An Evolutionary Algorithm For The Nurse Scheduling Problem With Circadian Rhythms [RT89.N76 R278 2004 f rb][Microfiche 7574].

This thesis investigates the use of memetic algorithm (MA) for solving the nurse scheduling problem

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

The new Dutch timetable: The OR revolution

In December 2006, Netherlands Railways introduced a completely new timetable. Its objective was to facilitate the growth of passenger and freight transport on a highly utilized railway network, and improve the robustness of the timetable resulting in less train delays in the operation. Further adjusting the existing timetable constructed in 1970 was not option anymore, because further growth would then require significant investments in the rail infrastructure. Constructing a railway timetable from scratch for about 5,500 daily trains was a complex problem. To support this process, we generated several timetables using sophisticated operations research techniques, and finally selected and implemented one of these timetables. Furthermore, because rolling-stock and crew costs are principal components of the cost of a passenger railway operator, we used innovative operations research tools to devise efficient schedules for these two resources. The new resource schedules and the increased number of passengers resulted in an additional annual profit of 40 million euros ($60 million) of which about 10 million euros were created by additional revenues. We expect this to increase to 70 million euros ($105 million) annually in the coming years. However, the benefits of the new timetable for the Dutch society as a whole are much greater: more trains are transporting more passengers on the same railway infrastructure, and these trains are arriving and departing on schedule more than they ever have in the past. In addition, the rail transport system will be able to handle future transportation demand growth and thus allow cities to remain accessible. Therefore, people can switch from car transport to rail transport, which will reduce the emission of greenhouse gases.

Strategic Nurse Allocation Policies Under Dynamic Patient Demand

ABSTRACT STRATEGIC NURSE ALLOCATION POLICIES UNDER DYNAMIC PATIENT DEMAND by Osman T. Aydas The University of Wisconsin-Milwaukee, 2017 Under the Supervision of Professor Anthony D. Ross Several studies have shown a strong association between nurse staffing and patient outcomes. When a nursing unit is chronically short-staffed, nurses must maintain an intense pace to ensure that patients receive timely care. Over time this can result in nurse burnout, as well as dissatisfied patients and even medical errors. Improved accuracy in the allocation of nursing staff can mitigate these operational risks and improve patient outcomes. Nursing care is identified as the single biggest factor in both the cost of hospital care and patient satisfaction. Yet, there is widespread dissatisfaction with the current methods of determining nurse staffing levels, including the most common one of using minimum nurse-to-patient ratios. Nurse shortage implications go beyond healthcare quality, extending to health economics as well. In addition, implementation of mandatory nurse-to-patient ratios in some states creates a risk of under- or over-estimating required nurse resources. With this motivation, this dissertation aims to develop methodologies that generate feasible six-week nurse schedules and efficiently assign nurses from various profiles to these schedules while controlling staffing costs and understaffing ratios in the medical unit. First, we develop and test various medium-term staff allocation approaches using mixed-integer optimization and compare their performance with respect to a hypothetical full information scenario. Second, using stochastic integer programming approach, we develop a short-term staffing level adjustment model under a sizable list of patient admission scenarios. We begin by providing an overview of the organization of the dissertation. Chapter 1 presents the problem context and we provide research questions for this dissertation. Chapter 2 provides a review of the literature on nurse staffing and scheduling specifically from the Operations Management journals. We introduce the challenges of nursing care and nurse scheduling practices. We identify major research areas and solution approaches. This is followed by a discussion of the complexities associated with computing nursing requirements and creating rosters. Staffing requirements are the result of a complex interaction between care-unit sizes, nurse-to-patient ratios, bed census distributions, and quality-of-care requirements. Therefore, we review the literature on nursing workload measurement approaches because workloads depend highly on patient arrivals and lengths of stay, both of which can vary greatly. Thus, predicting these workloads and staffing nurses accordingly are essential to guaranteeing quality of care in a cost-effective manner. For completeness, a brief review of the literature on workforce planning and scheduling that is linked to the nurse staffing and scheduling problem is also provided. Chapter 3 develops a framework for estimating the daily number of nurses required in Intensive Care Units (ICUs). Many patient care units, including ICUs, find it difficult to accurately estimate the number of nurses needed. One factor contributing to this difficulty is not having a decision support tool to understand the distribution of admissions to healthcare facilities. We statistically evaluate the existing staff allocation system of an ICU using clinical operational data, then develop a predictive model for estimating the number of admissions to the unit. We analyze clinical operational data covering 44 months for three wards of a pediatric ICU. The existing staff allocation model does not accurately estimate the required number of nurses required. This is due in part to not understanding the pattern and frequency of admissions, particularly those which are not known 12 hours in advance. We show that these “unknown” admissions actually follow a Poisson distribution. Thus, we can more accurately estimate the number of admissions overall. Analytical predictive methods that complement intuition and experience can help to decrease unplanned requirements for nurses and recommend more efficient nurse allocations. The model developed here can be inferred to estimate admissions for other intensive care units, such as pediatric facilities. Chapter 4 examines an integrated nurse staffing and scheduling model for a Pediatric Intensive Care Unit (PICU). This model is targeted to recommend initial staffing plans and schedules for a six-week horizon given a variety of nurse groups and nursing shift assignment types in the PICU. Nurse rostering is an NP-hard combinatorial problem, which makes it extremely difficult to efficiently solve life-sized problems due to their complexity. Usually, real problem instances have complicated work rules related to safety and quality of service issues, as well as preferences of the personnel. To avoid the size and complexity limitations, we generate feasible nurse schedules for the full-time equivalent (FTE) nurses, using algorithms that will be employed in the mixed-integer programming models we develop. Pre-generated schedules eliminate the increased number of constraints, and reduce the number of decision variables of the integrated nurse staffing and scheduling model. We also include a novel methodology for estimating nurse workloads by considering the patient, and individual patient’s acuity, and activity in the unit. When the nursing administration prepares the medium-term nurse schedules for the next staffing cycle (six weeks in our study), one to two months before the actual patient demand realizations, it typically uses a general average staffing level for the nursing care needs in the medical units. Using our mixed-integer optimization model, we examine fixed vs. dynamic medium-term nurse staffing and scheduling policy options for the medical units. In the fixed staffing option, the medical unit is staffed by a fixed number of nurses throughout the staffing horizon. In the dynamic staffing policy, we propose, historical patient demand data enables us to suggest a non-stationary staffing scheme. We compare the performance of both nurse allocation policy options, in terms of cost savings and understaffing ratios, with the optimal staffing scheme reached by the actual patient data. As a part of our experimental design, we evaluate our optimization model for the three medical units of the PICU in the “as-is” state. In Chapter 5, we conduct two-stage short-term staffing adjustments for the upcoming nursing shift. Our proposed adjustments are first used at the beginning of each nursing shift for the upcoming 4-hour shift. Then, after observing actual patient demand for nursing at the start of the next shift, we make our final staffing adjustments to meet the patient demand for nursing. We model six different adjustment options for the two-stage stochastic programming model (five options available as first-stage decisions and one option available as the second-stage decision). Because the adjustment horizon is less than 12 hours, the current patient census, patient acuity, and the number of scheduled admissions/discharges in the current and upcoming shift are known to the unit nurse manager. We develop a two-stage stochastic integer programming model which will minimize total nurse staffing costs (and the cost of adjustments to the original schedules developed in the medium-term planning phase) while ensuring adequate coverage of nursing demand. Chapter 6 provides conclusions from the study and identify both limitations and future research directions

