WO2014032097A1

WO2014032097A1 - A workforce allocation method

Info

Publication number: WO2014032097A1
Application number: PCT/AU2013/000961
Authority: WO
Inventors: Richard Rosewarne
Original assignee: Applied Aged Care Solutions Pty Ltd
Priority date: 2012-08-28
Filing date: 2013-08-28
Publication date: 2014-03-06
Also published as: AU2013308392A1; AU2021201115A1; AU2019201932A1

Abstract

A computer-implemented method to produce a staffing roster for patients in a healthcare facility, the roster applicable for a given period having a number of intervals each of a predetermined number of minutes. The method includes (a) retrieving specific activities to be carried out to address each respective patient's care needs, each activity associated with a frequency of occurrence, (b) matching each activity to an appropriate category of staff (c) to carry out said activity, where n = a total number of categories, (c) allocating a time indicator indicative of a length of time to carry out each activity, (d) for each category of staff and for each interval: (i) determining the specific activities to be carried out within said interval and calculating a total number of minutes of staff time required to carry out said activities; and (ii) determining an estimate of a number of staff required, (e) for c_n, where n is also the highest ranked category, and for each interval within the period: (i) optimizing the estimate of the number of staff required; and (ii) determining a spare capacity for c_n, (f) for c_n-i, where i = 1:n –1, and for each interval within the period, determining an adjusted number of staff required by subtracting the spare capacity for c_nfrom the estimate of the number of staff required for c_n-i and optimising the adjusted number of staff required, (g) repeating (f) for each subsequent category of staff, and (h) generating a staffing roster indicating for each interval within a period, the optimized adjusted number of staff required in each category.

Description

"A workforce allocation method"

Cross-Reference to Related Applications

The present application claims priority from Australian Provisional Patent Application No 2012903725 filed on 28 August 2012, the content of which is incorporated herein by reference.

Technical Field

Described embodiments relate generally to methods for generating an evidenced based staffing workforce roster for health care organisations. More particularly to determine staffing requirements to meet client care needs in longer term care settings such as residential aged care facilities, supported residential environments and retirement villages. Described embodiments also provide an evidenced based staffing model for any congregate environment where staff are supervising, supporting or caring for individuals including children, people with disabilities and those with behavioural or psychiatric care support requirements.

Described embodiments also provide an evidenced based staffing model for any hospital or health care environment where staff are supervising, supporting or caring for individuals with health conditions requiring su pervision and clinical support from a variety of professionally qualified staff.

Background

Managing staffing requirements for meeting client care needs in the health care sector requires efficient, detailed, and time-accurate staff scheduling to ensure service-oriented and efficient operation. Traditionally, workforce requirements in the health care sector have been estimated by simple ratios of staff numbers to patients to provide an "averaged" coverage. This approach works reasonably well in hospital environments which have wards of "like" patients being treated for a defined presenting problem such as those in intensive care, cardiac care, orthopaedic care, palliative care etc, and decisions about the competencies of the staff and number of staff required in any one shift are usually based on the typical (historical) needs. The patients in these wards have been filtered through the hospital system and they are generally placed into groups of patients with relatively defined care needs and acuity levels and ratio based approaches can be usually justified. However, in longer term settings the larger number of clients within any one facility, the number of clients with highly variable chronic and unstable health conditions and range of functional dependencies means that staff numbers and mix should vary to match the care need requirements of the group and individual clients/residents. However, with health system providers under pressure to reduce costs and improve efficiencies in longer term settings, decisions to reduce or change the staffing mix may often be made on economic grounds without an evidence basis to determine or advise on appropriate staffing profiles for the clients needing care. I n this environment facilities may put staff under additional pressure by understaffing or using staff in roles that they are not competent in or best qualified to adequately perform. This can result in elevated staff stress as a result of being expected to perform at a level that they feel underqualified for or not competent in, overworking of staff and high turnover of staff. Further, understaffing or staff performing roles and activities that are inadequately qualified for or not competent in increases the risk of poor service, misdiagnosis and, in the worst case scenario, negligence. At the other end of the spectrum is overstaffing which whilst it may be service intensive, is cost inefficient and not sustainable for the health service provider.

In environments where the patient/resident mix is variable, decisions about (i) the actual daily start/finish times and shifts lengths needed to perform various roles (ii) structuring when individual residents prefer particular tasks/activities to be performed (iii) the type of staff needed (qualifications, skills, competencies) to perform the required activities and (iv) the number of staff needed to support the client/patient/resident group at any one time period (e.g. every 30 minutes) are usually all deduced using ad hoc, historic or averaged approaches based on a simple staffing ratio., for example, one staff member of a particular type for every ten or so residents. However, this may result in an inefficient or inappropriate staffing models/inputs whereby possibly (i) too many staff are allocated, (ii) too few staff are allocated, and/or (iii) the mix of staff skills available is inappropriate to properly address the activity and/or care requirements of clients/residents.

In this specification the terms patient, client and resident are used interchangeably.

Throughout this specification the word "comprise", or variations such as "comprises" or "comprising", will be understood to imply the inclusion of a stated element, integer or step, or group of elements, integers or steps, but not the exclusion of any other element, integer or step, or group of elements, integers or steps.

Any discussion of documents, acts, materials, devices, articles or the like which has been included in the present specification is not to be taken as an admission that any or all of these matters form part of the prior art base or were common general knowledge in the field relevant to the present invention as it existed before the priority date of each claim of this application. Summary

A computer-implemented method is provided to produce a health care facility staffing roster for patients in or associated with a health care facility, the staffing roster applicable for at least one given period having a predetermined number of intervals each of a predetermined number of minutes, the method comprising:

(a) retrieving specific activities to be carried out to address each respective patient's care needs, each specific activity associated with a frequency of occurrence selected from a group comprising at least daily, weekly and monthly;

(b) matching each specific activity to an appropriate category of staff (c) to carry out said specific activity, where n = a total number of categories;

(c) allocating a time indicator indicative of a length of time to carry out each specific activity;

(d) for each category of staff and for each interval within the period:

(i) determining the specific activities to be carried out within said interval and calculating a total number of minutes of staff time required to carry out said specific activities; and

(ii) determining an estimate of a number of staff required;

(e) for c_n , where n is also the highest ranked category, and for each interval within the period:

(i) optimizing the estimate of the number of staff required; and (ii) determining a spare capacity for c_n by subtracting the estimate of the number of staff required from the optimized estimate;

(f) for c_n-;_t , where i = l:n - 1, and for each interval within the period, determining an adjusted number of staff required by subtracting the spare capacity for c„from the estimate of the number of staff required for c_n_, and optimising the adjusted number of staff required;

(g) repeating step (f) for each subsequent category of staff; and (h) generating a staffing roster indicating for each interval within a period, the optimized adjusted number of staff required in each category.

