Reexamining the Nurse Scheduling Problem: Staffing Ratios and Nursing Shortages*

Legislators at the state and national levels are addressing renewed concerns over the adequacy of hospital nurse staffing to provide quality care and ensure patient safety. At the same time, the well‐known nursing shortage remains an ongoing problem. To address these issues, we reexamine the nurse scheduling problem and consider how recent health care legislation impacts nursing workforce management decisions. Specifically, we develop a scheduling model and perform computational experiments to evaluate how mandatory nurse‐to‐patient ratios and other policies impact schedule cost and schedule desirability (from the nurses' perspective). Our primary findings include the following: (i) nurse wage costs can be highly nonlinear with respect to changes in mandatory nurse‐to‐patient ratios of the type being considered by legislators; (ii) the number of undesirable shifts can be substantially reduced without incurring additional wage cost; (iii) more desirable scheduling policies, such as assigning fewer weekends to each nurse, have only a small impact on wage cost; and (iv) complex policy statements involving both single‐period and multiperiod service levels can sometimes be relaxed while still obtaining good schedules that satisfy the nurse‐to‐patient ratio requirements. The findings in this article suggest that new directions for future nurse scheduling models, as it is likely that nurse‐to‐patient ratios and nursing shortages will remain a challenge for health care organizations for some time.     

ELECTED VERSUS APPOINTED REGULATORS: THEORY AND EVIDENCE

This paper contrasts direct election with political appointment of regulators. When regulators are appointed, regulatory policy becomes bundled with other policy issues the appointing politicians are responsible for. Because voters have only one vote to cast and regulatory issues are not salient for most voters, there are electoral incentives to respond to stakeholder interests. If regulators are elected, their stance on regulation is the only salient issue so that the electoral incentive is to run a pro‐consumer candidate. Using panel data on regulatory outcomes from U.S. states, we find new evidence in favor of the idea that elected states are more pro‐consumer in their regulatory policies. (JEL: H1, K2)     

Elusive Critical Elements of Transformative Risk Assessment Practice and Interpretation: Is Alternatives Analysis the Next Step?

This article argues that “game‐changing” approaches to risk analysis must focus on “democratizing” risk analysis in the same way that information technologies have democratized access to, and production of, knowledge. This argument is motivated by the author's reading of Goble and Bier's analysis, “Risk Assessment Can Be a Game‐Changing Information Technology—But Too Often It Isn't” (Risk Analysis, 2013; 33: 1942–1951), in which living risk assessments are shown to be “game changing” in probabilistic risk analysis. In this author's opinion, Goble and Bier's article focuses on living risk assessment's potential for transforming risk analysis from the perspective of risk professionals—yet, the game‐changing nature of information technologies has typically achieved a much broader reach. Specifically, information technologies change who has access to, and who can produce, information. From this perspective, the author argues that risk assessment is not a game‐changing technology in the same way as the printing press or the Internet because transformative information technologies reduce the cost of production of, and access to, privileged knowledge bases. The author argues that risk analysis does not reduce these costs. The author applies Goble and Bier's metaphor to the chemical risk analysis context, and in doing so proposes key features that transformative risk analysis technology should possess. The author also discusses the challenges and opportunities facing risk analysis in this context. These key features include: clarity in information structure and problem representation, economical information dissemination, increased transparency to nonspecialists, democratized manufacture and transmission of knowledge, and democratic ownership, control, and interpretation of knowledge. The chemical safety decision‐making context illustrates the impact of changing the way information is produced and accessed in the risk context. Ultimately, the author concludes that although new chemical safety regulations do transform access to risk information, they do not transform the costs of producing this information—rather, they change the bearer of these costs. The need for further risk assessment transformation continues to motivate new practical and theoretical developments in risk analysis and management.     

