VINCE SLAUGH: In my experience, the biggest challenge is staffing for 1.4 million, 1.6 million residents in nursing homes who need two and a half to three hours of care each day per resident. Doing those, the staffing operations well is really a major challenge. 

Not only do we have to make a schedule seven days a week, three shifts a day. There are other additional complications like random staff absences. And we're not just trying to minimize costs, but we also have other complications, like we're trying to maximize consistency of care. Even nursing homes that seem to do staffing well might still end up with 30 to 40 different CNAs assigned to any given resident in one month. 

One of the things that can be really helpful here is the application of business analytics. Using descriptive analytics to try to diagnose problems, to try to invent new metrics can allow managers to get a better handle on problems. Sometimes through some mathematical modeling, managers can find the optimal solution, or they can find the trade-off between cost and quality, and make an informed decision about where they want to be. 

It's really exciting to see the organizations like the Advancing Excellence Campaign articulate person-centered care paradigms that really seem to be spreading like wildfire. Ideas like consistency of care are really something that can benefit nursing home managers, nursing home residents, and make it a better experience for staff. 

People really seem dissatisfied with the current state of the delivery of care. Too many different faces as CNA caregivers on the floors or in the residents' households. And nursing home managers are getting a lot of negative feedback from the residents or from family members saying there's just too many different faces caring for the residents. 

So I would imagine the quality of life issues would-- the quality of life concerns could continue to be a problem if those issues aren't addressed. 

With my background in supply chain management and service operations, we've really spent a lot of time studying uncertainty. Uncertainty can really be difficult for nursing homes, especially when it comes to whether CNAs show up for their scheduled shifts. The problem of last-minute absences, there's about a 5% absence rate, last-minute absences among CNA caregivers. 

And how nursing homes plan for that and react to that can make a big difference in the quality of life that the residents experience. 

We can develop mathematical models that can help optimize the staffing level. Say we have 20 CNAs scheduled. We can think about, well, maybe we should consider scheduling 21 or 22. How should we design on-call pools, or how should we design the flow pools? Those are questions that can be great for the field of service operations to bring its techniques to bear, and also listen to the problems that nursing home managers have. 

By designing your staffing policies well, by implementing best practices like consistency of care, you can make for more rewarding work for your CNAs. And studies have shown that consistency of care programs lead to a higher job satisfaction among CNAs.