Home Care in Australia: 50 Shades of Optimisation

Over the past 24 months, we’ve been working with providers in the aged care sector to support them in optimising the way they roster and schedule home care visits. We’ve learnt something important: there are 50 shades of optimisation and not all of them are optimal.

This is something that every large Australian provider will discover in their optimisation journey, so we’ve put together a few articles to unpack it.

Rostering and scheduling home care visits

Firstly, what do we mean by rostering and scheduling of home care visits? Well, in order to deliver home care services, providers must:

Create a master roster & schedule from scratch – that means:

• rostering their care workers
• scheduling home care visits
• and allocating them to care workers.

Creating a master roster & schedule is typically infrequent – it might happen in the event of a branch restructuring, or perhaps on a 6-12 cycle to re-optimise a degraded roster.

Maintain the roster & schedule every roster cycle in the lead-up to each day-of-operation, managing cancellations, staff unavailabilities, fill in spaces and just generally shuffle the plan to make things work as things change in the lead up to the day.

Manage the execution of the schedule on-the-day, mitigating the impacts of unplanned changes and disruptions such as absenteeism and exceptions. This is where even the best plans can be undone.

Different home care providers will have a slew of processes and rules of thumb that they use to create and maintain the roster & schedule. These processes may even differ branch-by-branch, and by different operational planners within the same branch. These processes might be aided by technologies; spreadsheets are a common starting point for many providers, and lately there’s been wider adoption of workforce planning software, along with optimisation capability to aid the planning process.

How well these processes are performed directly impacts an organisation’s performance, including:

• how many visits they can cover using their salaried workforce and without requiring agency staff,
• the cost to deliver a home visit,
• client experience and churn
• care worker experience and churn

To architect a highly effective process, it is important for a provider to understand:

• where the opportunities are to optimise given their operational constraints,and
• how they can combine people, tools and processes to execute an efficient roster & schedule

In this article, we discuss the different processes, good and bad, used by providers to create a master roster & schedule.

Good, Better, Best – the different ways to create a roster & schedule

The traditional way

Let’s talk about a day at work for our friend Felicity the planner. Felicity’s branch has recently merged with an acquired branch, and she now has to build a new master roster. Her workforce is made up of full-time and part-time care workers with minimum contracted hours but without a fixed roster pattern. When necessary, she can use agency staff, but her job is to find a way to cover as much work as she can with her full-time and part-time workers.

She pours a strong cup of coffee and cracks her knuckles – there’s work to do. Her day might look a little like this:

1. On a day of the roster, she picks a care worker who is available on that day and currently has less than minimum contracted hour rostered on.
2. She assigns them some work to fill up their shift.
3. She repeats this process until all work is assigned for the day.
4. And repeats the above for each day of the roster period.
5. Once Felicity is happy with the roster & schedule, she will release it to the care workers.

By breaking the process down into these different steps, Felicity has made the planning simpler and easier. But this is also how inefficiencies can creep in.

Beginning to incorporate some smarts

How Felicity performs each step of the planning process is probably hard for an outsider to understand.

For instance, take steps 2 and 3. When she begins allocating visits on a day, she needs to consider many factors all at once. To name a few:

• Which visits the care worker is best suited to that day, due to their qualifications, familiarity or personal match to the client.
• How she is going to schedule the visits to ensure there is sufficient time between visits, not only for travel but also breaks and ensuring they line up with contractual obligations for each worker.
• Trading off assigning someone at a higher duty to fit in a visit.
• Ensuring the shift is desirable – e.g. not short or with breaks of engagement.
• Managing fatigue.

This is a lot to think about all at once! In fact, this is more than any regular person can hold in their head all together. To manage this Felicity will recognise patterns and employ some rules of thumb to construct a feasible schedule. Her patterns and rules of thumb probably differ to those followed by other planners, even within her own branch.

Another layer to this onion is that visits typically have some level of flexibility in timing (depending on the client), and clients may be flexible in their chosen care worker (especially if they are a new client). This provides Felicity with lots of options in how she allocates care workers, both in terms of which care worker is allocated and the timing of the visit.

This flexibility is a good thing – it gives Felicity more opportunities to string together visits into a good shift! But when scaled up to an entire branch, it makes the planning problem hard. There are just so many ways for Felicity to construct the schedule that she can’t possibly think of all the options and be confident she’s found the best.

