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A nurse home care scheduling system is described. The objective is to provide medical care at patients’ homes using the fewest number of nurses possible to deliver the required care. The heuristic scheduling system is easy to implement as a computerized adaptive system. As such, it is easy to use on a daily basis and easy to update as new data related to completed treatment and new requests are obtained. A case study illustrates the advantages of implementing such a system.

In this study, the authors investigate a different routing and scheduling problem in the field of home health care (HHC) management system. The purpose of this paper is to route and schedule the workday of health workers, assign the patients to suitable health workers, make accurate decisions to minimize costs, provide timely services and, in general, enhance the efficiency of HHC centers.

A mixed-integer linear programming model is developed to assign health workers to patients. The model considers health professionals with different skills, namely nurses and physicians. Additionally, three groups of patients are considered: patients who need a nurse, patients who need a physician and patients who need both. In the third group, the nurse must be present at the patient’s home following the physician’s visit in order to perform the required tasks.

The results of this study show a reduction in costs which results from the fewer health workers employed and dispatched in comparison with traditional approaches. With the help of our solution approach and model, HHC centers may not only successfully reduce their costs but also manage to meet their patients’ demands by assigning suitable nurses and physicians.

Previous studies have often focused on problems involving only one group of health professionals and rarely address problems involving multiple groups. The authors consider this a shortcoming, because in many cases, patients should be visited several times and by various health professionals.

The purpose of this paper is to investigate aspects related to difficulty to retain nursing assistants at nursing homes in Sweden related to perceived work environment characteristics.

To reveal aspects related to difficulty to retain nursing assistants, the paper uses the BIKVA model, sense of coherence and New Public Management (NPM). In total, three focus groups with nursing assistants at three nursing homes are interviewed with corresponding individual interviews with their senior managers and users. The purpose is to analyze the situation from the affected group of nursing assistants. The focus of this study is how nursing assistants discuss related to recruit and retain nursing assistants at nursing homes and elderly care and the response from senior management related to those aspects.

The main conclusions are that nursing assistants consider their job as meaningful, but limited latitude and direct involvement in managing their daily tasks in a continuous communication with management affect negatively. Furthermore and combined with wage levels, aspects related to scheduling, working hours, shift work, split shifts and understaffing generate a burdensome and stressful environment affecting the possibility to retain staff in a negative direction.

The research uses a new approach utilizing the BIKVA model, sense of coherence and NPM. The study shows that central in retaining nursing assistants at nursing homes relates to aspects such as wages, staffing, shift work and split shifts and continuous communication between nursing assistants and management.

The number of care‐dependent people will rise in future. Therefore, it is important to support home health care (HHC) providers with suitable methods and information, especially in times of disasters. The purpose of this paper is to reveal potential threats that influence HHC and propose an option to incorporate these threats into the planning and scheduling of HHC services.

This paper reveals the different conditions and potential threats for HHC in rural and urban areas. Additionally, the authors made a disaster vulnerability analysis, based on literature research and the experience of the Austrian Red Cross (ARC), one of the leading HHC providers in Austria. An optimization approach is applied for rural HHC that also improves the satisfaction levels of clients and nurses. A numerical study with real life data shows the impacts of different flood scenarios.

It can be concluded that HHC service providers will be faced with two challenges in the future: an increased organizational effort and the need for an anticipatory risk management. Hence, the development and use of powerful decision support systems are necessary.

For an application in urban regions new methods have to be developed due to the use of different modes of transport by the nurses. Additionally, an extension of the planning horizon and triage rules will be part of future research.

The presented information on developments and potential threats for HHC are very useful for service providers. The introduced software prototype has proven to be a good choice to optimize and secure HHC; it is going to be tested in the daily business of the ARC.

Even in the case of disasters, HHC services must be sustained to avoid health implications. This paper makes a contribution to securing HHC, also with respect to future demographic trends.

To the best of the authors’ knowledge there are no comprehensive studies that focus on disaster management in the field of HHC. Additionally, the combination with optimization techniques provides useful insights for decision makers in that area.

As a way of alleviating nursing workforce shortages, health care managers are employing two types of workforce flexibility: supplemental staffing and floating among units. In this paper, the authors investigate the moderating effects of two critical situational variables – namely, job-level workload and severity of illness (SOI) in a given unit – on the relationship between workforce flexibility and quality of care as assessed by the nurses at the unit-level.

The authors empirically test the relationship between a unit's floating of nurses and the use of supplemental workforce on the quality of patient care and the moderating role of patient SOI and job-level workload on this relationship using 357 hospital-unit observations.

The authors find that situational variables play a critical role in flexible staffing strategies and they should be accounted for carefully to obtain the best quality of care outcomes. The authors find that the well-known negative effect of supplemental staffing on quality of care is not universal and appears to be moderated by the situational factors studied in this paper.

For best outcomes, staffing manager who oversee multiple units should use supplemental staff on units that have lower job-level workload and on units that have high severity of illness. The authors also find that managers of units with patients who are less-severely ill should encourage nurses to float out and return to their home unit. This strategy will improve quality of patient care in the home unit.

While some research analyzes the direct link between flexibility and quality performance, how this relationship is affected by varying situational factors within a unit has not been studied so far.

