Towards facilitated optimisation

Optimisation modelling in healthcare has addressed a diverse range of challenges inherent to decision-making and supports decision-makers in determining the best solution under a variety of constraints. In contrast, optimisation models addressing planning and service delivery issues in mental healthcare have received limited attention. Mental healthcare services in England are routinely facing issues relative to scarcity of available resources, inequities in their distribution, and inefficiencies in their use. Optimisation modelling has the potential to support decision making and inform the efficient utilisation of scare resources. Mental healthcare services are a combination of several subsystems and partnerships comprising of numerous stakeholders with a diversity of interests. However, in optimisation literature, the lack of stakeholder involvement in the development process of optimisation models is increasingly identified as a missed opportunity impacting the practical applicability of the models and their results. This thesis argues that simulation modelling literature offers alternative modelling approaches that can be adapted to optimisation modelling to address the shortcoming highlighted. In this study, we adapt PartiSim, a multi-methodology framework to support facilitated simulation modelling in healthcare, towards facilitated optimisation modelling and test it using a real case study in mental healthcare. The case study is concerned with a Primary Care Mental Healthcare (PCMH) service that deploys clinicians with different skills to several General Practice (GP) clinics. The service wanted support to help satisfy increasing demand for appointments and explore the possibility of expanding their workforce. This research puts forward a novel multimethodology framework for participatory optimisation, called PartiOpt. It explores the adaptation and customisation of the and PartiSim framework at each stage of the optimisation modelling lifecycle. The research demonstrates the applicability and relevance of a 'conceptual model' to optimisation modelling, highlighting the potential of facilitated optimisation as a methodology. This thesis argues for the inclusion of conceptual modelling in optimisation when dealing with real world practice-based problems. The thesis proposes an analytics-driven optimisation approach that integrates descriptive, predictive, and prescriptive analytics stages. This approach is utilised to construct a novel multi-skill multi-location optimisation model. By applying the analytics-driven optimisation approach to the case study, previously untapped resource potential is uncovered, leading to the identification of various strategies to improving service efficiency. The successful conceptualisation of an optimisation model and the quantitative decision support requirements that emerged in the initial stages of the study drive the analytics-driven optimisation. Additionally, this research also presents a facilitative approach for stakeholder participation in the validation, experimentation, and implementation of a mathematical optimisation model. Reflecting on the adaptation and subsequent amendments to the modelling stages, the final PartiOpt framework is proposed. It is argued that this framework could reduce the gap between theory and practice for optimisation modelling and offers guidance to optimisation modellers on involving stakeholders in addressing real world problems

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

Analyst-driven development of an open-source simulation tool to address poor uptake of O.R. in healthcare

Computer simulation studies of health and care problems have been reported extensively in the academic literature, but the one-off research projects typically undertaken have failed to create an enduring legacy of widespread use by healthcare practitioners. Simulation and other modelling tools designed and developed to be used routinely have not fared much better either. Following a review of the literature and a survey of frontline analysts in the UK NHS, we found that one reason for this is because simulation tools have, to date, not been developed with the requirements of the end-user in the heart of the development process. Starting with a thorough needs assessment of NHS based healthcare analysts, this study outlines a set of practical design principles to guide development of simulation software tool for conducting patient flow simulation studies. The overall requirement is that patient flow be modelled over a number of inter-connected points of delivery while capturing the stochastic nature of patient arrivals and hospital length of stay, as well as the dynamic delays to patient discharge and transfer of care between different points of care delivery. In ensuring a cost-free solution that is both versatile and user-friendly, and coded in an increasingly popular language among the envisaged end users, the tool was implemented is the R programming language and software environment, with the user interface implemented in the interactive R-Shiny application. The talk will provide an overview of the project lifecycle including an illustrative example of an empirical simulation study concerning the centralisation of an acute stroke pathway

An Optimisation-based Framework for Complex Business Process: Healthcare Application

