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

Managing appointment booking under customer choices

Motivated by the increasing use of online appointment booking platforms, we study how to offer appointment slots to customers to maximize the total number of slots booked. We develop two models, nonsequential offering and sequential offering, to capture different types of interactions between customers and the scheduling system. In these two models, the scheduler offers either a single set of appointment slots for the arriving customer to choose from or multiple sets in sequence, respectively. For the nonsequential model, we identify a static randomized policy, which is asymptotically optimal when the system demand and capacity increase simultaneously, and we further show that offering all available slots at all times has a constant factor of two performance guarantee. For the sequential model, we derive a closed form optimal policy for a large class of instances and develop a simple, effective heuristic for those instances without an explicit optimal policy. By comparing these two models, our study generates useful operational insights for improving the current appointment booking processes. In particular, our analysis reveals an interesting equivalence between the sequential offering model and the nonsequential offering model with perfect customer preference information. This equivalence allows us to apply sequential offering in a wide range of interactive scheduling contexts. Our extensive numerical study shows that sequential offering can significantly improve the slot fill rate (6%–8% on average and up to 18% in our testing cases) compared with nonsequential offering. Given the recent and ongoing growth of online and mobile appointment booking platforms, our research findings can be particularly useful to inform user interface design of these booking platforms

Block-based Outpatient Clinic Appointments Scheduling Under Open-access Policy

Outpatient clinic appointment scheduling is an important topic in OR/IE studies. Open-access policy shows its strength in improving patient access and satisfaction, as well as reducing no-show rate. The traditional far-in-advance scheduling plays an important role in handling chronic and follow-up care. This dissertation discusses a hybrid policy under which a clinic deals with three types of patients. The first type of patients are those who request their appointments before the visit day. The second type of patients schedule their appointment on the visit day. The third type of patients are walk-in patients who go to the clinic without appointments and wait to see the physician in turn. In this dissertation, the online scheduling policy is addressed for the Type 2 and Type 3 patients, and the offline scheduling policy is used for the Type 1 patients. For the online scheduling policy, two stochastic integer programming (SIP) models are built under two different sets of assumptions. The first set of assumptions ignores the endogenous uncertainty in the problem. An aggregate assigning method is proposed with the deterministic equivalent problem (DEP) model. This method is demonstrated to be better than the traditional one-at-a-time assignment through both overestimation and underestimation numerical examples. The DEP formulations are solved using the proposed bound-based sampling method, which provides approximated solutions and reasonable sample size with the least gap between lower and upper bound of the original objective value. On the basis of the first set of assumptions and the SIP model, the second set of assumptions considers patient no-shows, preference, cancellations and lateness, which introduce endogenous uncertainty into the SIP model. A modified L-shaped method and aggregated multicut L-shaped method are designed to handle the model with decision dependent distribution parameter. Distinctive optimality cut generation schemes are proposed for three types of distribution for linked random variables. Computational experiments are conducted to compare performance and outputs of different methods. An alternative formulation of the problem with simple recourse function is provided, based on which, a mixed integer programming model is established as a convenient complementary method to evaluate results with expected value. The offline scheduling aims at assigning a certain number of Type 1 patients with deterministic service time and individual preferences into a limited number of blocks, where the sum of patients’ service time in a block does not exceed the block length. This problem is associated with bin packing problem with restrictions. Heuristic and metaheuristic methods are designed to adapt the added restrictions to the bin packing problem. Zigzag sorting is proposed for the algorithm and is shown to improve the performance significantly. A clique based construction method is designed for the Greedy Randomized Adaptive Search Procedure and Simulated Annealing. The proposed methods show higher efficiency than traditional ones. This dissertation offers a series of new and practical resolutions for the clinic scheduling problem. These methods can facilitate the clinic administrators who are practicing the open-access policy to handle different types of patients with deterministic or nondeterministic arrival pattern and system efficiency. The resolutions range from operations level to management level. From the operations aspect, the block-wise assignment and aggregated assignment with SIP model can be used for the same-day request scheduling. From the management level, better coordination of the assignment of the Type 1 patients and the same-day request patients will benefit the cost-saving control

Access and Resource Management for Clinical Care and Clinical Research in Multi-class Stochastic Queueing Networks.

