Essays on resource flexibilities in services Public Deposited

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  • March 20, 2019
  • Amal Samuel, Adelina Gnanlet
    • Affiliation: Kenan-Flagler Business School
  • Service firms unable to store services, constantly search for strategies to minimize supply-demand imbalance in resources. Escalating costs, nursing shortages, and process inefficiencies have led the US healthcare system to operate at near-full capacity and maintain high utilization levels. Even though hospitals often function at full capacity, they are expected to treat all patients due to legal, social and moral obligations. Hospitals use a combination of resource flexibility strategies to reduce supply-demand imbalance due to demand variability. In this dissertation, we analyze the benefits of using flexibility strategies on critical resources such as labor (nursing staff), equipment (bed spaces), and patient assignment to contain demand variability in the short-term. Staffing flexibility, often referred to as cross-training, is widely used in many service firms to increase labor utilization, morale, and job enrichment. Although cross-training is cost-efficient, cross-trained nurses are less productive in new units. In the first essay, we analyze the cost savings vs. productivity changes when using staffing flexibility in hospitals. We find that productivity of cross-trained nursing staff has a significant effect on the optimal amount of cross-training. There is also an interaction effect between productivity of cross-trained nurses, cross-training cost, and demand variability. In the second essay, we add a second resource flexibility strategy referred to as demand upgrades. Patients who are typically treated in a simple unit can be upgraded to a complex unit when beds are unavailable in the simple unit. We compare the impact of these two resource flexibility strategies on a hospital’s ability to meet stochastic patient demand. We also look at the impact of the timing of capacity and staffing decisions on system performance. In the third essay, we develop a resource flexibility strategy framework that utilizes internal resources (labor, equipment, and patient assignment) to efficiently manage different levels of demand variability. The insights, issues and implications needed for managers to implement flexibility models are also presented in the third essay. Thus, this dissertation has analyzed the benefit, trade-offs, limitations, and outcomes in implementing critical resource flexibility strategies in hospitals to minimize supply-demand imbalance and address short-term demand variability.
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  • In Copyright
  • Gilland, Wendell G.
  • Open access

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