Taxonomic classification of planning decisions in health care: a review of the state of the art in OR/MS

We provide a structured overview of the typical decisions to be made in resource capacity planning and control in health care, and a review of relevant OR/MS articles for each planning decision. The contribution of this paper is twofold. First, to position the planning decisions, a taxonomy is presented. This taxonomy provides health care managers and OR/MS researchers with a method to identify, break down and classify planning and control decisions. Second, following the taxonomy, for six health care services, we provide an exhaustive specification of planning and control decisions in resource capacity planning and control. For each planning and control decision, we structurally review the key OR/MS articles and the OR/MS methods and techniques that are applied in the literature to support decision making

Operating room planning and scheduling: A literature review.

This paper provides a review of recent research on operating room planning and scheduling. We evaluate the literature on multiple fields that are related to either the problem setting (e.g. performance measures or patient classes) or the technical features (e.g. solution technique or uncertainty incorporation). Since papers are pooled and evaluated in various ways, a diversified and detailed overview is obtained that facilitates the identification of manuscripts related to the reader's specific interests. Throughout the literature review, we summarize the significant trends in research on operating room planning and scheduling and we identify areas that need to be addressed in the future.Health care; Operating room; Scheduling; Planning; Literature review;

A survey of health care models that encompass multiple departments

In this survey we review quantitative health care models to illustrate the extent to which they encompass multiple hospital departments. The paper provides general overviews of the relationships that exists between major hospital departments and describes how these relationships are accounted for by researchers. We find the atomistic view of hospitals often taken by researchers is partially due to the ambiguity of patient care trajectories. To this end clinical pathways literature is reviewed to illustrate its potential for clarifying patient flows and for providing a holistic hospital perspective

Integrated Planning in Hospitals: A Review

Efficient planning of scarce resources in hospitals is a challenging task for which a large variety of Operations Research and Management Science approaches have been developed since the 1950s. While efficient planning of single resources such as operating rooms, beds, or specific types of staff can already lead to enormous efficiency gains, integrated planning of several resources has been shown to hold even greater potential, and a large number of integrated planning approaches have been presented in the literature over the past decades. This paper provides the first literature review that focuses specifically on the Operations Research and Management Science literature related to integrated planning of different resources in hospitals. We collect the relevant literature and analyze it regarding different aspects such as uncertainty modeling and the use of real-life data. Several cross comparisons reveal interesting insights concerning, e.g., relations between the modeling and solution methods used and the practical implementation of the approaches developed. Moreover, we provide a high-level taxonomy for classifying different resource-focused integration approaches and point out gaps in the literature as well as promising directions for future research

Robust Optimization Framework to Operating Room Planning and Scheduling in Stochastic Environment

Arrangement of surgical activities can be classified as a three-level process that directly impacts the overall performance of a healthcare system. The goal of this dissertation is to study hierarchical planning and scheduling problems of operating room (OR) departments that arise in a publicly funded hospital. Uncertainty in surgery durations and patient arrivals, the existence of multiple resources and competing performance measures are among the important aspect of OR problems in practice. While planning can be viewed as the compromise of supply and demand within the strategic and tactical stages, scheduling is referred to the development of a detailed timetable that determines operational daily assignment of individual cases. Therefore, it is worthwhile to put effort in optimization of OR planning and surgical scheduling. We have considered several extensions of previous models and described several real-world applications. Firstly, we have developed a novel transformation framework for the robust optimization (RO) method to be used as a generalized approach to overcome the drawback of conventional RO approach owing to its difficulty in obtaining information regarding numerous control variable terms as well as added extra variables and constraints into the model in transforming deterministic models into the robust form. We have determined an optimal case mix planning for a given set of specialties for a single operating room department using the proposed standard RO framework. In this case-mix planning problem, demands for elective and emergency surgery are considered to be random variables realized over a set of probabilistic scenarios. A deterministic and a two-stage stochastic recourse programming model is also developed for the uncertain surgery case mix planning to demonstrate the applicability of the proposed RO models. The objective is to minimize the expected total loss incurred due to postponed and unmet demand as well as the underutilization costs. We have shown that the optimum solution can be found in polynomial time. Secondly, the tactical and operational level decision of OR block scheduling and advance scheduling problems are considered simultaneously to overcome the drawback of current literature in addressing these problems in isolation. We have focused on a hybrid master surgery scheduling (MSS) and surgical case assignment (SCA) problem under the assumption that both surgery durations and emergency arrivals follow probability distributions defined over a discrete set of scenarios. We have developed an integrated robust MSS and SCA model using the proposed standard transformation framework and determined the allocation of surgical specialties to the ORs as well as the assignment of surgeries within each specialty to the corresponding ORs in a coordinated way to minimize the costs associated with patients waiting time and hospital resource utilization. To demonstrate the usefulness and applicability of the two proposed models, a simulation study is carried utilizing data provided by Windsor Regional Hospital (WRH). The simulation results demonstrate that the two proposed models can mitigate the existing variability in parameter uncertainty. This provides a more reliable decision tool for the OR managers while limiting the negative impact of waiting time to the patients as well as welfare loss to the hospital

Robust Optimization With Applications In Healthcare Operations Management

Ph.DDOCTOR OF PHILOSOPH

Application of Lean Thinking Using Simulation Modelling in a Private Hospital

Timely access, prompt responses to patient needs, and availability of resources to deliver quality service are the key priorities of healthcare systems, in particular hospitals. To cope with these constraints, healthcare managers have turned into lean thinking and approaches in their attempts to reduce non-value added activities and save costs by reducing wastes. This paper presents a case study of a private hospital in Dublin that used integrated approach of value stream mapping and simulation modeling to assess lean implementation in admission and discharge processes. Simulation enabled the strategic management to examine the outcomes of three possible improvement scenarios on hospital performance before implementing lean strategies. The proposed methodology helped to identify bottlenecks and non-value added procedures. Results analysis showed potential improvement in patients’ admission and discharge cycle times and offered the hospital the cost-saving opportunity of reducing the numbers of bed required

Predictive and Prescriptive Analytics for Multi-Site Modeling of Frail and Elderly Patient Services

Recent research has highlighted the potential of linking predictive and prescriptive analytics. However, it remains widely unexplored how both paradigms could benefit from one another to address today's major challenges in healthcare. One of these is smarter planning of resource capacities for frail and elderly inpatient wards, addressing the societal challenge of an aging population. Frail and elderly patients typically suffer from multimorbidity and require more care while receiving medical treatment. The aim of this research is to assess how various predictive and prescriptive analytical methods, both individually and in tandem, contribute to addressing the operational challenges within an area of healthcare that is growing in demand. Clinical and demographic patient attributes are gathered from more than 165,000 patient records and used to explain and predict length of stay. To that extent, we employ Classification and Regression Trees (CART) analysis to establish this relationship. On the prescriptive side, deterministic and two-stage stochastic programs are developed to determine how to optimally plan for beds and ward staff with the objective to minimize cost. Furthermore, the two analytical methodologies are linked by generating demand for the prescriptive models using the CART groupings. The results show the linked methodologies provided different but similar results compared to using averages and in doing so, captured a more realistic real-world variation in the patient length of stay. Our research reveals that healthcare managers should consider using predictive and prescriptive models to make more informed decisions. By combining predictive and prescriptive analytics, healthcare managers can move away from relying on averages and incorporate the unique characteristics of their patients to create more robust planning decisions, mitigating risks caused by variations in demand