Framework for Microbial Food‐Safety Risk Assessments Amenable to Bayesian Modeling

Regulatory agencies often perform microbial risk assessments to evaluate the change in the number of human illnesses as the result of a new policy that reduces the level of contamination in the food supply. These agencies generally have regulatory authority over the production and retail sectors of the farm‐to‐table continuum. Any predicted change in contamination that results from new policy that regulates production practices occurs many steps prior to consumption of the product. This study proposes a framework for conducting microbial food‐safety risk assessments; this framework can be used to quantitatively assess the annual effects of national regulatory policies. Advantages of the framework are that estimates of human illnesses are consistent with national disease surveillance data (which are usually summarized on an annual basis) and some of the modeling steps that occur between production and consumption can be collapsed or eliminated. The framework leads to probabilistic models that include uncertainty and variability in critical input parameters; these models can be solved using a number of different Bayesian methods. The Bayesian synthesis method performs well for this application and generates posterior distributions of parameters that are relevant to assessing the effect of implementing a new policy. An example, based on Campylobacter and chicken, estimates the annual number of illnesses avoided by a hypothetical policy; this output could be used to assess the economic benefits of a new policy. Empirical validation of the policy effect is also examined by estimating the annual change in the numbers of illnesses observed via disease surveillance systems.     

Terrorism Risk Assessment,Recollection Bias,and Public Support for Counterterrorism Policy and Spending

Recollection bias (RB) refers to the phenomenon whereby after an adverse event people report that their risk assessment about a similar future event is presently no higher than their recollection of their pre‐event risk assessment. While previous research has outlined this theoretical construct and generated important empirical findings, there were some limitations. We design and employ a new national representative survey to address these limitations in this study. We examine the existence and persistence of RB among the general public in the context of a number of domestic and international terrorist attacks. We further examine the socioeconomic and political base of RB and the influences of RB on a wide range of citizens’ counterterrorism policy preferences. Our data analyses reveal strong evidence showing the occurrence of RB and its persistence across various forms of terrorism risk. With regard to the socioeconomic and political base, we find that females, older people, political conservatives, and Republicans are less likely to be subject to RB. For the effects of RB on public counterterrorism policy preferences, our analyses demonstrate that this bias significantly dampens public support for a wide range of preventive policy measures and government anti‐terrorism spending. Overall, our study, based on a national representative sample and an extended survey design, provides robust evidence of RB in terrorism risk assessment, and adds further evidence to support the idea that RB is likely a generalizable phenomenon. Implications and suggestions for future research are discussed in the conclusion.     

Regulations,policies and practices concerning work stress in five European countries

Abstract

A comparative inventory of regulations, policies and practices in The Netherlands, Sweden, UK, Germany and France with regard to the prevention of work stress was carried out. In each country data were collected by means of interviews with key informants and through exploring relevant documents and literature. It was found that Sweden, The Netherlands and the UK—those countries with framework legislation in the field of health and safety—recognize stress as an important health and safety topic, whereas Germany and France do not yet recognize stress as an important policy issue. However, even in the first group of countries less attention is being paid towards psychosocial work characteristics when compared with traditional health and safety issues, such as noise, machine safety and toxic agents. There is a clear lack of well-documented (national) ‘examples of good preventive practice’, even in Sweden and The Netherlands. Recommendations are being formulated concerning type of legislation, guidance and information, monitoring and risk assessment, costs and benefits, examples of good practice and European networking.     

Sales Force and Competition in Financial Product Markets: The Case of Mexico's Social Security Privatization

This paper examines how sales force impacts competition and equilibrium prices in the context of a privatized pension market. We use detailed administrative data on fund manager choices and worker characteristics at the inception of Mexico's privatized social security system, where fund managers had to set prices (management fees) at the national level, but could select sales force levels by local geographic areas. We develop and estimate a model of fund manager choice where sales force can increase or decrease customer price sensitivity. We find exposure to sales force lowered price sensitivity, leading to inelastic demand and high equilibrium fees. We simulate oft proposed policy solutions: a supply‐side policy with a competitive government player and a demand‐side policy that increases price elasticity. We find that demand‐side policies are necessary to foster competition in social safety net markets with large segments of inelastic consumers.     

Beyond Transparency: Information Overload and a Model for Intelligibility

The role and evaluation of the modern corporation is being challenged by multiple stakeholders, changing markets and public expectations. Unfortunately, corporate governance, regulation and accounting have played a prominent role in business failure for the past decade resulting in a growing lack of public confidence in our markets. We present a new model that contributes to improving the quality of corporate information by providing not more, but better information through increased intelligibility of overall information, benefiting both the firm and its broad array of stakeholders. It has become apparent that boards, management and regulators have been unable to cope with the rise of business failures by adding increasing layers of regulation that have often served only to exacerbate the complexity and further cloud the transparency of needed information. We have identified a growing number of forward‐thinking firms that have found alternative means to provide betterinformation and strengthen their companies. We offer a stakeholder‐centric model for improving information intelligibility based upon the extensive scope and variety of external input derived from the growing social movement organizations. With the added focus on intelligibility, these groups can help foster greater corporate responsibility, meaningful transparency, increased stakeholder benefits, and improved overall performance of the firm.     

