MMHA 5500 Week 1 Healthcare Workforce Forecast Example

Workforce Forecast: Staffing the Total Joint Service Line at Lakeside Surgery Center

Student Name

Walden University

MMHA 5500: Human Resource Management and Organizational Development and Leadership for Healthcare Administrators

Instructor Name

Month Day, Year

Workforce Forecast: Staffing the Total Joint Service Line at Lakeside Surgery Center

Introduction

An orthopedic surgery group plans to move its total hip and knee replacement cases into Lakeside Surgery Center, the ambulatory surgery center of the composite Lakeside Outpatient Network, beginning next year. Before any position is posted, this forecast asks how many people, holding which licenses, the new service line will need. Demand is built from projected case volume; supply is counted from the current roster, less announced retirements and ordinary departures; and the gap is stated role by role under low, expected and high volume. Every figure is illustrative and labeled as an estimate. Demand for joint replacement is expected to keep growing as the population ages, which national projections have long anticipated (Kurtz et al., 2007), so the expected scenario is not the ceiling.

Volume Assumptions

Table 1 sets out the assumptions, drawn from the surgery group's own scheduling projections.

Table 1

Volume Assumptions for the Total Joint Service Line (Estimates)

From Volume to Roles

Each case occupies a room for about two and a half hours including turnover, so the expected six cases a day require about 15 staffed room-hours a day, or 3,750 a year. The center's staffing policy assigns every running room a circulating registered nurse, a surgical technologist and anesthesia coverage by a certified registered nurse anesthetist under the anesthesiologist's supervision. Each of those roles therefore needs about 3,750 hours a year for the expected volume. At about 1,800 productive hours per full-time equivalent, after leave and education, that is about 2.1 full-time equivalents per role, rounded up to 2.3 to cover room setup before the first case and the last case's close.

Recovery is staffed by registered nurses at ratios drawn from perianesthesia practice recommendations, which call for one nurse to two patients in phase I recovery for stable patients and one nurse to three in phase II (American Society of PeriAnesthesia Nurses, 2022). At two hours of phase I and three of phase II per patient, each joint patient needs about one nurse-hour in each phase, or about 3,000 recovery nurse-hours a year at expected volume, about 1.7 full-time equivalents. Pre-operative calls and preparation add about half an hour per case, or 0.4 full-time equivalent.

Procedure times in ambulatory surgery centers tend to be shorter than in hospitals (Munnich & Parente, 2014), so the room time assumption, taken from the group's hospital times, may prove conservative. The forecast keeps it, because underestimating room time is the more costly error.

Supply

The center's current staff are fully used by its existing caseload, so the new service line adds to existing demand. Table 2 shows next year's supply by role: the current roster, less one announced circulating nurse retirement, a recovery nurse moving to part-time and ordinary departures estimated at about a tenth of each role, the center's recent turnover rate.

Table 2

Supply Next Year by Role, in Full-Time Equivalents (Estimates)

The Gap

Demand next year is the existing caseload's requirement plus the new service line's. Table 3 states the gap by role under each scenario.

Table 3

Gap by Role Next Year, in Full-Time Equivalents (Estimates)

Reading the Gap

Part of each gap would exist even without the joint service line. The circulating nurse retirement and ordinary departures alone leave the center about 1.4 full-time equivalents short of its existing demand for circulating nurses. The new line roughly doubles that gap in the expected scenario. For certified registered nurse anesthetists, the existing gap is small, but the new line creates most of a gap of nearly three full-time equivalents, and anesthetists take longer to recruit than any other role in the table.

Risks to the Forecast

Three assumptions carry most of the risk. The first is case volume: if the surgery group moves fewer cases than projected, the center could hire ahead of demand, which is why only the slowest roles are recruited to the expected scenario. The second is recovery time. Joint replacement patients in an ambulatory setting may need longer phase II recovery than the anesthesia group estimates, especially early on, and an extra hour per patient would add about half a full-time equivalent of recovery nursing at expected volume. The third is turnover. If experienced staff leave faster than the recent rate, perhaps because the new service line brings longer days, the supply column will fall and every gap will widen. Each assumption can be checked against actual data within the first quarter of the new service line, which is why the forecast is built to be revised quarterly rather than set once.

Recommendations

The center should recruit now to the expected scenario for the roles that take longest to fill, anesthetists and circulating nurses, since a gap in either would stop rooms from running. For surgical technologists and recovery nurses, it should recruit to the low scenario now and hold approvals for the difference up to the expected scenario until the surgery group confirms its first quarter's schedule. Pre-operative coverage can be met with a new licensed practical nurse role for pre-operative calls, defined in the job description that follows, supervised by the existing pre-operative registered nurses. The forecast should be revised each quarter as the group's actual case volume replaces its projection.

References

American Society of PeriAnesthesia Nurses. (2022). 2023-2024 perianesthesia nursing standards, practice recommendations and interpretive statements. American Society of PeriAnesthesia Nurses.

Kurtz, S., Ong, K., Lau, E., Mowat, F., & Halpern, M. (2007). Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. Journal of Bone and Joint Surgery, 89(4), 780-785. https://doi.org/10.2106/JBJS.F.00222

Munnich, E. L., & Parente, S. T. (2014). Procedures take less time at ambulatory surgery centers, keeping costs down and ability to meet demand up. Health Affairs, 33(5), 764-769. https://doi.org/10.1377/hlthaff.2013.1281