The step of optimizing the estimate of the number of staff required for the highest ranked category, or the step of optimizing the adjusted number of staff for any category of staff other than the highest ranked, over any interval may comprise a least squares method or a similar method, for instance regression. As should be appreciated, other methods may be employed which are designed to achieve the best fit by the overall facility, or for instance a facility area, a section and a wing as related to the demand for care. The requirement is to meet that demand, and as the invention is dealing in whole numbers (in other words people), there will be ideally a slight oversupply. This may further comprise shift optimisation to best fit the required minutes of staff time required given the constraints of the available shift times for a particular staff member, and over, under and minimum net provision limits.

Over provision limits are those that relate to the maximum allowable allocation of staff over the required staffing level in a given interval. For example, an over provision limit of 1 means that at any point within a given period, the number of staff allocated cannot be greater than 1 staff member above the required amount.

Under provision limits are those that relate to the maximum allowable allocation of staff under the required staffing level in a given interval. For example, an under provision limit of 1 means that at any point within a given period, the number of staff allocated cannot be more than 1 staff member below the required amount.

Minimum net provisions are those that relate to the minimum overall difference between the allocation of staff and the required staffing level over a given period. For example, a minimum net provision of 0, means that over a given period the amount of allocated staff must at least be the same as the level required.

Shift optimisation may be based on a variety of shift lengths for particular categories of staff. The shift optimisation is configurable (based on user selected over and under provision parameters) providing the best fit for the configuration settings in terms of the number and mix of staff into the most efficient "shift" options for a 24 hour period. Shift lengths may be of any length that is deemed appropriate for the relevant industry, for instance the shift length may range from 1 hour to 12 hours. Advantageously, the result is a mix of and numbers of staff matched to the times residents need the care (over the given period) and with shift lengths that produce the significantly more efficient outcome in terms of costs to the health care provider and care for the patients.

The phrase 'appropriate category of staff preferably refers to that category of staff deemed as the most competent to carry out the activity. The category of staff deemed as the most competent may be determined from a database of staff competencies, including, but not limited to the respective person's qualifications and experiences. In other embodiments the category of staff to perform said activity may be selected irrespective of staff competencies.

Activities that individual staff members are competent in carrying out may be determined by a senior staff person's assessment or may be determined according to the demonstrated competency of said member of staff based on an independent assessment system. A list of activities is then able to be compiled and matched to the activities required for the particular residents in care in a facility. A category of staff carrying out the activity may include one or more of a category of staff actually performing the activity, supervising another member of staff performing the activity and directly assisting another member of staff in performing the activity.

The predetermined number of minutes for each interval may be constant. Alternatively the predetermined number of minutes for each interval may vary across all intervals or across one or more subsets of intervals. Furthermore, variation of the predetermined number of minutes for all or a subset of intervals may be applied to all categories, or a specific category or categories of staff. The specific activities required to address each respective patient's care needs may be retrieved from a predetermined assessment. The specific activities may be stored in a data store on the machine readable storage medium. Optionally, the list of activities may be read from a data store which is accessed over a network such as the internet. Retrieving the specific activities to be carried out to address each respective patient's care needs may comprise a preliminary step of identifying the specific activities from a master list of activities. The group from which each specific activity is selected from may further comprise one or more of n x daily, every second day, every third day, twice weekly, fortnightly, every n months where n is selected from 2 to 12. The master list may comprise a list of activities required to address patient care needs, each activity in the list associated with a frequency of occurrence, and a time indicator indicating a length of time taken to carry out the activity.

The time indicator may indicate an average length of time taken for the respective category of staff to perform a particular activity or activity grouping. An activity grouping is a set of activities that comprise the required steps to address a particular care need requirement. In other embodiments the time indicator may indicate a specific length of time taken for a person from the respective category of staff to perform the particular activity.

The method may further comprise allocating a time adjustment indicator to either lengthen or shorten the previously allocated time indicator. For instance the time indicator may first be allocated in order to indicate an average length of time taken for the respective category of staff to perform a specific activity. The application of the time adjustment indicator for that specific activity enables adjustment of the model so as to suit the actual time taken for any particular member of staff, whether the adjustment is directly due to the member of staff or indirectly due to a particular patient under that member of staff's watch. Indeed adjustment is desirable to allow for individual patients whose needs regularly/consistently deviate from the norm (as estimated by the model) or whose personal preferences for how long and when the activity is to take place are a required consideration.

In relation to (d) (ii), the step of estimating the number of staff required may comprise dividing the total number of minutes of staff time by the predetermined number of minutes. The resultant number of staff required for any category may not be a whole number. In some embodiments the method may comprise rounding the estimated number of staff to the nearest whole number or rounding up or down the estimated number of staff.

In some embodiments, once having determined the number of staff required in each category according to the number of minutes of staff time required for each interval, the method may further comprise determining the number of staff across all categories and if the number of staff across all categories is less than a specified amount, e.g. two, then the method may comprise allocating additional staff so that the number of staff across all categories is at least the specified amount. The allocation of additional staff may come from any of the categories of staff.

Advantageously, the methodology produces an outcome that automatically adjusts for (i) the number of patients/residents in the facility and (ii) the case mix (dependency profile) of the facility when determining staffing and shift requirements.

The methodology of embodiments of the invention advantageously calculates measures of efficiency. This involves the calculation of the area under the curve between the required roster and the model roster. The sum of the areas where the model roster is below the required roster represent the "under provision" of care (in minutes, full time equivalents (FTEs), etc). The sum of the areas where the model roster is above the required roster represent the "over provision" of care (in minutes, FTEs, etc). The "needs alignment" measure comprises the sum total of the under and over provision metrics and the "net provision" measure is the difference between the over provision and under provision metrics.

Also provided is a computer program to implement the methodology as described, to produce a staffing roster for patients in or associated with a health care facility.

Also provided is a machine readable storage medium having stored thereon computer executable instructions to implement the methodology as described, to produce a staffing roster for patients in or associated with a health care facility.

