The shortage of healthcare workers is accelerating. An longer-living, ageing population is demanding more medical service while healthcare worker retirements and high turnover is decreasing the worker pool. Shortages can be reduced or eliminated by scheduling only the number of staff needed to meet the hour-by-hour demand for medical service and using flexible shifts to do so. Think of bank teller scheduling, where more staff are scheduled at peak demand. Current attempts to schedule to demand are relatively primitive: a small number of quantized fixed shifts, for example: 7am-3pm, 8am-4pm, 10am-6pm, 3pm-11pm, 7am- 7pm, 7pm-7am, etc. is allowed. The pre-determined fixed shifts are input parameters to the scheduling process and workers are assigned to the shifts. The scheduler's objective is to fill enough morning, afternoon and evening shifts to meet expected demand for medical service throughout the day. In our innovation, fixed shifts are replaced with flexible shift parameters; specifically, a range of start times and shift lengths which become inputs to the scheduling algorithm. The actual shift assigned to a worker on any particular day is computed with the objective to have just enough workers to meet hour-by-hour demand for medical service. Phase I will determine the efficacy of flexible shift scheduling to meet demand for medical service and estimate the possible efficiency. Phase II will develop an algorithm that automates the process using flexible shifts and Monte-Carlo simulation. The literature indicates 2-15% FTE efficiencies are possible by using flexible shifts, corresponding to an annual societal economic impact of $1.7 billion to $8 billion. The commercialized product will be a new module for DOCS Scheduler, our scheduling software that currently is being used by 120 healthcare organizations. Our current product schedules using fixed shifts. The addition of a flexible shift scheduler module providing FTE efficiencies of 2-15% would be a market-changing competitive advantage. PUBLIC HEALTH RELEVANCE: An ageing population with increasing lifespan, coupled with healthcare worker retirements and high turnover, is exacerbating the shortage of healthcare workers. The USA nurse shortage of 200,000 workers in 2008 is estimated to be 1,000,000 by 2014. Healthcare worker shortages can be significantly reduced, possibly eliminated, and healthcare worker morale improved, by using flexible shifts that are harmonious with worker lifestyles to schedule staff precisely according to demand for medical service. [unreadable] [unreadable] [unreadable] [unreadable]