Strategies for Addressing the Nursing Shortage: Coordinated Decision Making and Workforce Flexibility

In this article, we present strategies to help combat the U.S. nursing shortage. Key considerations include providing an attractive work schedule and work environment—critical issues for retaining existing nurses and attracting new nurses to the profession—while at the same time using the set of available nurses as effectively as possible. Based on these ideas, we develop a model that takes advantage of coordinated decision making when managing a flexible workforce. The model coordinates scheduling, schedule adjustment, and agency nurse decisions across various nurse labor pools, each of differing flexibility levels, capabilities, and costs, allowing a much more desirable schedule to be constructed. Our primary findings regarding coordinated decision making and how it can be used to help address the nursing shortage include (i) labor costs can be reduced substantially because, without coordination, labor costs on average are 16.3% higher based on an actual hospital setting, leading to the availability of additional funds for retaining and attracting nurses, (ii) simultaneous to this reduction in costs, more attractive schedules can be provided to the nurses in terms of less overtime and fewer undesirable shifts, and (iii) the use of agency nurses can help avoid overtime for permanent staff with only a 0.7% increase in staffing costs. In addition, we estimate the cost of the shortage for a typical U.S. hospital from a labor cost perspective and show how that cost can be reduced when managers coordinate.     

A Flexible Evaluative Framework for Order Picking Systems

This paper develops a novel framework to evaluate the integral performance of order picking systems with different combinations of storage and order picking policies. The warehousing literature on order picking mostly considers minimizing either elapsed time or distance as the sole objective, whereas warehouse managers in a supply chain have to look beyond single‐dimensional performance and consider trade‐offs among different criteria. Thus managers still need a unified and efficient framework to select a portfolio of appropriate order picking policies from a multi‐criteria and contextual perspective. Our framework—combining data envelopment analysis, ranking and selection, and multiple comparisons—provides an efficient methodology to simultaneously analyze several interrelated problems in order picking systems with multiple performance attributes, such as service levels and operational costs. We demonstrate our approach through comprehensive evaluations of order picking policies in three low‐level, picker‐to‐parts rectangular warehouses facing demand variations.     

ABC Classification: Service Levels and Inventory Costs

ABC inventory classifications are widely used in practice, with demand value and demand volume as the most common ranking criteria. The standard approach in ABC applications is to set the same service level for all stock keeping units (SKUs) in a class. In this paper, we show (for three large real life datasets) that the application of both demand value and demand volume as ABC ranking criteria, with fixed service levels per class, leads to solutions that are far from cost optimal. An alternative criterion proposed by Zhang et al. performs much better, but is still considerably outperformed by a new criterion proposed in this paper. The new criterion is also more general in that it can take criticality of SKUs into account. Managerial insights are obtained into what class should have the highest/lowest service level, a topic that has been disputed in the literature.     

Uncertainty and Variability in Health-Related Damages from Coal-Fired Power Plants in the United States

The health‐related damages associated with emissions from coal‐fired power plants can vary greatly across facilities as a function of plant, site, and population characteristics, but the degree of variability and the contributing factors have not been formally evaluated. In this study, we modeled the monetized damages associated with 407 coal‐fired power plants in the United States, focusing on premature mortality from fine particulate matter (PM_2.5). We applied a reduced‐form chemistry‐transport model accounting for primary PM_2.5 emissions and the influence of sulfur dioxide (SO₂) and nitrogen oxide (NO_x) emissions on secondary particulate formation. Outputs were linked with a concentration‐response function for PM_2.5‐related mortality that incorporated nonlinearities and model uncertainty. We valued mortality with a value of statistical life approach, characterizing and propagating uncertainties in all model elements. At the median of the plant‐specific uncertainty distributions, damages across plants ranged from $30,000 to $500,000 per ton of PM_2.5, $6,000 to $50,000 per ton of SO₂, $500 to $15,000 per ton of NO_x, and $0.02 to $1.57 per kilowatt‐hour of electricity generated. Variability in damages per ton of emissions was almost entirely explained by population exposure per unit emissions (intake fraction), which itself was related to atmospheric conditions and the population size at various distances from the power plant. Variability in damages per kilowatt‐hour was highly correlated with SO₂ emissions, related to fuel and control technology characteristics, but was also correlated with atmospheric conditions and population size at various distances. Our findings emphasize that control strategies that consider variability in damages across facilities would yield more efficient outcomes.     

Competitive Strategies and Firm Performance: a Comparative Analysis of Pure,Hybrid and ‘Stuck‐in‐the‐middle’ Strategies in Spanish Firms

The purpose of this study was to examine the viability of hybrid competitive strategies, which combine differentiation and cost elements, and their impact on organizational performance in comparison to pure strategies and ‘stuck‐in‐the‐middle’ combinations. Previous studies have focused above all on US data. The analysis carried out in this paper has centred on a multisectorial sample of 164 Spanish firms. The findings show that a large number of the organizations use different types of hybrid strategies and also that such strategies tend to be associated with higher levels of firm performance, particularly those strategies which place emphasis on a greater number of strategic dimensions, and specifically on innovation differentiation.     

Your E‐mail Trail: Where Ethics Meets Forensics1

This article addresses ethical and legal issues arising from the increasing use of e‐mail and other forms of instant written communication in the conduct of business. E‐mail communications are often casual and informal. Yet e‐mail is a written record that can be more permanent and widely accessible than a paper communication. This article focuses on the implications of this fact, including (1) how individuals compromise their own privacy by the voluntary use of e‐mail; (2) how e‐mail has complicated the duty of confidentiality of employees to employers, and professionals to clients; (3) whether the use of e‐mail affects ethical deliberation and choice; and (4) the use of e‐mail as evidence of corporate conduct and intent in civil and criminal litigation. The article suggests that e‐mail users think “forensically” about their e‐mail—i.e., consider its potential as evidence in the context of other emails and underlying events—before pressing the “send” button.