Efficiency and welfare implications of managed public sector hospital waiting lists

A queuing model for public health service waiting lists is developed, and the implications for patient welfare of different systems for managing the waiting list are analysed. If patients are admitted to hospital on a first-come-first-served basis, a welfare gain is achieved by moving from a system of implicit to one of explicit rationing of access to the waiting list. If individual waiting times and hospital admissions are dependent on clinical priority, a further welfare gain is achievable without the use of explicit rationing, by reallocating the total waiting time from the more towards the less seriously ill. On efficiency and welfare criteria, a maximum waiting time guarantee does not appear to be a desirable development.     

A Hospital Throughput Model in the Context of Long Waiting Lists

In a public health system, one of the problems is the size of the waiting list for admission to hospital. This research involves establishing a method of analysing the general surgery waiting list problem at hospital and district level. While there are many aspects to such a study, this paper concentrates on a linear programming model to plan the aggregate throughput of the general surgical department. Preliminary results from applying the techniques to actual health districts in the United Kingdom are reported.     

Multi-depot vehicle scheduling problems with time windows and waiting costs

The multi-depot vehicle scheduling problem with time windows (MDVSPTW) consists of scheduling a fleet of vehicles to cover a set of tasks at minimum cost. Each task is restricted to begin within a prescribed time interval and vehicles are supplied by different depots. The problem is formulated as an integer nonlinear multi-commodity network flow model with time variables and is solved using a column generation approach embedded in a branch-and-bound framework. This paper breaks new ground by considering costs on exact waiting times between two consecutive tasks instead of minimal waiting times. This new and more realistic cost structure gives rise to a nonlinear objective function in the model. Optimal and heuristic versions of the algorithm have been extensively tested on randomly generated urban bus scheduling problem (UBSP) and freight transport scheduling problem (FTSP). The results show that such a general solution methodology outperforms specialized algorithms when minimal waiting costs are used, and can efficiently treat the case with exact waiting costs.     

Lower Bounds for Scheduling a Single Robot in a Job-Shop Environment

We consider a single-machine scheduling problem which arises as a subproblem in a job-shop environment where the jobs have to be transported between the machines by a single transport robot. The robot scheduling problem may be regarded as a generalization of the traveling salesman problem with time windows, where additionally generalized precedence constraints (minimal time-lags) have to be respected. The objective is to determine a sequence of all nodes and corresponding starting times in the given time windows in such a way that all generalized precedence relations are respected and the sum of all traveling and waiting times is minimized.We calculate lower bounds for this problem using constraint propagation techniques and a linear programming formulation which is solved by a column generation procedure. Computational results are presented for test data arising from job-shop instances with a single transport robot and some modified traveling salesman instances.     

Modeling the transplant waiting list: A queueing model with reneging

Motivated by the problem of organ allocation, we develop a queueing model with reneging that provides a stylistic representation of the transplant waiting list. The model assumes that there are several classes of patients, several classes of organs, and patient reneging due to death. We focus on randomized organ allocation policies and develop closed-form asymptotic expressions for the stationary waiting time, stationary waiting time until transplantation, and fraction of patients who receive transplantation for each patient class. Analysis of these expressions identifies the main factors that underlie the performance of the transplant waiting list and demonstrates that queueing models can prove useful when evaluating the organ allocation system. This revised version was published online in June 2006 with corrections to the Cover Date.     

Single-machine scheduling problems with past-sequence-dependent delivery times and position-dependent processing times

This paper considers single-machine scheduling problems with job delivery times where the actual job processing time of a job is defined by a function dependent on its position in a schedule. We assume that the job delivery time is proportional to the job waiting time. We investigate the minimization problems of the sum of earliness, tardiness, and due-window-related cost, the total absolute differences in completion times, and the total absolute differences in waiting times on a single-machine setting. The polynomial time algorithms are proposed to optimally solve the above objective functions. We also investigate some special cases of the problem under study and show that they can be optimally solved by lower order algorithms.     

Check-in computation and optimization by simulation and IP in combination

This paper presents and investigates a check-in problem for a twofold reason:

• (i)as a problem of practical and novel scientific interest in itself and
• (ii)as a problem which requires both a stochastic (simulation) and deterministic (integer programming) approach.

First, simulation is used to determine minimal numbers of desks in order to meet a service level for each separate flight. Next, integer programming formulations are provided to minimize the total number of desks and the total number of desk hours under the realistic constraint that desks for one and the same flight should be adjacent. Both opening intervals with constant and variable capacities will be studied.A numerical example of real world order shows a triple win in waiting time performance, in number of desks and in number of desk hours (staffing). As simulation and integer programming tools are widely available, this combination of simulation and integer programming can thus be regarded as an illustration of a ‘new’ practical OR-tool for optimization.     

