Developing geographical indicators of mileage-related costs: a case study exploring travelling public services in English local areas

The context of this study is the public sector provision of services involving travelling in local authority areas in England. Such travelling services are costly and the relative levels of these costs across different local areas have raised a number of policy issues, particularly how performance assessments of local authorities and capitation-based funding by central government take into account (or fail to take into account) the differential travel costs faced in geographical areas that differ in population dispersion (sparsity) characteristics. The research presented here is concerned with identifying and evaluating practical indicators of mileage-related costs faced in local areas and a range of indicators have been explored for three services: domiciliary care, refuse collection and home-to-school transport. The findings suggest that currently used population dispersion indicators could be improved and that the current sparsity allowances in England underestimate the relative cost effects by a considerable amount.     

A hub covering network design problem for cargo applications in Turkey

Hub location problems involve locating hub facilities and allocating demand nodes to hubs in order to provide service between origin–destination pairs. In this study, we focus on cargo applications of the hub location problem. Through observations from the Turkish cargo sector, we propose a new mathematical model for the hub location problem that relaxes the complete hub network assumption. Our model minimizes the cost of establishing hubs and hub links, while designing a network that services each origin–destination pair within a time bound. We formulate a single-allocation hub covering model that permits visiting at most three hubs on a route. The model is then applied to the realistic instances of the Turkish network and to the Civil Aeronautics Board data set.     

Mid-term and short-term planning support for home health care services

In this paper we are looking at routing and scheduling problems arising in the context of home health care services. Many small companies are working in this sector in Germany and planning is still done manually, resulting in long planning times and relatively inflexible solutions.     

The Use of a Strategic Planning Model for Health and Personal Social Services

Experience in using a mathematical model in the strategic planning of Health and Personal Social Services (HPSS) suggests some lessons that may be relevant to strategic modelling in other public services. Two attributes of the HPSS are that its final outputs cannot be measured reliably and that it is organized hierarchically with field authorities having considerable autonomy from the central authority. A model that has proved useful in this situation simulates how the field authorities respond to decisions taken at the centre on aggregate resource availabilities and describes their responses in terms of intermediate or proxy measures of service output. The model is used interactively with planners to examine policy options. It takes account of ideal patterns of service delivery, not merely current practice, and of the priorities and preferences employed by service personnel in the field.     

Computerized Routeing for Community Nurses — A Pilot Study

Community nurses spend a relatively large proportion of their time travelling. If this could be reduced, benefits would include increased time for direct patient care and reduced costs. This paper describes a pilot study in the Dumfries and Galloway Health Board to see if computerized vehicle routeing could reduce the distance and time of travelling. It is concluded that problems with implementation and characteristics of nurses' journeys (particularly the short distances travelled between long stops) make it unlikely that net savings could be achieved using computers. Nonetheless, some benefits might be obtained by taking a rational look at aspects of nurses' travelling.     

An analysis of p-median location problem: Effects of backup service level and demand assignment policy

Any solution to facility location problems will consider determining the best suitable locations with respect to certain criteria. Among different types of location problems, involving emergency service system (ESSs) are one of the most widely studied in the literature, and solutions to these problems will mostly aim to minimize the mean response time to demands. In practice, however, a demand may not be served from its nearest facility if that facility is engaged in serving other demands. This makes it a requirement to assign backup services so as to improve response time and service quality. The level of backup service is a key, strategic-level planning factor, and must be taken into consideration carefully. Moreover, in emergency service operations conducted in congested demand regions, demand assignment policy is another important factor that affects the system performance. Models failing to adopt sufficient levels of backup service and realistic demand assignment policies may significantly deteriorate the system performance.Considering the classic p-median problem (pMP) location model, this paper investigates the effects of backup service level, demand assignment policy, demand density, and number of facilities and their locations on the solution performance in terms of multiple metrics. For this purpose, we adopt a combined optimization and simulation approach. We will first modify the classic pMP to account for distances to backup services. Next, we employ a discrete event simulation to evaluate the performance of location schemes obtained from the deterministic mathematical model. Our results provide insights for decision-makers while planning ESS operations.     