Brief Description of the Drawings

The following figures are included in this specification:

Figure 1 is a block diagram which illustrates the client-server architecture which may be employed in some embodiments;

Figure 2 is a flow chart which illustrates the methodology of a preferred embodiment of the invention; Figure 3 is a graph showing predetermined limits for Registered Nurse (RN) Managers to be used in an optimization step of the methodology shown in the flow chart of Figure 2;

Figure 4 is a graph showing predetermined limits for Registered Nurses to be used in an optimization step of the methodology shown in the flow chart of Figure 2;

Figure 5 is a graph showing predetermined limits for ED 2 Nurses to be used in an optimization step of the methodology shown in the flow chart of Figure 2;

Figure 6 is a graph showing predetermined limits for Enrolled Nurses to be used in an optimization step of the methodology shown in the flow chart of Figure 2;

Figure 7 is a graph showing predetermined limits for Personal Care Workers to be used in an optimization step of the methodology shown in the flow chart of Figure 2; and

Figure 8 is a schematic diagram of a facility which is segregated into a number of pods and to which the methodology of the invention is applied.

Detailed Description

Referring to Figure 1, there is shown a client computing device 110 communicating over a network 120 with a server system 130. The client computing device 110 may comprise a desktop, mobile or handheld computing device having a processor (CPU) and memory comprising volatile (RAM) and non-volatile memory (a hard disk drive) The machine readable storage medium may be in communication with the nonvolatile memory. A user interface may comprise a display including at least one input device such as a keyboard, mouse or touch screen that can provide input to the client computing device. Client system 110 may store executable program code and software applications in the non-volatile memory, including program code stored in memory 112 to implement an operating system 115 and a browser application 117 to enable a user to navigate sites which are accessible over the network 120. Client system 110 has at least one processor 111 that has access to the code in memory 112 in order to execute that code. Embodiments of the invention operate on the client system 110 by execution of one or more sequences of one or more instructions contained in memory 112. Execution of the sequences causes the processor 111 to perform the process steps described herein.

The term "computer-readable medium" as used herein refers to any medium that participates in providing instructions to processor 111 for execution. Such a medium may take many forms, including but not limited to, non-volatile media, volatile media, and transmission media. Non-volatile media include, for example, optical or magnetic disks. Volatile media include dynamic memory. Transmission media include coaxial cables, copper wire and fibre optics, including conductors that comprise a bus (not shown). Transmission media can also take the form of acoustic or electromagnetic waves, such as those generated during radio frequency (RF) and infrared (IR) data communications. Common forms of computer-readable media include, for example, a hard disk, magnetic tape, any other magnetic medium, a CD-ROM, DVD, any other optical medium, a RAM, a PROM (programmable ROM), a nd EPROM (electronically PROM) a FLASH-EPROM, any other memory chip or cartridge, a carrier wave, or any other medium from which a computer can read. Various forms of computer-readable media may be involved in carrying one or more sequences of one or more instructions to processor for execution. For example, the instructions may initially be borne on a magnetic disk of a remote computer 130. The remote computer 130 can load instructions into its dynamic memory 132 and send the instructions over the internet 120.

Client system 110 also includes a communication interface 119 coupled to a bus 118. The communication interface 119 provides a two-way data communication coupling to a communication link. For example, the communication interface 119 may be an integrated services digital network (ISDN) card or modem to provide a data communication connection to a corresponding type of telephone line. As another example, communication interface 119 may be a local area network (LAN) card to provide a data communication connection to a compatible LAN. Wireless links may also be implemented. In any such implementation, communication interface 119 sends and receives electrical, radio frequency, or optical signals that carry digital streams representing various types of information. Client system 110 can send messages and receive data, including program code, through the network(s), communication link and communication interface 119. In this Internet example, client system 110 can transmit a requested code for an application program through the communication interface 119 and Internet 120 and to the remote server 130.

Server system 130 comprises a communication interface 131, bus 132 and at least one processing device 133 to operate a web server (HTTP) 146 or local server functions, data processing functions, data storage and retrieval functions (e.g. Using MySQL or SQL) in conjunction with database 140. Server system 130 may also comprise scripting language support such as Microsoft ASP.NET and may also comprise non volatile data storage (memory 134) for storing executable program code including operating system 136 and software modules. Processing device 132 is operable to access code in memory 134.

To illustrate the working of the invention, and with reference to figure 2, we first consider how the data is collected and compiled. For illustration purposes, sample data was provided from twenty high care aged care facilities. In table 2, each row reflects the responses to the aged care funding instrument (ACFI) assessment for each resident used to assess the resident's care needs - Step 210.

The ACFI assessment includes detailed information, for example tasks, checklists, diagnoses & ratings, which are then related to the ACFI profile of the individual patients in the facility. That is, the ACFI Assessment outcomes are then used to deduce further care need requirements that were not directly measured by the ACFI. This aspect covers the need for care planning, health reviews and general support that all residents could expect to receive in an aged care facility.

In table 3, the actual AFCI assessment items are listed. The model uses an extended version of these assessment items as described in table 4. The ACFI is an Australian government means of allocating subsidies to residential aged care providers. It should be noted that this methodology is not dependent on the actual assessment system being applied but it can be applied to any standardised assessment of a person's care needs. For example it could also apply to residents assessed with the InterRAI Family of Assessment Systems or any other standardised assessment model and tools.

218 Yes Yes No

221 Yes No No

234 Yes Yes No

233 No No No

215 Yes Yes No

239 No Yes Yes

232 Yes No No 235 Yes Yes No

237 Yes No No

228 No No No

219 No Yes No

227 No Yes No

Table 3 ACFI Items used for Assessment

ACFI Item

Cutting up food

Placing or gu iding the food into the resident's mouth for most of the meal Placing utensils in resident's hand

Providing assistance with daily oral intake when ordered by a dietitian for a Morning,, afternoon tea and supper for residents

Use of mechanical lifting equipment for transfers

Moving to and from chairs, wheelchairs or beds

Pushing wheelchair (Included collecting and returning wheelchair); Assistance with walking

Handing the resident a mobility aid; Fitting of calipers, leg braces or lower limb prostheses; Standing by to provide assistance

Choosing and laying out appropriate garments; Undoing and doing up zips, including velcro; Standing by to provide assistance (verbal/physical)

Dressing and undressing (clothing) - physical assistance; Fitting and removing of cuffs, splints, medical braces and prostheses other than for the lower limb Washing and/or drying the body

Assistance with dental care; Assistance with hair care; Assistance with shaving Setting up toiletries; Turning on and adjusting taps; Standing by to provide Positioning resident for use of toilet; Positioning resident for use of commode; use of bedpan; Positioning resident for use of urinal

