Group 4

Applied Operations Research

Final Report

Liessens Heleen

Pham Thanh

Roelens Ben

Spriet Michael

Vercruysse David

Verhofstadt Valérie
 Group 4

Table of contents

1. Introduction ................................................................................................................................... 3

2. Managing the demand ................................................................................................................... 4

3. Budget partitioning........................................................................................................................ 6

4. Re-designing the nursing organisation ........................................................................................ 9

5. Ward budgeting ........................................................................................................................... 13

6. Shift Scheduling............................................................................................................................ 17

7. Determining the size of the float unit ......................................................................................... 21

Appendix 1: Schematic view of the demand managing model ..................................................... 22

Appendix 2: Scenarios represented in graph 1 and 2 ................................................................... 23

Appendix 3: Schematic view of the budget partitioning calculations ......................................... 24

Appendix 4: Schematic representation of the re-design of the shift system method ................ 25

Appendix 5: Examples of used models........................................................................................... 26

Appendix 6: Personnel costs per department for the different scheduling policies for the 9h 3
shifts scenario .................................................................................................................................. 28

Appendix 7: Personnel costs per department for the different scheduling policies for the 12h 2
shifts scenario .................................................................................................................................. 32

Appendix 8: Monthly rosters developed by the single pass algorithm........................................ 36

Appendix 9: Monthly rosters developed by the multi pass algorithm. ....................................... 39

Appendix 10: schematic display of the approach to determine the number of float nurses ..... 42

Appendix 11: Schedule for float nurses for the chosen scenario ................................................. 43

2
 Group 4

Case Sint-Catherine hospital

1. Introduction

The purpose of this project is to improve the match between nurse supply and demand in 4
departments of Sint-Catherine hospital. It appears that the personnel complains about the current
workload. Furthermore, there have been huge budget overruns in the last few years and patient’s
satisfaction is declining. Therefore, we’ve been asked to find a solution by either altering patient
demand patterns or improve the nurse scheduling.

First, we attempt to get a clear view on the patient inflow. We also look whether it is beneficial to
reassign the operating schedule in order to alter the workload. If this is not sufficient to solve the
demand-supply mismatch, we will focus on the supply side. Furthermore, we will also propose a new
budget partitioning for every department, better answering the current needs.

Our analysis starts from the current 2-shift system (a day and a night shift) and the minimal staffing
requirements collected by Denis Van de Velde. We also take into account that the hospital wants to
guarantee a 60% service level but aspires to reach a 66% service level. Finally, it is given that there
are 2 types of nurses: type I and type II.

3
 Group 4

2. Managing the demand

During this project phase, we strive to minimize the difference between supply and demand in the
four departments by improving the operating schedule. The nursing schedule (in other words the
supply side) and the uncontrollable inflow of patients (emergency inflow) are here considered a
given.

To analyze whether changing the operating schedule would be beneficial, we want to check whether
it can be improved enough to outweigh the disadvantages such a change would bring. To do this, we
use a linear programming model to perform scenario analysis on. Optimizing this model means
minimizing the discrepancy between supply and demand per working block of 3 hours.
The data on which the model is based are collected by Denis Van de Velde.

In short, the model is constructed as follows: for both controlled and uncontrolled patient inflow, the
number of patients per acuity class per department per day is calculated using the operation room
organisation and patient workload data provided by the hospital. The sum of these numbers of
patients gives us the aggregated number of patients per acuity class per day per department, which
is then converted to the workload per department on a given moment. This gives us the nurse
demand, expressed in workload. Finally, this demand is compared with the given supply. The model
tries to minimize the discrepancies between them by changing the days on which the different
disciplines are scheduled in the operating rooms (master surgery schedule).
The complete construction of the model is schematically depicted in appendix 1.

After performing scenario analysis (i.e. entering different possible schedules for the operating rooms
and looking how much the discrepancy between supply and demand increases or decreases) for a
60% service level as well as a 66% service level, we can conclude that no significant improvements
can be made to the operating schedule. Out of the multiple tested scenarios, only few improved the
schedule marginally. In the best scenario, the discrepancy between supply and demand went down
with only 0.09h compared to the current schedule, which is only an improvement of 0.1%. Part of the
tested scenarios are shown in graph 1 (for 60% service level) and graph 2 (for 66% service level).
Which scenario represents which schedule is mentioned in appendix 2.

Since people don’t like to change, the efforts to change the operating schedule would outweigh this
minimal benefit. Therefore, we suggest the management of the hospital to rather re-evaluate the
supply side (nurses’ schedule) than making changes to the demand side.

4
 Group 4

Graph 1: Discrepancies (=sum((supply-demand)²)) of scenarios for 60% service level

Graph 2: Discrepancies (=sum((supply-demand)²)) of scenarios for 66% service level

5
 Group 4

3. Budget partitioning

Since the previous project phase showed us that changing the demand side of the departments
doesn’t give the desired results, it is now recommended to try to improve the supply side (the nurse
schedule). We start this improvements by repartitioning the department budgets. The history-based
percentages are no longer accurate, because they no longer reflect the estimated workload in each
department.

The first step is to determine the cost per single workload unit. After calculating the total workload
for each year based on the data provided in the financial details, we divide this workload for each
year by the total spending of each respective year. This provides us with the annual cost per unit
workload from 1987 till 2007. To calculate the cost per unit workload valid over all departments, we
compute the weighted average of the cost per unit workload from 1993 till 2007, because the
percentages haven’t been adjusted since 1993. As weights we use 1 from 1993 till 1997, 2 from 1998
till 2002 and 3 from 2003 till 2007 to indicate that more importance is attached to the cost of a single
workload of the last years. Eventually we obtain €1,68 cost per single workload unit.

The predicted workload for each department is given by aggregating the workload on a given
moment per department (cfr. Calculation for the demand management, appendix 1) for a whole
year. These data are given in graph 3 below.

Graph 3: Predicted workload per department

Based on this workload, the new budget partitioning is as follows: 21% for department A, 19% for
department B, 25% for department C and 35% for department D. With the postulated total budget
of €7.350.000, this means department A receives €1.580.598,08, department B €1.384.997,46,
department C €1.846.215,66 and department D €2.538.188,81. The way the budget partitioning is
based on the predicted workload is shown in graph 4.

6
 Group 4

Graph 4: The predicted workload and the assigned budget (based on the new percentages) for each
department

However, based on the predicted workload, the postulated budget won’t suffice. The budget
shortage for 2008, aiming for a 66% service level, nears €1.380.000, so we strongly advise the
management to increase the allocated budget. Even to achieve a 60% service level, the budget of
€7.350.000 won’t suffice. In this case, a budget shortage of €1.191.938,44 is to be expected.

Because of these budget shortages, we advise the hospital management to first focus on obtaining
and maintaining a 60% service level. Later on, when the budget is sufficiently raised or the cost per
unit workload is sufficiently reduced, the hospital can strive to achieve a 66% service level.

The calculated data are summarized in table 1 and shown in graph 5. A schematic representation of
the calculation of these figures can be found in appendix 3.

Predicted workload 2008 Percentages Budget Costs Shortage

Dep A 1095454,312 22% 1.580.598,08 € 1.836.921,29 € 256.323,21 €
Dep B 959890,7273 19% 1.384.997,46 € 1.609.600,41 € 224.602,95 €
Dep C 1279544,08 25% 1.846.215,66 € 2.145.613,68 € 299.398,02 €
Dep D 1759125,179 35% 2.538.188,81 € 2.949.803,06 € 411.614,26 €
Total 5094014,298 100% 7.350.000,00 € 8.541.938,44 € 1.191.938,44 €

Table 1: Repartitioned budget, costs and budget shortages per department for a 60% service level

7
 Group 4

Graph 5: Costs, budget and budget shortage per department (based on the new percentages)

8
 Group 4

4. Re-designing the nursing organisation

After repartitioning the budget, we want to determine whether it’s preferable to keep the current
shift system of 2 shifts of 12h or whether it would be better to redesign the nursing organisation.
Also, the starting hours of the different shifts have to be re-evaluated. Firstly, we take into account
that the (new) shift system has to fulfil the nurses demand requirements at all times. As discussed
above, we assume a 60% service level. Furthermore, we want to keep a close eye on the satisfaction
and fatigue of the nurses (we take into account the necessary breaks) and the contentment of the
patients. However, our main criterion remains the costs (the sum of the cost of budgeted labor hours
and the cost of the number of shift types), because the departments have to operate under a limited
budget.

To see which shift design fulfils the hospital’s needs best, we test different scenarios of number of
shifts and duration of shifts in a linear optimization model. The demand that has to be met in a block
for a certain department is the maximum number of required nurses over all days of the week for
this block and this department, because it is postulated that the shift types and number of needed
nurses should be identical for all days of the week. Further, the number of shifts should be equal for
all departments. Shifts starting at 3 am and 12pm were left out of the model to meet the preferences
of the labor unions and the nursing personnel. A schematic representation of the used method can
be found in appendix 4.

The results of analyzing the different scenarios are summarized in the following table 2 and depicted
in graphs 6 and 7.

