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Rostering general medicine physicians to balance workload across inpatient wards: a case study
  1. Thomas Adams1,
  2. Michael O'Sullivan1,
  3. Jonathan Christiansen2,
  4. Paul Muir2,
  5. Cameron Walker1
  1. 1Department of Engineering Science, University of Auckland, Auckland, New Zealand
  2. 2Division of Medicine and Health of Older People, Waitemata District Health Board, Auckland, New Zealand
  1. Correspondence to Thomas Adams, Department of Engineering Science, University of Auckland, Room 215, Level 2, 70 Symonds Street, Auckland 1142, New Zealand; tada955{at}


During an expansion of the General Medicine (GM) department at Waitakere Hospital, a new roster was required for its teams. Patients being transferred to another hospital due to uneven patient workloads between the teams were identified as an issue that could be addressed by an improved roster. A more even distribution of patients among the teams is desirable because it is fairer for the staff and it also improves the continuity of care for patients. Continuity of care is improved by balanced workloads because fewer patients need to be transferred from teams with high workloads. A novel rostering technique, using a mixed integer programme (MIP), which uses past data on patient admissions to track team workloads, was implemented. This allowed multiple rosters for different configurations of admitting teams to be created and evaluated against past data traces, in terms of the difference in workloads of the teams and estimated ward occupancies. The best performing of the constructed rosters reduced the median difference in workload between the team with the most patients and the team with the fewest from 14.5 to 12.5 (13.8% reduction) for the data traces considered, when compared with a roster from an internal rostering group. Waitakere Hospital has put this roster in place and has observed a reduction in the variation in workload between the teams, with fewer patients being transferred to other hospitals due to high team workloads. These improvements cannot be solely attributed to rostering improvements, as other factors such as an increase in the number of inpatient teams have also contributed. However, the generation and evaluation of multiple different rosters via MIP was central to the process that determined the final configuration of the GM department.

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  • Contributors TA performed modelling, analysis and prepared the manuscript. MOS and CW supervised the modelling and editing. JC and PM collected and prepared data.

  • Funding University of Auckland Doctoral Scholarship. Waitemata District Health Board.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.