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Staffing crisis capacity: a different approach to healthcare resource allocation for a different type of scarce resource
  1. Catherine R Butler1,2,
  2. Laura B Webster3,4,
  3. Douglas S Diekema5,6
  1. 1 Division of Nephrology, Department of Medicine, University of Washington, Seattle, Washington, USA
  2. 2 Hospital and Speciality Medicine, VA Puget Sound Health Care System Seattle Division, Seattle, Washington, USA
  3. 3 Bioethics Progam, Virginia Mason Medical Center, Seattle, Washington, USA
  4. 4 Bioethics and Humanities, University of Washington School of Medicine, Seattle, Washington, USA
  5. 5 Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA
  6. 6 Trueman Katz Center for Pediatric Bioethics, Seattle Children's Research Institure, Seattle, Washington, USA
  1. Correspondence to Dr Catherine R Butler, University of Washington, Seattle, Washington, USA; cathb{at}


Severe staffing shortages have emerged as a prominent threat to maintaining usual standards of care during the COVID-2019 pandemic. In dire settings of crisis capacity, healthcare systems assume the ethical duty to maximise aggregate population-level benefit of existing resources. To this end, existing plans for rationing mechanical ventilators and intensive care unit beds in crisis capacity focus on selecting individual patients who are most likely to survive and prioritising these patients to receive scarce resources. However, staffing capacity is conceptually different from availability of these types of discrete resources, and the existing strategy of identifying and prioritising patients with the best prognosis cannot be readily adapted to fit this real-world scenario. We propose that two alternative approaches to staffing resource allocation offer a better conceptual fit: (1) prioritise the worst off: restrict access to acute care services and hospital admission for patients at relatively low clinical risk and (2) prioritise staff interventions with high near-term value: universally restrict selected interventions and treatments that require substantial staff time and/or energy but offer minimal near-term patient benefit. These strategies—while potentially resulting in care that deviates from usual standards–support the goal of maximising the aggregate benefit of scarce resources in crisis capacity settings triggered by staffing shortages. This ethical framework offers a foundation to support institutional leaders in developing operationalisable crisis capacity policies that promote fairness and support healthcare workers.

  • COVID-19
  • resource allocation
  • policy

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  • Contributors CRB wrote the primary draft. CRB, LBW and DSD contributed to the conception and critically revised and approved the final draft.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.