9h shifts 12h shifts

labour hours cost labour hours cost
∞ shifts (LP) 664 962.344,58 €
6 shifts (IP) 693 1.692.945,00 €
5 shifts (IP) 702 1.456.230,00 €
4 shifts (IP) 702 1.216.230,00 € 660 1.840.900,00 €
3 shifts (IP) 711 979.515,00 € 678 1.454.040,00 €
2 shifts (IP) 696 1.054.040,00 €

Table 2

9
 Group 4

Graph 6: Total costs for the different shift design scenarios

Graph 7: Total labour hours for the different shift design scenarios

10
 Group 4

It turns out that a 9 hour shift system with 3 shifts per day is the best solution. The shifts start in
each department at 6 am, 3 pm and 9pm. This system has a total cost of €979.515. This is
substantially lower than the 9 hour shift system with 4 shifts per day, which amounts to €1.216.230.
The 9 hour shift system with 5 shifts per day even costs €1.456.230. The number of labour hours for
the 9h/3 shifts scenario is higher than for the other scenarios, but this labour cost is compensated by
the lower administrative costs. The 12h shifts scenarios have distinctly lower numbers of labour
hours, but the longer shifts lead to a higher nurse fatigue and as a consequence to less satisfied
patients.

If, however, the hospital management chooses to keep the duration of the shifts at 12 hours, then it
is best to remain with the current system of 2 shifts per day since this is the least costly scenario of
all 12h scenarios.

Graph 8 – 11 show the costs per department of the cheapest 9h scenario and the cheapest 12h
scenario.

Graph 8: Costs per cost type and per department for the 9h 3 shifts scenario

Graph 9:Total costs per department for the 9h 3 shifts scenario

11
 Group 4

Graph 10: Costs per cost type and per department for the 12h 2shifts scenario

Graph 11:Total costs per department for the 12h 2 shifts scenario

12
 Group 4

5. Ward budgeting

After optimizing the shift design, we will now analyse different scheduling policy alternatives. For
each set of policies we want to determine the number of needed nurses and the budget implications.
At this stage, we make a distinction between type I and type II nurses. In every department there
should always be at least 1 type I nurse present. The nurse demand as calculated in the previous
project phases, is raised with 25% to take into account the nurse availability. Nurse-specific
characteristics are not yet taken included.

For ethical reasons, we put forward a number of extra constraints. There has to be at least 11 hours
between two shifts the same nurse is assigned to. Nurses that are made redundant in a certain
department are first hired in other departments where there is a nurse shortage, before extra nurses
are hired from the labour market. It is also assumed that in a 12h duration shift design, nurses have
to work 4 days a week (3 days off), while in the case of a 9h shift duration nurses work 5 days a week
(2 days off). This to remain within reasonable boundaries of minimum and maximum working hours
per week.

Again, linear optimization is used to compare the alternative scenarios. The model minimizes the
total personnel costs. A few examples of used models can be found in appendix 5. The constraint
that demand has to be fulfilled at all times is also applied here. The different scenarios are only
tested for the cheapest 9h shift scenario (i.e. 9h 3 shifts) and the cheapest 12h shift scenario (i.e. 12h
2 shifts) obtained in the “re-designing the nurse organisation” phase.

The comparison of the different scenarios is shown in table 3 and 4 below. More detailed results per
department can be found in appendix 6 and 7.

Comparing the alternative policies for the 9h 3 shifts scenario shows that the combination of non-
identical weekend, not consecutive working days and not the same shift on every day is financially
speaking the optimal one. This policy alternative also offers the most flexibility. What this means in
terms of costs for the different departments is shown in graph 12. For department A we need 30
nurses of which 8 type I and 22 type II nurses. Department B requires a total of 24 nurses, 8 of type I
and 16 of type II nurses. Department C needs a total of 42 nurses, 13 type I and 29 type II nurses.
Finally, department D requires 44 nurses, of which 6 type I and 38 type II nurses. The total personnel
cost amounts to €23.933,70, €19.822, €33.684.2 and €34.353,6 for department A, B, C and D
respectively.

For the 12h 2 shifts scenario, the combination of identical weekend, not the same shift on every day
and 4 days on, 3 days off gives the lowest costs. The impact for each department is shown in graph
13. However, we advise the hospital management to use the 9h 3 shift schedule described above.

13
 Group 4

number of personnel
Scenario description personnel costs
Type 1 Type 2
scheduling horizon of one
week;
same shift on all days; 37 108 116.010,90 €
non-identical weekend;
5 days on, 2 days off

scheduling horizon of one

week;
not same shift on all days;
35 105 111.853,50 €
non-identical weekend;
non-consecutive days
working

scheduling horizon of one

week;
same shift on all days; 37 116 121.872,80 €
identical weekend;
5 days on, 2 days off

scheduling horizon of
one week;
same shift on all days;
37 109 116.939,20 €
identical weekend;
non-consecutive days
working

scheduling horizon of
one week;
same shift on all days;
36 104 114.912,60 €
non-identical weekend;
non-consecutive days
working

Table 3: Personnel costs for the different scheduling policies for the 9h 3 shifts scenario

14
 Group 4

number of personnel
Scenario description personnel costs
Type 1 Type 2
scheduling horizon of one
week;
same shift on all days; 31 100 129.400,70 €
non-identical weekend;
4 days on, 3 days off

scheduling horizon of one

week;
same shift on all days; 37 110 144.731,10 €
identical weekend;
4 days on, 3 days off

scheduling horizon of
one week;
same shift on all days;
32 100 131.120,40 €
identical weekend;
non-consecutive days
working

scheduling horizon of
one week;
same shift on all days;
31 100 129.549,30 €
non-identical weekend;
non-consecutive days
working
scheduling horizon of one
week;
not same shift on all days;
25 99 127.260,30 €
non-identical weekend;
non-consecutive days
working
scheduling horizon of one
week;
not same shift on all days;
29 100 126.990,30 €
identical weekend;
non-consecutive days
working

scheduling horizon of one

week;
not same shift on all days; 23 100 125.421,30 €
identical weekend;
4 days on, 3 days off

Table 4: Personnel costs for the different scheduling policies for the 12h 2 shifts scenario

15
 Group 4

Graph 12: The personnel costs per department for the non-identical weekend, not same shift every
day and not consecutive working days policy alternative for the 9h 3 shifts scenario.

Graph 13: The personnel costs per department for the identical weekend, not same shift every day
and 4 days on 3 days off policy alternative for the 12h 2 shifts scenario.

16
 Group 4

6. Shift Scheduling

After having set up anonymous cyclical rosters for the different departments, we have tried to
automate the shift scheduling process in order to obtain important time savings for the head nurses.
As the cyclical rosters were developed in such a way that staff expenses are minimized, it is the ideal
base to start from in this step.
The shift system that we use is a 9 hour shift system with 3 shifts per day, which we obtained by
minimizing the total personnel fleet. Furthermore, we pay a lot of attention to the preferences of
our nurses. We have tried to minimize the total violations of their whishes in this step.

The first step in the scheduling process was the calculation of the total preference penalty of each
nurse for each cyclical roster. In a second step we have arranged the nurses in such a way that the
nurses with the highest preference for a certain roster, will be assigned to it first. This system is
clarified further from figure 1 to figure 3.

Figure 1: Example of a cyclical roster.

Day 1 Day 2 Day 3 Day 4 Day 5

S1 S2 S3 S0 S1 S2 S3 S0 S1 S2 S3 S0 S1 S2 S3 S0 S1 S2 S3 S0
Nurse 1 1 5 7 3 2 1 4 7 100 100 100 0 100 100 100 0 6 9 5 8
Nurse 2 100 100 100 0 100 100 100 0 7 1 6 6 4 1 1 3 9 9 0 2
Nurse 3 5 1 1 1 100 100 100 0 4 6 8 8 100 100 100 0 100 100 100 0

Figure 2 : Example of preference penalties for three nurses.

Assume this example of a cyclical roster and specific preference penalties of three nurses. As we
apply our priority rule to this example, we obtain the following result.

Total preference penalty

Nurse 2 104

Nurse 3 111

Nurse 1 113

Figure 3: Result of the priority rule for nurses.

17
 Group 4

It is obvious that we also need to specify a sequence of the days that we will use to assign nurses. We
are aware that for some days, it is more difficult to find nurses that want to work. To tackle this
problem, we calculated the total preference penalty per day. Afterwards, we will first assign nurses
to the days that have the highest preference penalty. If we use the example of figure 4, we get the
following order of days.

Total preference penalty

Day 2 614
Day 4 609
Day 5 348
Day 3 346
Day 1 324

Figure 4: Result of the priority rule for days.

After having applied these two priority rules, we can start assigning the nurses. Of course, there are
some other important factors that we can’t forget. We have to take into account the degree of
employment of nurses. We assumed that a full time employee can work 20 shifts per month. The
other employment degrees were calculated proportionately. Furthermore, we assumed that a nurse
is only able to work 5 days in a row and needs enough rest between two shifts. Only in really
exceptional cases the number of consecutive working days can be extended to 6.

In a first implementation, we have tried to assure that the program assigned nurses in such a way
that the minimal requirements per shift and per department were met. A first result for department
A can be found in table 5. The nurses of type 1 have got a grey colour. The results of the other
applications of our single-pass algorithm can be found in appendix 8.

The horizontal header indicates the days of the month. The number at the intersection of a nurse
and a day of the month indicates whether a nurse works on that particular day and if she works,
which shift she is assigned to. A 0 means that the nurse has a day off. The early shift is indicated by a
1. 2 and 3 refer to the late and night shift respectively.
For example, nurse 1 in the schedule below works the early shift on the 6th day of the month, the
night shift on the 12th and the 14th and again the early shift on the 20th and the 27th day of the month.
The other days, this particular nurse is free. The schedules of the other nurses and other
departments can be read in the same way.