Performance Monitoring and Competence Assessment in Health Services

Health and health service monitoring is among the most promising research area today and the world work towards efficient and cost effective health care. This paper deals with monitoring health service performance using more than one performance outcome variable (multi-attribute processes), which is common in most health services. Although monitoring whether a health service changes or improves over time is important this is well covered in the current literature. Therefore this paper focuses on comparing similar health services in terms of their performance. The proposed procedure is based on an appropriate control chart. The paper deals with firstly the case when no risk adjustment is required because the health services being compared treat the same patient case-mix which does not vary over time. Secondly it deals with comparing health services where risk adjustment is required because the patient case-mix they service do differ because they service either very different geographical locations or service very different demographics of the same population. The technology developed in this paper could be used for example to assess and compare health practitioners’ competence over time, i.e. to decide if two doctors are equivalent in terms of their outcome performances. The waiting time random variable associated with the run length distribution of the control charts (as well as to competence testing) is studied using a Markov Chain embedding technique. Numerical results are provided that exhibit the value of the proposed procedures.     

Improving operational effectiveness of tactical master plans for emergency and elective patients under stochastic demand and capacitated resources

This paper develops a two-stage planning procedure for master planning of elective and emergency patients while allocating at best the available hospital resources. Four types of resources are considered: operating theatre, beds in the medium and in the intensive care units, and nursing hours in the intensive care unit. A tactical plan is obtained by minimizing the deviations of the resources consumption to the target levels of resources utilization, following a goal programming approach. The MIP formulation to get this tactical plan is specifically designed to account for emergency care since it allows for the reservation of some capacity for emergency patients and possible capacity excess. To deal with the deviation between actually arriving elective patients and the average number of patients on which the tactical plan is based, we consider the possibility of planning a higher number of patients than the average to create operating slots in the tactical plan (slack planning). These operating slots are then filled in the operational plan following several flexibility rules. We consider three options for slack planning that lead to three different tactical plans on which we apply three flexibility rules to get finally nine alternative weekly schedules of elective patients. We then develop an algorithm to modify this schedule on a daily basis so as to account for emergency patients’ arrivals. Scheduled elective patients may be cancelled and emergency patients may be sent to other hospitals. Cancellation rules for both types of patients rely on the possibility to exceed the available capacities. Several performance indicators are defined to assess patient service and hospital efficiency. Simulation results show a trade-off between hospital efficiency and patient service.     

An Operational Research Approach to Allocation of Clients to a Certain Class of Service Institutions

A model is developed to explain the allocation of clients to different locations of a certain class of service institutions. It can be used for all types of allocation-problems which have the features: clients are travelling from their home locations to the service places. They can choose among several locations of the institution all of which offer the same services. The clients need constant travelling times or costs, and they cause different waiting times or costs at each location, which are a function of the number of clients choosing that service station. The objective of the individual client is to minimize the total time or cost required.Since exact alogrithms cannot be used because of the large number of variables and the non-linearity of the problem, a special approximation algorithm is developed.The paper presents the results of a study concerning the allocation of cars, which must periodically be checked for traffic safety at official test stations.     

The implementation and utilisation of operational research in the reorganised National Health Service Part II

The paper outlines some effects of the reorganisation of the British National Health Service with its increasing emphasis on service planning. Current policies will involve substantial change in the configuration of the Health Service. Various aspects of the management of change, the involvement with decision makers and the implementation of results are discussed. It is expected that Operational Research in the health services will become more closely concerned with the medical and nursing aspects of the provision of care and the measured benefits to patients from this care. This involvement will assist in the production of more realistic models for decision making within districts, areas, regions and at the national level.     

