From Metaheuristics to Exact Methods: A CP-SAT Approach for Multi-Objective Healthcare Workforce Scheduling

Abstract

Healthcare workforce scheduling is an NP-hard optimization problem requiring simultaneous satisfaction of labor regulations, coverage requirements, employee preferences and cost objectives. Existing approaches (genetic algorithms, integer programming, constraint programming) model 6-12 constraints at shift-level granularity and cannot guarantee regulatory compliance. They also lack support for multi-role, multi-skill heterogeneity, mandatory break scheduling with midpoint control, acuity-weighted workload equity, sub-shift granularity, inter-week stability, and cross-midnight shifts. This paper presents CP-SAT: a Constraint Programming formulation for multi-role, multi-skill healthcare scheduling. CP-SAT enforces 14 hard constraints guaranteeing zero regulatory violations, while optimizing 15 soft objectives via a unified weighted penalty function. Contributions include a shift-window decomposition enabling break scheduling with centrality control, acuity-weighted workload equity, multi-granularity resolution from 15 minutes to 1 day, inter-week stability, and grid-offset preprocessing mapping cross-midnight shifts into a single scheduling day without solver changes. CP-SAT is evaluated on 18 instances: five synthetic hospital units (10-33 nurses), 10 INRC-II benchmarks (5-80 nurses, up to 8-week horizons) and 3 NRP-23 compatible instances (10-25 nurses) with cross-midnight Night shifts. Results: zero hard-constraint violations across all 18 instances by construction; proven optimality on INRC-II n005w4 (objective 118, gap 0.0%, 104s); feasible schedules scaling to 179,800 variables and 351,425 constraints (80 nurses); service quality improved 50-67% over MOGA; and model size scaling near-linearly at approximately 4,400 variables per employee. The formulation enforces 29 total constraints (14 hard, 15 soft), nearly three times the industry average.