Physical assistance with adjusting clothing and wiping

Standing by to provide verbal assistance with adjusting clothing; Standing by to assist with adjusting clothing; Standing by to provide verbal assistance with More than three (3) episodes daily of urinary incontinence or passing of urine during scheduled toileting

More than four (4) episodes per week of faecal incontinence or passing faeces

Incontinent of faeces once (I) or twice (2) per week

Blood pressure measurement for diagnosed hyper/hypotension

Blood glucose measurement for diagnosed medical condition

Therapeutic massage or heat packs for pain 1 management

Skin integrity management, involving repositioning, for non ambulant residents

Management of one on one special feeding for residents with severe dysphasia

Administering suppositories or enemas

Management of ongoing catheters - Enrolled Nurse

Management of ongoing catheters - Registered Nurse

Management of chronic infectious conditions

Management of chronic wounds

Management of ongoing administration of intravenous fluids etc

Management of oedema, DVT, arthritic joints, or chronic skin conditions Palliative intensive care and complex pain management - EN

Palliative intensive care and complex pain management - RN

Management of ongoing stoma care

Suctioning airways, tracheostomy care

Management of ongoing tube feeding

Use of technical equipment for continuous monitoring of vital signs

Application of patches at least weekly but less frequently than daily

Needs assistance for less than 6 minutes per 24 hour period with daily

Needs assistance for between 6 & 11 minutes per 24 hour period with daily

Needs assistance for more than 11 minutes per 24 hour period with daily

Needs daily administration of subcutaneous drug

Needs daily administration of intramuscular drug

Needs daily administration of intravenous drug

Problem physical behaviour occurs at least six days in a week

Problem physical behaviour occurs at least once in a week

Problem physical behaviour occurs twice a day or more, at least six days in a

Problem verbal behaviour occurs at least six days in a week

Problem verbal behaviour occurs at least once in a week

Problem verbal behaviour occurs twice a day or more, at least six days in a week Problem wandering occurs at least six days in a week

Problem wandering occurs at least once in a week

Problem wandering occurs twice a day or more, at least six days in a week

Problem depression causes moderate interference with regular activities

Problem depression causes major interference with regular activities

Problem depression causes mild interference with regular activities

Next, a list, referred to as the master list, which indicates possible patient care needs and the frequency when which such care needs are required to be met is compiled. The master list needs only to be created once, although it will be appreciated that it is able to be modified or expanded as necessary. The master list may be stored in the database 140 of the remote sever 130 which is accessible to the client computer 110 over the network 120 - step 220.

A portion of the master list is shown in Table 4, illustrating a list of activities which is used to determine patient care needs and the period when the particular care is required. For instance, the activity moving to and from chairs, wheelchairs or beds" occurs around 8 times a day and is required to be performed between the hours of 7am and 4pm, thus providing a high degree of flexibility as to when the actual activity is performed. For certain activities or tasks, the time at which the respective care is required will need to be more specific (for example in the morning or immediately following a meal), and hence the range of the period (for example a 15 minute or 30 minute window) within which the respective care is required will be very short. These activities are classed 'critical activities'. For instance, the activity "cutting up food" is a thrice daily activity which is required to be performed between the hours of 8am- 10am, 12pm-2pm and 4pm-6pm correlating to mea l times when the task has to be performed within. The management and provision of ongoing ad ministration of intravenous fluids is a nother such exa mple. Other non exhaustive examples include palliative intensive care and complex pain ma nagement, blood glucose measurement and a na lysis for those with a diagnosed medica l condition, daily administration of subcuta neous d rug which is essential for the person's hea lth condition management, suctioning airways and the ma nagement a nd intervention of ongoing tube feeding a nd tracheostomy ca re.

Table 4 Activity Times Master List

Specific Days

Period of

Activity Time Period Performed activity

Range

Cutting up food 3 times per day Eg. 7am-4pm

Placing or guiding the food into the resident's mouth Eg. 7am-4pm

3 times per day

for most of the meal

Morning, afternoon tea and supper for residents day Eg. 7am-4pm

Use of mechanical lifting equipment for transfers 8 times per day Eg. 7am-4pm

Moving to and from chairs, wheelchairs or beds 8 times per day Eg. 7am-4pm

Dressing & undressing (clothing) - physical assistance; Eg.7am-4pm

cuffs, splints, medical braces & prostheses other than

2 times per day

for the lower limb

Washing and/or drying the body day Eg . 7am-4pm All

Assistance with dental care, with hair care and with 2 times per day Eg . 7am-4pm All

Positioning resident for use of toilet; Positioning Eg 7am-4pm All of bedpan; Positioning resident for use of urinal 4 times per day

Standing by to provide verbal assistance with adjusting 4 times per day Eg 7am-4pm All

More than three episodes daily of urinary incontinence Eg . 7am-4pm All day

or passing of urine during scheduled toileting

Physiotherapy program - High ADL day Eg . 7am-4pm Weekdays

Physiotherapy program - Low ADL day Eg . 7am-4pm Weekdays

Physiotherapy program - Med ADL day Eg . 7am-4pm Weekdays

Planning - Blood pressure measurement for diagnosed 7am-4pm Weekdays half-yearly Eg .

hyper/hypotension

Intervention - Blood pressure measurement for Eg . 7am-4pm Weekdays day

diagnosed hyper/hypotension

Planning - Blood glucose measurement for diagnosed Eg . 7am-4pm Weekdays half-yearly

medical condition

Intervention - Blood glucose measurement for Eg . 7am-4pm Weekdays day

diagnosed medical condition

Planning - Skin integrity management, involving 7am-4pm

half-yearly Eg . Weekdays repositioning, for non ambulant residents

Intervention - Skin integrity management, involving Eg . 7am-4pm Weekdays x times per day

repositioning, for non ambulant residents Planning - Management of ongoing catheters half-yearly Eg. 7am-4pm Weekdays

Planning - Management of chronic infectious month Eg. 7am-4pm Weekdays

Intervention - Management of chronic infectious day Eg. 7am-4pm Weekdays

Planning - Management of chronic wounds - CNS month Eg. 7am-4pm Weekdays

Intervention - Management of chronic wounds day Eg. 7am-4pm Weekdays

Planning - Management of ongoing administration of Eg. 7am-4pm All week

intravenous fluids etc

Intervention - Management of ongoing administration day Eg. 7am-4pm All

Planning - Palliative intensive care and complex pain week Eg. 7am-4pm Weekdays

Intervention - Palliative intensive care and complex x times per day Eg. 7am-4pm Weekdays