18
 Group 4

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28
Nurse 1 0 0 0 0 0 1 0 0 0 0 0 3 0 3 0 0 0 0 0 1 0 0 0 0 0 0 1 0
Nurse 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Nurse 3 1 1 0 2 2 0 0 1 1 0 2 2 0 0 1 1 0 2 2 0 0 1 1 0 0 2 0 0
Nurse 4 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Nurse 5 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Nurse 6 0 3 0 0 0 0 0 0 3 0 0 0 0 0 0 3 0 0 0 0 0 0 3 0 0 0 0 0
Nurse 7 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Nurse 8 0 0 3 0 0 0 1 0 0 3 0 0 0 1 0 0 3 0 0 0 1 0 0 3 0 0 0 1
Nurse 9 2 2 0 0 1 2 2 2 2 0 0 1 2 2 2 2 0 0 1 2 2 2 2 0 0 1 2 2
Nurse 10 3 0 1 1 0 3 3 3 0 1 1 0 3 0 3 0 1 1 0 3 3 3 0 1 1 3 3 3
Nurse 11 2 2 0 0 2 3 0 2 2 2 0 0 0 0 2 2 2 0 0 0 0 2 2 2 0 2 3 0
Nurse 12 1 0 3 0 0 0 1 0 0 0 0 0 0 1 0 0 3 0 0 0 1 0 0 3 3 0 0 1
Nurse 13 3 0 1 3 0 1 3 3 0 1 3 0 1 3 3 0 1 3 0 1 3 3 0 1 3 0 1 3
Nurse 14 0 1 1 2 0 0 0 0 1 2 2 3 3 0 0 1 0 2 3 3 0 0 1 0 2 0 1 0
Nurse 15 1 3 0 2 2 0 1 1 3 0 2 0 0 0 1 3 0 2 0 0 0 1 3 0 2 2 0 0
Nurse 16 0 2 2 0 0 0 0 1 2 3 3 3 0 0 1 2 0 3 3 0 0 1 2 2 0 3 0 0
Nurse 17 2 0 1 0 0 0 1 2 2 2 0 2 0 3 0 2 2 0 0 1 3 0 0 2 0 0 0 3
Nurse 18 3 0 0 2 0 1 3 3 0 1 2 0 1 0 3 0 1 2 0 0 0 3 0 1 2 0 1 0
Nurse 19 1 0 0 2 3 3 0 1 0 1 2 0 0 0 1 0 1 2 0 0 0 1 0 1 2 3 3 0
Nurse 20 0 2 0 3 0 2 2 0 2 2 3 0 2 0 0 2 2 3 0 0 0 0 2 2 3 0 2 0
Nurse 21 1 0 2 0 1 1 2 0 0 3 0 0 1 2 0 0 2 0 0 1 2 0 0 2 0 1 1 2
Nurse 22 0 3 0 1 2 2 2 0 3 0 1 0 2 0 0 3 0 1 0 2 0 0 3 0 1 2 2 0
Nurse 23 3 0 2 3 0 1 1 3 0 2 3 0 1 1 3 0 2 3 0 1 1 3 0 2 3 0 1 1
Nurse 24 2 0 2 0 3 0 1 2 3 0 0 2 2 2 2 3 0 1 2 2 2 2 0 0 1 3 0 2
Nurse 25 0 1 0 1 2 2 2 0 1 0 1 0 2 0 0 1 0 1 0 2 0 0 1 0 1 2 2 0
Nurse 26 0 1 3 0 3 3 0 0 1 3 0 1 0 1 0 0 3 0 1 1 1 0 0 3 0 3 0 1
Nurse 27 2 0 0 0 1 2 0 2 0 1 0 2 0 2 2 0 1 0 2 0 2 2 0 1 0 0 2 2
Nurse 28 0 2 2 0 0 1 2 0 2 3 0 2 3 0 2 2 0 0 2 3 0 2 3 0 0 0 0 2
Nurse 29 0 1 0 2 2 2 2 0 1 0 2 2 2 2 0 1 0 2 2 2 2 0 1 0 2 2 2 2
Nurse 30 2 0 0 1 2 2 0 2 0 1 1 0 0 0 2 0 1 1 0 0 0 2 0 1 1 2 2 0
Nurse 31 2 2 0 2 3 0 0 2 2 2 2 0 0 0 2 2 2 2 0 0 0 2 2 0 2 0 0 0
Nurse 32 3 0 1 1 1 1 0 3 0 1 1 1 1 0 3 0 1 1 1 1 0 3 0 1 1 1 1 0

Table 5: Result of the single pass algorithm for department A.

To further improve this schedule we looked at which shift assignment has a big penalty and should
be replaced. This shift was chosen randomly between the 56 worst assignments in the monthly
roster.
In the next step we searched for the nurse that has the best preference to replace this shift. Taking
into account all the constraints mentioned before, the shifts between these two nurses were
swapped and the total preference penalty of the monthly roster was reduced.

We have repeated the application of this algorithm 35000 times in order to create a monthly
schedule that better fits all the quality performance measures. The result for department A can be
found in table 6. The monthly roster of the other departments can be found in appendix 9.

19
 Group 4

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28
Nurse 1 2 2 2 0 1 1 2 2 2 0 3 3 0 3 0 2 0 0 1 1 2 2 2 0 0 1 1 2
Nurse 2 3 0 1 1 0 3 0 3 0 1 1 1 3 0 3 0 1 1 0 0 0 3 0 1 0 0 3 0
Nurse 3 1 1 1 2 2 0 0 1 1 0 2 2 3 0 1 1 0 2 2 3 0 1 1 1 0 2 3 0
Nurse 4 3 3 0 1 2 3 0 3 3 0 1 1 3 0 3 0 1 1 3 3 0 3 0 1 0 1 3 1
Nurse 5 1 3 0 2 2 0 1 1 3 0 2 2 0 1 1 3 0 2 2 0 1 1 3 3 0 2 0 1
Nurse 6 2 1 2 3 3 0 3 0 1 0 3 3 0 3 0 1 2 3 3 0 3 0 1 2 0 3 3 3
Nurse 7 2 2 0 0 1 2 2 2 2 0 0 1 2 2 2 2 0 0 1 2 2 2 2 0 0 1 2 2
Nurse 8 3 0 1 1 0 3 3 3 0 1 1 0 3 0 3 0 1 1 0 3 3 3 0 1 1 3 3 3
Nurse 9 1 2 0 1 1 0 1 2 2 0 1 1 1 1 0 2 0 1 1 1 1 0 2 0 0 1 1 1
Nurse 10 1 1 3 0 1 1 1 1 0 3 0 0 1 1 1 1 3 0 0 1 1 1 1 3 0 0 1 1
Nurse 11 2 2 0 0 2 3 0 2 2 2 0 0 0 0 2 2 2 0 0 0 0 2 2 2 0 2 3 0
Nurse 12 1 2 3 0 3 0 1 2 2 2 0 0 0 1 0 0 3 0 0 0 1 2 0 3 0 3 0 1
Nurse 13 3 0 1 2 0 1 3 3 0 1 2 0 1 3 3 0 1 2 0 1 3 3 0 1 2 0 1 3
Nurse 14 0 1 1 2 0 0 0 0 1 2 2 3 3 0 0 1 0 2 3 3 0 0 1 0 2 0 1 0
Nurse 15 1 3 0 2 2 0 1 1 3 0 2 0 0 0 1 3 0 2 0 0 0 1 3 0 2 2 0 0
Nurse 16 0 2 2 3 0 0 0 1 2 3 3 3 0 0 1 2 0 3 3 0 0 1 2 0 0 3 0 0
Nurse 17 2 0 1 0 0 0 1 2 2 2 0 2 0 3 0 2 2 0 0 1 3 0 2 2 0 0 0 3
Nurse 18 3 0 0 3 0 1 3 3 0 1 3 0 1 0 3 0 1 3 0 0 0 3 0 1 3 0 1 0
Nurse 19 1 0 0 2 3 3 0 1 0 1 2 0 0 0 1 0 1 2 0 0 0 1 0 1 2 3 3 0
Nurse 20 0 2 0 3 0 2 2 0 2 2 3 0 2 0 0 2 2 3 0 0 0 0 2 2 3 0 2 0
Nurse 21 1 0 2 0 1 1 2 0 0 3 0 0 1 2 0 0 2 0 0 1 2 0 0 2 0 1 1 2
Nurse 22 0 3 0 1 2 2 2 0 3 0 1 0 2 0 0 3 0 1 0 2 0 0 3 0 1 2 2 0
Nurse 23 3 0 2 3 0 1 1 3 0 2 3 0 1 1 3 0 2 3 0 1 1 3 0 2 3 0 1 1
Nurse 24 2 0 2 2 3 0 1 2 3 0 0 2 2 2 2 3 0 1 2 2 2 2 0 0 1 3 0 2
Nurse 25 0 1 0 1 2 2 2 0 1 0 1 0 2 0 0 1 0 1 0 2 0 0 1 0 1 2 2 0
Nurse 26 0 1 3 0 3 3 0 0 1 3 0 1 0 1 0 0 3 0 1 1 1 0 0 3 0 3 0 1
Nurse 27 2 0 0 0 1 2 0 2 0 1 0 2 0 2 2 0 1 0 2 0 2 2 0 1 0 0 2 2
Nurse 28 0 2 2 0 0 1 2 0 2 3 0 2 3 0 2 0 2 0 2 3 0 2 3 0 0 0 0 2
Nurse 29 0 1 0 2 2 2 2 0 1 0 2 2 2 2 0 1 0 2 2 2 2 0 1 0 2 2 2 2
Nurse 30 2 0 0 1 2 2 0 2 0 1 1 0 0 0 2 0 1 1 0 0 0 2 0 1 1 2 2 0
Nurse 31 2 2 0 2 3 0 0 2 2 2 2 0 0 0 2 2 0 2 0 0 0 2 2 2 2 0 0 0
Nurse 32 3 0 1 1 1 1 0 3 0 1 1 1 1 0 3 0 1 1 1 1 0 3 0 1 1 1 1 0

Table 6: Result of the multi pass algorithm for department A.

