Time-dependent stochastic methods for managing and scheduling Emergency Medical Services

Emergency Medical Services (EMS) are facing increasing pressures in many nations given that demands on the service are rising. This article focuses in particular on the operations of the Welsh Ambulance Service Trust (WAST), which is the only organisation that provides urgent paramedical care services on a day-to-day basis across the whole of Wales. In response to WAST’s aspiration to improve the quality of care it provides, this research investigates several interrelated advanced statistical and operational research (OR) methods, culminating in a suite of decision support tools to aid WAST with capacity planning issues. The developed techniques are integrated in a master workforce capacity planning tool that may be independently operated by WAST planners. By means of incorporating methods that seek to simultaneously better predict future demands, recommend minimum staffing requirements and generate low-cost rosters, the tool ultimately provides planners with an analytical base to effectively deploy resources. Whilst the tool is primarily developed for WAST, the generic nature of the methods considered means they could equally be applied to any service subject to demand that is of an urgent nature, cannot be backlogged, is heavily time-dependent and highly variabl

Time-dependent stochastic modelling for predicting demand and scheduling of emergency medical services

As the prominence of the service sector is increasing in developed nations, new and exciting opportunities are arising for operational researchers to develop and apply models which offer managers solutions to improve the quality of their services. The development of time-dependent stochastic models to analyse complex service systems and generate effective personnel schedules are key to this process, enabling organisations to strike a balance between the provision of a good quality service whilst avoiding unnecessary personnel costs. Specifically within the healthcare sector, there is a need to promote efficient management of an Emergency Medical Service (EMS), where the probability of survival is directly related to the speed of assistance. Motivated by case studies investigating the operation of the Welsh Ambulance Service Trust (WAST), this thesis aims to investigate how operational research (OR) techniques can be developed to analyse priority service systems subject to demand that is of an urgent nature, cannot be backlogged, is heavily time-dependent and highly variable. A workforce capacity planning tool is ultimately developed that integrates a combination of forecasting, queueing theory, stochastic modelling and optimisation techniques into a single spreadsheet model in order to predict future demand upon WAST, set staffing levels, and optimise shift schedules and rosters. The unique linking together of the techniques in a planning tool which further captures time-dependency and two priority classes enables this research to outperform previous approaches, which have generally only considered a single class of customer, or generated staffing recommendations using approximation methods that are only reliable under limited conditions. The research presented in this thesis is novel in several ways. Primarily, the first section considers the potential of a nonparametric modelling technique known as Singular Spectrum Analysis (SSA) to improve the accuracy of demand forecasts. Secondly, the main body of work is dedicated to adapting numerical queueing theory techniques to accurately model the behaviour of time-dependent multi-server priority systems across shift boundaries and evaluate the likelihood of excessive waits for service for two customer classes. The final section addresses how shifts can be optimally scheduled using heuristic search techniques. The main conclusions are that in addition to offering a more flexible approach, the forecasts generated by SSA compare favourably to those obtained using traditional methods, and both approximate and numerical modelling techniques may be duly extended to set staffing levels in complex priority systems

Sustaining a new model of acute stroke care : A mixed-method process evaluation of the Melbourne Mobile Stroke Unit

Background Internationally, Mobile Stroke Unit (MSU) ambulances have changed pre-hospital acute stroke care delivery. MSU clinical and cost-effectiveness studies are emerging, but little is known about important factors for achieving sustainability of this innovative model of care. Methods Mixed-methods study from the Melbourne MSU (operational since November 2017) process evaluation. Participant purposive sampling included clinical, operational and executive/management representatives from Ambulance Victoria (AV) (emergency medical service provider), the MSU clinical team, and receiving hospitals. Sustainability was defined as ongoing MSU operations, including MSU workforce and future model considerations. Theoretically-based on-line survey with Unified Theory of Acceptance and Use of Technology (UTAUT), Self Determination Theory (SDT, Intrinsic Motivation), and open-text questions targeting barriers and benefits was administered (June-September 2019). Individual/group interviews were conducted, eliciting improvement suggestions and requirements for ongoing use. Descriptive and regression analyses (quantitative data) and directed content and thematic analysis (open text and interview data) were conducted. Results There were 135 surveys completed. Identifying that the MSU was beneficial to daily work (β = 0.61), not experiencing pressure/tension about working on the MSU (β = 0.17) and thinking they did well working within the team model (β = 0.17) were significantly associated with wanting to continue working within the MSU model [R2 = 0.76; F(15, 60) = 12.76, P < .001]. Experiences varied between those on the MSU team and those working with the MSU. Advantages were identified for patients (better, faster care) and clinicians (interdisciplinary learning). Disadvantages included challenges integrating into established systems, and establishing working relationships. Themes identified from 35 interviews were MSU team composition, MSU vehicle design and layout, personnel recruitment and rostering, communication improvements between organisations, telemedicine options, MSU operations and dispatch specificity. Conclusion Important factors affecting the sustainability of the MSU model of stroke care emerged. A cohesive team approach, with identifiable benefits and good communication between participating organisations is important for clinical and operational sustainability

New South Wales Auditor-General’s report: financial audit volume twelve 2014 focusing on health

Executive Summary This report sets out the results of the financial statement audits of entities in the Health Cluster for the year ended 30 June 2014. Unqualified audit opinions were issued on all financial statements for the year. The report also provides Parliament and other users of the financial statements with an analysis of the NSW Government health entities’ results and key observations in the following areas: Financial and Performance Reporting Financial Controls Governance Service Delivery Structure of the Health Cluster The Ministry of Health is the lead agency in the Health Cluster. It is responsible for: providing health care services to patients and the community promoting wellness and illness prevention developing health care policy and planning managing, monitoring and reporting on health system performance building healthy communities by working with other parts of the NSW Government &nbsp