In healthcare delivery systems, proper coordination between patient visits and the health care resources they rely upon is an area in which important new planning capabilities are very valuable to provide greater value to all stakeholders. Managing supply and demand, while providing an appropriate service level for various types of care and patients of differing levels of urgency is a difficult task to achieve. This task becomes even more complex when planning for (i) stochastic demand, (ii) multi-class customers (i.e., patients with different urgency levels), and (iii) multiple services/visit types (which includes multi-visit itineraries of clinical care and/or clinical research visits that are delivered according to research protocols). These complications in the demand stream require service waiting times and itineraries of visits that may span multiple days/weeks and may utilize many different resources in the organization (each resource with at least one specific service being provided). The key objective of this dissertation is to develop planning models for the optimization of capacity allocation while considering the coordination between resources and patient demand in these multi-class stochastic queueing networks in order to meet the service/access levels required for each patient class. This control can be managed by allocating resources to specific patient types/visits over a planning horizon. In this dissertation, we control key performance metrics that relate to patient access management and resource capacity planning in various healthcare settings with chapters devoted to outpatient services, and clinical research units. The methods developed forecast and optimize (1) the access to care (in a medical specialty) for each patient class, (2) the Time to First Available Visit for clinical research participants enrolling in clinical trials, and (3) the access to downstream resources in an itinerary of care, which we call the itinerary flow time. We also model and control how resources are managed, by incorporating (4) workload/utilization metrics, as well as (5) blocking/overtime probabilities of those resources. We control how to allocate resource capacity along the various multi-visit resource requirements of the patient itineraries, and by doing so, we capture the key correlations between patient access, and resource allocation, coordination, and utilization.PhDIndustrial and Operations EngineeringUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/116770/1/jivan_1.pd

A review of the healthcare-management (modeling) literature published at Manufacturing and Service Operations Management

Healthcare systems throughout the world are under pressure to widen access, improve efficiency and quality of care, and reduce inequity. Achieving these conflicting goals requires innovative approaches, utilizing new technologies, data analytics, and process improvements. The operations management community has taken on this challenge: more than 10% of articles published in M&SOM in the period from 2009 to 2018 has developed analytical models that aim to inform healthcare operational decisions and improve medical decision-making. This article presents a review of the research published in M&SOM on healthcare management since its inception 20 years ago and reflects on opportunities for further research

Integrated Machine Learning and Optimization Frameworks with Applications in Operations Management

Incorporation of contextual inference in the optimality analysis of operational problems is a canonical characteristic of data-informed decision making that requires interdisciplinary research. In an attempt to achieve individualization in operations management, we design rigorous and yet practical mechanisms that boost efficiency, restrain uncertainty and elevate real-time decision making through integration of ideas from machine learning and operations research literature. In our first study, we investigate the decision of whether to admit a patient to a critical care unit which is a crucial operational problem that has significant influence on both hospital performance and patient outcomes. Hospitals currently lack a methodology to selectively admit patients to these units in a way that patient’s individual health metrics can be incorporated while considering the hospital’s operational constraints. We model the problem as a complex loss queueing network with a stochastic model of how long risk-stratified patients spend time in particular units and how they transition between units. A data-driven optimization methodology then approximates an optimal admission control policy for the network of units. While enforcing low levels of patient blocking, we optimize a monotonic dual-threshold admission policy. Our methodology captures utilization and accessibility in a network model of care pathways while supporting the personalized allocation of scarce care resources to the neediest patients. The interesting benefits of admission thresholds that vary by day of week are also examined. In the second study, we analyze the efficiency of surgical unit operations in the era of big data. The accuracy of surgical case duration predictions is a crucial element in hospital operational performance. We propose a comprehensive methodology that incorporates both structured and unstructured data to generate individualized predictions regarding the overall distribution of surgery durations. Consequently, we investigate methods to incorporate such individualized predictions into operational decision-making. We introduce novel prescriptive models to address optimization under uncertainty in the fundamental surgery appointment scheduling problem by utilizing the multi-dimensional data features available prior to the surgery. Electronic medical records systems provide detailed patient features that enable the prediction of individualized case time distributions; however, existing approaches in this context usually employ only limited, aggregate information, and do not take advantages of these detailed features. We show how the quantile regression forest, can be integrated into three common optimization formulations that capture the stochasticity in addressing this problem, including stochastic optimization, robust optimization and distributionally robust optimization. In the last part of this dissertation, we provide the first study on online learning problems under stochastic constraints that are "soft", i.e., need to be satisfied with high likelihood. Under a Bayesian framework, we propose and analyze a scheme that provides statistical feasibility guarantees throughout the learning horizon, by using posterior Monte Carlo samples to form sampled constraints that generalize the scenario generation approach commonly used in chance-constrained programming. We demonstrate how our scheme can be integrated into Thompson sampling and illustrate it with an application in online advertisement.PHDIndustrial & Operations EngineeringUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttps://deepblue.lib.umich.edu/bitstream/2027.42/145936/1/meisami_1.pd