Conflicts between public and private opinion

The opportunities for research in the 1980s will be much affected by changes in society. In particular, by a clash between two powerful forces—the producer bureaucracy and the new individualism. It will be a clash of values and opinions; and research will be needed to measure them.However, there are dangers in the way that opinion research will be used, and especially in the way that it will be publicized. The protagonists in the arguments on many social issues are likely to make increasing use of published ‘research events’— that is, over-simplified and superficial figures on public opinion, designed mainly to appeal to the media's need for simple and dramatic news, and thence to affect public policies.In fact, the evidence is very strong that there is a genuine difference between people's private opinions and their public opinions. But the requirements of media contests will tend to force research methods to concentrate heavily on public opinions. The danger is not so much that this would distort social policies (though it might) as that it could damage the reputation of market research in general—especially if, as is likely, the findings of one group's ‘research events’ appeared to be directly opposed to those of another's.One important challenge of the 1980s will be to identify these risks and do something to guard against them. Five simple guidelines are suggested which I hope can contribute to a joint campaign to educate in the proper use and presentation of opinion research.     

The Role of Industry Studies and Public Policies in Production and Operations Management

The research domain Industry Studies and Public Policy (IS&PP) seeks to further our understanding of industrial practices and managerial challenges by explicitly considering contextual details in the design and interpretation of research studies. These details can be vital considerations when shaping public policies. This article reviews a sample of IS&PP publications and analyzes the content of 180 selected papers—85 papers published in the Production and Operations Management (POM) journal and 95 papers published in related journals between 1992 and 2014. Our analysis of the sample dataset and examination of exemplar papers provide four findings. First, studies in different industries emphasize different themes of operational decisions. This difference in emphasis reveals potential research opportunities, especially for conducting inter‐industry studies. Second, our analysis reveals a shift in focus over time. Earlier studies contain a mix of benchmarks and inter‐industry comparisons, while later studies tend to be context‐specific, intra‐industry studies. Third, we report on empirics → analytics → empirics cycles that reveal gaps for building novel theories. Finally, we observe that the relationship between POM decisions and public policy is bi‐directional. This highlights the need to jointly examine operational decisions with policy considerations, especially in information goods, healthcare, sustainable operations and high‐tech manufacturing industries.     

Who Would Be Willing to Accept Disaster Debris in Their Backyard? Investigating the Determinants of Public Attitudes in Post‐Fukushima Japan

In the wake of the 2011 Great East Japan Earthquake and tsunami, the Ministry of Environment in Japan asked municipalities nationwide to accept and treat disaster waste. This call for cross‐jurisdictional waste treatment provoked considerable public controversy. To explore how the national and municipal governments can seek more public acceptance in the wake of future disasters, this study implemented a nationwide survey and addressed the question of what factors influence the public's willingness to support their municipalities’ plans to host disaster waste. Three strands of the literature—on risk perception, public dissent, and prosocial behavior—offer valuable insights into hypothesis building, although none has addressed the above question. Estimates from an ordered logistic regression (N = 1,063) reveal that the conditions of a nuclear accident and living with a small child in the household would lower the level of support for accepting disaster waste, although this does not mean that people would give their support in the absence of a nuclear accident. The results also suggest that the national and municipal governments should communicate more with the public about the risks, benefits, and costs associated with hosting disaster debris, and make efforts to improve public trust in the national government.     

Developments in Brazilian food safety policy

Brazil is an important case study of food safety policies because it is the eighth largest economy in the world in terms of Gross Domestic Product. Analysis of the policy and quality management initiatives of the Brazilian government shows that recent activities are more strongly oriented toward assuring access to international markets than to assuring the safety of food sold in domestic markets. This orientation has important implications for agribusiness firms operating in Brazil. Consumer awareness and consumer protection activities are increasing within the Brazilian economy, often with government support. However, developments in Brazil's food safety policy are likely to continue to emphasize quality assurance for the export market.     