Intervention - Palliative intensive care and complex day Eg. 7am-4pm Weekdays

Planning - Management of ongoing tube feeding month Eg. 7am-4pm

Intervention - Management of ongoing tube feeding day Eg. 7am-4pm All

Planning - Use of technical equipment for continuous Eg. 7am-4pm All half-yearly

monitoring of vital signs

Intervention - Use of technical equipment for Eg. 7am-4pm All day

continuous monitoring of vital signs

Application of patches weekly but less frequently than week Eg. 7am-4pm Weekend

Needs daily administration of subcutaneous drug day Eg. 7am-4pm Weekdays

Needs daily administration of intramuscular drug day Eg. 7am-4pm All

Needs daily administration of intravenous drug day Eg. 7am-4pm All

Problem physical behaviour occurs at least six days in a 6 times/week Eg. 7am-4pm All

Problem physical behaviour occurs at least once in a week Eg. 7am-4pm All

Problem physical behaviour occurs twice a day or more 12 times/ Eg. 7am-4pm All

Assessment Physical Behaviour half-yearly Eg. 7am-4pm Weekend

Care Plan Physical Behaviour quarterly Eg. 7am-4pm Weekend

Problem verbal behaviour ( PVB) occurs at least six days 6 times/ week Eg. 7am-4pm All

PVB occurs at least once in a week week Eg. 7am-4pm All

PVB occurs twice a dav or more, at least six davs in a 12 times/ Eg. 7am-4cm All

Assessment Verbal half-yearly Eg. 7am-4pm All

Care Plan Verbal Behaviour quarterly Eg. 7am-4pm All

Problem depression causes moderate interference with day Eg. 7am-4pm All

Problem depression causes major interference with day Eg. 7am-4pm

Problem depression causes mild interference with day Eg. 7am-4pm All

Severe Cognitive Impairment day Eg. 7am-4pm All

Moderate Cognitive Impairment day Eg. 7am-4pm All

Mild Cognitive Impairment day Eg. 7am-4pm All

Next a determination of the different type, or category, of staff whom ca n add ress each of the patient care needs is made and a matrix (of which only a portion is shown listed in ta ble 5) is compiled - step 230.

I n this exa mple, the options a re al located to the lowest staff type that has the required com petencies to perform, supervise or directly assist with (buddy) the particu lar aspect of care. Table 5 Staff Types and Activities

Assist

Supervisor Assist

Activity Performer Supervisor (Buddy)

< ) (Buddy)

Cutting up food PCW

Placing or guiding the food into the PCW

Placing utensils in resident's hand PCW

Providing assistance with daily oral

intake when ordered by a dietitian for EN 20%

a person with a PEG tube

Nutrition Care Plan/Review

Moving to and from chairs, PCW PCW 100% Problem depression causes moderate

PCW 20%

interference with regular activities

(PCW: Personal Care Worker, EN : Enrolled Nurse, RN : Registered Nurse)

For exam ple in row 4 we see that, the ADL Activity "Providing assista nce with daily oral inta ke when ordered by a dietician for a person with a PEG tube" can be carried out by a n enrol led nurse (EN) (or higher), whilst the formulation of the ca re pla n (row 5) needs to be carried out by a registered nu rse (RN ) (or higher).

Next it is necessary to determine the average time required to address each of the patient care needs listed in Ta ble 4 - step 240. I n this example a n indication of average time was determined principally from consultation with representatives from an authorised senior nurse leadership group, although resea rch publications were also consu lted. These average du rations are then adjusted to cater for deviations from the average for individual staff mem bers - Step 250. Times, durations, frequencies a nd the days that a specified activity is carried out, a re adjusted a nd a pplied to meet the needs and preferences of specific residents - Step 260. For particular activities termed critica l tasks, the time at which the respective ca re is required wil l be relatively specific.

Ta bles 5.1 to 5.4 illustrate va riations in the time al located to specific activities due to specific staff or specific patients and critical tasks associated with patients. Table 5.1 Standard Activities and Times

Activity Frequency Duration Specific Time

Period Range Performed

Cutting Up Food 3 times a day l min 8:00 AM - 10:00

AM

12:00 PM - 2:00

Washing and/or drying the body Once a day lO mins 7am - 11am

Table 5.2 Specific Staff Adjustments

ii Activity Frequency Duration Specific Ti j

Performed

111 Cutting Up Food 3 times a day 2 min 8:00 AM - 10:00 All

AM

12:00 PM - 2:00

111 Washing and/or Once a day 8 mins 7am - 11am All drying the body

Table 5.3 Specific Resident Requirements or Preferences irf nt Specific Time Davs

Activity Frequency Duration _{Period Range} p_erf_ormed

ID

7:00 AM -8:00 AM

22 Cutting Up Food 3 times a day l min 11:00 AM - 12:00 PM

3:00 PM - 5:00 PM

15 mins 7:00 PM -8:00 PM

Washing and/or drying the

22 Once a day

body

Table 5.4 Critical Tasks Required for Specific Residents (examples)

Specific T ime Da

Critical Duration

Activity Frequency Period Ra nge Pe rfo 'med Task ID per eventl

(indicative only)

The management and

At least daily or 8am-10am,

provision of ongoing

35 multiple times 30 mins 12pm-2pm,

administration of

daily 4pm-6pm

intravenous fluids

20 mins 8am-10am,

Intervention - Palliative

At least daily or 12pm-2pm,

intensive care and complex

45 multiple times 4pm-6pm,

pain management

daily 8pm-10pm,

2am - 6am Blood glucose 3 mins 8am-10am All measurement and analysis At least daily or

