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

Appointment scheduling system in multi doctor/multi services environment

Appointment scheduling systems are used by health care providers to manage access to their services. In this paper an algorithm and a web application for automatic appointment scheduling is presented. Both are implemented using the concept of booking appointments for patients for a specific service offered by each doctor. The purpose of the application is to make signing up for a specific service easier for patients and to improve health tourism in Croatia by maximizing doctor’s efficiency and minimize patient waiting time. Medical providers are added to the system, they add the services which they provide, and each service offered has its own duration time. Users register, search for services matching their parameters, and schedule an appointment for the requested service. Available appointments are generated using the presented algorithm, which is the main part of this paper. The algorithm searches the database and returns possible appointments. If patient has more than one appointment, possible appointments time can be before the existing appointment, between two appointments, or at the end of the last appointment. Thus, web application enables the patient to reserve desirable appointment time

Recent Developments in German Corporate Governance

We contrast the features of the German corporate governance system with those of other systems and discuss the recent regulatory initiatives.For example, the rules on insider trading and anti-trust have been strengthened.The Restructuring Act has been revised to prevent minority shareholders from stalling corporate restructuring via legal actions.The Takeover Act now prescribes a tender offer as soon as an investor acquires at least 30% of a firm's equity.However, the Act also allows anti-takeover devices.Despite the recent, substantial changes, we conclude that the main characteristics of the German system are still in place.Corporate governance;ownership structure;co-determination;mergers and acquisitions;board of directors

Scheduling in healthcare with multiple resources

The need for improving efficiency in healthcare is motivated largely by increasing global costs of healthcare. One possibility for improvement is in the optimization of the many schedules found within healthcare. This dissertation focuses on just that for two scheduling problems found within healthcare: the appointment scheduling problem and the master surgery scheduling problem. We first look at the appointment scheduling problem – the problem of assigning time slots to patients booking an appointment at a clinic – examining the various ways in which the randomness of this problem is accounted for, and generalising the problem so that its solutions may be used in a wider range of settings in practice. We consider the application of phase-type distributions as well as simulation and analytical approaches, and we optimize appointment schedules for settings both with multiple healthcare providers, and where patients may arrive in batches rather than one-by-one as is usual. Hereafter, we look at a practical scheduling issue, reporting upon the optimization – via mixed integer linear programming – and subsequent implementation of a surgery schedule for a medium sized hospital in the Netherlands. This problem requires assigning surgical specialties to operate in a given room at a given time during a four-week long repeating schedule; the number of possible combinations of which grows extraordinarily fast, even for a small number of specialties and rooms. In this dissertation, we present the method by which we handled the size of the problem, and pay particular attention to the matter of expectations management throughout the project

Recent developments in German corporate governance.

This paper provides an overview of the German corporate governance system. We review the governance role of large shareholders, creditors, the product market and the supervisory board. We also discuss the importance of mergers and acquisitions, the market in block trades, and the lack of a hostile takeover market. Given that Germany is often referred to as a bank-based economy, we pay particular attention to the role of the universal banks (Hausbanken). We show that the German system is characterised by a market for partial corporate control, large shareholders and bank/creditor monitoring, a two-tier (management and supervisory) board with co-determination between shareholders and employees on the supervisory board, a disciplinary product-market, and corporate governance regulation largely based on EU directives but with deep roots in the German codes and legal doctrine. Another important feature of the German system is its corporate governance efficiency criterion which is focused on the maximisation of stakeholder value rather than shareholder value. However, the German corporate governance system has experienced many important changes over the last decade. First, the relationship between ownership or control concentration and profitability has changed over time. Second, the pay-for-performance relation is influenced by large shareholder control: in firms with controlling blockholders and when a universal bank is simultaneously an equity- and debtholder, the pay-for-performance relation is lower than in widely-held firms or blockholder-controlled firms. Third, since 1995 several major regulatory initiatives (including voluntary codes) have increased transparency and accountability

Effect of Appointment Schedules on the Operational Performance of a University Medical Clinic

