Operating theatre modelling: integrating social measures

Hospital resource modelling literature is primarily focussed on productivity and efficiency measures. In this paper, our focus is on the alignment of the most valuable revenue factor, the operating room (OR) with the most valuable cost factor, the staff. When aligning these economic and social decisions, respectively, into one sustainable model, simulation results justify the integration of these factors. This research shows that integrating staff decisions and OR decisions results in better solutions for both entities. A discrete event simulation approach is used as a performance test to evaluate an integrated and an iterative model. Experimental analysis show how our integrated approach can benefit the alignment of the planning of the human resources as well as the planning of the capacity of the OR based on both economic related metrics (lead time, overtime, number of patients rejected) and social related metrics (personnel preferences, aversions, roster quality)

Heuristic scheduling for clinical physicians.

Personnel scheduling is a problem faced by many organizations in the healthcare industry, particularly in rapidly developing outpatient centers. The task of creating a schedule that adequately covers patient demand while satisfying the preferences of employees, observing work regulations, and ensuring a fair distribution of work is highly complex. Even though this highly complex task directly affects measures such as patient waiting time and employee satisfaction, many organizations still resort to the traditional and cumbersome manual solution methods. A large segment of prior research on personnel scheduling in healthcare focuses on nurse rostering and the development of automated tools to aid in scheduling. The drawbacks to these methods include the lack of generality and the need for specialized software packages and training. The aim of this study is the development of an effective, low cost, and uncomplicated heuristic tool to aid schedulers in outpatient centers. Solution methodologies used by previous researchers in problems such as nurse rostering and aircrew rostering are adapted to the particular problem of physician scheduling in mixed specialty outpatient clinics. The developed heuristic tool obtains an initial feasible solution using a greedy algorithm and then uses the simulated annealing metaheuristic to improve the solution, which is a measure of physician satisfaction. The heuristic tool developed in this study was tested using eight randomly generated data sets to model 45 unique cases. The heuristic found the optimal solution in 19 of the 45 tested cases. The average difference from the optimal physician satisfaction rating in the other 26 cases was 0.35%

Improving Physician Schedules by Leveraging Equalization: Cases from Hospitals in U.S.

In this paper, we consider physician scheduling problems originating from a medical staff scheduling service provider based in the United States. Creating a physician schedule is a complex task. An optimal schedule must balance a number of goals including adequately staffing required assignments for quality patient care, adhering to a unique set of rules that depend on hospital and medical specialties, and maintaining a work-life balance for physicians. We study various types of physician and hospital requirements with different priorities, including equalization constraints to ensure that each provider will receive approximately the same number of a specified shift over a given time period. A major challenge involves ensuring an equal distribution of workload among physicians, with the end goal of producing a schedule that will be perceived by physicians as fair while still meeting all other requirements for the group. As the number of such equalization constraints increases, the physician scheduling optimization problem becomes more complex and it requires more time to find an optimal schedule. We begin by constructing mathematical models to formulate the problem requirements, and then demonstrate the benefits of a polyhedral study on a relaxation of the physician scheduling problem that includes equalization constraints. A branch-and-cut algorithm using valid inequalities derived from the relaxation problem shows that the quality of the schedules with respect to the soft constraints is notably better. An example problem from a hospitalist department is discussed in detail, and improvements for other schedules representing different specialties are also presented

An Integrated Framework for Staffing and Shift Scheduling in Hospitals

Over the years, one of the main concerns confronting hospital management is optimising the staffing and scheduling decisions. Consequences of inappropriate staffing can adversely impact on hospital performance, patient experience and staff satisfaction alike. A comprehensive review of literature (more than 1300 journal articles) is presented in a new taxonomy of three dimensions; problem contextualisation, solution approach, evaluation perspective and uncertainty. Utilising Operations Research methods, solutions can provide a positive contribution in underpinning staffing and scheduling decisions. However, there are still opportunities to integrate decision levels; incorporate practitioners view in solution architectures; consider staff behaviour impact, and offer comprehensive applied frameworks. Practitioners’ perspectives have been collated using an extensive exploratory study in Irish hospitals. A preliminary questionnaire has indicated the need of effective staffing and scheduling decisions before semi-structured interviews have taken place with twenty-five managers (fourteen Directors and eleven head nurses) across eleven major acute Irish hospitals (about 50% of healthcare service deliverers). Thematic analysis has produced five key themes; demand for care, staffing and scheduling issues, organisational aspects, management concern, and technology-enabled. In addition to other factors that can contribute to the problem such as coordination, environment complexity, understaffing, variability and lack of decision support. A multi-method approach including data analytics, modelling and simulation, machine learning, and optimisation has been employed in order to deliver adequate staffing and shift scheduling framework. A comprehensive portfolio of critical factors regarding patients, staff and hospitals are included in the decision. The framework was piloted in the Emergency Department of one of the leading and busiest university hospitals in Dublin (Tallaght Hospital). Solutions resulted from the framework (i.e. new shifts, staff workload balance, increased demands) have showed significant improvement in all key performance measures (e.g. patient waiting time, staff utilisation). Management team of the hospital endorsed the solution framework and are currently discussing enablers to implement the recommendation

