountered by care staff, but also the human aspects and specificities of their mission. The end result should be a triple benefit: enabling healthcare managers to devote more time to their teams; improving the quality of working life and staff cohesion; and contributing to the quality of care.
A dozen researchers and three hospitals
OptiHSoins is an interdisciplinary project, bringing together teams from two of the institution's departments: experts in Operations Research (1) from the Département Automatique, Productique et Informatique (DAPI) - laboratoire LS2N, and experts in sociology and management from the Département Interdisciplinaire de Sciences Sociales (DI2S) - laboratoires LEMNA et CENS.
Other academic partners include the University of Angers via the Laboratoire Angevin de Recherche en Ingénierie des Systèmes (LARIS) in collaboration with the Université Catholique de l'Ouest (UCO) and the Groupe de Recherche Angevin en Économie et Management (GRANEM), and the University of Tours via the Laboratoire d'Informatique Fondamentale et Appliquée de Tours (LIFAT). In all, some ten associate professors, plus a number of PhD and post-doctoral students. Three hospitals (Nantes, Tours and Angers) are project partners. OptiHSoins will run for 4 years, starting in January 2024, with ANR funding of 455,000 euros.
Odile Bellenguez, Michel Devigne, Romain Lonceint and Sarah Ghaffari
Numerous parameters to take into account
« In a hospital, scheduling is a particularly tricky business », points out Odile Bellenguez, a professor at DAPI and one of the project leaders. « Not only do we have to provide round-the-clock care and maintain its quality, but we also have to take into account the very wide diversity of missions and statuses, respect the allocated budget... and constantly deal with unforeseen events. This multitude of parameters greatly increases the 'mathematical' complexity of the task for managers. »
« Not to mention the fact that some caregivers, disappointed by the lack of recognition for their work, tend to sacrifice their personal lives less than in the past », adds Sarah Ghaffari, an associate professor at DI2S. « Add to that difficult employment conditions, and a chronic shortage of staff, and the slightest absence or departure becomes a headache for the healthcare manager, who has to limit disruption to the organization of work. As a result, scheduling is a constant challenge for managers, who are no longer able to support their teams. »
As for the time management softwares or Excel spreadsheets available on the market, they don't take into account personal obligations - a parent who has to pick up his child after school, for example - nor individual preferences in terms of working hours, vacations, etc.
In each hospital department, a general schedule for the year is drawn up and validated with the unions, then broken down month by month. But practically, most of the work is done on a day-to-day basis, dealing with absences and unforeseen circumstances. Sometimes, this means working short-staffed. Odile Bellenguez explains: « Depending on the situation, professionals may call on pre-designated substitutes, or ask for the services of colleagues on leave. Each hospital has its own rules. » At the Nantes hospital, for example, a system known as “portholes” provides a pool of volunteers for replacements. In addition, each hospital has its own “white plan”, enabling it to rapidly mobilize a wide range of resources in the event of an influx of patients or an exceptional health situation.
The reign of “resourcefulness”
As a result, the hospital can only function at the cost of a quasi-permanent gymnastics exercise, at all levels. “On a day-to-day basis, the question of planning is constantly present in the background,” sums up Sarah Ghaffari.
To achieve its goals, OptiHSoins has a fairly well-defined roadmap. The first phase of the project is the diagnostic one, carried out by humanities and social sciences researchers. The program included on-site observation sessions, in-depth interviews with the players involved - in particular with a dozen executives... The next stage, involving both departments, will consist of building models that integrate these field observations. The RO team will then develop a flexible scheduling tool that can be adapted to different hospital departments.
The whole process will be carried out in close collaboration with hospital staff. “The result must be intelligible to everyone,” adds Odile Bellenguez. « The people involved have to understand why this or that organization was chosen. » As Sarah Ghaffari notes, « the tool must not become a black box of which we know nothing. Staff must retain control. » Ultimately, the aim is not to deliver a finished product that can be marketed, but a proof of concept that software publishers can use.
The equity imperative
The OptiHsoins approach has already highlighted a number of key points. First and foremost, the close interweaving of human factors - with their habits, desires, projects, etc. - and “technical” or regulatory issues in the design of schedules. Another factor to take into account is the multiplicity of tasks, sometimes unsuspected, that fall to caregivers, any one of which could dismantle the machine.
Finally, equity stays an important notion. « Every caregiver must be able to benefit from recognition of his or her own constraints - picking up children from school or looking after an elderly relative, for example », stresses Sarah Ghaffari. « Priorities in this area vary from one individual to another. Not to mention the fact that attitudes are changing: seniority benefits, for example, are often called into question. To build a schedule accepted by everyone, it has to be deemed fair. »
This acceptability of planning and its harmonious implementation are key factors in the quality of working life and team cohesion. Ultimately, it has a major influence on the efficiency of the establishment and the quality of the care provided. Schedule management is therefore a major challenge for hospitals. It offers a serious avenue for progress, at a time when the health of the future is a question coming to the fore.
The project is therefore in line with the theme of optimization, which cuts across all disciplines, and which the CNRS has chosen to focus on in 2024. OptiHSoins will be presented on October 18th at the CHU in Nantes, during the 4th paramedical symposium on health research and innovation.
- Operational Research (OR) refers to all methods and techniques aimed at finding the optimum choice to achieve a result. It is a discipline at the frontier of applied mathematics and information management. It is part of the field of decision support.
by Pierre-Hervé VAILLANT