REPATRIATION OF DEBT IN THE EURO CRISIS

With the beginning of the Euro Crisis, the long‐standing trend of European financial integration reversed. Investors unwound cross‐border positions of debt obligations and increased holdings of locally issued debt. In other words, debt obligations were repatriated. We use data on bank portfolios to document three new empirical regularities of the financial disintegration: (i) repatriation affected mainly debt of crisis countries; (ii) repatriation affected mainly public debt; (iii) the public debt of crisis countries that was not repatriated was reallocated to large and politically influential countries within the Euro area. We read these results in light of standard theories of cross‐border portfolio allocation and argue that the sum of these patterns constitutes evidence for the secondary market theory of public debt.     

POWER APPROXIMATIONS FOR A TWO-ECHELON INVENTORY SYSTEM USING SERVICE LEVELS

We consider a two-echelon inventory system with one warehouse and several stores. The warehouse as well as the stores are controlled by periodic review (s, S) inventory policies. We study the interrelationship between the safety stocks at the warehouse and the stores. Stockouts at the warehouse will result in supply delays to the stores and cause the lead time to be stochastic. The stores may react by increasing their safety stock. However, there is a trade-off between the safety stock at the warehouse and the safety stock at the stores. We use a service level at the warehouse to quantify the effect of warehouse stockouts on the lead time to the stores. The service level at the warehouse is considered a decision variable to find the best compromise between the various safety stocks by minimizing the overall costs. Using power approximations for the (s, S) policies, we provide an iterative procedure for adjusting the lead time distribution to the stores; this can result in substantial savings, but it doesn't guarantee the overall optimality. Numerical studies are provided to test the accuracy of approximations. The effects of the different system parameters on the inventory policy give general guidelines for use of the policies.     

Valuation of childhood risk reduction: the importance of age, risk preferences, and perspective.

This article explores two problems analysts face in determining how to estimate values for children's health and safety risk reductions. The first addresses the question: Do willingness‐to‐pay estimates for health risk changes differ across children and adults and, if so, how? To answer this question, the article first examines the potential effects of age and risk preferences on willingness to pay. A summary of the literature reporting empirical evidence of differences between willingness to pay for adult health and safety risk reductions and willingness to pay for health and safety risk reductions in children is also provided. The second dimension of the problem is a more fundamental issue: Whose perspective is relevant when valuing children's health effects—society's, children's, adults‐as‐children, or parents'? Each perspective is considered, followed ultimately by the conclusion that adopting a parental perspective through an intrahousehold allocation model seems closest to meeting the needs of the estimation problem at hand. A policy example in which the choice of perspective affects the outcome of a regulatory benefit‐cost analysis rounds out the article and emphasizes the importance of perspective.     

Would Allowing Privately Funded Health Care Reduce Public Waiting Time? Theory and Empirical Evidence from Canadian Joint Replacement Surgery Data

This study develops a theoretical model and then, using Canadian joint replacement surgery data, empirically tests the relationship between government policies that promote privately funded health care and patients’ waiting time in the public health care system. Two policies are tested: one policy allows opt‐out physicians to extra‐bill private patients, and the other provides public subsidies to private patients. We find that both policies are associated with shorter public waiting time, and that the subsidy policy appears to be more effective in waiting time reduction than the extra‐billing policy. Our findings are consistent with a dominant demand‐side effect in that these policies would provide patients an option, and some incentive, to opt out of the public health system, shifting the demand from the public health system to the private care market.     

Impact of Retailers with Knowledge of Supplier's Inventory on Supply Chain Performance

We model a supply chain consisting of a supplier and multiple retailers facing deterministic demand. We denote some retailers as strategic in the sense that given the supplier inventory information, they will implement the optimal stocking policy by incorporating such information. On the other hand, some retailers are denoted as naïve in the sense that they ignore supply information and resort to a simplistic ordering policy. Naïve retailers learn the optimal policy over time and adjust their orders accordingly. We study the dynamics of this game and investigate the impact of such strategic and naïve retailers on the cost, ordering pattern and stocking policies of all parties. We analyze the supply chain under two scenarios: the centralized supply chain where the objective is to minimize the total supply chain cost, and the decentralized supply chain where each self‐interested player minimizes its own cost in a Stackelberg game setting. We fully characterize the optimal policies under both centralized and decentralized scenarios and show that, surprisingly, the supply chain might be better off by virtue of naïve retailers. The result is driven by the fact that strategic and naïve players’ decisions shift the positioning of inventory in the supply chain with its final impact being determined by the relative costs of different retailer‐types. Our results also offer managerial insights into how access to supply information can improve supply chain performance.     