This scheduling problem is something seen in a lot of industries – in fact, it’s similar to the travelling salesman problem, which is a problem loved by maths junkies everywhere. Optimising the schedule for a travelling salesman is a very difficult mathematics problem, and one that continues to challenge both academics and commercial ventures globally.

Thankfully, there are now some off-the-shelf optimisation solutions for field force scheduling that automate and optimise the process of creating visit schedules. This can improve scheduling by:

• Creating better schedules with more visits planned, less travel and less overtime.
• Automating the process, saving on time and effort spent planning.

These solutions do something which is closer to a “holistic” optimisation for the day – they don’t just aid Felicity to assign visits one-at-a-time. Instead they consider all of the visits planned for the day, and prescribe the efficient schedule of visits for every rostered care worker – all in one hit.

These kinds of tools have been a step change improvement for home care providers and field forces in various sectors. But depending on a provider’s operational and workforce constraints, there could be even more opportunities just waiting around the corner.

Next level optimisation

By splitting up her planning method into multiple steps, Felicity has effectively separated the problems of rostering and scheduling – that is, she assigns someone to work on a day, and then she works out what their day looks like. The reason that Felicity would choose to split those problems is because it makes planning a lot easier – there are just fewer decisions to consider at the same time.

This makes perfect sense if her care workers are on a fixed roster pattern, since there is no roster to make. But in the case of a flexible workforce, she is essentially clipping her wings.

One opportunity for many home care providers is that:

1. Many of their care workers are on minimum contracted hours, but can be flexible on their day of work.
2. Care workers usually start and end their shift from their home.

Look at it this way: home care providers have a level of flexibility on which care worker works on which days. On some days, the branch will have visits that are situated closer to certain care worker’s residences than others. In order to optimise a day, Felicity might wish to roster a care worker onto a day in which they were closer to visits, allowing them to fit in more care and spend less time travelling.

In a nutshell – by separating rostering and scheduling, Felicity has limited her ability to optimise. In order to make the most out of the available staff, it’s important for her to consider both rostering and scheduling at the same time.

So how does a planner like Felicity do this? To be fair to Felicity, she probably does do this to some degree when she thinks about who should work each day.

But it’s a problem of scale. Once Felicity has to think about rostering a whole week or longer, and considers all the visits to be planned, and all the possible allocations – this just isn’t something that fits easily in one person’s head.

So how can we help Felicity? Well, that’s where customizable rostering and scheduling optimisation software like Biarri’s shine. These kinds of software  will consume an organisations data for:

• Care workers and their availability.
• Visits and their level of flexibility (in both time and worker allocated)
• Employee agreements and organisational objectives

The software’s optimisation engine will then crunch the data and, like a crystal ball, consider the possible ways to roster and schedule the workers. It will then provide a roster and schedule which includes:

• Which care worker works on which day,
• What time each visit occurs
• Which care worker is allocated to the visit
• What the care worker’s day looks like

These kinds of software take the concept of “holistic optimisation” to a whole new level. They are able to consider the possible trade-offs of different rostering and scheduling decisions, and deliver efficient schedules and rosters for all of the branch’s care workers in the roster period – as one big bang holistic recommendation.

This kind of software can perform above and beyond what Felicity could do manually, or what can be achieved by a non-fit-for-purpose optimiser. They also enable efficiencies of scale, allowing organisations to grow footprint and market share while mitigating the accompanying increase in their cost profile. In fact, for one of our customers, it meant a 15% reduction in the cost to serve a home visit.

The bottom line

There’s a few ways to skin this cat, but some ways are better than others. We recommend to providers that they should take the time to understand:

1. where their own unique operational inefficiencies exist
2. where the opportunities are for better outcomes
3. what tools are out there that will best solve their particular challenge.

In the next article, we’ll continue this theme of going from good to great, but focus on the challenge of maintaining a roster for a typical home care provider.

We’ve been working in the workforce optimisation game since 2009, supporting customers with large workforces to use their resources more efficiently and effectively. Our (not-so-) secret sauce is mathematical optimisation – a technology that has been around for a long time, but has only recently begun to see wide adoption as AI and algorithms enter the zeitgeist. We’ve learnt a lot over the past 15 years and love to share what we’ve picked up along the way.

TALK TO US ->