The Irish healthcare system is currently facing major pressures due to rising demand, caused by population growth, ageing and high expectations of service quality. This pressure on the Irish healthcare system creates a need for support from research institutions in dealing with decision areas such as resource allocation and performance measurement. While approaches such as modelling, simulation, multi-criteria decision analysis, performance management, and optimisation can – when applied skilfully – improve healthcare performance, they represent just one part of the solution. Accordingly, to achieve significant and sustainable performance, this research aims to develop a practical, yet effective, optimisation-based framework for managing complex processes in the healthcare domain. Through an extensive review of the literature on the aforementioned solution techniques, limitations of using each technique on its own are identified in order to define a practical integrated approach toward developing the proposed framework. During the framework validation phase, real-time strategies have to be optimised to solve Emergency Department performance issues in a major hospital. Results show a potential of significant reduction in patients average length of stay (i.e. 48% of average patient throughput time) whilst reducing the over-reliance on overstretched nursing resources, that resulted in an increase of staff utilisation between 7% and 10%. Given the high uncertainty in healthcare service demand, using the integrated framework allows decision makers to find optimal staff schedules that improve emergency department performance. The proposed optimum staff schedule reduces the average waiting time of patients by 57% and also contributes to reduce number of patients left without treatment to 8% instead of 17%. The developed framework has been implemented by the hospital partner with a high level of success

The bi-objective travelling salesman problem with profits and its connection to computer networks.

This is an interdisciplinary work in Computer Science and Operational Research. As it is well known, these two very important research fields are strictly connected. Among other aspects, one of the main areas where this interplay is strongly evident is Networking. As far as most recent decades have seen a constant growing of every kind of network computer connections, the need for advanced algorithms that help in optimizing the network performances became extremely relevant. Classical Optimization-based approaches have been deeply studied and applied since long time. However, the technology evolution asks for more flexible and advanced algorithmic approaches to model increasingly complex network configurations. In this thesis we study an extension of the well known Traveling Salesman Problem (TSP): the Traveling Salesman Problem with Profits (TSPP). In this generalization, a profit is associated with each vertex and it is not necessary to visit all vertices. The goal is to determine a route through a subset of nodes that simultaneously minimizes the travel cost and maximizes the collected profit. The TSPP models the problem of sending a piece of information through a network where, in addition to the sending costs, it is also important to consider what “profit” this information can get during its routing. Because of its formulation, the right way to tackled the TSPP is by Multiobjective Optimization algorithms. Within this context, the aim of this work is to study new ways to solve the problem in both the exact and the approximated settings, giving all feasible instruments that can help to solve it, and to provide experimental insights into feasible networking instances

Organizing timely treatment in multi-disciplinary care

Healthcare providers experience an increased pressure to organize their processes more efficiently and to provide coordinated care over multiple disciplines. Organizing multi-disciplinary care is typically highly constrained, since multiple appointments per patient have to be scheduled with possible restrictions between them. Furthermore, schedules of professionals from various facilities or with different skills must be aligned. Since it is important that patients are treated on time, access time targets are set on the time between referral to the facility and the actual start of the treatment. These targets may vary per patient type: e.g., urgent patients have shorter access time targets than regular patients. In this thesis, we use operations research methods to support multi-disciplinary care settings in providing timely treatments with an excellent quality of care, against affordable costs, while taking patient and employee satisfaction into account. We consider settings in rehabilitation care and radiotherapy, but the underlying planning problems are applicable to many other multi-disciplinary care settings, such as cancer care or specialty clinics. The developed models are applied to case studies in the Sint Maartenskliniek Nijmegen, the AMC Amsterdam and a BCCA cancer clinic in Vancouver, Canada. The results of the thesis demonstrate that adequate admission policies and capacity allocation to different activities and stages in complex treatment processes can improve compliance with access time targets for multi-disciplinary care systems considerably, while using the available resource capacities and taking patient and employee satisfaction into account