Understanding and Reducing Inconsistency in Seatbelt‐Use Decisions: Findings from a Cardinal Decision Issue Perspective

This article has two aims. The first is to present results that partly explain why some automobile drivers choose to use their seatbelts only part time, thereby exposing themselves to unnecessary risk. The second is to offer and illustrate the “cardinal decision issue perspective”⁽¹⁾ as a tool for guiding research and development efforts that focus on complex real‐life decision behaviors that can entail wide varieties of risk, including but not limited to inconsistent seatbelt use. Each of 24 young male participants drove an instrumented vehicle equipped to record continuously seatbelt use as well as other driving data. After all trips were finished, each participant completed an interview designed to reconstruct how he made randomly selected seatbelt‐use decisions under specified conditions. The interview also examined whether and how drivers established “decision policies” regarding seatbelt use. Such policies were good predictors of inconsistent seatbelt use. Drivers who had previously adopted policies calling for consistent seatbelt use were significantly more likely than others to actually drive belted. Meta‐decisions about seatbelt policy adoption appeared to rest on factors such as whether the driver had ever been asked to consider selecting a policy. Whether a driver made an ad hoc, on‐the‐spot seatbelt‐use decision was associated with a perceived need to make such a decision. Finally, participants with full‐time policies were especially likely to deploy their seatbelts by default, without recognizing the need to decide about belt use on a trip‐by‐trip basis. We end with recommendations for reducing inconsistencies in seatbelt use in actual practice.     

Safety sans Frontières: An International Safety Culture Model

The management of safety culture in international and culturally diverse organizations is a concern for many high‐risk industries. Yet, research has primarily developed models of safety culture within Western countries, and there is a need to extend investigations of safety culture to global environments. We examined (i) whether safety culture can be reliably measured within a single industry operating across different cultural environments, and (ii) if there is an association between safety culture and national culture. The psychometric properties of a safety culture model developed for the air traffic management (ATM) industry were examined in 17 European countries from four culturally distinct regions of Europe (North, East, South, West). Participants were ATM operational staff (n = 5,176) and management staff (n = 1,230). Through employing multigroup confirmatory factor analysis, good psychometric properties of the model were established. This demonstrates, for the first time, that when safety culture models are tailored to a specific industry, they can operate consistently across national boundaries and occupational groups. Additionally, safety culture scores at both regional and national levels were associated with country‐level data on Hofstede's five national culture dimensions (collectivism, power distance, uncertainty avoidance, masculinity, and long‐term orientation). MANOVAs indicated safety culture to be most positive in Northern Europe, less so in Western and Eastern Europe, and least positive in Southern Europe. This indicates that national cultural traits may influence the development of organizational safety culture, with significant implications for safety culture theory and practice.     

Replenishment Policies for Multi‐Product Stochastic Inventory Systems with Correlated Demand and Joint‐Replenishment Costs

This study analyzes optimal replenishment policies that minimize expected discounted cost of multi‐product stochastic inventory systems. The distinguishing feature of the multi‐product inventory system that we analyze is the existence of correlated demand and joint‐replenishment costs across multiple products. Our objective is to understand the structure of the optimal policy and use this structure to construct a heuristic method that can solve problems set in real‐world sizes/dimensions. Using an MDP formulation we first compute the optimal policy. The optimal policy can only be computed for problems with a small number of product types due to the curse of dimensionality. Hence, using the insight gained from the optimal policy, we propose a class of policies that captures the impact of demand correlation on the structure of the optimal policy. We call this class (s, c, d, S)‐policies, and also develop an algorithm to compute good policies in this class, for large multi‐product problems. Finally using an exhaustive set of computational examples we show that policies in this class very closely approximate the optimal policy and can outperform policies analyzed in prior literature which assume independent demand. We have also included examples that illustrate performance under the average cost objective.