Integrated workforce and territory planning for home social care under variable demand

PurposeThe aim of this action research was to explore, from a workforce and a patient/carer perspective, the skills and the capacity required to deliver integrated care and to inform future workforce development and planning in a new integrated care system in England.Design/methodology/approachSemi-structured interviews and focus groups with primary, community, acute care, social care and voluntary care, frontline and managerial staff and with patients and carers receiving these services were undertaken. Data were explored using framework analysis.FindingsAnalysis revealed three overarching themes: achieving teamwork and integration, managing demands on capacity and capability and delivering holistic and user-centred care. An organisational development (OD) process was developed as part of the action research process to facilitate the large-scale workforce changes taking place.Research limitations/implicationsThis study did not consider workforce development and planning challenges for nursing and care staff in residential, nursing care homes or domiciliary services. This part of the workforce is integral to the care pathways for many patients, and in line with the current emerging national focus on this sector, these groups require further examination. Further, data explore service users' and carers' perspectives on workforce skills. It proved challenging to recruit patient and carer respondents for the research due to the nature of their illnesses.Practical implicationsMany of the required skills already existed within the workforce. The OD process facilitated collaborative learning to enhance skills; however, workforce planning across a whole system has challenges in relation to data gathering and management. Ensuring a focus on workforce development and planning is an important part of integrated care development.Social implicationsThis study has implications for social and voluntary sector organisations in respect of inter-agency working practices, as well as the identification of workforce development needs and potential for informing subsequent cross-sector workforce planning arrangements and communication.Originality/valueThis paper helps to identify the issues and benefits of implementing person-centred, integrated teamworking and the implications for workforce planning and OD approaches.

Background: Older persons want to remain in their own homes as long as possible, making home care services essential for maintaining independence, completing daily activities and delaying entry into institutional care 1. While home care has the potential to improve health and well-being and reduce health care costs, provision of these services to the geriatric population is complicated by complex, multi-morbid health issues requiring care from a range of providers who work in isolation of each other. Improved integration from planning through delivery is a key priority for Canadian home care 2. Aims: This study aimed to develop an implementation framework for an integrated geriatric care planning approach in home care. Key objectives were to: a investigate current geriatric assessment practices; b collect ideas for improving person- and family-centred goal setting; and c co-design solutions for more integrated geriatric care planning with older adults, family caregivers and health care providers. Methods: This study applied a sequential transformative mixed methods design 3. Quantitative data were collected through a web-based survey that was developed with and delivered to frontline home health care nurses, occupational therapists and physiotherapists n=303. Qualitative data were collected in-person through solutions-focused key informant interviews with older adults and family caregivers n=24. Statistical and thematic analysis of the data was iterative and ongoing. Survey and interview data were brought together during the interpretation phase, where older adults, family caregivers, and health care providers n=19 were engaged in a workshop to co-design solutions for more integrated geriatric home care planning. Results: An implementation framework for integrated geriatric care planning in home care was developed. Components of the framework include: a common clinical and non-clinical information needed by everyone involved; b key touch points and actions for achieving the integrated care planning experience everyone involved wants; and c nine ideas for tools and technology to support integrated data collection, goal-setting and communication. Conclusions: Older adults, family caregivers and health care providers have both common and unique needs for sharing and receiving information to support planning care in the home. Home care planning should begin with a holistic baseline understanding of an individual person that prioritizes and applies information on personal background, goals, needs and preferences in seeking to understand individuals’ health challenges and plan for their care. Limitations: This study was conducted in a single region within Ontario, Canada. Suggestions for Future Research: Next steps for this research include additional co-design workshops in other regions, to develop prototypes of these new processes and tools for integrated geriatric care planning to be pilot tested in home care practice.

Governments undertake extensive planning of many services and functions, but tend to neglect planning of public service workforces. Disruptions to public service delivery, such as shortages of nurses and doctors, have rejuvenated interest in workforce planning, but many organisations struggle to do it effectively. This historical study examines the capacity of central personnel agencies to predict workforce risks and support workforce planning, using a study of the Queensland public service. It identifies lack of workforce data as a barrier to effective workforce planning, as a result of factors such as changes in the direction of the central personnel agency, lack of appreciation for the value of comprehensive central workforce data, and limited agency human resource (HR) skills or capacity.

