Does Centralised Planning Make Teams in Care Homes and Hospitals Happier?

The situation is serious, but manageable

Swiss care homes and hospitals are caught between rising demand for treatment, increasing case complexity and a tight skills shortage. Recent analyses show that the workload in nursing remains high, whilst the proportion of qualified nursing staff in the acute care sector has fallen relatively over the years. This has noticeable consequences for the quality of care, workload and staff turnover. At the same time, pressure is mounting to plan reliably with limited resources. Waiting times are to be reduced, overtime cut back and last-minute rescheduling made less frequent. This is where integrated capacity management (ICM) comes into play. It combines forecasting, centralised planning and interdisciplinary and cross-departmental coordination. This enables patient flows, resources and staff deployment to be better aligned, with the aim of ensuring the quality of care and easing the burden on staff in their day-to-day work. ^{2, 3}

What ICM really achieves

ICM views staffing, patient flows and resources as an interconnected system. Rather than optimising individual departments in isolation, it coordinates beds, operating theatres, diagnostic facilities, treatment areas and staffing profiles. The common guiding principle is the utilisation forecast. This highlights expected peaks in demand at an early stage and enables occupancy, surgical programmes and staffing schedules to be smoothed out proactively. Bottlenecks are not only addressed once they have escalated in day-to-day operations, but are identified earlier and managed in a more targeted manner. 

Swiss hospitals are already leading the way in this regard. The University Hospital of Basel, for example, brings together bed management, temporary staff, case management and social counselling within an integrated structure. The aim is to manage capacity proactively and across the entire hospital. From an academic perspective, too, ICM is regarded as a key driver of efficiency and quality: forecasts, interdisciplinary collaboration and clear objectives form the basis for this.^{3, 4} 

Why predictability changes the atmosphere

When peaks in workload can be smoothed out more effectively, day-to-day working life changes. Short-notice assignments decrease, overtime can be reduced and duty rosters become more reliable. This has a direct positive impact on stress levels, rest and the team atmosphere. In recent surveys, nursing managers have prioritised precisely these levers for efficiency and digitalisation. Not as an end in itself, but because they make day-to-day life more predictable. Where planning certainty increases, staff preferences can be better accommodated: days off, shift preferences, part-time roles or split shifts. The result: greater commitment, fewer absences and lower staff turnover. Professional associations and observatories have been demonstrating for years that the strain on the system is very real. At the same time, organisations with consistent forecasting and capacity management show that this strain can be countered, at least in part, through smart management.^{2, 3, 6} 

From vision to implementation

IKM is less a tool than a management and transformation programme. Those who introduce it make strategic decisions: What are the hospital-wide targets (e.g. defined targets for access times or length of stay)? What decision-making powers does capacity management have in relation to individual clinics? How are operating theatres, wards, diagnostics and nursing services synchronised with one another – on a daily, weekly or seasonal basis? And how is the change managed, trained for and monitored? Postgraduate training programmes at university level therefore emphasise integration into governance, target systems and change management. Without clear roles, standardised processes and transparent data flows, the impact fizzles out. This is precisely where the weak point lies in many hospitals: silos that have developed over time, decentralised planning units and manual coordination make planning reactive, error-prone and time-consuming.^{7, 10}

Four key areas determine success

For integrated capacity management to be effective in day-to-day operations, four levels must work together: systems, processes, organisation and leadership.
 

1. Systems: Data must be available and usable 

ICM stands or falls on data quality, interoperability and timeliness. Forecasts require robust and consistent data from the hospital information system (HIS), surgical planning, workforce scheduling and bed management. Where dashboards display bed availability and occupancy scenarios in real time, better decisions are made instead of relying on telephone chains and Excel spreadsheets. In the area of staffing, it is not enough simply to know availability figures. Equally important are skills, qualifications, employment levels, preferences and employment law requirements. Only when this information is available in a structured format can planning processes be set up effectively. Flexibility is a factor that should not be underestimated in this context. Many planning models are based on inflexible early, late and night shifts, which are planned in a relatively linear fashion throughout the year. In a forecast-driven planning process, flexible models can provide additional relief. For example, rules can be defined to determine which mix of staff is required for which expected volume. Modern workforce management systems can support such rules. They enable flexible shifts to be arranged as required, for example with defined minimum and maximum durations, whilst taking necessary qualifications into account. This allows daily peaks in workload to be specifically managed. At the same time, such models can often better accommodate employees’ individual preferences, thereby improving the quality of planning and Team satisfaction. 
 

2. Processes: Forecasts require binding procedures 

A forecast alone does not bring about any change. It only becomes effective when clear processes follow from it. These include standardised procedures for registering for and withdrawing from operations, clear exit protocols, defined interfaces between A&E, wards, the operating theatre and diagnostics, as well as binding escalation procedures. It is only these standards that make forecasts effective. They ensure that expected peaks in workload result in concrete measures rather than merely additional information.
 

3. Organisation: Demand and capacity must be discussed at the same table 

Centrally managed capacity hubs coordinate across departments. In doing so, both key control variables must work in tandem: demand management – for example, planned admissions or elective procedures – and capacity management, in particular staffing, qualifications and available shifts. A company-wide perspective is crucial. Local optimisations may be effective in some areas but can create new bottlenecks elsewhere. IKM therefore requires (cross-functional) defined processes, clear interfaces and the commitment to plan from the perspective of the organisation as a whole.
 