55 for those with a diagnosed multiple times

medical condition daily

10 mins 8am-10am, All

Daily administration of

12pm-2pm,

subcutaneous drug which is At least daily or

4pm-6pm

65 essential for the persons multiple times

health condition daily

management

20 mins 8am-10am, All

At least daily or

Intervention - ongoing tube 12pm-2pm,

75 multiple times

feeding 4pm-6pm

daily

60 mins 8am-10am, All

Intervention - Suctioning At least daily or

12pm-2pm,

airways, tracheostomy multiple times

4pm-6pm

care. daily

From table 5 we see that there is a performer, supervisor and assisting or "buddy" staff person sometimes involved. The performer is the staff person primarily responsible for performing the activity (based on their competency match to the activity). A supervisor is required if the activity complexity (skills required) means that a higher competency level is needed to support the staff member primarily responsible for the activity. I n this case the performer needs a higher qualified staff person/s being present for a proportion of the activity time allocated, to act in a supervisory role during the activity performance. Some activities also necessitate a 'buddy' (another staff person similarly qualified) to assist the performer for a proportion of the activity time allocated. For example, a staff member may require assistance for 20% of the time for an activity from another similarly qualified/competent staff person with a patient lifting task. From the preceding information a targeted list of activities which are required to address each respective patient's care needs (those patients listed in Table 2) is formed, each activity in the targeted list associated with a period when said activity is required to be performed (as identified from Table 4), a category of staff to perform said activity (as identified from Table 5), and a time indicator indicating a length of time taken for the respective category of staff to perform said activity. The methodology in this example is based on the following assumptions. Firstly, if there is a need for a particular skill level as determined by the activity and staff allocation approach (refer Table 5), an employee with at least that level of skill must be included in the roster in the required time period. Secondly, for staff, a hierarchy of staff categories, e.g. PCW, EN, ED2N, RN and RN Manager, determines that if necessary a higher level staff member could perform all lower level staff duties. Thirdly, staff are selected so that as far as is reasonable, all work is done at the most cost effective rate for the skill level required. Lastly, there is a base level of staff for any period that can be nominated in the model.

When calculating the required amount and type of staffing for each interval, the methodology takes into consideration if a higher qualified staff member can perform the duties of a less qualified staff member. The methodology accounts for this by determining whether a higher qualified staff member has spare capacity to fulfil the staff time required from lower qualified staff. Given this approach the calculation starts by estimating the number of minutes of staff time needed at each skill level for each interval from the modelling - Step 280. The number of staff required is then determined by calculation - Step 290. At this stage, the number will include nominal fractions of staff. Starting at the highest skill level needed, actual staff person numbers are then calculated, with respect to available shift times and over/under/net provision constraints- Step 300. This process is repeated down to the lowest skill level (PCW), except that where there is spare capacity from the higher skill levels (as a result of fractional staff indicated for a time period in the model), it is absorbed before more staff are employed - Step 310. For example if there were 1.3 registered nurses required in a shift resulting in an allocation of two registered nurses, the 0.7 spare capacity in the second registered nurse would be used to replace 0.7 of an ED2N (but only if an ED2N was nominated as being required at some fraction). Any fractional spare capacity in the ED2N would then be used to replace enrolled nurse time and so on down to personal care worker time fractions. Finally, a base number of staff may be nominated in the model for any period.

Some embodiments of the methodology may apply an unrounded approach which uses the fractions of staff indicated by the methodology to determine the actual number of staff required. This approach produces the lowest number of staff and staff cost as only staff fractions are costed. Worked Example for determining the allocation of staff over a given time period.

I n this exa mple, staff a re al located to shifts between 7:00 AM and 11:00 PM. However it should be a ppreciated that the model is flexible to accommodate the window within which shifts are a llocated, and to accommodate the length of the shift within the window. Shift lengths may for insta nce be selected from periods of between 1 hours and 24 hou rs, a lthough legislative requirements may ma ndate a minimum shift length.

Step 1: The system retrieves the resident assessments, and determines the activities that a re required to ca re for the resident based on predetermined rules.

Step 2: The system matches the activities requi red by each of the residents to the predetermined staff types that can perform the activity.

Step 3: Using interva ls in this exam ple of 30 mins across the whole period, the methodology calcu lates the total minutes required to care for residents by each staff type.

Table 6.1: Minutes required per 30 minute interval by staff type

Staff Type 7:00 AM 7 30 is!i rn

PCW 462.63 462.63 238.55 238.55

EN 25.47 25.47 7.47 7.47

ED2N 28.79 28.79 28.79 28.79

RN 48.93 48.93 33.46 33.46

RN 30.75 30.75 30.75 30.75

Manager

Step 4: The methodology divides the num ber of minutes required in each ha lf hour interval by 30 minutes to determine the number of people required in each i nterval.

Table 6.2: Staff (unrounded) required per 30 minute interval by staff type

Staff Type 7:00 AM 7:30 ... 11:00 11:30

ΔΜ DM DM

PCW 15.42 15.42 7.95 7.95

EN 0.85 0.85 0.25 0.25

ED2N 0.96 0.96 0.96 0.96

RN 1.63 1.63 1.12 1.12

RN 1.03 1.03 1.03 1.03

Manager Step 5: The methodology uses the least squares method (or an alternative method) to allocate staff numbers for the highest qualified staff, the RN Manager, to best fit the required staffing level, based on:

A. Shift times for RN Managers, e.g.7am - 3pm and 3pm-llpm.

B. Predetermined limits above the required staffing at any point in time across a time period (day, shift or other interval), i.e. the area above the solid line 310 required staffing line and the dotted line 320 calculated roster in Figure 3. Referred to as "Over Provision limits".

C. Predetermined limits below the required staffing at any point in time across a time period (day, shift or other interval), i.e. the area below the solid line 310 required staffing line and the dotted line 320 calculated roster in Figure 3. Referred to as "Under Provision limits".

D. Predetermined minimum allocation of staff compared to the required staffing amount over a time period (day, shift or other interval), i.e. the difference between the area below the dotted line 320 calculated roster and the area below the solid line 310 required staffing line in Figure 3. Referred to as "Net Provision limits".

In the case where not all the above parameters A-D can be complied with to result in a full staff member, the methodology allows for adjustments to the limits in B and C, until a result is reached.

Based on the required RN Managers in Table 6.2, and the above parameters, the methodology allocates the RN Managers. Table 6.3: Allocated RN Managers

Staff Type Ni jmber required Start time EndTi me

RN Manager 2 7:00 AM 3:00 PM

RN Manager 1 3:00 PM 11:00 PM

Step 6: The methodology allocates the next highest qualified level of staff, RN, by checking whether a higher qualified staff (RN Manager) can perform duties of the RN. If it has been predetermined that an RN Manager can perform the duties of the RN, the spare capacity of the RN Managers allocated in step 5 is taken away from the raw number of required RN staff in Table 6.2.

