A Dual-objective Workforce-management Model for Single-payer Hospital Systems: Sectoral Redistribution and Normative Establishment

Public hospital systems face simultaneous shortage and surplus of clinical staff within the same national network, yet lack instruments that combine cross-institutional comparison with a normative establishment recommendation. This paper describes a dual-objective workforce-management model that separates a redistribution proposal from a normative establishment recommendation. The method processes monthly-to-quarterly data per (specialty × progressivity × institution × occupational group) stratum in five stages. Stages A–D produce a lossless sectoral redistribution of filled FTE via peer-group-internal benchmark comparators, a priority matrix, a two-branch complexity weight (active-care: CMI × case count; chronic-care: weighted chronic nursing days), and a correction coefficient with policy-stability guards. Stage E constructs the normative establishment: a nationally weighted collective norm with its operational-staffing-requirement (OSR) denominator re-expressed in equity-weighted units yields established and modified frames between a filled-post floor and an OSR ceiling. Adoption requires three infrastructural preconditions: a unified activity-and-case-mix data source, a central post-level payroll register, and standardised institutional strata. A five-month 2025 case study on inpatient gastroenterology (progressivity II.b) across 19 Hungarian public-network hospitals illustrates the pipeline: redistribution cuts the load-ratio Gini on this stratum from 0.28 to 0.06, while the normative stage delivers actionable diagnostics for governmental decisions. The system is in introduction phase: the model makes embedded staffing knowledge explicit, auditable and contestable; system-level effects are not yet evaluated.