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

Location models in the public sector

The past four decades have witnessed an explosive growth in the field of networkbased facility location modeling. This is not at all surprising since location policy is one of the most profitable areas of applied systems analysis in regional science and ample theoretical and applied challenges are offered. Location-allocation models seek the location of facilities and/or services (e.g., schools, hospitals, and warehouses) so as to optimize one or several objectives generally related to the efficiency of the system or to the allocation of resources. This paper concerns the location of facilities or services in discrete space or networks, that are related to the public sector, such as emergency services (ambulances, fire stations, and police units), school systems and postal facilities. The paper is structured as follows: first, we will focus on public facility location models that use some type of coverage criterion, with special emphasis in emergency services. The second section will examine models based on the P-Median problem and some of the issues faced by planners when implementing this formulation in real world locational decisions. Finally, the last section will examine new trends in public sector facility location modeling.Location analysis, public facilities, covering models

Planning of mental health services in Portugal under uncertain conditions

The demand for mental health care services is increasing significantly in the World and in Europe. For a country like Portugal, that is one of the countries with the largest prevalence of mental illnesses in Europe and with a level of supply that is not enough for the level of demand that exists nowadays, the urgency to be able to present a mental health care network able to respond to the expected increase in the demand for mental health services is higher and higher. In this thesis, a mathematical programming model - MHCU model - is presented in order to assist the decision makers to plan a mental health network that can respond to the current and future situation of the mental health care in Portugal. The model focus in the Great region of Lisbon and considers the different services provided and multiple objectives relevant in the mental health sector like the minimization of the cost or the maximization of the different equities values that are used in the model. The MHCU model is a stochastic model in order to be able to take into consideration the uncertainty associated with the mental health sector in different parameters like the demand for service and the length of stay in the network for each patient.A procura por serviços da rede de saúde mental está a aumentar significativamente no mundo e na Europa. Para um país como Portugal, que é um dos países com maior número de doentes mentais na Europa e com um nível de oferta deste tipo de serviços que não é suficiente para corresponder ao nível de procura que existe. A urgência de conseguir reformular a rede de saúde mental em Portugal de forma a que consiga responder ao expectável aumento da procura é cada vez maior. Nesta tese, é apresentado um modelo matemático - modelo MHCU - como forma de assistir os responsáveis pela gestão da saúde mental em Portugal a tomar decisões que permitam reformular a rede de saúde mental em Portugal de forma a que esta consiga responder a atual e futura realidade deste sector em Portugal Este modelo é focado na grande região de Lisboa e considera os diferentes serviços e diferentes objetivos que são relevantes para o sector da saúde mental, como minimizar o custo ou maximizar as diferentes equidades que são utilizadas no modelo. O modelo MHCU é um modelo estocástico de forma a que consiga ter em consideração a incerteza que se encontra associada ao sector da saúde mental em diferentes parâmetros como a procura pelos serviços e o tempo de permanencia nos serviços por parte de cada paciente

Ambulance Emergency Response Optimization in Developing Countries

The lack of emergency medical transportation is viewed as the main barrier to the access of emergency medical care in low and middle-income countries (LMICs). In this paper, we present a robust optimization approach to optimize both the location and routing of emergency response vehicles, accounting for uncertainty in travel times and spatial demand characteristic of LMICs. We traveled to Dhaka, Bangladesh, the sixth largest and third most densely populated city in the world, to conduct field research resulting in the collection of two unique datasets that inform our approach. This data is leveraged to develop machine learning methodologies to estimate demand for emergency medical services in a LMIC setting and to predict the travel time between any two locations in the road network for different times of day and days of the week. We combine our robust optimization and machine learning frameworks with real data to provide an in-depth investigation into three policy-related questions. First, we demonstrate that outpost locations optimized for weekday rush hour lead to good performance for all times of day and days of the week. Second, we find that significant improvements in emergency response times can be achieved by re-locating a small number of outposts and that the performance of the current system could be replicated using only 30% of the resources. Lastly, we show that a fleet of small motorcycle-based ambulances has the potential to significantly outperform traditional ambulance vans. In particular, they are able to capture three times more demand while reducing the median response time by 42% due to increased routing flexibility offered by nimble vehicles on a larger road network. Our results provide practical insights for emergency response optimization that can be leveraged by hospital-based and private ambulance providers in Dhaka and other urban centers in LMICs

