Interactive Nurse Scheduling.

Repeatedly solving nurse scheduling problems is one of the most difficult and time-consuming tasks for nurse managers. Although software solutions exist to solve nurse scheduling problems automatically, they are limited to cases in which scheduling rules can be easily formalized and are relatively stable. In other cases, nurse scheduling problems must be solved manually. Thus, this article proposes a new general method for solving nurse scheduling problems that overcomes the limitations of existing methods by introducing human-computer interaction. The solution is based on not only the computer's algorithmic logic but also the nurse manager's knowledge and experiences. We tested the method in a large hospital. The results show that our method also can be used for cases in which fully automated nurse scheduling is not feasible and that it performs better than manual scheduling. In addition, the time spent on scheduling decreased by 80%, and nurse satisfaction with the schedule increased.

Hand hygiene improvement of individual healthcare workers: results of the multicentre PROHIBIT study.

BACKGROUND: Traditionally, hand hygiene (HH) interventions do not identify the observed healthcare workers (HWCs) and therefore, reflect HH compliance only at population level. Intensive care units (ICUs) in seven European hospitals participating in the "Prevention of Hospital Infections by Intervention and Training" (PROHIBIT) study provided individual HH compliance levels. We analysed these to understand the determinants and dynamics of individual change in relation to the overall intervention effect. METHODS: We included HCWs who contributed at least two observation sessions before and after intervention. Improving, non-changing, and worsening HCWs were defined with a threshold of 20% compliance change. We used multivariable linear regression and spearman's rank correlation to estimate determinants for the individual response to the intervention and correlation to overall change. Swarm graphs visualized ICU-specific patterns. RESULTS: In total 280 HCWs contributed 17,748 HH opportunities during 2677 observation sessions. Overall, pooled HH compliance increased from 43.1 to 58.7%. The proportion of improving HCWs ranged from 33 to 95% among ICUs. The median HH increase per improving HCW ranged from 16 to 34 percentage points. ICU wide improvement correlated significantly with both the proportion of improving HCWs (ρ = 0.82 [95% CI 0.18-0.97], and their median HH increase (ρ = 0.79 [0.08-0.97]). Multilevel regression demonstrated that individual improvement was significantly associated with nurse profession, lower activity index, higher nurse-to-patient ratio, and lower baseline compliance. CONCLUSIONS: Both the proportion of improving HCWs and their median individual improvement differed substantially among ICUs but correlated with the ICUs' overall HH improvement. With comparable overall means the range in individual HH varied considerably between some hospitals, implying different transmission risks. Greater insight into improvement dynamics might help to design more effective HH interventions in the future.