Pricing peer-produced services: Quality,capacity, and competition issues

Peer production has played an important role in the economics of Web 2.0 related services in which user participation and contribution become the main driving dynamics. However, the quality of peer-produced services is uncertain because of inherently decentralized and heterogeneous participants. In the paper, utilizing reliability and game theoretic models, we develop a QoS measure and pricing schemes for this emerging type of service under various market structures. Our results suggest that a monopolistic platform provider has no incentive to offer multiple quality classes of service. Two competing platform providers may offer identical service contracts but still receive non-negative profit. If they offer heterogeneous service contracts, the provider with the lower quality service may provide higher quality than he advertises. This research contributes to the literature with a number of unique and interesting implications for the issues of service contract design, capacity planning, and market interactions for operations of community-based or peer-produced services.     

Equity and Access: Exploring the Effects of Hospital Location on the Population Served — A Case Study in Strategic Planning

This paper describes a case study in which a simulation model, specifically an attraction-constrained spatial interaction model, is used to provide information to assist in the exploration of different options for the future provision of in-patient hospital facilities in an English Regional Health Authority. The model is used to evaluate options on the basis of their effect on two different criteria: first the level of utilization of hospital in-patient facilities relative to need of populations resident in different parts of the region, and secondly the relative ease of geographical access of the facilities to the populations served.     

The application of reliability constrained stochastic capacity planning models to the service sector

Emphasis on quality management has recently permeated not only the manufacturing sector, but the service sector as well. Consequently, quality service and consumer satisfaction have become realities for many monopolistic service oriented industries facing competition. In order to effectively implement timely service within these industries (i) capacity plans must be developed which provide adequate staffing during both peakload and offpeak hours, as well as optimal (ii) prices and (iii) reliability of service. This paper builds on the results of Boronico (1992) in illustrating how reliability constrained marginal cost, within which optimal price is embodied, and minimum cost capacity plans may be determined for a service provider facing stochastic demand. Excess demand is not lost, but is deferred: a characteristic that typifies the operation of many delivery systems, such as postal services. Results indicate that marginal costs are convex with respect to reliability of service, while changes in the demand distribution's variability may impact optimal capacity by either increasing or decreasing required capacity.     

Developing a platform for comparison of hospital admission systems: An illustration

There is an increasing need to develop a platform for comparing hospital admission planning systems due to a shift in the service paradigm in the health sector. The current service concept of hospital admission planning aims at optimising the use of scarce hospital resources without paying much attention to the level of service offered to patients. As patients nowadays do not accept long waiting times for hospital admission, it becomes necessary to consider alternative admission service concepts. Waiting lists have also become a political issue, and alternative concepts have been advocated such as giving all patients an appointment for admission. A simulation model was built to examine the impacts of extreme admission service concepts in a simplified hospital setting. The alternative concepts considered are based on the ‘zero waiting time’ principle (immediate treatment), and the ‘booked admissions’ principle (using an appointment for admission). The results of these admission service concepts are compared with the results of the current concept, based on the ‘maximising resource use’ principle. The paper deals with the development of a framework and tool that allows evaluating different, somehow conflicting, hospital admission planning concepts and the usefulness of such framework and tool for more refined/real-life approaches to hospital admission planning.     

Planning midwifery services to deliver continuity of care

This paper describes a simulation model of maternity services which was developed to support the planning of midwifery services to meet demands for continuity of care. A Government report of maternity services in 1992 emphasised the need to replace the fragmented care offered to pregnant women by a more personalised type of approach. One way of doing this is by the implementation of team midwifery in which care is provided, antenatally, during labour, and then postnatally by either the same midwife or, more usually a small team of midwives.The model described in this paper attempts to assess the effects of team size upon the continuity of care provided to pregnant women under different implementations. Continuity is measured in terms of the percentage of occasions a team midwife will be available to meet the health care demands of pregnant women. The model may be used not only for the evaluation of services already in use, but also for the planning of alternative and better services.     