Background:The COVID-19 pandemic highlighted the need for innovative approaches to healthcare delivery, particularly for older adults with frailty in crowded settings. In Québec, Canada, the shortage of hospital beds during the pandemic exposed critical gaps in the capacity to provide appropriate end-of-life care for affected residents of residential care facilities (RCFs).Aim:This study aimed to examine the implementation of the COVID-19 Intensive Home Care Team (IHCT) and how it transformed the physical and social environment of RCFs to enable end-of-life care and “dying at home” in an unprecedented time.Design:A qualitative case study design was used. Between September 2020 and January 2021, qualitative data were collected through 30 in-depth interviews with front-line workers of the IHCT, healthcare managers, and academics in the home care sector. Thematic analysis reveals three interrelated themes: the ambiguities of caring spaces, the centrality of medication management, and the reconfiguration of RCFs through new spatial, technological, and relational arrangements that enabled “dying at home” during the COVID-19 pandemic.Results:Findings revealed that the IHCT initiative reshaped RCFs into a necropolitical space, showing the complex interplay between space, care practices, and societal values toward older adults with frailty. The transformation enabled a form of compassionate end-of-life care within familiar settings as well as exposed underlying societal hierarchies that determine whose lives, and deaths, are valued.Conclusion:The IHCT model illustrates how emergency health interventions can reconfigure care spaces and challenge conventional boundaries between home, private, and public care systems. However, it also underscores the ethical and political dimensions of care for frail older adults in crisis contexts.

Objective: to describe the facilitating and inhibiting determinants of transitional care at the discharge of older people and the interventions for a healthy transition. Method: qualitative and comprehensive study, carried out in a general hospital in Paraná, Brazil, with 11 health professionals, from December 2019 to May 2021, through semi-structured interviews. Content Analysis was used to analyze the data and the theoretical framework was the Transition Theory. Results: the following emerged as Facilitating Determinants: communication with the home care service; family involvement in hospitalization and multidisciplinary work. The Inhibitors were failures in communication with the primary health unit; little preparation and involvement of the family in care; lack of economic resources; scarce human resources in the health care network; physician-centered care transition. Interventions include discharge reports from the multidisciplinary team; home care plan; use of the senior citizen card; implementation of a computerized system integrating levels of care; multidisciplinary involvement and guidance to the caregiver during the older person hospitalization; network management of the older person's hospital-home care transition. Conclusion: the transition from hospital to home care for the older person is inefficient; interventions can reduce discontinuity of care and contribute to the implementation of strategies that favor comprehensive care, promoting safety for the older people. Transition Theory is a guide for healthcare professionals to understand transition as a dynamic and complex process that allows planning and implementation of interventions for a healthy care transition.

This contribution has two key objectives. First, inspired by earlier studies in comparative welfare state and in (social) gerontology, we develop a conceptualization of autonomy that is rooted in its social dimensions. This concept is then deployed to assess its policy considerations within the field of home care, both with regards to access and generosity in 21 industrialized countries. Second, this contribution performs a comparative assessment of the key factors resulting in a prioritization of the social dimensions of home care and social services in long term care. This study involves an-depth analysis of policy instruments deployed by public authorities to enhance the (social) autonomy of older adults, complemented with interviews with policy makers in diverse home care policy settings (Canada, France, South Korea, Sweden, and the United States). As such, this study features an evaluation of the presence of social elements in the definition and supply of care needs across 21 countries. It leads to the construct of a social dimensions of autonomy index based upon these instruments and the budgetary prioritization of home care within long term care policies. Among core findings, one discovers broader access and more generous funding when home care responsibilities are firmly embedded at the local level.

An increasing amount of Web services are being implemented using process management tools and languages (BPML, BPEL, etc.). The main advantage of processes is that designers can express complex business conversations at a high level of abstraction, even reusing standardized business protocols. The downside is that the infrastructure behind the Web service becomes more complex. This is particularly critical for Web services that may be subjected to high variability in demand and suffer from unpredictable peaks of heavy load. In this paper we present a flexible architecture for process execution that has been designed to support autonomic scalability. The system runs on a cluster of computers and reacts to workload variations by altering its configuration in order to optimally use the available resources. Such changes happen automatically and without any human intervention. This feature completely removes the need for the manual monitoring and reconfiguration of the system, which in practice is a difficult and time-consuming operation. In the paper we describe the architecture of the system and present an extensive performance evaluation of its autonomic capabilities.

Children with medical complexity and pediatric palliative care: Data by a respiratory intermediate care unit.

A home care plan defines the set of medical and/or social activities that are carried out day after day at a patient's home. Such a care plan is usually constructed through a complex process involving a comprehensive assessment of patient's needs as well as his/her social and physical environment. Specification of home care plans is challenging for several reasons: care plans are inherently non-structured processes which involve repetitive, but irregular, activities, whose specification requires complex temporal expressions. These features make home care plans difficult to model using traditional process modeling technologies. In this paper, we describe how home care plans, formalized as timed automata, can be generated from a set of high level and user-oriented abstractions. The resulting care plan encompasses all the possible allowed schedules of activities for a given patient. We discuss then how verification and monitoring of the resulting care plan can be handled using existing techniques and tools (e.g., UPPAAL model checker).

