Organizing timely treatment in multi-disciplinary care

Healthcare providers experience an increased pressure to organize their processes more efficiently and to provide coordinated care over multiple disciplines. Organizing multi-disciplinary care is typically highly constrained, since multiple appointments per patient have to be scheduled with possible restrictions between them. Furthermore, schedules of professionals from various facilities or with different skills must be aligned. Since it is important that patients are treated on time, access time targets are set on the time between referral to the facility and the actual start of the treatment. These targets may vary per patient type: e.g., urgent patients have shorter access time targets than regular patients. In this thesis, we use operations research methods to support multi-disciplinary care settings in providing timely treatments with an excellent quality of care, against affordable costs, while taking patient and employee satisfaction into account. We consider settings in rehabilitation care and radiotherapy, but the underlying planning problems are applicable to many other multi-disciplinary care settings, such as cancer care or specialty clinics. The developed models are applied to case studies in the Sint Maartenskliniek Nijmegen, the AMC Amsterdam and a BCCA cancer clinic in Vancouver, Canada. The results of the thesis demonstrate that adequate admission policies and capacity allocation to different activities and stages in complex treatment processes can improve compliance with access time targets for multi-disciplinary care systems considerably, while using the available resource capacities and taking patient and employee satisfaction into account

Online capacity planning for rehabilitation treatments: an approximate dynamic programming approach

We study an online capacity planning problem in which arriving patients require a series of appointments at several departments, within a certain access time target. This research is motivated by a study of rehabilitation planning practices at the Sint Maartenskliniek hospital (the Netherlands). In practice, the prescribed treatments and activities are typically booked starting in the rst available week, leaving no space for urgent patients who require a series of appointments at a short notice. This leads to rescheduling of appointments or long access times for urgent patients, which has a negative effect on the quality of care and on patient satisfaction. We propose an approach for allocating capacity to patients at the moment of their arrival, in such a way that the total number of requests booked within their corresponding access time targets is maximized. The model considers online decision making regarding multi-priority, multi-appointment, and multi-resource capacity allocation. We formulate this problem as a Markov decision process (MDP) that takes into account the current patient schedule, and future arrivals. We develop an approximate dynamic programming (ADP) algorithm to obtain approximate optimal capacity allocation policies. We provide insights into the characteristics of the optimal policies and evaluate the performance of the resulting policies using simulation