How stochasticity and emergencies disrupt the surgical schedule

In health care system, the operating theatre is recognized as having an important role, notably in terms of generated income and cost. Its management, and in particular its scheduling, is thus a critical activity, and has been the sub ject of many studies. However, the stochasticity of the operating theatre environment is rarely considered while it has considerable effect on the actual working of a surgical unit. In practice, the planners keep a safety margin, let’s say 15% of the capacity, in order to absorb the effect of unpredictable events. However, this safety margin is most often chosen sub jectively, from experience. In this paper, our goal is to rationalize this process. We want to give insights to managers in order to deal with the stochasticity of their environment, at a tactical–strategic decision level. For this, we propose an analytical approach that takes account of the stochastic operating times as well as the disruptions caused by emergency arrivals. From our model, various performance measures can be computed: the emergency disruption rate, the waiting time for an emergency, the distribution of the working time, the probability of overtime, the average overtime, etc. In particular, our tool is able to tell how many operations can be scheduled per day in order to keep the overtime limited.health care, surgical schedule, emergencies, Markov chain.

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

Compensatory Time vs. Cash Wages: Amending the Fair Labor Standards Act?

In the 108th Congress, two work hours flexibility bills have been introduced: S. 317 by Senator Gregg and H.R. 1119 by Representative Biggert. Both bills deal with a compensatory time off option (comp time) — though the Gregg proposal is somewhat broader, projecting other changes in the overtime provisions of the Fair Labor Standards Act (FLSA) as well. This report is limited to consideration of the issue of comp time

Compensatory Time vs. Cash Wages: Amending the Fair Labor Standards Act?

CRS_February_2005_Compensatory_Time_vs_Cash_Wages.pdf: 489 downloads, before Oct. 1, 2020

Fast evaluation of appointment schedules for outpatients in health care

We consider the problem of evaluating an appointment schedule for outpatients in a hospital. Given a fixed-length session during which a physician sees K patients, each patient has to be given an appointment time during this session in advance. When a patient arrives on its appointment, the consultations of the previous patients are either already finished or are still going on, which respectively means that the physician has been standing idle or that the patient has to wait, both of which are undesirable. Optimising a schedule according to performance criteria such as patient waiting times, physician idle times, session overtime, etc. usually requires a heuristic search method involving a huge number of repeated schedule evaluations. Hence, the aim of our evaluation approach is to obtain accurate predictions as fast as possible, i.e. at a very low computational cost. This is achieved by (1) using Lindley's recursion to allow for explicit expressions and (2) choosing a discrete-time (slotted) setting to make those expression easy to compute. We assume general, possibly distinct, distributions for the patient's consultation times, which allows us to account for multiple treatment types, as well as patient no-shows. The moments of waiting and idle times are obtained. For each slot, we also calculate the moments of waiting and idle time of an additional patient, should it be appointed to that slot. As we demonstrate, a graphical representation of these quantities can be used to assist a sequential scheduling strategy, as often used in practice

Capacity Planning and Leadtime management

In this paper we discuss a framework for capacity planning and lead time management in manufacturing companies, with an emphasis on the machine shop. First we show how queueing models can be used to find approximations of the mean and the variance of manufacturing shop lead times. These quantities often serve as a basis to set a fixed planned lead time in an MRP-controlled environment. A major drawback of a fixed planned lead time is the ignorance of the correlation between actual work loads and the lead times that can be realized under a limited capacity flexibility. To overcome this problem, we develop a method that determines the earliest possible completion time of any arriving job, without sacrificing the delivery performance of any other job in the shop. This earliest completion time is then taken to be the delivery date and thereby determines a workload-dependent planned lead time. We compare this capacity planning procedure with a fixed planned lead time approach (as in MRP), with a procedure in which lead times are estimated based on the amount of work in the shop, and with a workload-oriented release procedure. Numerical experiments so far show an excellent performance of the capacity planning procedure