Introducing health gains in location-allocation models: A stochastic model for planning the delivery of long-term care

Although the maximization of health is a key objective in health care systems, location-allocation literature has not yet considered this dimension. This study proposes a multi-objective stochastic mathematical programming approach to support the planning of a multi-service network of long-term care (LTC), both in terms of services location and capacity planning. This approach is based on a mixed integer linear programming model with two objectives – the maximization of expected health gains and the minimization of expected costs – with satisficing levels in several dimensions of equity – namely, equity of access, equity of utilization, socioeconomic equity and geographical equity – being imposed as constraints. The augmented ε-constraint method is used to explore the trade-off between these conflicting objectives, with uncertainty in the demand and delivery of care being accounted for. The model is applied to analyze the (re)organization of the LTC network currently operating in the Great Lisbon region in Portugal for the 2014-2016 period. Results show that extending the network of LTC is a cost-effective investment

Supplier selection under disaster uncertainty with joint procurement

Master of ScienceDepartment of Industrial & Manufacturing Systems EngineeringJessica L. Heier StammHealth care organizations must have enough supplies and equipment on hand to adequately respond to events such as terrorist attacks, infectious disease outbreaks, and natural disasters. This is achieved through a robust supply chain system. Nationwide, states are assessing their current supply chains to identify gaps that may present issues during disaster preparedness and response. During an assessment of the Kansas health care supply chain, a number of vulnerabilities were identified, one of which being supplier consolidation. Through mergers and acquisitions, the number of suppliers within the health care field has been decreasing over the years. This can pose problems during disaster response when there is a surge in demand and multiple organizations are relying on the same suppliers to provide equipment and supplies. This thesis explores the potential for joint procurement agreements to encourage supplier diversity by splitting purchasing among multiple suppliers. In joint procurement, two or more customers combine their purchases into one large order so that they can receive quantity discounts from a supplier. This research makes three important contributions to supplier selection under disaster uncertainty. The first of these is the development of a scenario-based supplier selection model under uncertainty with joint procurement. This optimization model can be used to observe customer purchasing decisions in various scenarios while considering the probability of disaster occurrence. Second, the model is applied to a set of experiments to analyze the results when supplier diversity is increased and when joint procurement is introduced. This leads to the third and final contribution: a set of recommendations for health care organization decision makers regarding ways to increase supplier diversity and decrease the risk of disruption associated with disaster occurrence

Human-Machine Collaborative Optimization via Apprenticeship Scheduling

Coordinating agents to complete a set of tasks with intercoupled temporal and resource constraints is computationally challenging, yet human domain experts can solve these difficult scheduling problems using paradigms learned through years of apprenticeship. A process for manually codifying this domain knowledge within a computational framework is necessary to scale beyond the ``single-expert, single-trainee" apprenticeship model. However, human domain experts often have difficulty describing their decision-making processes, causing the codification of this knowledge to become laborious. We propose a new approach for capturing domain-expert heuristics through a pairwise ranking formulation. Our approach is model-free and does not require enumerating or iterating through a large state space. We empirically demonstrate that this approach accurately learns multifaceted heuristics on a synthetic data set incorporating job-shop scheduling and vehicle routing problems, as well as on two real-world data sets consisting of demonstrations of experts solving a weapon-to-target assignment problem and a hospital resource allocation problem. We also demonstrate that policies learned from human scheduling demonstration via apprenticeship learning can substantially improve the efficiency of a branch-and-bound search for an optimal schedule. We employ this human-machine collaborative optimization technique on a variant of the weapon-to-target assignment problem. We demonstrate that this technique generates solutions substantially superior to those produced by human domain experts at a rate up to 9.5 times faster than an optimization approach and can be applied to optimally solve problems twice as complex as those solved by a human demonstrator.Comment: Portions of this paper were published in the Proceedings of the International Joint Conference on Artificial Intelligence (IJCAI) in 2016 and in the Proceedings of Robotics: Science and Systems (RSS) in 2016. The paper consists of 50 pages with 11 figures and 4 table