Work force assignment and planning for onshore oil and gas wells cementing operations

In oil and gas well cementing operations, workers are exposed to long consecutive hours of work and irregular off times due to the nature of such service and inefficient workforce assignment. Overloading human resources increases the potential of errors during service execution, which is mostly considered catastrophic in this field of services. Efficiency of human resources overall reduces as they become over utilized. Finally, loyalty of employees to the company becomes unstable. The objective of this project is to develop a more efficient workforce assignment policy for oil and gas well cementing operations. Cementing operation is critical and vital in a life cycle of any oil or gas well. Operating companies consider this operation as one of the most critical operations during the construction of a well and they explicitly place a zero margin of error in this operation. A case study from the land field of Dukhan is examined in this project. An international oil field services provider is the current service provider for cementing services. The main deficiency of the existing planning policy is the overloading of resources performing the service operation. The project ultimately aims to reduce the average positive deviation from the maximum shift duration for each member of the service team. A sub-objective of the project is limit the maximum waiting time a drilling rig spend waiting on crew members to execute the job to 24 hours. Methodology of the project starts by studying the current personnel deployment policy and defining the problem. Following that, previous operational data is collected over the span of 1 year and probability distributions are determined for uncertain variables. Finally, the new proposed planning policy is simulated in AnyLogic Multimethod Simulation software to examine its efficiency, where generated data is collected, analyzed and compared to the existing planning policy. The combination of both the project methodology and the relevant literature review provide strong bases for developing alternative personnel assignment policies. Methodology in general is considered a good foundation for staff assignment problems, while literature review gives insight for the possibility of improving current assignment policy in order to have a more balanced work load distribution. Obtained results confirm superiority of proposed planning policy. Average positive deviation dropped considerably compared to the current assignment policy. Drilling rig waiting time remains below pre-set maximum waiting time. Thus, proposed policy enhanced personnel assignment without compromising the integrity of operations

Gestión logística de sistemas de hospitalización domiciliaria: una revisión crítica de modelos y métodos

RESUMEN: Los servicios de Hospitalización Domiciliaria (HD) se basan en una red de distribución, en la cual los pacientes son hospitalizados en sus casas y los prestadores de servicios de salud deben entregar cuidados médicos coordinados a los pacientes. La demanda de estos servicios está creciendo rápidamente y los gobiernos y proveedores de servicios de salud enfrentan el reto de tomar un conjunto de decisiones complejas en un sector con un componente logístico importante. En este artículo se presenta una revisión crítica de los modelos y métodos utilizados para darle soporte a las decisiones logísticas en HD. Para esto se presenta primero un marco de referencia, con el objetivo de identificar las oportunidades de investigación en el campo. Con base en dicho marco, se presenta la revisión de la literatura y la identificación de brechas en la investigación. En particular, se hace énfasis en la necesidad de desarrollar e implementar metodologías más integradas para dar soporte a las decisiones estratégicas y tácticas y de considerar puntos clave de los sistemas reales.ABSTRACT: Home Health Care (HHC) services are based on a delivery network in which patients are hospitalized at their homes and health care providers must deliver coordinated medical care to patients. Demand for HHC services is rapidly growing and governments and health care providers face the challenge to make a set of complex decisions in a medical service business that has an important component of logistics problems. The objective of this paper is to provide a critical review of models and methods used to support logistics decisions in HHC. For this purpose, a reference framework is proposed first in order to identify research perspectives in the field. Based on this framework, a literature review is presented and research gaps are identified. In particular, the literature review reveals that more emphasizes is needed to develop and implement more integrated methodologies to support decisions at tactical and strategic planning levels and to consider key features from real systems

Operational Squadron Scheduling

The 28th Operational Weather Squadron (28th OWS) is responsible for producing and disseminating mission planning and execution weather analyses and forecasts. The squadron must prepare schedules that meet the needs of their mission while dealing with real-world constraints such as time windows, task priorities, and intermittent recurring missions. The 28th OWS\u27s manning consists of active duty, deployed in-place, reserve, civilian and contract personnel. In this research, a scheduling model and algorithm are provided as an approach to crew scheduling for the 28th Operational Weather Squadron. Scheduling in the 28th OWS is complex and can be time consuming. This model will reduce the time and burden of scheduling the squadron

Centralized versus market-based approaches to mobile task allocation problem: State-of-the-art

Centralized approach has been adopted for finding solutions to resource allocation problems (RAPs) in many real-life applications. On the other hand, market-based approach has been proposed as an alternative to solve the problem due to recent advancement in ICT technologies. In spite of the existence of some efforts to review the pros and cons of each approach in RAPs, the studies cannot be directly applied to specific problem domains like mobile task allocation problem which is characterised with high level of uncertainty on the availability of resources (workers). This paper aims to review existing studies on task allocation problems(TAPs) focusing on those two approaches and their comparison and identify major issues that need to be resolved for comparing the two approaches in mobile task allocation problems. Mobile Task Allocation Problem (MTAP) is defined and its problematic structures are explained in relation with task allocation to mobile workers. Solutions produced by each approach to some applications and variations of MTAP are also discussed and compared. Finally, some future research directions are identified in order to compare both approaches in function of uncertainty emerging from the mobile nature of the MTAP