Design of intermodal logistics networks with hub delays

In an intermodal hub network, cost benefits can be achieved through the use of intermodal shipments and the economies of scale due to consolidation of flows at the hubs. However, due to limited resources at the logistics hubs, shipment delays may affect the service performance. In this research hub operations are modeled as a GI/G/1 queuing network and the shipments as multiple job classes with deterministic routings. By integrating the hub operation queuing model and the hub location-allocation model, the effect of limited hub resources on the design of intermodal logistics networks under service time requirements is investigated. The managerial insights gained from a study of 25-city road-rail intermodal logistics network show that the level of available hub resources significantly affects the logistics network structure in terms of number and location of hubs, total network costs, choice of single-hub and inter-hub shipments and service performance.     

Location of services and the impact on healthcare quality: insights from a simulation of a musculoskeletal physiotherapy service

Many healthcare systems are being redesigned to deliver local care with more services within the community. Relocation may enhance access but other aspects of healthcare quality should also be considered, notably waiting times and equity of care. This study examined a musculoskeletal physiotherapy service using a discrete-event simulation with simple heuristics to model patient behaviour. This combination provided an effective mechanism for incorporating the individuality of the patients in the flows along the patient pathways, subject to the varying availabilities of key resources. In particular, it captured the feedback that is critical in system performance, especially where waiting times are important. The model recognised the heterogeneity of patient attitudes and demonstrated how the behaviour of a relatively small proportion can affect the experience of all patients. The study suggested that, with careful operational management, more care could be delivered locally while exploiting many of the benefits of a centralised service.     

Resource,service quality and performance triad: a framework for measuring efficiency of banking services

In this paper, we present the development of a theoretical framework for measuring the efficiency of banking services taking into account physical and human resources, service quality and performance. Expenditures on quality improvement efforts and the impact of service quality on financial outcomes have long intrigued researchers. Banks have traditionally focused on how to transform their physical resources to generate financial performance, and they inadvertently ignored the mediating intangible factor of service quality. A theoretical framework on the optimization triad of resource, service quality and performance is proposed here, thereby linking the marketing variables to the financial metrics. A measure for the return on quality is developed as the ratio of the potential improvements in financial performance by enhancement of service quality to the observed performance figures. Empirical results obtained from a study of 27 Indian public sector banks and their customers allow us to measure the impact of service quality on financial performance, optimal level of service quality that can be generated using existing resources and the opportunity cost for sub-optimal service delivery. Banks delivering better service are shown to have better transformation of resource to performance using superior service delivery as the medium. Our results confirm the linkage between resource, service quality and performance for services.     

The Development of a Decision-support System for Planning Services within Hospitals

The planning of services within district health authorities is a complex task, but the process of planning is often crude: few options for addressing issues are considered, and these are inadequately assessed. These deficiencies led to research of which the aim was to identify the types of information and systems needed for improved planning. This paper describes the product of that research, the Hospital Planning Model. It is a decision-support system which gives planners fast access to relevant information for planning hospital services. This allows them to consider quickly a range of options for addressing a particular planning issue, and to test how sensitive the implications of proposals are to differing planning assumptions. The system has been shown to be generalizable, and is currently used in 28 health districts and other health organizations throughout the United Kingdom. The proposed reforms of the NHS are likely to increase the relevance of the system: the purchaser/provider market will result in a greater awareness by hospitals of the importance of identifying measures to improve the cost-effectiveness of care. Purchasers too may want to scrutinize hospitals in terms of their efficiency.     

Modeling congestion and service time in hub location problems

In this paper, we present a modeling framework for hub location problems with a service time limit considering congestion at hubs. Service time is modeled taking the traveling time on the hub network as well as the handling time and the delay caused by congestion at hubs into account. We develop mixed-integer linear programming formulations for the single and multiple allocation versions of this problem. We further extend the multiple allocation model with a possibility of direct shipments. We test our models on the well-known AP data set and analyze the effects of congestion and service time on costs and hub network design. We introduce a measure for the value of modeling congestion and show that not considering the effects of congestion may result in increased costs as well as in building infeasible hub networks.