20
 Group 4

7. Determining the size of the float unit

Now that we have optimized the monthly schedule for the midterm, we want to investigate whether
this schedule can cope with variations caused by the dynamic nature of the demand for nursing
services, absenteeism and other unforeseen circumstances. Moreover, we want to determine the
size of the float nurse unit that is needed to deal with this daily unbalances of demand and supply.

To tackle this issue, we start by analyzing the monthly schedule that resulted from case E to see
where there might be a discrepancy problem. We noted that there are nurse shortage problems
especially on day 2, 17 and 18 of the month. As for the other days, supply and demand match each
other quite well except between 9PM and midnight. During these 3 hours we observed an
oversupply of nurses, but this was expected since there is an overlap of shifts.

Next, we conducted different scenarios where demand and supply fluctuate, to get an idea of what
the number of float nurses should be and how many float nurses should be present each day. We’ve
increased the demand workload with 5%, 10%, 15% and 20%. This corresponds with an increase in
the total patient population or a relative increase of the higher acuity classes in comparison with the
lower acuity classes. The supply side is decreased with 5%, 10%, 15% and 20% to account for
absenteeism, etc. Furthermore, we played with scenarios of different combinations. In the table
below you can find the results of this scenario analysis. Appendix 10 shows the schematic display of
our approach.

Increase in demand Decrease in supply Size float nurse unit

5% 0% 8
10% 0% 10
15% 0% 12
20% 0% 14
0% 5% 8
0% 10% 10
0% 15% 12
0% 20% 14
5% 5% 10
10% 5% 12
5% 10% 12
10% 10% 13
15% 5% 13
5% 15% 14

Table 7: Several scenarios with their respective float unit size

As fluctuations in demand and supply hardly ever exceed the 10% boundaries, we concluded that a
float nurse unit size of 13 would be solid. This way, we can fulfil our service level almost at all times.
In appendix 11, a schedule is given of the float nurses for this scenario.

Now suppose the demand stays the same, but the supply changes because of a changing shift
system. As we’ve shown in the part of the ward budgeting this only has a small impact as long as the
changes aren’t too drastic.

21
 Group 4

Appendix 1: Schematic view of the demand managing model

22
 Group 4

Appendix 2: Scenarios represented in graph 1 and 2

Discrepancy: workload: sum((Supply-Demand)²) Discrepancy

60% 66%
Base Case Mo Tue Wed Thu Fri 6337223 6047265
1.1 2.1 3.1 6.2 4.2
5.1 6.1 1.2 5.2 3.2
4.1 2.2

Scenario A Mo Tue Wed Thu Fri 6338304 6047217

6.1 4.2 3.2 3.1 4.1
2.1 1.1 2.2 6.2 1.2
5.1 5.2

Scenario B Mo Tue Wed Thu Fri 6336874 6046141

1.1 2.1 3.1 3.2 4.2
5.1 6.1 1.2 5.2 6.2
4.1 2.2

Scenario C Mo Tue Wed Thu Fri 6323250 6031941

2.1 1.1 3.2 6.2 4.2
6.1 5.1 1.2 5.2 3.1
4.1 2.2

Scenario D Mo Tue Wed Thu Fri 6323720 6032739

2.1 1.1 3.1 6.2 4.2
6.1 5.1 1.2 5.2 3.2
4.1 2.2

Scenario E Mo Tue Wed Thu Fri 6559394 6264613

1.1 2.1 3.1 6.2 4.2
5.1 6.1 5.2 1.2 3.2
4.1 2.2

Scenario F Mo Tue Wed Thu Fri 6660379 6361390

6.1 4.1 6.2 3.2 4.2
5.2 5.1 2.1 1.2 3.1
1.1 2.2

23
Appendix 3: Schematic view of the budget partitioning calculations
 Group 4

Appendix 4: Schematic representation of the re-design of the shift system

method

25
 Group 4

Appendix 5: Examples of used models

Same: identical shifts during the week

Identical: identical shifts during the weekend
Consecutive: consecutive working days

Not same, not identical, not consecutive

Variables (binary)
o 1: working a certain shift on a certain day
o 1: you work during that week

Minimize: Labour costs

Subjected to:
o 11 hours between 2 shifts
 9-hour model: early shift day 1 + middle shift day 1 + late shift day 1 <= 1
 9-hour model: middle shift day 1 + late shift day 1 + early shift day 2 <= 1
 9-hour model: late shift day 1 + early shift day 2 + middle shift day 2 <= 1
 12-hour model: early shift day 1 + late shift day 1 <= 1
 12-hour model: late shift day 1 + early shift day 2 <= 1
o Variable of working that week *4 (12-hour model) or *5 (9-hour model)
= working days during that week
o Supply total nurses >= demand total nurses
o Supply type I nurses >= demand type I nurses
o Binary variables

Same, identical, consecutive

Variables (binary)
o 1: working a certain pattern (same shifttype)
 Working on Monday-Tuesday-Wednesday-Thursday-Friday
 Working on Saturday-Sunday-Monday-Tuesday-Wednesday
 Working on Wednesday-Thursday-Friday-Saturday-Sunday
 Working on Thursday-Friday-Saturday-Sunday-Monday
 Working on Friday-Saturday-Sunday-Monday-Tuesday

Minimize: Labour costs

Subjected to:
o Sum of patterns for a nurse <= 1
o Supply total nurses >= demand total nurses
o Supply type I nurses >= demand type I nurses
o Binary variables

26
 Group 4

Same, same, not consecutive

Variables (binary
o 1: having those 2 days off and doing a certain shift type:
 ZaZo– MaDi– MaWo– MaDo– MaVr- DiW- DiDo- DiVr– WoDo- WoVr- DoVr
e.g.: a 1 on ZaZo 06 means you work 5 days the shift starting on 6 am and
you don’t work on Saturday and Sunday
 Identical logic for 12-hour model

Minimize: Labour costs

Subjected to
o Sum of patterns for a nurse <=1
o Supply total nurses >= demand total nurses
o Supply type I nurses >= demand type I nurses
o Binary variables

Same, not identical, consecutive

Variables (binary)
o 1: working 5 consecutive days the same shift starting on that day
e.g.: a 1 on Tue 6am means you work the shift of 6am on Tuesday-Wednesday-
Thursday-Friday-Saturday

Minimize: Labour costs

Subjected to
o Sum of working that week for a certain nurse <=1
o Supply total nurses >= demand total nurses
o Supply type I nurses >= demand type I nurses
o Binary variables

Same, not identical, not consecutive

Variables (binary)
o 1: working a certain shift on a certain day
o 1: shift assignment: you work a certain shift type (early, middle, late)

Minimize: Labour costs

Subjected to
o Sum of shift assignment variables for a nurse <=1
o Sum of a certain shift type over the 7 days = sum of the variable shift assignment of
that shift type*5
o Supply total nurses >= demand total nurses
o Supply type I nurses >= demand type I nurses
o Binary variables

27
 Group 4

Appendix 6: Personnel costs per department for the different scheduling

policies for the 9h 3 shifts scenario

Department A

Scenario description number of personnel personnel costs

Type 1 Type 2
scheduling horizon of one
week;
same shift on all days; 9 22 24.983,10 €
non-identical weekend;
5 days on, 2 days off

scheduling horizon of one

week;
not same shift on all days; 8 22 23.993,70 €
non-identical weekend;
non-consecutive days working

scheduling horizon of one

week;
same shift on all days; 10 22 25.920,00 €
identical weekend;
5 days on, 2 days off

scheduling horizon of
one week;
same shift on all days; 9 22 24.844,80 €
identical weekend;
non-consecutive days working

scheduling horizon of
one week;
same shift on all days; 9 22 24.844,80 €
non-identical weekend;
non-consecutive days working

28
 Group 4

Department B

Scenario description number of personnel personnel costs

Type 1 Type 2
scheduling horizon of one
week;
same shift on all days; 9 16 20.732,00 €
non-identical weekend;
5 days on, 2 days off

scheduling horizon of one

week;
not same shift on all days; 8 16 19.822,00 €
non-identical weekend;
non-consecutive days working

scheduling horizon of one

week;
same shift on all days; 9 17 21.542,00 €
identical weekend;
5 days on, 2 days off

scheduling horizon of
one week;
same shift on all days; 9 16 20.732,00 €
identical weekend;
non-consecutive days working

scheduling horizon of
one week;
same shift on all days; 9 16 20.732,00 €
non-identical weekend;
non-consecutive days working

