Engineering Innovative Clinical Resource Management By Design: A guided Emergent Search Through a Complex Adaptive System of Systems

Labor planning and allocation are critical success factors for hospitals in today's low margin, competitive healthcare environment. Unfortunately, the inability of even the most advanced automated planning systems for nursing labor to account for the within-shift and between-shift dynamic demands of patient care routinely leads to inefficiencies—and resulting cost overruns—in nurses’ actual utilization. We identify that the problem is exacerbated by typical labor measures. We use an elaborated action design science research (eADR) approach to iterate through multiple artifacts with practitioners
in situ
to address this persistent, wicked problem. We find that an understanding of complex adaptive systems behaviors is critical when filling essential nursing and support roles in real time. We use this knowledge to identify conflicting management processes that prevent system balancing feedback loops from operating efficiently. Our eADR approach led to the codesign, coevaluation, and coinstantiation of novel structures, roles, and tasks for the real-time nursing labor planning and allocation. The innovative artifact proposed incorporates the actors’ dynamic behaviors to dramatically improve labor utilization and support care standards essential to improved patient outcomes.