The longstanding nurse shortage has risen to the level of a global health crisis, with the United States projected to face a deficit of half a million nurses by 2025 and annual burnout and turnover rates over 20%, according to Pengyi Shi, an associate professor in the supply chain and operations management area at Purdue University’s Mitch Daniels School of Business. Combined with large spikes in demand, the accelerating shortage of nurses has prompted hospitals and health systems to explore innovative solutions for both the short and long term.
Shi presents one such breakthrough innovation in "Delta Coverage: The Analytics Journey to Implement a Novel Nurse Deployment Program," published in the INFORMS Journal on Applied Analytics. Coauthored by Jonathan Helm from the Indiana University Kelley School of Business and Mary Drewes and Jacob Cecil from Indiana University Health (IUH), the paper was selected as one of three finalists for the prestigious INFORMS Daniel H. Wagner Prize, which recognizes excellence in the practice of advanced analytics and operations research.
IUH, the largest healthcare system in Indiana, includes 16 hospitals and over 9,000 nurses, serving 1.4 million residents across five diverse regions spanning 14,000 square miles. In collaboration with its university partners, IUH addressed the nursing shortage with the successful implementation of the Delta Coverage (DC) internal travel nursing program.
“To our best knowledge, the DC program is the first implemented, state-wide program that utilizes a flexible pool of resource nurses, effectively moving them between the 16 IUH hospitals, to addresses understaffing challenges by harnessing the expansive reach of such large hospital system,” Shi says. “In contrast to typical travel nursing contracts, DC employs short-term deployments, dynamically responding to geographic and temporal fluctuations in hospital occupancies.”
The collaboration also led to the development of the innovative Delta Coverage Analytics Suite, a comprehensive and pioneering solution that leverages state-of-the-art generative AI techniques and prescriptive analytics to support the DC program, optimizing nurse deployment and staffing on an unprecedented scale. This contrasts with off-the-shelf nurse scheduling analytics, which usually target individual units or hospitals, or other existing hospital analytics that prioritize physicians and patients.
Launched in October 2021, the analytics suite underwent three phases of implementation. The final pilot phase, which ran from May to June 2023, achieved remarkable results: a 13% reduction in understaffing, a 5% reduction in over-staffing, and an allocation that is fair to participating hospitals and nurses. All this was made possible by moving only 10 DC nurses among six hospitals participating in the six-week pilot.
“The results demonstrate that each DC nurse is equivalent to 1.6-1.9 non-DC nurses, effectively mitigating staffing deficits,” Shi says. “Extrapolating this impact to the United States’ 1.7 million hospital registered nurses indicates the potential to almost cover the nation’s half-a-million nurse shortfall.”
The concept behind Delta Coverage is to allow highly skilled nurses to float and work on any unit, including other hospitals in the network, to the right unit at the right timing. The ultimate goal is to respond rapidly to fluctuations in staff and occupancy across hospitals in different geographical locations.
Unlike programs for traditional resource nurses, who usually float between units within a hospital and receive their assignments less than 24 hours before a shift, Delta Coverage requires sophisticated advanced planning that utilizes predictive analytics to forecast occupancies and prescriptive analytics to determine optimal on-call and call-in decisions for nurse transfers.
The reduction in understaffing achieved through the DC program has numerous long-term benefits, including improved patient care, increased professional satisfaction among bedside nurses and ultimately, lives saved. “The long-term impact of broader deployment of the DC program is significant because the novel system directly addresses the primary cause of the nursing crisis — nurses leaving the profession due the pervasive issue of understaffing,” Shi says.
In the long term, the program promotes workforce stability and a supportive environment, resulting in a more resilient and satisfied nursing workforce. “More importantly, our analysis shows that the DC program’s benefits extend to rural and marginalized areas that often bear the brunt of nursing shortages, disproportionately affecting access to quality healthcare in these areas,” Shi says. “By distributing DC shifts fairly among participating hospitals, we ensure rural hospitals receive the support needed to provide uninterrupted care to their communities.”
From a broader perspective, the success of Delta Coverage highlights the viability and benefits of internal float nurse programs as a solution for managing nurse shortages and optimizing workforce allocation. This sets new benchmarks for efficiency and adaptability in addressing nurse shortages and fluctuating patient demands with data-driven and analytics-based decision-making, encouraging other hospitals to adopt similar strategies to meet the urgent demands of the healthcare landscape.
“This pioneering program offers a sustainable solution to address the multifaceted challenges of nurse staffing, burnout, and healthcare disparities, fostering a nurturing environment for nurses and strategically allocating resources,” Shi says. “The program’s positive impact extends beyond immediate staffing concerns, leaving a lasting impression on the well-being of the nursing workforce and the communities they serve.”