Use of VNS heuristics for scheduling of patients in hospital

One of the important problems in hospital management is how to schedule the treatments of resident patients in hospital for a given day due to the restrictions imposed by their medical condition as well as restrictions on medical machines and qualified medical personnel availability. Patients are to be subjected to different kinds of treatments, each requiring a medical machine of a certain type as well as a physician being qualified to operate it. This is a highly complex problem not yet adequately addressed in the literature. At present in most hospitals the problem is being solved manually by specialized personnel. However, the resulting schedules are very often inaccurate and inefficient with patients waiting for a long time to be treated and medical personnel often working overtime. In this paper we formulate the model for this problem and develop a simple and efficient method based on Variable Neighbourhood Search for solving it. The heuristics has been tested on real-life as well as on generated instances. Numerical results show that the heuristics proposed outperform commercial software for optimization as well as manual solutions both in quality of solution and in computational time.     

A novel ant colony optimization approach for on-line scheduling and due date determination

This paper aims to develop an on-line Ant Colony Optimization (ACO) framework, where jobs arrive over time, and at any time we lack knowledge concerning future jobs. A due date is determined upon job arrival, and jobs are sequenced on the machine to optimize the sum of weighted lead times with all due dates met. We propose that each ant is associated with a sequence of waiting jobs with quoted due dates. This waiting sequence is constantly updated over time (whenever a job is selected to be processed or a new job arrives). The on-line schedule is constructed by selecting the first job in the waiting list of the “best” ant to process (along with its due date) as the machine becomes available. However, for the ant where this job is not the first one in the list, processing it pushes back the waiting jobs positioned before it. If such push back results in a due date violation, this ant will be eliminated. Further, our ACO framework does not include the iterative procedure due to the characteristics of the on-line problem; this is one difference from the traditional ACO framework besides ant elimination. The computational testing on generated instances shows that our ACO algorithm outperforms an existing effective on-line algorithm in the literature. Also, with local search incorporated using the EDD (Earliest Due Date) rule, improvements can be obtained in both computational outcome and time.     

Single machine scheduling problems with controllable processing times and total absolute differences penalties

In this paper, we consider single machine scheduling problem in which job processing times are controllable variables with linear costs. We concentrate on two goals separately, namely, minimizing a cost function containing total completion time, total absolute differences in completion times and total compression cost; minimizing a cost function containing total waiting time, total absolute differences in waiting times and total compression cost. The problem is modelled as an assignment problem, and thus can be solved with the well-known algorithms. For the case where all the jobs have a common difference between normal and crash processing time and an equal unit compression penalty, we present an O(n log n) algorithm to obtain the optimal solution.     

具有恶化效应和凸资源分配关系的单机排序问题

研究工件加工时间具有恶化效应和凸资源关系的单机排序问题,其中工件的实际加工时间是其正常的加工时间,工件开工时间(具有恶化效应)及消耗资源量的函数。目标为在最大完工时间(总完工时间、总等待时间、完工时间总绝对差与等待时间总绝对差)小于或等于给定常数的条件下找到工件的最优排序和最优的资源分配使工件的总资源消耗量最少。在单机状态下,证明了此问题是多项式时间可解的,并给出了求解该问题的算法和数值实例。     

Route problem with constraints depending on a list of tasks

An additive route problem with preceding conditions is considered in which the cost function and the move constraints both depend on a list of tasks that have not been performed by the current time. The problem is solved by applying a dynamic programming method that takes into account both these factors and is implemented in the construction of a (generally) incomplete array of Bellman function values.     

A multi-depot period vehicle routing problem arising in the utilities sector

This paper considers the resource planning problem of a utility company that provides preventive maintenance services to a set of customers using a fleet of depot-based mobile gangs. The problem is to determine the boundaries of the geographic areas served by each depot, the list of customers visited each day and the routes followed by the gangs. The objective is to provide improved customer service at minimum operating cost subject to constraints on frequency of visits, service time requirements, customer preferences for visiting on particular days and other routing constraints. The problem is solved as a Multi-Depot Period Vehicle Routing Problem (MDPVRP). The computational implementation of the complete planning model is described with reference to a pilot study and results are presented. The solution algorithm is used to construct cost-service trade-off curves for all depots so that management can evaluate the impact of different customer service levels on total routing costs.     