29
 Group 4

Department C

Scenario description number of personnel personnel costs

Type 1 Type 2
scheduling horizon of one
week;
same shift on all days; 12 32 34.968,20 €
non-identical weekend;
5 days on, 2 days off

scheduling horizon of one

week;
not same shift on all days; 13 29 33.684,20 €
non-identical weekend;
non-consecutive days working

scheduling horizon of one

week;
same shift on all days; 9 38 36.505,40 €
identical weekend;
5 days on, 2 days off

scheduling horizon of
one week;
same shift on all days; 11 33 34.732,20 €
identical weekend;
non-consecutive days working

scheduling horizon of
one week;
same shift on all days; 11 28 34.008,20 €
non-identical weekend;
non-consecutive days working

30
 Group 4

Department D

Scenario description number of personnel personnel costs

Type 1 Type 2
scheduling horizon of one
week;
same shift on all days; 7 38 35.327,60 €
non-identical weekend;
5 days on, 2 days off

scheduling horizon of one

week;
not same shift on all days; 6 38 34.353,60 €
non-identical weekend;
non-consecutive days working

scheduling horizon of one

week;
same shift on all days; 9 39 37.905,40 €
identical weekend;
5 days on, 2 days off

scheduling horizon of
one week;
same shift on all days; 8 38 36.630,20 €
identical weekend;
non-consecutive days working

scheduling horizon of
one week;
same shift on all days; 7 38 35.327,60 €
non-identical weekend;
non-consecutive days working

31
 Group 4

Appendix 7: Personnel costs per department for the different scheduling

policies for the 12h 2 shifts scenario

Department A

Scenario description number of personnel personnel costs

Type 1 Type 2
scheduling horizon of one
week;
same shift on all days; 6 22 27.682,50 €
non-identical weekend;
4 days on, 3 days off
scheduling horizon of one
week;
same shift on all days; 10 22 32.107,50 €
identical weekend;
4 days on, 3 days off

scheduling horizon of
one week;
same shift on all days; 7 22 29.017,50 €
identical weekend;
non-consecutive days working

scheduling horizon of
one week;
same shift on all days; 6 22 27.763,50 €
non-identical weekend;
non-consecutive days working

scheduling horizon of one

week;
not same shift on all days; 6 22 27.742,50 €
non-identical weekend;
non-consecutive days working

scheduling horizon of one

week;
not same shift on all days; 6 22 27.742,50 €
identical weekend;
non-consecutive days working

scheduling horizon of one

week;
not same shift on all days; 5 22 27.682,50 €
identical weekend;
4 days on, 3 days off

32
 Group 4

Department B

Scenario description number of personnel personnel costs

Type 1 Type 2
scheduling horizon of one
week;
same shift on all days; 6 16 22.014,30 €
non-identical weekend;
4 days on, 3 days off
scheduling horizon of one
week;
same shift on all days; 8 16 24.267,30 €
identical weekend;
4 days on, 3 days off

scheduling horizon of
one week;
same shift on all days;
6 16 22.095,30 €
identical weekend;
non-consecutive days
working

scheduling horizon of
one week;
same shift on all days;
6 16 22.095,30 €
non-identical weekend;
non-consecutive days
working
scheduling horizon of one
week;
not same shift on all days;
5 16 21.009,30 €
non-identical weekend;
non-consecutive days
working

scheduling horizon of one

week;
not same shift on all days;
5 16 20.988,30 €
identical weekend;
non-consecutive days
working

scheduling horizon of one

week;
not same shift on all days; 4 16 20.748,30 €
identical weekend;
4 days on, 3 days off

33
 Group 4

Department C

Scenario description number of personnel personnel costs

Type 1 Type 2
scheduling horizon of one
week;
same shift on all days; 14 27 41.003,70 €
non-identical weekend;
4 days on, 3 days off
scheduling horizon of one
week;
same shift on all days; 12 34 44.645,70 €
identical weekend;
4 days on, 3 days off

scheduling horizon of
one week;
same shift on all days; 15 26 41.387,70 €
identical weekend;
non-consecutive days working

scheduling horizon of
one week;
same shift on all days; 15 26 41.366,70 €
non-identical weekend;
non-consecutive days working

scheduling horizon of one

week;
not same shift on all days; 15 26 41.114,70 €
non-identical weekend;
non-consecutive days working

scheduling horizon of one

week;
not same shift on all days; 14 27 40.865,70 €
identical weekend;
non-consecutive days working

scheduling horizon of one

week;
not same shift on all days; 10 29 39.776,70 €
identical weekend;
4 days on, 3 days off

34
 Group 4

Department D

Scenario description number of personnel personnel costs

Type 1 Type 2
scheduling horizon of one
week;
same shift on all days; 5 35 38.700,20 €
non-identical weekend;
4 days on, 3 days off
scheduling horizon of one
week;
same shift on all days; 7 38 43.710,60 €
identical weekend;
4 days on, 3 days off
scheduling horizon of
one week;
same shift on all days;
4 36 38.619,90 €
identical weekend;
non-consecutive days
working
scheduling horizon of
one week;
same shift on all days;
4 36 38.323,80 €
non-identical weekend;
non-consecutive days
working
scheduling horizon of one
week;
not same shift on all days;
4 35 37.393,80 €
non-identical weekend;
non-consecutive days
working
scheduling horizon of one
week;
not same shift on all days;
4 35 37.393,80 €
identical weekend;
non-consecutive days
working

scheduling horizon of one

week;
not same shift on all days; 4 33 37.213,80 €
identical weekend;
4 days on, 3 days off

35
 Group 4

Appendix 8: Monthly rosters developed by the single pass algorithm.

Department B

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28
Nurse 1 0 0 1 0 0 0 2 0 0 0 3 0 1 2 0 0 1 3 0 1 0 0 0 0 0 0 1 2
Nurse 2 2 2 3 3 0 1 0 2 0 1 1 3 3 0 2 2 0 1 3 0 2 2 0 1 3 3 3 0
Nurse 3 0 0 0 2 2 0 0 0 0 0 2 2 0 0 0 0 0 2 2 0 0 0 0 0 2 2 0 0
Nurse 4 0 0 0 0 0 0 0 0 0 3 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Nurse 5 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Nurse 6 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Nurse 7 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Nurse 8 3 3 0 1 0 0 3 3 3 0 0 0 0 3 3 3 0 0 0 0 3 3 3 0 1 0 0 3
Nurse 9 1 1 2 0 1 0 1 1 1 2 0 1 0 1 1 1 2 0 1 0 1 1 1 2 0 1 0 1
Nurse 10 3 0 1 1 0 1 3 3 3 0 1 0 1 1 3 0 3 3 0 1 3 3 0 1 1 0 1 1
Nurse 11 0 3 3 0 1 3 0 0 2 3 0 0 3 3 0 0 2 2 0 3 0 0 0 2 0 1 3 3
Nurse 12 2 2 0 3 0 1 1 2 2 2 0 0 1 1 0 2 0 3 0 1 1 0 0 0 0 0 0 1
Nurse 13 1 1 1 0 3 0 1 1 1 1 0 3 0 1 1 1 1 0 3 0 1 1 1 1 0 3 0 1
Nurse 14 2 2 0 0 0 0 0 2 0 0 3 0 0 0 2 2 0 0 0 0 0 2 2 0 3 0 1 0
Nurse 15 0 3 0 2 2 2 2 0 3 0 2 2 2 2 0 3 0 2 2 2 2 0 3 0 2 2 2 2
Nurse 16 0 0 0 0 0 1 1 0 2 0 0 0 0 0 0 0 3 0 0 0 1 0 0 3 0 0 0 0
Nurse 17 0 3 3 0 2 2 3 0 3 3 0 2 2 3 0 3 3 0 2 2 3 0 3 3 0 2 2 3
Nurse 18 3 0 2 0 2 2 2 3 0 2 0 2 2 2 3 0 2 0 2 2 2 3 0 2 0 2 2 2
Nurse 19 0 3 0 1 3 3 3 0 3 0 1 3 3 3 0 3 0 1 3 3 3 0 3 0 1 3 3 3
Nurse 20 0 0 0 2 0 3 3 0 0 0 0 3 3 3 3 0 0 2 3 3 3 3 0 0 2 0 3 3
Nurse 21 2 0 0 2 2 2 2 2 0 0 2 2 2 2 2 0 0 2 2 2 2 2 0 0 2 2 2 2
Nurse 22 2 2 2 2 0 0 0 2 0 2 2 0 3 0 2 2 0 0 0 3 0 2 2 0 2 0 3 0
Nurse 23 3 0 3 0 2 2 2 3 0 3 0 2 2 2 3 0 3 0 2 2 2 3 0 3 0 2 2 2
Nurse 24 0 2 2 3 0 1 0 2 2 2 2 3 0 2 2 0 2 3 3 0 0 2 2 2 3 3 0 2
Nurse 25 0 2 2 3 0 1 1 0 2 2 3 0 1 1 0 2 2 3 0 1 1 0 2 2 3 0 1 1