The purpose of this paper is to develop an Internet of medical things (IoMT)-based geriatric care management system (I-GCMS), integrating IoMT and case-based reasoning (CBR) in order to deal with the global concerns of the increasing demand for elderly care service in nursing homes.

The I-GCMS is developed under the IoMT environment to collect real-time biometric data for total health monitoring. When the health of an elderly deteriorates, the CBR is used to revise and generate the customized care plan, and hence support and improve the geriatric care management (GCM) service in nursing homes.

A case study is conducted in a nursing home in Taiwan to evaluate the performance of the I-GCMS. Under the IoMT environment, the time saving in executing total health monitoring helps improve the daily operation effectiveness and efficiency. In addition, the proposed system helps leverage a proactive approach in modifying the content of a care plan in response to the change of health status of elderly.

Considering the needs for demanding and accurate healthcare services, this is the first time that IoMT and CBR technologies have been integrated in the field of GCM. This paper illustrates how to seamlessly connect various sensors to capture real-time biometric data to the I-GCMS platform for responsively supporting decision making in the care plan modification processes. With the aid of I-GCMS, the efficiency in executing the daily routine processes and the quality of healthcare services can be improved.

The purpose of this study is to explore home care nurses' experience of learning in a multicultural environment.

The study was based on qualitative research design. Data were collected through repeated interviews with registered home care nurses working in a multicultural area. The data were analyzed through a qualitative content analysis with a direct approach.

Six categories describing nurses' experiences of learning were developed in order to define which components were determinative in facilitating or constraining home care in a multicultural environment. The findings show that home care demands high individual nursing skills and also offers many opportunities for further learning. The most important sources of learning were the challenges presented in the daily experience of encountering diversity of patients and families, by informal social interactions and exchange of knowledge with colleagues.

The strength of this study is that data are collected by two different methods with time for reflection in between. Limitations are that only female nurses participate in the study and from one team of nurses.

The findings can be used by nurses to create an awareness of the opportunities that exist in everyday work. For managers, this study highlights learning and constraints that exist on the organisation level.

This article adds to existing research by describing the learning environment for home care nurses in relation to the theoretical framework that examines the factors which either facilitate or constrain learning at work.

The performative approach views organizational routines as generative systems with internal aspects – ostensive and performative – and dynamics (Feldman and Pentland, 2003). The purpose of this paper is to better understand under which conditions the routine dynamics happens or not.

To deal with this issue, for 13 months, the authors conducted a comparative and longitudinal case studies based on the evolution of the organizational routines in absence management in two departments of a French hospital.

The results show contrasting dynamics in the studied organizational routines: one evolved, the other in contrast, seemed blocked. The authors suggest that the routine dynamics depends on the relative weight of its ostensive and performative aspects: a balance situation makes mutual adaptions possible and an imbalance situation leads to the conservation of defective routine. The research underlines also that, in the hospital context, the capacity of management and teams to discuss and to negotiate the implementation of external rules plays an important role in the balance of the internal dimensions of routine.

While the literature on performative approach focusses on the “how and why” the routine act as a source of continuous change, this research investigates more in depth the working of the routines dynamics itself. The issue of balance or imbalance introduces a new element in the framework of routine dynamics and can constitute an interesting focus for managers looking to transform their organizational routines.

Over 3 million intermittently employed and socially disadvantaged workers receive low wages and limited benefits in diverse long-term care settings and employment arrangements as they try to become a positively valued unified occupation: “direct care workers.” Before this occurs, these workers must overcome negative definitions imposed by three powerful institutions: professional guilds, employers, and states. Care workers’ legitimacy is challenged as nursing labels them “unlicensed, assistive personnel,” defining them in terms of their task relationship to nurses rather than their social relationship to clients. Care workers’ identity is obscured as corporate rationalization nullifies their unique contributions with task unbundling, part-time work, short staffing, and turnover undermining bonding with colleagues and clients. State regulation impedes care workers’ integration, segmenting similar workers under different regulatory regimes, defining workers negatively rather than by their educational attainments and competencies. Overcoming this triple negation will require not just cultural change, but also real structural changes, and can occur only through concerted actions involving coalitions. Labor market intermediaries, public authorities, labor unions, workforce investment boards, philanthropic organizations, and government interagency groups are among those supporting direct care workers’ advancement by strategically coordinating licensing, purchasing, and developing the workforce. Recent federal policy changes and health reform legislation have enhanced recognition of this occupation and are providing new resources for its development.

The objective of the research is to assess the degree of adoption of high‐involvement nursing work practices in long‐term care organizations. It seeks to determine the organizational and workplace factors that are associated with the uptake/adoption of ten selected human resource high‐involvement employee work practices.

A survey questionnaire was sent to 300 long‐term care organizations (nursing homes) in western Canada. Results from 125 nursing home establishments (43 percent response rate) are reported herein.

Of the ten high‐involvement nursing work practices examined, employee suggestion and recognition systems are the most widely adopted by homes in the sample, while shared governance and incentive/merit‐base pay are used by a small minority of establishments.

The uptake of high‐involvement nursing work practices is not adopted in a haphazard fashion. Their uptake is variously associated with a number of establishment and workplace factors, including the presence of a supportive and enabling workplace culture.

The objective of this research is to examine the extent and degree of adoption of high involvement work practices in a sample of long‐term care establishments operating in the four provinces of western Canada.