Multi-mode resource-constrained project scheduling using RCPSP and SAT solvers

This paper reports on a new solution approach for the well-known multi-mode resource-constrained project scheduling problem (MRCPSP). This problem type aims at the selection of a single activity mode from a set of available modes in order to construct a precedence and a (renewable and non-renewable) resource feasible project schedule with a minimal makespan. The problem type is known to be NP-hard and has been solved using various exact as well as (meta-)heuristic procedures.The new algorithm splits the problem type into a mode assignment and a single mode project scheduling step. The mode assignment step is solved by a satisfiability (SAT) problem solver and returns a feasible mode selection to the project scheduling step. The project scheduling step is solved using an efficient meta-heuristic procedure from literature to solve the resource-constrained project scheduling problem (RCPSP). However, unlike many traditional meta-heuristic methods in literature to solve the MRCPSP, the new approach executes these two steps in one run, relying on a single priority list. Straightforward adaptations to the pure SAT solver by using pseudo boolean non-renewable resource constraints has led to a high quality solution approach in a reasonable computational time. Computational results show that the procedure can report similar or sometimes even better solutions than found by other procedures in literature, although it often requires a higher CPU time.     

Waiting list behaviour and the consequences for NHS targets

The United Kingdom's National Health Service (NHS) is investing considerable resources in reducing patient waiting times for elective treatment. This paper describes the development of a waiting list model and its use in a simulation to assess management options. Simulation usually assumes that waiting is adequately described by simple queuing disciplines, typically first-in-first-out. However, waiting in the United Kingdom's NHS is a more complex phenomenon. The waiting list behaviour is explored through an analysis of the changes in waiting time distributions for elective orthopaedics in one Scottish Health Board, NHS Fife. The evolving distributions suggest that there have been substantial changes in priorities in response to the various NHS targets. However, in the short or medium term, the form of the distribution appears reasonably stable, providing a basis for estimating future waiting times in different scenarios. A model of the waiting behaviour and prioritization in the appointment allocations was embedded in a simulation of the complete elective orthopaedic patient journey from referral, through outpatients and diagnostics to surgery. The model has been used to explore the consequences of various management options in the context of the NHS target that no patient should wait more than 18 weeks between referral and treatment.     

Investigation of two-warehouse inventory problems in interval environment under inflation via particle swarm optimization

ABSTRACT

In this paper, a two-warehouse inventory problem has been investigated under inflation with different deterioration effects in two separate warehouses (rented warehouse, RW, and owned warehouse, OW). The objective of this investigation is to determine the lot-size of the cycle of the two-warehouse inventory system by minimizing the average cost of the system. Considering different inventory policies, the corresponding models have been formulated for linear trend in demand and interval valued cost parameters. In OW, shortages, if any, are allowed and partially backlogged with a variable rate dependent on the duration of the waiting time up to the arrival of the next lot. The corresponding optimization problems have been formulated as non-linear constrained optimization problems with interval parameters. These problems have been solved by an efficient soft computing method, viz. practical swarm optimization. To illustrate the model, a numerical example has been solved with different partially backlogging rates. Then to study the effect of changes of different system parameters on the optimal policy, sensitivity analyses have been carried out graphically by changing one parameter at a time and keeping the others at their original values. Finally, a fruitful conclusion has been reached regarding the selection of an appropriate inventory policy of the two-warehouse system.     

Scheduling deteriorating jobs with a learning effect on unrelated parallel machines

In this study we consider unrelated parallel machines scheduling problems with learning effect and deteriorating jobs, in which the actual processing time of a job is a function of joint time-dependent deterioration and position-dependent learning. The objective is to determine the jobs assigned to corresponding each machine and the corresponding optimal schedule to minimize a cost function containing total completion (waiting) time, total absolute differences in completion (waiting) times and total machine load. If the number of machines is a given constant, we show that the problems can be solved in polynomial time under the time-dependent deterioration and position-dependent learning model.     

Local search for the surgery admission planning problem

We present a model for the surgery admission planning problem, and a meta-heuristic algorithm for solving it. The problem involves assigning operating rooms and dates to a set of elective surgeries, as well as scheduling the surgeries of each day and room. Simultaneously, a schedule is created for each surgeon to avoid double bookings. The presented algorithm uses simple Relocate and Two-Exchange neighbourhoods, governed by an iterated local search framework. The problem’s search space associated with these move operators is analysed for three typical fitness surfaces, representing different compromises between patient waiting time, surgeon overtime, and waiting time for children in the morning on the day of surgery. The analysis shows that for the same problem instances, the different objectives give fitness surfaces with quite different characteristics. We present computational results for a set of benchmarks that are based on the admission planning problem in a chosen Norwegian hospital.