Shift rostering using decomposition: assign weekend shifts first

This paper introduces a shift rostering problem that surprisingly has not been studied in literature: the weekend shift rostering problem. It is motivated by our experience that employees’ shift preferences predominantly focus on the weekends, since many social activities happen during weekends. The Weekend Rostering Problem (WRP) addresses the rostering of weekend shifts, for which we design a problem specific heuristic. We consider the WRP as the first phase of the shift rostering problem. To complete the shift roster, the second phase assigns the weekday shifts using an existing algorithm. We discuss effects of this two-phase approach both on the weekend shift roster and on the roster as a whole. We demonstrate that our first-phase heuristic is effective both on generated instances and real-life instances. For situations where the weekend shift roster is one of the key determinants of the quality of the complete roster, our two-phase approach shows to be effective when incorporated in a commercially implemented algorithm

An assessment of a days off decomposition approach to personnel scheduling

This paper studies a two-phase decomposition approach to solve the personnel scheduling problem. The first phase creates a days off schedule, indicating working days and days off for each employee. The second phase assigns shifts to the working days in the days off schedule. This decomposition is motivated by the fact that personnel scheduling constraints are often divided in two categories: one specifies constraints on working days and days off, while the other specifies constraints on shift assignments. To assess the consequences of the decomposition approach, we apply it to public benchmark instances, and compare this to solving the personnel scheduling problem directly. In all steps we use mathematical programming. We also study the extension that includes night shifts in thefirst phase of the decomposition. We present a detailed results analysis, and analyze the effect of various instance parameters on the decompositions' results. In general, we observe that the decompositions significantly reduce the computation time, and that they produce good solutions for most instances