Table 6.4: Spare Capacity

Staff Type 7:00 AM 7:30 AM 10:00 PM 10:30 PM

Raw RNs Required 1.63 1.63 1.12 1.12

Raw RN Managers Required 1.03 1.03 1.03 1.03 RN Managers Allocated 2 2 1 1

Spare Capacity of RN

Manager 0.97 0.97 0 0

Adjusted RNs Required 0.66 0.66 1.12 1.12

Step 7: As per step 5, the methodology uses the least squares method (or an alternative method) to allocate the number of RNs using the adjusted number of RNs required in Table 6.4, RN shift times, e.g. 7am-3pm, 3pm-llpm and the over/under/net provision limits, see also figure 4.

Table 6.5: Allocated RNs

Staff Type I lumber required time End Time

RN

Manager 2 7:00 AM 3:00 PM

RN

Manager 1 3:00 PM 11:00 PM

RN 1 7:00 AM 3:00 PM

RN 2 3:00 PM 11:00 PM

Step 8: As per Step 6, calculate the spare capacity of allocated staff to perform duties of lower qualified staff.

Table 6.6: Spare Capacity of RNs

7:00 10:00

Staff Type AM 7:30 AM ... PM 10:30 PM Raw ED2Ns Required 0.96 0.96 0.96 0.96

Adjusted RNs Required 0.66 0.66 1.12 1.12

RNs Allocated 1 1 2 2

Spare Capacity of RNs 0.34 0.34 0.88 0.88

Adjusted ED2Ns

Required 0.62 0.62 0.08 0.08

Step 9: The methodology uses the least squares method (or an alternative method) to allocate the number of ED2Ns using the adjusted number of ED2Ns required in Table 6.6, ED2N shift times 7am-3pm, 3pm-llpm and the over/under/net provision limits, see also figure 5. Table 6.7: Allocated ED2Ns

Staff Type Number required Start time End Time

RN Manager 2 7:00 AM 3:00 PM

RN Manager 1 3:00 PM 11:00 PM

RN 1 7:00 AM 3:00 PM

RN 2 3:00 PM 11:00 PM

ED2N 1 7:00 AM 3:00 PM

ED2N 1 3:00 PM 11:00 PM

Step 10: Calcu late the spare capacity of a llocated staff to perform duties of lower qua lified staff.

Table 6.8: Spare Capacity of ED2Ns

7:00 7:30 10:00 10:30

Staff Type AM AM PM PM Raw ENs Required 0.85 0.85 0.25 0.25

Adjusted ED2Ns

Required 0.62 0.62 0.08 0.08

ED2Ns Allocated 1 1 1 1

Spare Capacity of ED2Ns 0.38 0.38 0.88 0.88

Adjusted ENs Required 0.46 0.46 0 0

Step 11: The methodology uses the least squa res method (or a n alternative method) to a llocate the nu mber of ENs using the adjusted nu m ber of ENs required in Ta ble 6.8, EN shift times 7am-3pm, 3pm-llpm a nd the over/u nder/net provision limits, see also figure 6.

Table 6.9: Allocated ENs

RN Manager 2 7:00 AM 3:00 PM

RN Manager 1 3:00 PM 11:00 PM

RN 1 7:00 AM 3:00 PM

RN 2 3:00 PM 11:00 PM

ED2N 1 7:00 AM 3:00 PM

ED2N 1 3:00 PM 11:00 PM

EN 1 7:00 AM 3:00 PM

Step 12: Calcu late the spare ca pacity of allocated staff to perform duties of lower qua lified staff. Table 6.10: Spare Capacity of ENs

7:00 7 3 0 10:00 10: m

Staff Type AM mm m PM f Λ Raw PCWs Required 15.42 15.42 7.95 7.95 Adjusted ENs Required 0.46 0.46 0 0 ED2Ns Allocated 1 1 0 0 Spare Capacity of

ENs/ED2Ns 0.54 0.54 0.63*

Adjusted PCWs Required 14.88 14.88 7.32 7.32

* During the afternoon shift the methodology looks at the spare capacity of the ED2N as an EN was not allocated in step 11.

Step 13: The methodology uses the least squares method (or an alternative method) to allocate the number of PCWs using the adjusted number of PCWs required in Table 6.10, PCW shift times (including 4, 6 and 8 hour shifts) and the over/under/net provision limits.

Table 6.11: Allocated Staff from 7am to 11pm

Start

Staff Type Number required time End Time

RN

Manager 2 7:00 AM 3:00 PM

RN

Manager 1 3:00 PM 11:00 PM

RN 1 7:00 AM 3:00 PM

RN 2 3:00 PM 11:00 PM

ED2N 1 7:00 AM 3:00 PM

ED2N 1 3:00 PM 11:00 PM

EN 1 7:00 AM 3:00 PM

PCW 10 7:00 AM 3:00 PM

PCW 5 7:00 AM 11:00 AM

PCW 1 7:00 AM 3:00 PM

PCW 2 8:00 AM 2:00 PM

PCW 7 3:00 PM 11:00 PM

PCW 3 3:00 PM 9:00 PM

PCW 3 3:00 PM 7:00 PM

PCW 1 4:00 PM 10:00 PM

The inventors have devised a means of systematically matching the competencies of staff to the patient/resident care needs and then determining the appropriate numbers and mix of skills required e.g. the acuity model. Additional variations can be added by adjusting the proportions (mix) of the different staff types (and competencies) within the number of staff indicated as being required. For example staff providing the on the floor basic care tasks are described as PCW (personal care workers), EN (enrolled nurses) and ED2N (endorsed enrolled nurses for medication) categories. The mix of staff indicated for these direct basic care activities by the model can be further revised by variations in the proportions of staff types mix in the final model. The proportions can be determined from the number of PCWs and ENs (EN+ED2N) in total such that, for example, where the model suggests 10 direct basic care floor staff (e.g. PCWs, ENs, ED2Ns)are required, the proportions of these staff types within this overall group can be varied from 0% to 100%. For example the 10 direct care staff could be comprised of 30% PCWs and 70% ENs. The model allows for this adjustment if the option is selected. It is envisioned that the outcome of embodiments of the invention will produce better clinical and care outcomes and more efficient staffing approaches. It will be appreciated by persons skilled in the art that numerous variations and/or modifications may be made to the above-described embodiments, without departing from the broad general scope of the present disclosure e.g. adding a wider scope of staff types. The present embodiments are, therefore, to be considered in all respects as illustrative and not restrictive. For instance, whilst the described methodology matches staffing requirements to resident care needs there are a number of duties performed by senior care staff that have only a peripheral relationship to individual resident care need requirements. These activities are summarised as Nursing Management and cover areas such as ordering and stock supplies, workforce management, rosters, staff communication and supervision, consultants/doctor interactions, quality assurance, education and training support, nursing documentation, admissions and discharges, family and resident meetings, reporting to board, arranging maintenance.