Fairness aspects in personnel scheduling

In industries like health care, public transport or call centers a shift-based system ensures permanent availability of employees for covering needed services. The resource allocation problem – assigning employees to shifts – is known as personnel scheduling in literature and often aims at minimizing staffing costs. Working in shifts, though, impacts employees’ private lives which adds to the problem of increasing staff shortage in recent years. Therefore, more and more effort is spent on incorporating fairness into scheduling approaches in order to increase employees’ satisfaction. This paper presents a literature review of approaches for personnel scheduling considering fairness aspects. Since fairness is not a quantitative objective, but can be evaluated from different point of views, a large number of fairness measurements exists in the literature. Furthermore, perspective (group vs individual fairness) or time horizon (short-term vs long-term fairness) are often considered very differently. To conclude, we show that a uniform definition and approach for considering fairness in personnel scheduling is challenging and point out gaps for future research

Accountability by Design: Moving Primary Care Reform Ahead in Alberta

Health-care reform is perennially popular in Alberta, but reality doesn’t match the rhetoric. Government has invested more than $700 million in Primary Care Networks — with little beyond anecdotal evidence of the value achieved with this investment. As the province redirects primary care to Family Care Clinics, the authors assert that simply tinkering with one part of the system is not the answer: health care must change on a system-wide basis. Drawing on the experiences of frontline staff and a rich body of literature, the authors present their vision for integrated team-based primary care, designed to be accountable to meet the needs of populations. This will require governance that makes primary care the hub of the system, and brings together government and health-services leadership to support the integration of primary and specialty care. There are shared accountabilities for achieving primary care that exhibits the attributes of high performing primary care systems, and these exist at multiple levels, from individuals seeking primary care, up to and including government. The authors make these accountabilities explicit, and outline strategies to secure their achievement that include system redesign, service delivery redesign and payment reform. All of this demands whole-system reform focused on primary care, and it won’t be easy. There are plenty of vested interests at stake, and a truly transformative vision requires buy-in at every level. However, Alberta’s rapidly growing and aging population makes it more urgent than ever to realize such a vision. This paper offers guidelines to spark the fresh thinking required

Ontario’s Experiment with Primary Care Reform

For the past decade-and-a-half, the government of Ontario has been implementing sweeping reforms in an effort to improve primary health care delivery. Altering physician-compensation models is central to this initiative. One measure of the scale of change is that in 2000 roughly 95 per cent of general/family practitioners were paid traditional fee-for-service, but by 2013 that proportion had plunged to just 28 per cent. The province has clearly succeeded in largely replacing the traditional fee-for-service payment structure with blended payment models that are mostly group-oriented and include: 1) capitation (in some cases): a single payment for providing a particular “basket” of services to a patient for a fixed period, for example a year, regardless of the number of services provided, 2) fee-for-service payment, for services outside the capitated basket and provided in special situations, and 3) various bonuses and incentives (sometimes called pay-for-performance) that mostly focus on preventive care and the management of chronic conditions. Physicians in rural and northern areas, as well as some clinics, also have salary and similar models as options. Ontario has simultaneously introduced patient “rostering” — the formalized connecting of one patient to one physician and/or physician team/group — creating a relationship better suited to delivering preventive healthcare services. However, when surveyed, many patients are unaware that they have been “rostered” meaning that at present much of the benefit must be derived from the physician side alone. It remains to be seen whether or not it is important for patients to be aware that they are rostered. Beyond its clinical benefits, rostering has appreciable rhetorical and political value, as well as potential as a planning tool in efforts to ensure that the local and provincial supply of primary care is appropriate. In a health-care system as large and complex as Ontario’s, reform is more evolutionary than revolutionary; but the province has arguably moved rapidly within this context. Expenditures have been substantial and the initiatives groundbreaking. However, the same challenges that make reform a formidable undertaking also make it difficult to readily, or quickly, measure success, especially since many changes are ongoing. It is not yet demonstrably clear to what degree the government’s goals are being achieved. At present, there are mixed and conflicting findings about whether some of these changes have moved the health system towards the intended goals of improving health-care access and quality, and patient satisfaction, let alone whether the potential improvements can justify the resources expended to achieve them. Naturally, those results we do have at this point offer insight only into the short-term effects of these changes. Especially, it is too early for sufficient evidence to have accumulated on the impact of new physician-group models on downstream costs, including drug prescriptions, specialist care, hospital costs and the use of diagnostic tests. These are, however, central questions that will in large part determine success. Also, it appears that the Ontario government could have accomplished nearly all of its goals so far without having implemented capitation, although capitation may prove beneficial in the longer term as the scarcity of physicians since the 1990s seems to be shifting towards a surplus. In this new era, the health ministry will likely need to take a more hands-on role than it has in the past, including improved system monitoring. Going forward many stakeholders should be involved in evaluating this experiment on an ongoing basis to ensure that it is serving the healthcare needs of the population in an effective and efficient way.

Timetabling System for Medical Officer

The idea was proposed due to the issues that Medical Officer face which is unorganized and unstructured duty roster management. Thus, inspired by Prototyping – based methodology, Timetabling System for Medical officer was developed. This research studied about the scheduling algorithm, tools and knowledge required for system development and the development process involved. Feasibility study was carried out to ensure the timetabling system can be develop within scope, time and constrains. Beside the main constrains, other minor constrains such as cultural, technical and operational was included. Methodology analysis is carried out in order to choose the suitable methodology to develop the system. The prototype architecture is shown in the result and discussion. At the end of the report, few recommendations were listed for the betterment of the system. Besides that, it also can be used as the reference for the custodian to understand the current status of the project