Reducing No-Shows and Late Cancellations in Primary Care

No-shows and late cancellations are a challenge across medical practices, resulting in costly, fragmented care. Many patients do not understand the impact that not showing or cancelling an appointment less than 48 hours prior to a visit can have. While reminding the patient of the appointment has been a known tactic to improve patient’s attendance, the most effective mode of the reminder can vary significantly across patient populations. Just as critical as reminding the patient of the appointment is to ensure they understand the purpose of the visit along with showing respect for their time and any competing priorities. This quality improvement initiative aimed to reduce the no-show rate of 21.4% and late cancellation rate of 21.1% for the MassHealth population by 5%. Learning from previous studies, a hybrid approach to meet this population’s needs included a 7-day reminder call with a Patient Engagement Coordinator (PEC) and a 2-day automated reminder. During the 7-day reminder call the PEC identified barriers to attending the appointment through concrete planning and motivational interviewing strategies. Appointments were rescheduled as needed, additional information was provided to solidify shared goals for the visit, and patient’s time/obligations were validated. The intervention resulted in positive feedback from the majority of patients and revealed concrete planning prompts to be a very effective communication form. The post-intervention data analysis revealed both the no-show and late cancellation results were reduced for the MassHealth population. Due to data and confounding variable limitations this study is recommended to be a basis for future investigation as the principal investigators enter into the next pilot phase of this model

Strategies for dynamic appointment making by container terminals

We consider a container terminal that has to make appointments with barges dynamically, in real-time, and partly automatic. The challenge for the terminal is to make appointments with only limited knowledge about future arriving barges, and in the view of uncertainty and disturbances, such as uncertain arrival and handling times, as well as cancellations and no-shows. We illustrate this problem using an innovative implementation project which is currently running in the Port of Rotterdam. This project aims to align barge rotations and terminal quay schedules by means of a multi-agent system. In this\ud paper, we take the perspective of a single terminal that will participate in this planning system, and focus on the decision making capabilities of its intelligent agent. We focus on the question how the terminal operator can optimize, on an operational level, the utilization of its quay resources, while making reliable appointments with barges, i.e., with a guaranteed departure time. We explore two approaches: (i) an analytical approach based on the value of having certain intervals within the schedule and (ii) an approach based on sources of exibility that are naturally available to the terminal. We use simulation to get insight in the benefits of these approaches. We conclude that a major increase in utilization degree could be achieved only by deploying the sources of exibility, without harming the waiting time of barges too much

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

Bristol Maritime Center Operations Manual

Economic studies have indicated that visiting boaters spend between $25‐$300 per day per person ashore. The upper end of this average were visitors associated with regattas or events. $70 was the average expenditure used in the Bristol projections. It is important to note that Bristol’s marketing initiative can have a major influence on the level of visitor spending. For instance, coupons and information about local stores and restaurants do have a positive effect. Promoting the harbor for yacht club cruise events is not only appreciated by the event organizers, but is financially advantageous to Bristol

Approximate Algorithms for the Combined arrival-Departure Aircraft Sequencing and Reactive Scheduling Problems on Multiple Runways

The problem addressed in this dissertation is the Aircraft Sequencing Problem (ASP) in which a schedule must be developed to determine the assignment of each aircraft to a runway, the appropriate sequence of aircraft on each runway, and their departing or landing times. The dissertation examines the ASP over multiple runways, under mixed mode operations with the objective of minimizing the total weighted tardiness of aircraft landings and departures simultaneously. To prevent the dangers associated with wake-vortex effects, separation times enforced by Aviation Administrations (e.g., FAA) are considered, adding another level of complexity given that such times are sequence-dependent. Due to the problem being NP-hard, it is computationally difficult to solve large scale instances in a reasonable amount of time. Therefore, three greedy algorithms, namely the Adapted Apparent Tardiness Cost with Separation and Ready Times (AATCSR), the Earliest Ready Time (ERT) and the Fast Priority Index (FPI) are proposed. Moreover, metaheuristics including Simulated Annealing (SA) and the Metaheuristic for Randomized Priority Search (Meta-RaPS) are introduced to improve solutions initially constructed by the proposed greedy algorithms. The performance (solution quality and computational time) of the various algorithms is compared to the optimal solutions and to each other. The dissertation also addresses the Aircraft Reactive Scheduling Problem (ARSP) as air traffic systems frequently encounter various disruptions due to unexpected events such as inclement weather, aircraft failures or personnel shortages rendering the initial plan suboptimal or even obsolete in some cases. This research considers disruptions including the arrival of new aircraft, flight cancellations and aircraft delays. ARSP is formulated as a multi-objective optimization problem in which both the schedule\u27s quality and stability are of interest. The objectives consist of the total weighted start times (solution quality), total weighted start time deviation, and total weighted runway deviation (instability measures). Repair and complete regeneration approximate algorithms are developed for each type of disruptive events. The algorithms are tested against difficult benchmark problems and the solutions are compared to optimal solutions in terms of solution quality, schedule stability and computational time

