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Article
Publication date: 23 November 2021

Adelina Gnanlet, Luv Sharma, Christopher McDermott and Muge Yayla-Kullu

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…

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Abstract

Purpose

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.

Design/methodology/approach

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.

Findings

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.

Practical implications

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.

Originality/value

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.

Details

International Journal of Operations & Production Management, vol. 41 no. 12
Type: Research Article
ISSN: 0144-3577

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Article
Publication date: 11 August 2020

Rommel O. Salvador, Adelina Gnanlet and Chris McDermott

The purpose of this study is to examine the effect of the use of unit-level functional flexibility on one particular patient outcome, unit-acquired pressure ulcers, and the…

418

Abstract

Purpose

The purpose of this study is to examine the effect of the use of unit-level functional flexibility on one particular patient outcome, unit-acquired pressure ulcers, and the potential moderating influences of coworker support and workload.

Design/methodology/approach

This study uses an archival approach, examining data from 68 hospital units.

Findings

The results indicate that a unit's higher use of functionally flexible nurses in one-quarter was associated with a higher number of pressure ulcers among the unit's patients the following quarter. This detrimental effect was significantly diminished when coworker support within the unit was high. Unit-level nurse workload did not have any moderating influence.

Research limitations/implications

One of the scholarly contributions of this study is that it links greater use of functionally flexible employees to a negative patient safety outcome at the unit level. As most of the variables used in the study were archival measures, future research could examine the replicability of these findings using other indicators and measures.

Practical implications

Beyond healthcare settings, the results prompt managers in industries where there has been growing use of functional flexibility (e.g., banking) to think about the associated unintended negative consequences. That said, the results also point to coworker instrumental support as a means by which to mitigate negative outcomes.

Originality/value

Although functional flexibility has been shown to positively correlate with a number of organizational performance indicators, this is one of the very few studies that has examined its negative consequences, particularly on patient safety.

Details

Personnel Review, vol. 50 no. 3
Type: Research Article
ISSN: 0048-3486

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Article
Publication date: 13 May 2014

Adelina Gnanlet and Hyun-cheol Paul Choi

Hospitals procure high volumes of medical supplies through large distributors in order to leverage economies of scale. However, when shortages hit, hospitals incur high penalty…

253

Abstract

Purpose

Hospitals procure high volumes of medical supplies through large distributors in order to leverage economies of scale. However, when shortages hit, hospitals incur high penalty costs by purchasing from secondary markets. In this paper, the authors counter the hospital's typical purchasing strategy that a collaborative relationship with a large, Tier I medical supply distributor is beneficial under all conditions. The paper finds that during shortages the more beneficial strategy is for the hospital to add a medium-sized, Tier II distributor who offers a transactional relationship and is willing to provide a “preferred allocation” in return for a pre-committed annual purchase contract. The paper aims to discuss these issues.

Design/methodology/approach

The authors assume availability of order volume to be a stochastic process and formulate the problem as a two-stage stochastic programming model, with optimal allocation in the second stage. The authors analyze the first-stage objective function using full-factorial numerical experimentation and perform a complete search for optimal volume mix. In addition, the model accounts for purchasing relationship, shortage cost, and varying price discount schedules.

Findings

Under no shortage situation, hospitals purchase its entire order volume from Tier I distributor. However, during shortages, for any increase in preferred allocation from the Tier II distributor, hospitals purchase high volumes from the Tier II distributor except when preferred allocation and availability is high. The paper finds that the average cost savings for the use of preferred allocation is 16.14 percent.

Originality/value

Existing purchasing literature focusses on the benefit of using single/multiple homogenous distributors under all conditions. In this paper, the authors examine the benefit of using non-homogenous distributors under conditions of shortage when one of them is willing to provide preferred allocation under varying price discount schedules.

Details

Management Decision, vol. 52 no. 3
Type: Research Article
ISSN: 0025-1747

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