Impact of workforce flexibility on quality of care: moderating effects of workload and severity of illness

PurposeAs a way of alleviating nursing workforce shortages, health care managers are employing two types of workforce flexibility: supplemental staffing and floating among units. In this paper, the authors investigate the moderating effects of two critical situational variables – namely, job-level workload and severity of illness (SOI) in a given unit – on the relationship between workforce flexibility and quality of care as assessed by the nurses at the unit-level.Design/methodology/approachThe authors empirically test the relationship between a unit's floating of nurses and the use of supplemental workforce on the quality of patient care and the moderating role of patient SOI and job-level workload on this relationship using 357 hospital-unit observations.FindingsThe authors find that situational variables play a critical role in flexible staffing strategies and they should be accounted for carefully to obtain the best quality of care outcomes. The authors find that the well-known negative effect of supplemental staffing on quality of care is not universal and appears to be moderated by the situational factors studied in this paper.Practical implicationsFor best outcomes, staffing manager who oversee multiple units should use supplemental staff on units that have lower job-level workload and on units that have high severity of illness. The authors also find that managers of units with patients who are less-severely ill should encourage nurses to float out and return to their home unit. This strategy will improve quality of patient care in the home unit.Originality/valueWhile some research analyzes the direct link between flexibility and quality performance, how this relationship is affected by varying situational factors within a unit has not been studied so far.

Regulating the health workforce in Europe: implications of the COVID-19 pandemic

In the European free movement zone, various mechanisms aim to harmonize how the competence of physicians and nurses is developed and maintained to facilitate the cross-country movement of professionals. This commentary addresses these mechanisms and discusses their implications during the COVID-19 pandemic, drawing lessons for future policy. It argues that EU-wide regulatory mechanisms should be reviewed to ensure that they provide an adequate foundation for determining competence and enabling health workforce flexibility during health system shocks. Currently, EU regulation focuses on the automatic recognition of the primary education of physicians and nurses. New, flexible mechanisms should be developed for specializations, such as intensive or emergency care. Documenting new skills, such as the ones acquired during rapid training in the pandemic, in a manner that is comparable across countries should be explored, both for usual practice and in light of outbreak preparedness. Initiatives to strengthen continuing education and professional development should be supported further. Funding under the EU4Health programme should be dedicated to this endeavour, along with revisiting the scope of necessary skills following the experience of COVID-19. Mechanisms for cross-country sharing of information on violations of good practice standards should be maintained and strengthened to enable agile reactions when the need for professional mobility becomes urgent.

It may cost an arm and a leg: workers value and occupational fatality rates in the U.S.

Background The present study aims to observe how societal indicators of workers’ values at the state-level are related to health and safety outcomes, particularly major injuries and fatalities in the U.S. Underscoring workforce flexibility and workability over workforce stability and safety might be indicative of the worth of workers which can be associated with occupational safety and health concerns. Methods Linear regression analysis with a log-transformed dependent variable was adopted to examine how the state-level indicators of worker value in terms of 1) minimum wage, using data from 2015; 2) average of workers’ compensations for the loss of an arm, hand, leg, or foot in 2015 were concurrently and prospectively associated with occupational fatality rates averaged across 2015, 2016 and 2017. Socioeconomic contextual variables such as education level, GDP per capita, and population at the state-level were controlled for. Results The present study showed that state-level quantitative indicators of how workers are valued at work, namely minimum wage and workers’ compensation benefits, were significantly and negatively associated with fatality rates in the following year. Conclusions The present study illustrates the gap in how workers are valued across the U.S. The study speaks to the importance of contextual factors regarding worker value, as they can affect outcomes of health and safety culminating at a state-level.

Performance and Upskilling: Indian IT Sector Temporary Workers’ Job Insecurity Coping Strategies Identified Through Grounded Theory

Globally, the demand for temporary workers is rising across organizations and sectors, driven by benefits of lower cost and workforce flexibility. Flexibility for organizations, however, means job insecurity for the temporary worker. This study focuses on understanding how the Indian IT sector’s temporary agency workers (TAWs), that is, temporary workers recruited by staffing agencies to work with client organizations, cope with their job insecurity. Grounded theory-based analysis of 36 interviews revealed that TAWs rely on enhancing their employability as the primary strategy to combat job insecurity. In addition, to enhance employability, TAWs make proactive efforts to perform consistently and upskill continuously. TAWs also expect support, largely in the form of learning and development opportunities, from the staffing agency and client to augment employability. The findings and recommendations in this article to help TAWs improve employability hold significance for TAWs, staffing agencies as well as clients. With enhanced employability, TAWs overcome job insecurity—an impediment to job performance, which is of direct relevance to the worker and the client—and also affects the staffing agency’s long-term relationship with the client.

COVID-19 in obstetrics 2020: the experience at a New York City medical center

The global spread of the SARS-CoV-2 virus during the early months of 2020 was rapid and exposed vulnerabilities in health systems throughout the world. Obstetric SARS-CoV-2 disease was discovered to be largely asymptomatic carriage but included a small rate of severe disease with rapid decompensation in otherwise healthy women. Higher rates of hospitalization, Intensive Care Unit (ICU) admission and intubation, along with higher infection rates in minority and disadvantaged populations have been documented across regions. The operational gymnastics that occurred daily during the Covid-19 emergency needed to be translated to the obstetrics realm, both inpatient and ambulatory. Resources for adaptation to the public health crisis included workforce flexibility, frequent communication of operational and protocol changes for evaluation and management, and application of innovative ideas to meet the demand.

It May Cost an Arm and a Leg; Value on Workers and Occupational Fatality Rates in the U.S.

Background The present study aims to observe how societal indicators of workers’ values at the state-level are related to health and safety outcomes, particularly major injuries and fatalities in the U.S. Underscoring workforce flexibility and workability over workforce stability and safety might be indicative of the worth of workers which can be associated with occupational safety and health concerns. Methods Multiple regression analysis was adopted to examine how the state-level indicators of values on workers in terms of 1) minimum wage, using the data from 2015; 2) average of workers’ compensations for the loss of an arm, hand, leg, or foot in 2015 were prospectively associated with occupational fatality rates in 2016 and 2017. Socioeconomic contextual variables such as education level, GDP per capita, income gap, and population at the state-level were controlled for. Results The present study showed that state-level quantitative indicators of how workers are valued at work, namely minimum wage and workers’ compensation benefits, were significantly and negatively associated with fatality rates in the following year. Workers’ compensation benefits were significantly and negatively associated with fatality rates two years later, implying the lasting effect of this particular type of indicator of values on workers. Conclusions The present study illustrates the gap in how workers are valued across the U.S.. The study speaks to the importance of fostering culture where workers are adequately valued, cared about, and protected to prevent and curtail occupational fatality.

Employee Flexibility, Exogenous Risk, and Firm Value

We hypothesize that employee flexibility enhances firm value by helping firms respond to exogenous shocks. We estimate employee-flexibility scores through textual analysis of online job reviews, and we find that a high flexibility score leads to superior stock returns for firms exposed to external risk. During 2011–2017, the value-weighted hedge portfolio formed on employee flexibility earned a 5-factor annualized alpha of 9.5% during periods of high policy uncertainty. Earnings-announcement returns also suggest that investors do not fully value workforce flexibility. These results indicate that employee flexibility is a valuable corporate intangible that helps firms to manage risk during uncertain times.