To cover these areas a flexible approach was developed that would ensure an appropriate amount and level of appropriately qualified and competent staff was available for facility management purposes and other high competency and skill level duties if required. For example, in a small facility where only part (less than 50%) of a higher qualified staff member (e.g. a registered nurse) was required in the morning shift- that higher qualified staff member could cover both management and high level resident acuity needs (e.g. assessment and care planning, medication, staff supervision etc). By covering management duties in combination with higher level qualified staff member duties where required, the higher qualified staff members role is efficiently and flexibly utilised in activities requiring these higher level skills (e.g. a registered nurse). That is_; the higher qualified staff member is not used for duties that could be completed by lower qualified staff.

A further em bodiment of the invention is it application in respect of a facility whereby the facility is divided into its smaller components resulting in the staff as determined in the previous sections to be allocated to the different components of a facility. Referring to figure 8, a facility 800, referred to as 'XYZ' is organised into several hierarchical areas: (1) the overriding facility 800, (2) sections 805 and 810, and (3) pod levels within each section, 815, 820, 825 and 830, 835, 840 respectively. The skill requirement of the workers is determined as per the resident assessment data described in previous sections. Staff are then allocated on the basis of the following method. It should be appreciated that the example shown is illustrative only and the facility could have more or fewer sections and more or fewer pod levels.

The inventors refer to a 'floating roster' as essentially assigning staff to a given area where that area is not at lowest/pod level. For instance if staff are rostered at the facility level they are responsible for all residents in the facility. That is, they are responsible across each section and across all pod levels. However if staff are assigned a pod, these staff are only responsible for that pod to which they are assigned.

Assigning staff to areas will in general increase the number of staff required, as at each partitioning a rounding up is required to produce whole numbers. However the ability to have 'floating' staff reduces the cost in comparison to having every staff member working at the smallest area level.

According to this embodiment, for a period of time, the allocation of staff is determined by the following steps:

1. Determination of the minutes of care required by all residents in the facility;

2. Based on the minutes of care required by all residents in the facility, determining the number of a particular staff type needed to carry out those minutes of work;

3. Dividing the staff into the section based on the relative need of each section, assigning only whole people to each section. Any remainder of people as determined in step 2, are assigned to work at the facility level; and 4. Further dividing the staff for each section, based on the relative need of each pod, assigning only whole people to each pod. Any remainder of people as determined in step 3, are assigned to work at the section level.

Steps 3 and 4 can be repeated for any number of levels of how an organisation structures their staffing model. A working example of the floating roster is now described.

Step 1: Determination of the minutes of care required at the facility level

Step 2: Determination of the number of staff required at the facility level

In this example, the shift length is a period of 6 hrs. In total therefore, 17 staff are required to cover 5786 minutes of work.

Step 3: Determination of the number of staff required per Section

In this example, the fraction 0.95 is used to indicate that 5% of a person's time is allocated to walking, when assigned to work at the facility level. This fraction is variable depending on the specific environment. Resultantly, Section A will be assigned 6 staff, Section B will be assigned 9 staff and two staff will be assigned at the facility level.

Step 4: Assigning Staff at the Pod level

Resultantly, Pod 1 will be assigned 1 staff, Pod 2 will be assigned 1 staff and Pod 3 will be assigned 2 staff. The two remaining staff members will be assigned to work in section A, across Pods 1, 2 and 3. Pod 4 will be assigned 3 staff, Pod 5 will be assigned 3 staff and Pod 6 will be assigned 2 staff. The one remaining staff member will be assigned to work in section B, across Pods 1, 2 and 3.

It should be appreciated that the example shows staff being allocated at the facility level before allocating staff to the section and pod level. The example could also be presented in the reverse whereby staff are allocated into the pod level before being assigned to the section and facility level.

Claims

CLAIMS:

1. A computer-implemented method to produce a health care facility staffing roster for patients in or associated with a health care facility, the staffing roster applicable for at least one given period having a predetermined number of intervals each of a predetermined number of minutes, the method comprising:

(d) for each category of staff and for each interval within the period:

(ii) determining an estimate of a number of staff required;

(i) optimizing the estimate of the number of staff required; and

(ii) determining a spare capacity for c_n by subtracting the estimate of the number of staff required from the optimized estimate;

(g) repeating step (f) for each subsequent category of staff; and

(h) generating a staffing roster indicating for each interval within a period, the optimized adjusted number of staff required in each category.

2. The computer-implemented method according to claim 1, wherein the step of optimizing the estimate of the number of staff required for the highest ranked category, or the step of optimizing the adjusted number of staff for any category of staff other than the highest ranked, over any interval comprises a least squares method.

3. The computer-implemented method according to claim 2, further comprising shift optimisation to best fit the required minutes of staff time required given the constraints of the available shift times for a particular staff member, and over, under and minimum net provision limits.

4. The computer-implemented method according to claim 3, wherein over provision limits are defined as those that relate to a predetermined maximum allowable allocation of staff over a required staffing level in a given interval, under provision limits are defined as those that relate to a predetermined maximum allowable allocation of staff under the required staffing level in a given interval, and minimum net provisions are defined as those that relate to a minimum overall difference between an allocation of staff and a required staffing level over a given period.

5. The computer-implemented method according to claim 3 or 4, wherein shift optimisation is based on a variety of shift lengths for particular categories of staff.

6. The computer-implemented method according to any one of the preceding claims, wherein the predetermined number of minutes for each interval is constant.

7. The computer-implemented method according to any one of claims 1 to 5, wherein the predetermined number of minutes for each interval varies across all intervals or across one or more subsets of intervals.

8. The computer-implemented method according to any one of the preceding claims, wherein the specific activities required to address each respective patient's care needs are retrieved from a predetermined assessment.

9. The computer-implemented method according to claim 8, wherein retrieving the specific activities to be carried out to address each respective patient's care needs comprises a preliminary step of identifying the specific activities from a master list of activities which comprises a list of activities required to address patient care needs, each activity in the list associated with a frequency of occurrence, and a time indicator indicating a length of time taken to carry out the activity.

10. The computer-implemented method according to claim 9, wherein the time indicator indicates an average length of time taken for the respective category of staff to perform a particular activity or activity grouping.

11. The computer-implemented method according to any one of the preceding claims, further comprising allocating a time adjustment indicator to either lengthen or shorten the previously allocated time indicator.