36
 Group 4

Department C

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28
Nurse 1 3 0 0 3 3 0 3 3 0 0 0 3 3 3 3 0 0 3 0 0 0 3 0 0 3 3 3 3
Nurse 2 1 1 1 0 1 3 0 1 1 1 3 0 0 1 1 1 1 0 3 3 3 0 3 3 0 1 0 1
Nurse 3 0 0 3 0 0 0 1 0 0 0 1 1 0 0 0 0 3 0 1 0 1 1 1 1 0 0 0 0
Nurse 4 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Nurse 5 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Nurse 6 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Nurse 7 2 3 0 1 0 0 2 2 3 0 0 0 2 2 2 3 0 1 0 0 0 2 0 0 1 0 2 2
Nurse 8 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Nurse 9 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Nurse 10 2 0 3 3 0 1 1 2 0 3 3 0 1 1 0 0 3 0 0 0 1 0 0 3 3 0 0 1
Nurse 11 0 0 2 0 2 2 2 0 2 2 0 0 2 0 0 2 2 0 0 0 2 0 2 2 0 2 2 2
Nurse 12 0 0 0 2 3 3 3 0 2 0 2 0 3 0 0 2 0 0 3 0 3 0 2 0 2 3 3 3
Nurse 13 0 0 2 2 0 1 0 0 2 0 2 2 0 2 0 2 2 2 2 2 0 0 2 2 0 0 0 1
Nurse 14 2 0 1 0 0 0 1 2 0 1 0 2 0 0 2 0 1 0 2 2 0 2 0 1 2 0 2 2
Nurse 15 3 0 3 3 0 1 1 3 3 3 0 0 1 1 3 3 3 0 0 1 1 3 3 3 0 0 1 1
Nurse 16 3 0 2 3 0 2 2 3 0 2 3 0 2 2 3 0 2 3 0 2 2 3 0 2 3 0 2 2
Nurse 17 1 0 1 1 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 0 2
Nurse 18 1 2 0 1 1 1 0 1 2 0 1 0 1 0 0 2 0 0 1 0 0 0 2 0 1 1 1 0
Nurse 19 2 0 3 0 2 2 2 2 0 3 0 0 2 2 0 0 3 0 2 0 2 2 0 3 0 2 0 0
Nurse 20 2 0 0 0 3 0 1 2 0 2 0 3 0 1 2 2 0 3 3 0 0 2 2 0 3 3 0 0
Nurse 21 0 0 3 0 2 2 0 0 2 0 0 0 2 0 0 2 3 0 0 0 0 0 2 3 0 2 0 0
Nurse 22 0 0 0 2 3 0 3 0 0 3 0 2 3 3 0 1 0 2 2 2 0 0 1 0 2 3 0 0
Nurse 23 0 0 0 2 2 2 2 0 2 0 2 0 2 0 0 2 0 0 2 0 2 0 2 0 2 2 2 2
Nurse 24 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 0 0 1 0 0 0 1 0 0 0 0 0 0
Nurse 25 2 0 0 2 2 2 2 2 0 0 2 2 2 2 2 0 0 2 2 2 2 2 0 0 2 2 2 2
Nurse 26 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Nurse 27 2 0 0 1 1 1 2 2 0 0 1 0 1 2 0 0 0 0 1 0 2 0 0 0 1 1 1 2
Nurse 28 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Nurse 29 3 0 0 3 0 1 3 3 3 0 3 0 1 3 3 3 0 3 0 1 3 3 3 0 3 0 0 0
Nurse 30 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Nurse 31 0 0 1 2 2 2 2 0 0 1 2 0 2 0 0 0 1 0 2 0 2 0 0 1 0 2 2 2
Nurse 32 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Nurse 33 0 0 3 0 3 3 3 0 3 3 0 3 3 3 0 3 3 0 3 3 3 0 3 3 0 3 0 0
Nurse 34 0 0 2 2 2 2 2 0 2 0 2 2 2 2 0 2 0 2 2 2 2 0 2 2 2 2 0 1
Nurse 35 2 0 0 0 2 2 2 2 3 0 0 2 2 2 2 3 0 0 2 2 2 2 3 0 0 2 2 2
Nurse 36 0 0 0 0 0 0 0 0 0 0 0 2 0 2 0 0 0 2 0 2 0 0 0 0 0 0 0 0
Nurse 37 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Nurse 38 1 0 2 2 2 0 0 1 1 2 2 2 0 0 1 1 2 2 2 0 0 1 1 2 2 2 0 2
Nurse 39 1 1 1 1 1 0 0 1 1 1 1 1 0 0 1 1 1 1 0 1 0 1 1 1 1 1 0 0
Nurse 40 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 0 0 3 0 1 0 2 0 0 0 0 0 0
Nurse 41 2 0 0 3 0 1 1 2 0 2 3 0 1 1 2 2 0 3 0 1 1 2 2 0 3 0 0 0
Nurse 42 0 0 0 0 0 0 0 0 0 0 0 2 0 2 0 0 0 2 0 2 0 0 0 0 2 0 0 0
Nurse 43 3 0 2 0 2 2 2 3 0 2 0 1 2 2 2 0 0 1 0 1 2 2 0 2 2 2 0 0
Nurse 44 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

37
 Group 4

Department D

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28
Nurse 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Nurse 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Nurse 3 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Nurse 4 2 2 2 2 2 0 0 2 2 2 2 2 0 0 2 2 2 2 2 0 0 2 2 2 2 2 0 0
Nurse 5 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 0 0 1 1 1 1
Nurse 6 0 0 0 0 0 2 0 0 0 0 0 0 2 0 0 0 0 0 0 2 0 0 0 0 0 0 2 0
Nurse 7 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Nurse 8 3 0 1 0 3 3 3 3 0 1 0 3 3 3 3 0 1 3 0 3 3 3 0 1 3 0 3 3
Nurse 9 0 3 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3 0 0 0 0 0 0 3 0 0
Nurse 10 3 0 2 0 1 1 1 0 0 2 0 0 1 1 3 0 2 0 1 0 0 3 0 2 0 1 1 0
Nurse 11 2 0 0 0 0 1 1 0 0 0 0 0 1 1 0 2 0 0 1 0 0 2 0 0 0 1 1 0
Nurse 12 3 3 0 1 1 1 0 1 3 0 0 1 1 0 3 3 0 0 1 1 1 3 3 0 1 1 1 1
Nurse 13 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3 0 3 0 0 0 0 0 0 0 0
Nurse 14 1 1 1 1 0 0 1 0 1 1 0 0 0 1 1 1 1 0 0 0 0 1 1 1 1 0 0 0
Nurse 15 2 0 1 0 2 2 2 0 0 1 0 0 2 2 2 0 1 0 2 0 0 2 0 1 0 2 2 0
Nurse 16 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Nurse 17 2 0 0 1 0 2 0 0 2 0 0 0 2 0 0 2 0 0 2 0 0 2 0 0 0 2 2 0
Nurse 18 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Nurse 19 1 0 3 0 1 1 1 0 0 3 0 0 1 1 1 0 3 0 1 0 0 1 0 3 0 1 1 0
Nurse 20 0 0 2 3 3 3 3 0 0 2 3 3 3 3 0 0 2 3 3 3 3 0 0 2 3 3 3 3
Nurse 21 3 2 3 0 2 2 0 2 0 1 1 2 2 0 2 0 1 1 0 2 2 2 2 0 1 0 0 2
Nurse 22 0 1 0 1 1 1 1 0 1 0 1 1 1 1 0 1 0 1 1 1 1 0 1 0 1 1 1 1
Nurse 23 0 0 1 1 0 3 3 3 0 1 2 0 3 3 0 0 1 2 0 2 2 0 0 1 0 0 0 2
Nurse 24 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Nurse 25 0 0 0 2 2 2 2 2 0 0 0 0 2 2 0 1 0 2 0 1 2 0 1 0 0 2 2 2
Nurse 26 2 1 2 2 0 0 0 0 0 2 2 2 0 0 0 2 2 2 0 2 2 0 0 2 2 0 0 2
Nurse 27 0 1 2 3 0 1 1 2 0 2 0 2 0 1 0 0 2 0 0 2 2 0 0 2 0 0 1 2
Nurse 28 2 2 2 2 3 0 0 0 2 2 0 0 0 0 2 2 2 0 3 0 0 2 2 2 0 3 0 0
Nurse 29 1 3 0 3 3 3 0 0 3 0 3 3 3 0 1 3 0 0 3 0 0 1 3 0 3 0 0 0
Nurse 30 3 2 3 0 2 2 3 3 0 3 0 1 2 3 0 2 0 2 0 1 1 0 2 0 2 0 0 1
Nurse 31 1 0 2 0 1 1 1 1 0 2 0 1 1 1 1 0 2 0 1 1 1 1 0 2 0 1 1 1
Nurse 32 2 3 0 2 0 1 2 0 3 0 2 0 1 2 2 3 0 0 0 0 0 2 3 0 2 0 1 0
Nurse 33 2 2 2 2 0 0 0 2 2 2 2 0 3 0 2 2 2 2 3 0 1 2 2 2 2 0 0 1
Nurse 34 0 2 3 3 3 0 0 2 2 0 2 3 0 0 2 0 0 2 0 3 0 2 2 0 2 0 0 3
Nurse 35 2 0 1 0 1 1 1 0 0 1 0 1 1 1 2 0 1 0 1 0 0 2 0 1 0 0 1 0
Nurse 36 1 2 3 0 1 0 2 2 2 3 0 1 2 2 2 0 3 0 1 1 1 0 2 3 3 0 0 1
Nurse 37 1 2 2 2 0 0 1 0 2 2 0 0 0 1 1 2 2 0 0 0 0 1 2 2 2 0 0 0
Nurse 38 3 0 1 2 3 0 0 1 0 0 2 3 0 3 3 0 0 2 3 0 1 3 0 0 2 0 0 1
Nurse 39 2 2 0 1 0 2 2 0 2 0 3 0 2 2 0 0 0 3 0 1 1 0 2 0 3 0 0 1
Nurse 40 0 0 1 0 2 2 2 0 1 1 0 0 2 2 0 1 1 0 2 0 0 0 1 1 0 2 2 0
Nurse 41 0 0 1 2 0 0 2 2 0 1 0 2 0 2 2 0 1 0 2 2 2 0 0 1 0 2 0 2
Nurse 42 0 1 2 3 3 3 0 0 1 2 3 3 3 0 0 1 2 3 3 3 0 0 1 2 3 3 3 0
Nurse 43 1 0 0 1 2 3 0 2 2 0 2 2 3 0 1 2 0 2 2 0 2 0 0 0 2 0 0 2
Nurse 44 0 2 0 2 2 2 2 0 2 0 0 2 2 2 0 2 0 0 2 0 0 0 2 0 2 2 2 0
Nurse 45 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Nurse 46 3 0 3 0 2 0 0 1 3 3 0 0 0 3 3 3 0 1 2 0 1 3 3 3 0 0 0 0
Nurse 47 1 3 3 0 0 2 2 3 3 3 0 2 0 2 3 3 3 3 0 0 3 3 3 3 3 0 0 3

38
 Group 4

Appendix 9: Monthly rosters developed by the multi pass algorithm.