Online Algorithms for Dynamic Resource Allocation Problems

Dynamic resource allocation problems are everywhere. Airlines reserve flight seats for those who purchase flight tickets. Healthcare facilities reserve appointment slots for patients who request them. Freight carriers such as motor carriers, railroad companies, and shipping companies pack containers with loads from specific origins to destinations. We focus on optimizing such allocation problems where resources need to be assigned to customers in real time. These problems are particularly difficult to solve because they depend on random external information that unfolds gradually over time, and the number of potential solutions is overwhelming to search through by conventional methods. In this dissertation, we propose viable allocation algorithms for industrial use, by fully leveraging data and technology to produce gains in efficiency, productivity, and usability of new systems. The first chapter presents a summary of major methodologies used in modeling and algorithm design, and how the methodologies are driven by the size of accessible data. Chapters 2 to 5 present genuine research results of resource allocation problems that are based on Wang and Truong (2017); Wang et al. (2015); Stein et al. (2017); Wang et al. (2016). The algorithms and models cover problems in multiple industries, from a small clinic that aims to better utilize its expensive medical devices, to a technology giant that needs a cost-effective, distributed resource-allocation algorithm in order to maintain the relevance of its advertisements to hundreds of millions of consumers

MASDScheGATS - Scheduling System for Dynamic Manufacturing Environmemts

This chapter addresses the resolution of scheduling in manufacturing systems subject to perturbations. The planning of Manufacturing Systems involves frequently the resolution of a huge amount and variety of combinatorial optimisation problems with an important impact on the performance of manufacturing organisations. Examples of those problems are the sequencing and scheduling problems in manufacturing management, routing and transportation, layout design and timetabling problems

Developing a multi-methodological approach to hospital operating theatre scheduling

Operating theatres and surgeons are among the most expensive resources in any hospital, so it is vital that they are used efficiently. Due to the complexity of the challenges involved in theatre scheduling we split the problem into levels and address the tactical and day-to-day scheduling problems.Cognitive mapping is used to identify the important factors to consider in theatre scheduling and their interactions. This allows development and testing of our understanding with hospital staff, ensuring that the aspects of theatre scheduling they consider important are included in the quantitative modelling.At the tactical level, our model assists hospitals in creating new theatre timetables, which take account of reducing the maximum number of beds required, surgeons’ preferences, surgeons’ availability, variations in types of theatre and their suitability for different types of surgery, limited equipment availability and varying the length of the cycle over which the timetable is repeated. The weightings given to each of these factors can be varied allowing exploration of possible timetables.At the day-to-day scheduling level we focus on the advanced booking of individual patients for surgery. Using simulation a range of algorithms for booking patients are explored, with the algorithms derived from a mixture of scheduling literature and ideas from hospital staff. The most significant result is that more efficient schedules can be achieved by delaying scheduling as close to the time of surgery as possible, however, this must be balanced with the need to give patients adequate warning to make arrangements to attend hospital for their surgery.The different stages of this project present different challenges and constraints, therefore requiring different methodologies. As a whole this thesis demonstrates that a range of methodologies can be applied to different stages of a problem to develop better solutions