Backup planning is the technique of adding extra score constraints to create space in the planning for when things go wrong. That creates a backup plan in the plan. For example: try to assign an employee as the spare employee (1 for every 10 shifts at the same time), keep 1 hospital bed open in each department, …​

Then, when things go wrong (one of the employees calls in sick), change the problem facts on the original solution (delete the sick employee leave his/her shifts unassigned) and just restart the planning, starting from that solution, which has a different score now. The construction heuristics will fill in the newly created gaps (probably with the spare employee) and the metaheuristics will even improve it further.