Managing product variety with mixed make-to-stock/make-to-order production strategy and guaranteed delivery time under stochastic demand

To examine how case managers in a state-funded home care program allocate home care services in response to information about a client's Medicare home health care status, with particular attention to the influence of work environment. Primary data collected on 355 case managers and 26 agency directors employed in June 1999 by 26 of the 27 regional agencies administering the Massachusetts Home Care Program for low-income elders. Data were collected in a cross-sectional survey study design. A case manager survey included measures of work environment, demographics, and factorial survey vignette clients (N = 2,054), for which case managers assessed service eligibility levels. An agency director survey included measures of management practices. Hierarchical linear models estimated the effects of work environment on the relationship between client receipt of Medicare home health care and care plan levels while controlling for case-mix differences in agencies' clients. Case managers did not supplement extant Medicare home health services, but did allocate more generous service plans to clients who have had Medicare home health care services recently terminated. This finding persisted when controlling for case mix and did not vary by work environment. Work environment affected overall care plan levels. Study findings indicate systematic patterns of frontline resource allocation shaping the relationships among community-based long-term care payment sources. Further, results illustrate how nonuniform implementation of upper-level initiatives may be partially attributed to work environment characteristics.

This work considers the strategic flexibility and capacity planning under uncertain demands in production networks of automobile manufacturers. We present a deterministic and a stochastic model, which extend existing approaches, especially by an anticipation scheme for tactical workforce planning. This scheme is compared to an extended formulation of the deterministic model, which incorporates workforce planning via detailed shift models. The stochastic model is efficiently solved by an accelerated decomposition approach. The solution approach is integrated into a decision support system, which calculates minimum-cost product allocations and capacity plans. Our numerical results show that, in spite of the considerably increased complexity, our approach can efficiently handle hundreds of scenarios. Finally, we present an industrial case study.

Health rankings in Mississippi are abysmal. Mississippi also has fewer physicians to serve its population compared with all other states. Many residents of this predominately rural state do not have access to healthcare providers. To better understand the demographics and distribution of the current health workforce in Mississippi, the main objective of the study was to design a Web-based, spatial, interactive application to visualize and explore the physician workforce. A Web application was designed to assist in health workforce planning. Secondary datasets of licensure and population information were obtained, and live feeds from licensure systems are being established. Several technologies were used to develop an intuitive, user-friendly application. Custom programming was completed in JavaScript so the application could run on most platforms, including mobile devices. The application allows users to identify and query geographic locations of individual or aggregated physicians based on attributes included in the licensure data, to perform drive time or buffer analyses, and to explore sociodemographic population data by geographic area of choice. This Web-based application with analytical tools visually represents the physician workforce licensed in Mississippi and its attributes, and provides access to much-needed information for statewide health workforce planning and research. The success of the application is not only based on the practicality of the tool but also on its ease of use. Feedback has been positive and has come from a wide variety of organizations across the state.

Medical claims are widely used in workforce estimation and health services research but identifying primary care (PC) clinicians is challenging. Existing methods relying on specialty or activity-based metrics are imprecise and hard to duplicate. We seek to develop a simple, accurate decision tree classifier using claims data, trained on survey responses from family physicians (FPs). And to use this classifier to estimate the PC workforce in Virginia. We linked 2016-2023 Virginia All-Payer Claims Database (APCD) data with responses from American Board of Family Medicine surveys to infer whether FPs provided PC. Using claims-derived features, we trained a decision tree to classify clinicians providing PC. We developed an enhanced version of the tree, adding exclusion criteria, and applied both classifiers to the entire APCD, including other PC clinician types. Virginia clinicians. Estimated classifier accuracy by clinician type and workforce estimates with bootstrapping used to estimate 95% confidence intervals. The base decision tree correctly classified 93% of the training sample using three clinician-level features: percent of claims with diagnosis category of Z00, percent with place of service 19-23 or 31-32, and percent of patients having multiple visits with the clinician. We estimate the enhanced tree achieved at least 89% accuracy for every clinician type. We found that from 2016 to 2023, the percentage of Virginia PC clinicians who were nurse practitioners (NPs) grew from 17 to 32%, with NPs passing FPs as the most common PC clinician type. This decision tree approach overcomes shortcomings of existing methods and offers a straightforward, scalable, interpretable tool for classifying PC clinicians, with applications in workforce planning and health services research.

Tactical planning models for the Fast Moving Consumer Goods (FMCG) industry can quickly become intractable due to the extremely large number of Stock Keeping Units (SKUs). We propose an SKU decomposition algorithm that is aimed at being able to solve cases containing thousands of SKUs. The full tactical planning model is decomposed into a set of single SKU models. These models are then solved sequentially. The capacity used by other SKUs is removed from the available capacity and, at a certain penalty cost, a violation of the capacity is initially allowed. By slowly increasing the penalty cost, the capacity violations are decreased until a feasible solution is obtained. Using the algorithm it was possible to obtain solutions within a few percent of optimality for example cases containing 10 and 25 SKUs. It was also possible to solve a larger 100 SKU case for which the full space model was intractable. The main advantage of the algorithm is that the required CPU time scales approximately linearly with the number of SKUs.