Document Type



Doctor of Philosophy (PhD)


Business Administration

First Advisor's Name

Debra VanderMeer

First Advisor's Committee Title

Committee Chair

Second Advisor's Name

George Marakas

Second Advisor's Committee Title

Committee Member

Third Advisor's Name

Paulo Gomes

Third Advisor's Committee Title

Committee Member

Fourth Advisor's Name

Ellen Brown

Fourth Advisor's Committee Title

Committee Member

Fifth Advisor's Name

Hemang Subramanian

Fifth Advisor's Committee Title

Committee Member


Nurse-Patient Assignment, Workload, Continuity of Care, Tradeoff, Acuity Threshold

Date of Defense



Continuity of care is critical for delivering high-quality care, yet has seldom been considered in models supporting nurse-patient assignment decisions within inpatient units. Research in the nursing literature suggests that assigning nurses to patients they have cared for previously can help reduce care-related error rates and increase patient satisfaction. However, it is also essential to ensure that patient workloads are allocated to nursing staff in a balanced manner to avoid overwork and burnout.

This study investigates the tradeoffs associated with the assignment of patients to nurses in inpatient settings under the dual objective of maximizing continuity of care and minimizing workload imbalance. We develop a hybrid method that balances the need for fair workload distribution and continuity of care, and demonstrate the extent of the tradeoff between the level of continuity achieved and the associated cost in workload balance. To reduce the impact of this tradeoff, we relax the goal of maximizing continuity by introducing an acuity threshold. Here, patients with acuity values above the threshold vi are targeted for continuity-based assignment, and remaining patients are assigned to minimize workload imbalance.

We evaluate the utility of introducing the threshold under a variety of hospital environmental conditions using a simulation model of the inpatient environment. Our findings show that it is possible to provide a substantial continuity assignment with a marginal impact on workload imbalance under the hybrid policy using the acuity threshold. In virtually all cases studied, the results show that it is possible to use the acuity threshold and gain the benefits of continuity of care, even under conditions of a strong preference for minimizing acuity imbalance.





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