The purpose of this project is to design a user friendly system to support decisions related to the scheduling process of nursing resources at Stellenbosch Hospital on a regular basis. The following objectives are followed to achieve the purpose: provide decision maker with a tool to support decisions; improve and enhance nurse utilization; involve nurses in scheduling; improve worker morale.
ENGLISH ABSTRACT: Providing sufficient healthcare to all South African citizens is of significant concern to government. Major problem areas lie in the prevention and control of epidemics, allocation of resources and health systems management. The majority of the government facilitated hospitals in South Africa experience difficulty in attaining health care targets due to these problems. Stellenbosch Hospital, an 85- bed, non-profit public facility that serves a community of 170 000 people, is no exception. A root cause analysis revealed that an insufficient nurse scheduling process is the underlying cause of numerous problems and that a lack of worker morale is the largest predicament at Stellenbosch Hospital. Different motivational theories are investigated and it is concluded that worker morale at the hospital can be improved by empowering nurses to gain more control over schedules, and that the nurse scheduling process can be enhanced by supporting nurse scheduling with a decision support tool. The purpose of the decision support tool is scoped to deal with day and night scheduling and nurse-to-ward assignments particularly, as this is largest amount of work for the unit managers. Additionally it is decided to involve nurses in the annual day and night schedule as well as the ward preferences, as this has the most significant impact on nurses’ work lives. The inputs and expected outcomes of the decision support tool are discussed and the development platform was chosen to be a combination of Visual Basics and Microsoft Excel, as these programs are powerful and freely available. After careful consideration of different nurse scheduling methods linear programming and a self-developed algorithm were chosen by making use of the Analytical Hierarchy Process. The day and night schedule is solved with an integer programming model, with the drawback being the inflexibility of the fixed quarters which nurses can select, as well as the rigidity of the model and the suboptimal solution which needs rounding. The day and night scheduling results are an input to the self-developed algorithm, which imitates the thought process of the unit managers scheduling process to arrive at a feasible solution. The key to this method is the nurses available over nurses required ratio which drives the algorithm. A flowchart supporting the documentation and understanding of the code has been developed along with a testing table to verify the results of the code.
AFRIKAANSE OPSOMMING: Die verskaffing van voldoende gesondheidsorg aan alle Suid-Afrikaaners is 'n bekommernis vir die regering. Die meerderheid van Suid Afrikaanse hospitale se struikelblokke om gesondheidsorg teikens te behaal, lê in die voorkoming en beheer van epidemies, die toekenning van hulpbronne en die bestuur van gesondheidstelsels. Stellenbosch Hospitaal, wat sowat 170 000 mense dien is nie 'n uitsondering nie.
'n Oorsaak en gevolg diagram het openbaar dat 'n onvoldoende verpleegsterskeduleringsproses die onderliggende oorsaak van 'n meerderheid van probleme is, en dat 'n gebrek aan werkersmoraal die grootste struikelblok by Stellenbosch Hospitaal is. Verder is verskillende teorieë ondersoek en dit het tot die gevolgtrekking gelei dat die werkermoraal by die hospitaal verbeter kan word word deur die bemagtiging van verpleegkundiges om meer beheer oor hul schedules te verkry, en dat die verpleegkundige skeduleringsproses kan verbeter word deur die ondersteuning van die verpleegsterskedulering met 'n besluitsteuninstrument. Die doel van die besluitondersteunende instrument is bepaal om net dag- en nagskedulering en verpleegstersaalindeling te bevat. Dit is so gekies aangesien dit die grootste hoeveelheid werk vir die eenheidsbestuurders behels. Daarbenewens is besluit om verpleegsters in die jaarlikse dag- en nag skedule sowel as die saalvoorkeure te betrek, aangesien dit die mees beduidende impak op die verpleegsters se werklewens het. Die insette en die verwagte uitkomste van die besluitinstrument vir ondersteuning word bespreek en die ontwikkelingsplatform is gekies as 'n kombinasie van Visual Basics en Microsoft Excel aangesien hierdie programme kragtig en vrylik beskikbaar is.
Na deeglike oorweging van verskillende verpleegsterskeduleringsmetodes is heelgetalprogrammering en 'n self-ontwikkelde algoritme gekies deur gebruik te maak van die analitiese hiërargie proses. Die dag- en nag skedule is opgelos met 'n heelgetalprogrammersmodel. Die nadeel van die model is sy onbuigsaamheid ten opsigte van die vaste kwartiere wat verpleegsters kan kies, sowel as sy rigiditeit en die sub-optimale oplossing wat afgerond moet word. Die dag- en nagskedulering resultate is 'n inset aan die self ontwikkelde algoritme, wat die gedagte van die eenheidsbestuurder se skeduleringsproses naboots om ‘n haalbare oplossing te bereik. Die sleutel tot hierdie metode is die verpleegsters beskikbaar is oor verpleegsters vereis verhouding wat die algoritme dryf. 'n Vloeidiagram om die dokumentasie en begrip van die kode te verifieër is ontwikkel saam met 'n toetstabel om die resultate van die kode te toets. Die gebruikerskoppelvlak is deeglik ontwikkel en 'n gebruikersvriendelike uitset is ontwerp wat 'n opsomming van al die resultate insluit. Ten slotte is 'n gebruikersvalidering van die instrument by Stellenbosch Hospitaal deurgevoer. Sy bruikbaarheid en effektiwiteit in verpleegsterskedulering en waarde van besluitnemingsondersteuning is bevestig. Verder is die potensieël verbeterde werkermoraal deur die insluiting van die verpleegsters in die skeduleringsproses ook bevestig.
Nurses -- Schedules
Health systems -- Management