Department B

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28
Nurse 1 0 0 1 3 0 1 2 0 0 0 3 0 0 2 0 0 1 0 0 0 2 0 0 0 3 0 0 2
Nurse 2 2 2 0 1 3 0 1 2 0 1 1 3 3 0 2 2 3 0 3 3 0 2 0 1 1 3 3 0
Nurse 3 1 0 1 2 2 2 0 2 0 1 2 2 0 0 2 0 1 2 2 2 0 2 2 0 2 2 2 2
Nurse 4 0 1 2 0 1 1 0 1 1 3 0 1 0 1 1 1 2 0 1 0 1 1 1 2 0 1 1 1
Nurse 5 0 1 2 3 0 1 0 1 1 1 1 1 0 1 1 1 2 0 1 1 2 0 1 1 0 1 0 1
Nurse 6 1 1 1 1 3 0 1 1 0 1 0 1 0 1 1 1 1 0 3 0 0 1 1 1 1 3 0 3
Nurse 7 0 0 1 1 3 0 1 0 0 0 1 3 3 0 0 0 1 1 3 3 0 1 0 0 1 3 3 0
Nurse 8 3 3 0 1 1 0 3 3 3 0 1 3 0 3 3 3 0 1 0 3 3 3 3 0 1 0 1 3
Nurse 9 1 1 2 0 1 0 0 1 1 2 0 1 0 1 1 1 2 0 1 0 1 1 1 2 0 1 1 1
Nurse 10 3 0 1 1 0 1 3 3 3 0 1 0 1 1 3 0 3 3 0 1 3 3 0 1 1 0 1 1
Nurse 11 0 3 3 0 1 3 0 0 2 3 0 0 3 3 0 0 2 2 0 3 0 0 0 2 0 1 3 3
Nurse 12 2 2 0 3 0 1 1 2 2 2 0 0 1 1 0 2 0 3 0 1 1 0 0 0 0 0 0 1
Nurse 13 1 1 1 0 3 0 1 1 1 1 0 3 0 1 1 1 1 0 3 0 1 1 1 1 0 3 0 1
Nurse 14 2 2 0 0 0 0 0 2 0 0 3 0 0 0 2 2 0 0 0 0 0 2 2 0 3 0 1 0
Nurse 15 0 3 0 2 2 2 2 0 3 0 2 2 2 2 0 3 0 2 2 2 2 0 3 0 2 2 2 2
Nurse 16 0 0 3 0 0 1 1 0 2 0 0 0 2 2 3 0 3 0 2 0 1 3 0 3 0 2 2 2
Nurse 17 0 3 3 0 2 2 3 0 3 3 0 2 2 3 0 3 3 0 2 2 3 0 3 3 0 2 2 3
Nurse 18 3 0 2 0 2 2 2 3 0 2 0 2 2 2 3 0 2 0 2 2 2 3 0 2 0 2 2 2
Nurse 19 0 3 0 1 3 3 3 0 3 0 1 3 3 3 0 3 0 1 3 3 3 0 3 0 1 3 3 3
Nurse 20 0 0 0 2 0 3 3 0 0 0 0 3 3 3 3 0 0 2 3 3 3 3 0 0 2 0 3 3
Nurse 21 2 0 0 2 2 2 2 2 0 0 2 2 2 2 2 0 0 2 2 2 2 2 0 0 2 2 2 2
Nurse 22 2 2 2 2 0 0 0 2 0 2 2 0 3 0 2 2 0 0 0 3 0 2 2 0 2 0 3 0
Nurse 23 3 0 3 0 2 2 2 3 0 3 0 2 2 2 3 0 3 0 2 2 2 3 0 3 0 2 2 2
Nurse 24 0 2 2 3 0 1 0 2 2 2 2 3 0 2 2 0 2 3 3 0 0 2 2 2 3 3 0 2
Nurse 25 0 2 2 3 0 1 1 0 2 2 3 0 1 1 0 2 2 3 0 1 1 0 2 2 3 0 1 1

39
 Group 4

Department C

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28
Nurse 1 3 0 0 3 3 0 3 3 0 0 0 3 3 3 3 0 0 3 3 0 0 3 0 0 3 0 3 3
Nurse 2 1 1 1 0 1 3 0 1 1 1 3 0 0 1 1 1 1 0 1 3 3 0 3 3 0 3 0 1
Nurse 3 3 0 3 3 3 0 1 3 0 0 3 3 3 3 3 0 3 3 3 0 1 3 0 1 3 0 3 3
Nurse 4 0 3 0 1 0 0 0 2 3 0 1 1 0 2 2 3 0 0 0 0 0 1 1 1 1 1 0 2
Nurse 5 0 1 1 0 1 2 2 0 1 1 1 1 2 0 1 1 1 1 0 2 2 2 3 0 0 1 2 0
Nurse 6 0 0 3 0 0 0 1 1 0 0 3 3 0 1 3 0 3 0 1 0 1 1 1 3 3 0 0 1
Nurse 7 2 3 0 1 0 0 2 2 3 0 0 0 2 2 2 3 0 1 0 0 0 2 0 0 1 0 2 2
Nurse 8 0 3 3 0 1 3 0 2 3 0 1 0 2 2 2 3 0 1 0 2 2 2 3 0 1 1 2 2
Nurse 9 0 1 1 0 1 0 1 1 1 0 1 1 3 0 1 1 3 0 1 0 1 1 1 1 0 1 3 3
Nurse 10 2 0 3 3 0 1 1 2 0 3 3 0 1 1 0 0 3 0 0 0 1 0 0 3 3 0 0 1
Nurse 11 0 0 2 0 2 2 2 0 2 2 0 0 2 0 0 2 2 0 0 0 2 0 2 2 0 2 2 2
Nurse 12 0 0 0 2 3 3 3 0 2 0 2 0 3 0 0 2 0 0 3 0 3 0 2 0 2 3 3 3
Nurse 13 0 0 2 2 0 1 0 0 2 0 2 2 0 2 0 2 2 2 2 2 0 0 2 2 0 0 0 1
Nurse 14 2 0 1 0 0 0 1 2 0 1 0 2 0 0 2 0 1 0 2 2 0 2 0 1 2 0 2 2
Nurse 15 3 0 3 3 0 1 1 3 3 3 0 0 1 1 3 3 3 0 0 1 1 3 3 3 0 0 1 1
Nurse 16 3 0 2 3 0 2 2 3 0 2 3 0 2 2 3 0 2 3 0 2 2 3 0 2 3 0 2 2
Nurse 17 1 0 1 1 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 0 2
Nurse 18 1 2 0 1 1 1 0 1 2 0 1 0 1 0 0 2 0 0 1 0 0 0 2 0 1 1 1 0
Nurse 19 2 0 3 0 2 2 2 2 0 3 0 0 2 2 0 0 3 0 2 0 2 2 0 3 0 2 0 0
Nurse 20 2 0 0 0 3 0 1 2 0 2 0 3 0 1 2 2 0 3 3 0 0 2 2 0 3 3 0 0
Nurse 21 0 0 3 0 2 2 0 0 2 0 0 0 2 0 0 2 3 0 0 0 0 0 2 3 0 2 0 0
Nurse 22 2 0 0 2 3 0 3 0 2 3 0 2 3 3 0 1 0 2 2 2 2 0 1 1 2 3 0 0
Nurse 23 0 0 0 2 2 2 2 0 2 0 2 0 2 0 0 2 0 0 2 0 2 0 2 0 2 2 2 2
Nurse 24 1 0 1 1 1 2 0 1 1 1 1 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 0 0
Nurse 25 2 0 0 2 2 2 2 2 0 0 2 2 2 2 2 0 0 2 2 2 2 2 0 0 2 2 2 2
Nurse 26 1 0 0 2 2 2 0 1 0 1 2 2 2 0 1 1 0 2 2 2 0 1 1 2 2 2 0 0
Nurse 27 2 0 0 1 1 1 2 2 0 0 1 0 1 2 0 0 0 0 1 0 2 0 0 0 1 1 1 2
Nurse 28 2 0 0 2 2 2 2 0 0 0 2 0 2 0 0 0 0 0 0 0 2 0 0 0 0 2 0 2
Nurse 29 3 0 2 3 0 1 3 3 3 0 3 0 1 3 3 3 0 3 0 1 3 3 3 0 3 0 0 0
Nurse 30 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Nurse 31 0 0 1 2 2 2 2 0 0 1 2 0 2 0 0 0 1 0 2 0 2 0 0 1 0 2 2 2
Nurse 32 2 0 0 1 2 2 2 2 0 3 0 2 2 2 2 2 0 1 2 2 2 2 0 3 0 2 0 0
Nurse 33 3 0 3 0 3 3 3 0 3 3 0 3 3 3 0 3 3 0 3 3 3 0 3 3 0 3 0 0
Nurse 34 0 0 2 2 2 2 2 0 2 0 2 2 2 2 0 2 0 2 2 2 2 0 2 2 2 2 0 1
Nurse 35 2 0 0 0 2 2 2 2 3 0 0 2 2 2 2 3 0 0 2 2 2 2 3 0 0 2 2 2
Nurse 36 1 0 0 1 1 1 0 1 2 0 1 2 2 2 0 2 0 2 2 2 0 1 2 0 1 1 1 2
Nurse 37 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Nurse 38 1 0 2 2 2 0 0 1 1 2 2 2 0 0 1 1 2 2 2 0 0 1 1 2 2 2 0 2
Nurse 39 1 1 1 1 1 0 0 1 1 1 1 1 0 0 1 1 1 1 0 1 0 1 1 1 1 1 0 0
Nurse 40 2 0 3 3 0 1 1 2 0 3 3 0 1 1 2 0 3 3 0 1 1 2 0 3 3 0 0 1
Nurse 41 2 0 2 3 0 1 1 2 0 2 3 0 1 1 2 2 0 3 0 1 1 2 2 0 3 0 0 0
Nurse 42 0 0 1 2 2 2 2 0 0 2 2 2 2 2 0 0 1 2 2 2 2 0 0 1 2 2 0 2
Nurse 43 3 0 2 0 2 2 2 3 0 2 0 1 2 2 2 0 1 1 0 1 2 2 0 2 2 2 0 2
Nurse 44 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