Healthcare costs in the United States are one of the highest in the world. The healthcare expenditure alone accounted for 17.9% of the Gross Domestic Product of US in 2011. The National Healthcare Expenditure (NHE) is expected to increase at an annual rate of 6.6% from $2.6 Trillion in 2010 to$ 4.5 Trillion in 2019. The per capita expenditure for hospital outpatients and physicians has been the highest among other hospital expenses. This escalation in expenses created a need for productivity improvements in the healthcare industry to control costs. Some of the common problems encountered in outpatient clinics are high patient wait times, physician idle times, physician overtimes and high patient congestion. These problems not only lead to the inefficient operation of a clinic but also cause frustration and dissatisfaction to the physicians and patients. A well designed appointment system is very critical for the effective operation of outpatient clinics by minimizing these problems. The objective of this research was to study the effect of different appointment systems on the operational performance of a university medical clinic. The process at the medical clinic in the LSU Student Health Center (SHC) was modeled using the Rockwell Arena® simulation software. Four scheduling rules: Individual block rule, Bailey rule, 3-Bailey rule, and the Two-at-a-time rule, were studied to understand their effect on the performance parameters of the SHC. The performance parameters considered were the provider measures (provider idle time, startup idle time, provider overtime, provider utilization) and patient measures (patient wait time and patient throughput time). The individual block rule was the most patient friendly with shortest patient measures (patient throughput time - 39.6 min and patient wait time - 15.5 min); however it had the highest provider measures (Idle time – 50.5 min, Startup idle time – 10.4 min, Overtime – 16.2 min). The 3-Bailey rule was the most provider friendly rule with the least provider times (Idle time – 17 min, Startup idle time – 4.6 min, Overtime – 5.6 min) and best provider utilization (95%), but had high patient times (throughput time – 48.1 min and wait time – 24.1 minute). To aid the decision making process of the schedule selection for the SHC, a KT analysis was performed by weighing the performance parameters. The Bailey rule was observed to be the most suitable rule for the SHC as it had a good trade-off between the patient times and provider times compared to the other rules. The Bailey rule had better provider times (Idle time – 31.8 min, Startup idle time – 6.5 min, Overtime – 6.9 min) and better provider utilization rate (92%) when compared to the individual block rule and had marginally higher patient times (throughput time – 41.4 min and wait time – 17.3 min). A test run of the Bailey rule with one provider for ten days also confirmed this behavior of the rule

Autonomic State Management for Optimistic Simulation Platforms

We present the design and implementation of an autonomic state manager (ASM) tailored for integration within optimistic parallel discrete event simulation (PDES) environments based on the C programming language and the executable and linkable format (ELF), and developed for execution on x8664 architectures. With ASM, the state of any logical process (LP), namely the individual (concurrent) simulation unit being part of the simulation model, is allowed to be scattered on dynamically allocated memory chunks managed via standard API (e.g., malloc/free). Also, the application programmer is not required to provide any serialization/deserialization module in order to take a checkpoint of the LP state, or to restore it in case a causality error occurs during the optimistic run, or to provide indications on which portions of the state are updated by event processing, so to allow incremental checkpointing. All these tasks are handled by ASM in a fully transparent manner via (A) runtime identification (with chunk-level granularity) of the memory map associated with the LP state, and (B) runtime tracking of the memory updates occurring within chunks belonging to the dynamic memory map. The co-existence of the incremental and non-incremental log/restore modes is achieved via dual versions of the same application code, transparently generated by ASM via compile/link time facilities. Also, the dynamic selection of the best suited log/restore mode is actuated by ASM on the basis of an innovative modeling/optimization approach which takes into account stability of each operating mode with respect to variations of the model/environmental execution parameters

Scheduling rules to achieve lead-time targets in outpatient appointment systems

This paper considers how to schedule appointments for outpatients, for a clinic that is subject to appointment lead-time targets for both new and returning patients. We develop heuristic rules, which are the exact and relaxed appointment scheduling rules, to schedule each new patient appointment (only) in light of uncertainty about future arrivals. The scheduling rules entail two decisions. First, the rules need to determine whether or not a patient's request can be accepted; then, if the request is not rejected, the rules prescribe how to assign the patient to an available slot. The intent of the scheduling rules is to maximize the utilization of the planned resource (i.e., the physician staff), or equivalently to maximize the number of patients that are admitted, while maintaining the service targets on the median, the 95th percentile, and the maximum appointment lead-times. We test the proposed scheduling rules with numerical experiments using real data from the chosen clinic of Tan Tock Seng hospital in Singapore. The results show the efficiency and the efficacy of the scheduling rules, in terms of the service-target satisfaction and the resource utilization. From the sensitivity analysis, we find that the performance of the proposed scheduling rules is fairly robust to the specification of the established lead-time targets

Heuristic Solutions for Loading in Flexible Manufacturing Systems

Production planning in flexible manufacturing system deals with the efficient organization of the production resources in order to meet a given production schedule. It is a complex problem and typically leads to several hierarchical subproblems that need to be solved sequentially or simultaneously. Loading is one of the planning subproblems that has to addressed. It involves assigning the necessary operations and tools among the various machines in some optimal fashion to achieve the production of all selected part types. In this paper, we first formulate the loading problem as a 0-1 mixed integer program and then propose heuristic procedures based on Lagrangian relaxation and tabu search to solve the problem. Computational results are presented for all the algorithms and finally, conclusions drawn based on the results are discussed