Grid Analysis of Radiological Data

IGI-Global Medical Information Science Discoveries Research Award 2009International audienceGrid technologies and infrastructures can contribute to harnessing the full power of computer-aided image analysis into clinical research and practice. Given the volume of data, the sensitivity of medical information, and the joint complexity of medical datasets and computations expected in clinical practice, the challenge is to fill the gap between the grid middleware and the requirements of clinical applications. This chapter reports on the goals, achievements and lessons learned from the AGIR (Grid Analysis of Radiological Data) project. AGIR addresses this challenge through a combined approach. On one hand, leveraging the grid middleware through core grid medical services (data management, responsiveness, compression, and workflows) targets the requirements of medical data processing applications. On the other hand, grid-enabling a panel of applications ranging from algorithmic research to clinical use cases both exploits and drives the development of the services

Access and Resource Management for Clinical Care and Clinical Research in Multi-class Stochastic Queueing Networks.

In healthcare delivery systems, proper coordination between patient visits and the health care resources they rely upon is an area in which important new planning capabilities are very valuable to provide greater value to all stakeholders. Managing supply and demand, while providing an appropriate service level for various types of care and patients of differing levels of urgency is a difficult task to achieve. This task becomes even more complex when planning for (i) stochastic demand, (ii) multi-class customers (i.e., patients with different urgency levels), and (iii) multiple services/visit types (which includes multi-visit itineraries of clinical care and/or clinical research visits that are delivered according to research protocols). These complications in the demand stream require service waiting times and itineraries of visits that may span multiple days/weeks and may utilize many different resources in the organization (each resource with at least one specific service being provided). The key objective of this dissertation is to develop planning models for the optimization of capacity allocation while considering the coordination between resources and patient demand in these multi-class stochastic queueing networks in order to meet the service/access levels required for each patient class. This control can be managed by allocating resources to specific patient types/visits over a planning horizon. In this dissertation, we control key performance metrics that relate to patient access management and resource capacity planning in various healthcare settings with chapters devoted to outpatient services, and clinical research units. The methods developed forecast and optimize (1) the access to care (in a medical specialty) for each patient class, (2) the Time to First Available Visit for clinical research participants enrolling in clinical trials, and (3) the access to downstream resources in an itinerary of care, which we call the itinerary flow time. We also model and control how resources are managed, by incorporating (4) workload/utilization metrics, as well as (5) blocking/overtime probabilities of those resources. We control how to allocate resource capacity along the various multi-visit resource requirements of the patient itineraries, and by doing so, we capture the key correlations between patient access, and resource allocation, coordination, and utilization.PhDIndustrial and Operations EngineeringUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/116770/1/jivan_1.pd

İtfaiye Erlerinin Vardiya Çizelgeleme Sorununun Çözümünde Tamsayılı Programlama Yaklaşımı

Günümüzde hem özel sektörde hem de kamu sektöründe birçok kurum ve kuruluş vardiya usulüne göre çalışmaktadır. Bu kurum ve kuruluşlarda çalışan personellerin verimli bir şekilde faaliyetlerini sürdürebilmeleri için vardiyalarının etkin bir biçimde planlanması gerekmektedir. Etkin bir biçimde planlanmayan vardiyalarda çalışan personellerde, uyku bozukluğu, yorgunluk, kanser, kalp ve damar hastalıkları, ailevi ve psikolojik problemler gibi sorunlar meydana gelebilmektedir. Bu tür sorunları ortadan kaldırmak amacıyla, çalışanların vardiyalarının etkin bir şekilde planlanması gerekmektedir. Ayrıca, çalışan personelin isteklerini dikkate alarak oluşturulan planlamalar, işyerinde verimlilik artışı ve rekabet avantajı sağlanması beklenir. Bu çalışmada itfaiye teşkilatında çalışan itfaiye erlerinin vardiya planlama problemi ele alınmıştır. Planlanmanın çözümü için tamsayılı programlama modeli oluşturulmuş ve oluşturulan model GAMS paket programı ile çözülmüştür. Bu yöntem ile birlikte itfaiye erlerinin ve idarenin istekleri tam yerine getirilmiş ve optimal sonuca ulaşılmıştır