40
 Group 4

Department D

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28
Nurse 1 1 3 3 0 1 2 0 1 0 1 1 1 2 0 0 0 1 1 1 2 0 1 3 0 1 1 2 1
Nurse 2 1 0 3 0 3 0 0 1 3 3 3 3 0 0 0 3 3 0 3 0 0 1 3 3 3 0 0 0
Nurse 3 3 3 0 0 1 3 3 3 3 0 1 1 3 3 0 0 1 0 2 3 3 3 0 3 0 2 3 3
Nurse 4 2 2 2 2 2 0 0 2 2 2 2 2 0 1 2 2 2 3 0 0 0 2 2 2 2 2 0 0
Nurse 5 3 0 0 1 1 1 3 3 0 0 1 1 3 3 3 0 0 1 1 1 1 3 0 1 1 1 0 1
Nurse 6 0 1 1 0 1 1 2 0 1 1 1 0 2 2 0 1 0 1 1 1 1 0 1 1 1 1 0 1
Nurse 7 0 0 1 0 0 1 2 0 1 0 1 1 0 1 0 0 0 1 1 1 1 0 0 1 1 1 0 1
Nurse 8 1 1 3 0 3 0 1 1 0 1 3 3 0 1 1 0 1 2 3 0 0 1 1 3 3 3 0 2
Nurse 9 2 3 0 0 2 0 0 2 2 2 2 2 0 0 0 2 2 0 0 0 0 2 2 2 2 3 0 0
Nurse 10 3 0 2 0 1 1 1 0 0 2 0 0 1 1 3 0 2 0 1 0 0 3 0 2 0 1 1 0
Nurse 11 2 0 0 0 0 1 1 0 0 0 0 0 1 1 0 2 0 0 1 0 0 2 0 0 0 1 1 0
Nurse 12 3 3 0 1 1 1 0 1 3 0 0 1 1 0 3 3 0 0 1 1 1 3 3 0 1 1 1 1
Nurse 13 0 1 0 1 1 1 1 0 1 0 1 1 0 1 0 1 0 3 0 3 0 0 1 0 1 0 0 1
Nurse 14 1 1 1 1 0 0 1 0 1 1 0 0 0 1 1 1 1 0 0 0 0 1 1 1 1 0 0 0
Nurse 15 2 0 1 0 2 2 2 0 0 1 0 0 2 2 2 0 1 0 2 0 0 2 0 1 0 2 2 0
Nurse 16 2 0 1 0 2 2 2 2 0 1 1 2 0 2 2 0 1 0 2 2 2 2 0 1 1 0 0 2
Nurse 17 2 0 0 1 0 2 0 0 2 0 0 0 2 0 0 2 0 0 2 0 0 2 0 0 0 2 2 0
Nurse 18 2 2 0 1 2 2 0 2 2 0 1 2 2 0 2 2 0 1 2 2 0 2 2 0 1 0 2 2
Nurse 19 1 0 3 0 1 1 1 0 0 3 0 0 1 1 1 0 3 0 1 0 0 1 0 3 0 1 1 0
Nurse 20 0 0 2 3 3 3 3 0 0 2 3 3 3 3 0 0 2 3 3 3 3 0 0 2 3 3 3 3
Nurse 21 3 2 3 0 2 2 0 2 0 1 1 2 2 0 2 0 1 1 0 2 2 2 2 0 1 2 0 2
Nurse 22 0 1 0 1 1 1 1 0 1 0 1 1 1 1 0 1 0 1 1 1 1 0 1 0 1 1 1 1
Nurse 23 0 0 1 1 0 3 3 3 0 1 2 0 3 3 0 0 1 2 0 2 2 0 0 1 0 0 0 2
Nurse 24 2 1 0 3 3 3 0 1 1 2 3 3 0 2 0 1 2 3 0 3 3 0 1 2 3 0 0 3
Nurse 25 0 0 0 2 2 2 2 2 0 0 0 0 2 2 0 1 0 2 0 1 2 0 1 0 0 2 2 2
Nurse 26 2 1 2 2 0 0 0 0 0 2 2 2 0 0 0 2 2 2 0 2 2 0 0 2 2 0 0 2
Nurse 27 0 1 2 3 0 1 1 2 0 2 0 2 0 1 0 0 2 0 0 2 2 0 0 2 0 0 1 2
Nurse 28 2 2 2 2 3 0 0 0 2 2 0 0 0 0 2 2 2 0 3 0 0 2 2 2 0 3 0 0
Nurse 29 1 3 0 3 3 3 0 0 3 0 3 3 3 0 1 3 0 0 3 0 0 1 3 0 3 0 0 0
Nurse 30 3 2 3 0 2 2 3 3 0 3 0 1 2 3 0 2 0 2 0 1 1 0 2 2 2 0 1 1
Nurse 31 1 0 2 0 1 1 1 1 0 2 0 1 1 1 1 0 2 0 1 1 1 1 0 2 0 1 1 1
Nurse 32 2 3 0 2 0 1 2 0 3 0 2 0 1 2 2 3 0 0 0 0 0 2 3 0 2 0 1 0
Nurse 33 2 2 2 2 0 0 0 2 2 2 2 0 3 0 2 2 2 2 3 0 1 2 2 2 2 0 0 1
Nurse 34 0 2 3 3 3 0 0 2 2 0 2 3 0 0 2 0 0 2 0 3 0 2 2 0 2 0 0 3
Nurse 35 2 0 1 0 1 1 1 0 0 1 0 1 1 1 2 0 1 0 1 0 0 2 0 1 0 0 1 0
Nurse 36 1 2 3 0 1 0 2 2 2 3 0 1 2 2 2 0 3 0 1 1 1 0 2 3 3 0 0 1
Nurse 37 1 2 2 2 0 0 1 0 2 2 0 0 0 1 1 2 2 0 0 0 0 1 2 2 2 0 0 0
Nurse 38 3 0 1 2 3 0 0 1 0 0 2 3 0 3 3 0 0 2 3 0 1 3 0 0 2 0 0 1
Nurse 39 2 2 0 1 0 2 2 0 2 0 3 0 2 2 0 0 0 3 0 1 1 0 2 0 3 0 0 1
Nurse 40 0 0 1 0 2 2 2 0 1 1 0 0 2 2 0 1 1 0 2 0 0 0 1 1 0 2 2 0
Nurse 41 0 0 1 2 0 0 2 2 0 1 0 2 0 2 2 0 1 0 2 2 2 0 0 1 0 2 0 2
Nurse 42 0 1 2 3 3 3 0 0 1 2 3 3 3 0 0 1 2 3 3 3 0 0 1 2 3 3 3 0
Nurse 43 1 1 0 1 2 3 0 2 2 0 2 2 3 0 1 2 0 2 2 2 2 0 1 2 2 0 0 2
Nurse 44 0 2 0 2 2 2 2 0 2 0 0 2 2 2 0 2 0 0 2 0 0 0 2 0 2 2 2 0
Nurse 45 2 0 1 0 1 1 1 2 0 1 0 1 1 1 2 0 1 0 1 1 1 2 0 1 3 0 0 1
Nurse 46 3 0 3 0 2 0 0 1 3 3 0 0 0 3 3 3 0 1 2 0 1 3 3 3 0 0 0 0
Nurse 47 1 3 3 0 0 2 2 3 3 3 0 2 0 2 3 3 3 3 0 0 3 3 3 3 3 0 0 3

41
 Group 4

Appendix 10: schematic display of the approach to determine the number of

float nurses

42
Appendix 11: Schedule for float nurses for the chosen scenario