4. Leadership: Centralisation requires trust 

Capacity decisions are understood as a hospital-wide management task, not as a local optimisation exercise. At the same time, centralised planning alters existing roles. Decentralised managers and planners lose some of their autonomy because certain decisions are transferred to a central planning unit. This is a sensitive issue. That is why consistent change management is required. The planners and ward managers affected must be involved at an early stage. Their experience remains a key factor for success. Centralisation must not be perceived as a loss of power, but must demonstrate where it eases the workload in day-to-day operations.
 

Data-driven decision-making delivers better results whilst still leaving room for manual intervention where it is professionally necessary. The capacity freed up among managers and planners can then be channelled into areas where it is often lacking: supporting staff, improving processes and leading Teams. Where these four levels interact, organisations report less downtime, fewer last-minute cancellations, more stable daily schedules and a noticeable reduction in the workload at the bedside. ^{5, 7, 8} 

Practical examples from Switzerland

Basel University Hospital 

Basel University Hospital has organised capacity management as a separate unit. Bed management, temporary staff, case management and social counselling are all interlinked. This provides a forward-looking, hospital-wide view of bottlenecks, patient transfers and available resources. The result: better-coordinated patient flows, shorter response times and greater transparency for scheduling and wards.⁵
 

University Children’s Hospital Zurich 

As part of the construction of the new building, operational processes at the University Children’s Hospital Zurich were standardised and digitised. These include uniform capacity management across wards and operating theatres, a dashboard for early surgical planning, clear interfaces and robust discharge management. Reports indicate fewer last-minute surgery cancellations, better utilisation of theatre capacity and a noticeable reduction in the workload of day-to-day operations.⁸
 

Bülach Hospital 

In 2020, Bülach Hospital was one of the first hospitals in Switzerland to implement a capacity manager. Today, the hospital operates with an established system that utilises reliable and visualised data for capacity decisions. This development shows that Integrated Capacity Management (ICM) does not have to start as a major project. It can grow gradually if data, processes and decision-making pathways are consistently refined.¹¹

These examples make it clear that technology alone is not enough. Capacity management only works when systems, process discipline and leadership culture work together. Otherwise, central planning is quickly perceived as a distant administrative function rather than as support in day-to-day operations.^{4, 5, 8}

Measurable impact: satisfaction, quality, costs

The hypothesis behind IKM is that a more even workload leads to more reliable services. Reliable services reduce the burden on staff. Teams with a reduced workload help stabilise quality and organisational stability.  This impact can be measured. National monitoring programmes provide key figures on staffing levels, staff turnover, absenteeism and training outcomes. Such figures can serve as ‘before and after’ indicators. Professional and trade associations also demonstrate how understaffing and increased workload affect quality and outcomes. If IKM reduces peaks in workload, stabilises services and enables participation, overtime and short-notice assignments can be reduced. Experience shows that this also has an impact on absenteeism and commitment. At the same time, patients and residents benefit from more reliable processes, fewer last-minute cancellations and better utilisation of capacity.^{2, 3, 9} 

However, it is important to note that IKM must not aim for maximum utilisation. Those who fill every gap risk creating new levels of overload. Good capacity management seeks a balance between quality, cost-effectiveness and staff wellbeing. 

Where can adjustments be made?

There are two key levers for smoothing out the workload curve: planned admissions on the demand side (demand management) and workforce scheduling on the capacity side (capacity management). The objective is clear: patient planning and staff planning operate on the same data basis. They make joint decisions and coordinate with one another. 

Depending on the situation, both sides can contribute to smoothing the workload curve. For example, surgery days can be adjusted on the basis of data to better distribute the subsequent processes and the resulting staffing requirements in the long term. At the same time, staff planning can be made more flexible. In addition to fixed shifts, which are already known one to two months in advance, flexible shifts can also be deployed, for example via staff pools, short-notice availability or with additional financial incentives. This requires specific data on staff availability, qualifications and preferences. It also requires suitable staff deployment planning systems and a modern ‘ HR for the healthcare sector ’ that captures this information, uses it effectively and provides effective support for planning processes.

Above all, however, a change in mindset is needed! There must be a commitment to more effective processes from a corporate perspective, rather than local optimisations. It is not a question of either demand management or capacity management, but rather both working in tandem. Centralised planning then does not mean top-down control, but rather better decisions based on shared data. 

Conclusion: Yes – centralised planning can make staff happier

Centralised planning, in the sense of integrated capacity management, is neither an end in itself nor a top-down manoeuvre. It is the answer to the complexity of modern care provision. When implemented correctly, it brings together forecasts, processes, organisation and culture. Where workload is proactively balanced, rota plans are reliable and preferences are taken seriously, day-to-day working life improves noticeably. This makes Teams happier, stabilises care provision and ultimately has economic benefits too. After all, staff turnover, absenteeism, idle time and chronic overwork are among the most costly forms of inefficiency.^{4, 5, 6}

The shortage of skilled workers remains a reality. But the extent to which it impacts day-to-day operations also depends on how well demand, capacity and staff deployment work together. Centralised planning does not automatically make teams happier. It is effective when it creates greater transparency and reliability.