To pool or not to pool in hospitals: a theoretical and practical comparison for a radiotherapy outpatient department

This paper examines whether urgent and regular patients waiting for a consultation at a radiotherapy outpatient department should be pooled or not. Both queuing theory and discrete event simulation were applied to a realistic case study. The theoretical approach shows that pooling is not always beneficial with regard to the waiting times of urgent patients. Furthermore, the practical approach indicates that the separation of queues may require less capacity to meet the waiting time performance target for urgent as well as regular patients. The results seem to be of general interest for hospitals.     

A model for rational abandonments from invisible queues

We propose a model for abandonments from a queue, due to excessive wait, assuming that waiting customers act rationally but without being able to observe the queue length. Customers are allowed to be heterogeneous in their preferences and consequent behavior. Our goal is to characterize customers' patience via more basic primitives, specifically waiting costs and service benefits: these two are optimally balanced by waiting customers, based on their individual cost parameters and anticipated waiting time. The waiting time distribution and patience profile then emerge as an equilibrium point of the system. The problem formulation is motivated by teleservices, prevalently telephone- and Internet-based. In such services, customers and servers are remote and queues are typically associated with the servers, hence queues are invisible to waiting customers. Our base model is the M/M/m queue, where it is shown that a unique equilibrium exists, in which rational abandonments can occur only upon arrival (zero or infinite patience for each customer). As such a behavior fails to capture the essence of abandonments, the base model is modified to account for unusual congestion or failure conditions. This indeed facilitates abandonments in finite time, leading to a nontrivial, customer dependent patience profile. Our analysis shows, quite surprisingly, that the equilibrium is unique in this case as well, and amenable to explicit calculation. This revised version was published online in June 2006 with corrections to the Cover Date.     

Optimal Sequencing of Servers in the Two-Station Series Queueing System

This paper deals with determining an optimal sequence of service stations in a series queueing system. Optimality is defined in terms of the total time spent waiting for service. Sequences are compared on the basis of the moments of their steady-state total waiting time. In addition, the rules of stochastic dominance are applied which allow comparison of sequences on the basis of their waiting time distributions. Analytical results in the sequencing of service stations in series queues have been limited to stations with constant or exponential service times. This study extends the investigation to service distributions with varying degrees of statistical regularity given by the family of Erlang distributions.Relationships are developed for predicting optimal sequences. Validation is accomplished by simulating a number of systems and comparing the waiting time distribution functions for each sequence. The relationships are shown to be good predictors and useful in the study and design of systems of servers in series.     

Inventory control using a service constraint on the expected customer order waiting time

In this paper an analytical model is presented which permits the determination of the minimal inventory reorder point subject to (a) a maximum specified expected customer order waiting time or (b) a maximum specified probability of a customer order waiting more than a predetermined time span. The probability distribution of the customer order waiting time is determined for an arbitrary demand distribution (e.g. normal, gamma or exponential) and under stochastic replenishment lead time conditions by use of arguments from renewal theory. The results established can be used for the customer-oriented control of inventory policy as well as for the analysis of multi-echelon inventory systems.     

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.     

On the construction of analytic solutions for a diffusion-reaction equation with a discontinuous switch mechanism

The existence of waiting times, before boundary motion sets in, for a diffusion-diffusion reaction equation with a discontinuous switch mechanism, is demonstrated. Limit cases of the waiting times are discussed in mathematical rigor. Further, analytic solutions for planar and circular wounds are derived. The waiting times, as predicted using these analytic solutions, are perfectly between the derived bounds. Furthermore, it is demonstrated by both physical reasoning and mathematical rigor that the movement of the boundary can be delayed once it starts moving. The proof of this assertion resides on continuity and monotonicity arguments. The theory sustains the construction of analytic solutions. The model is applied to simulation of biological processes with a threshold behavior, such as wound healing or tumor growth.     

Perishable inventory systems with impatient demands

An inventory system for perishable commodities (PIS) with finite shelf size and finite waiting room for demands is studied; the maximum shelf life and the maximum waiting time of a demand are assumed to be either constant or exponentially distributed, and the arrival rates for items and for demands are state-dependent. We determine the stationary distribution of the system and derive various kinds of cost functionals that are useful to evaluate the efficiency of the PIS.     

Optimizing replacement policy for a cold-standby system with waiting repair times

This paper presents the formulas of the expected long-run cost per unit time for a cold-standby system composed of two identical components with perfect switching. When a component fails, a repairman will be called in to bring the component back to a certain working state. The time to repair is composed of two different time periods: waiting time and real repair time. The waiting time starts from the failure of a component to the start of repair, and the real repair time is the time between the start to repair and the completion of the repair. We also assume that the time to repair can either include only real repair time with a probability p, or include both waiting and real repair times with a probability 1 − p. Special cases are discussed when both working times and real repair times are assumed to be geometric processes, and the waiting time is assumed to be a renewal process. The expected long-run cost per unit time is derived and a numerical example is given to demonstrate the usefulness of the derived expression.     

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.     

The Discrete-Time GI/Geo/1 Queue with Multiple Vacations

We study a discrete-time GI/Geo/1 queue with server vacations. In this queueing system, the server takes vacations when the system does not have any waiting customers at a service completion instant or a vacation completion instant. This type of discrete-time queueing model has potential applications in computer or telecommunication network systems. Using matrix-geometric method, we obtain the explicit expressions for the stationary distributions of queue length and waiting time and demonstrate the conditional stochastic decomposition property of the queue length and waiting time in this system.     

Discrete NT-policy single server queue with Markovian arrival process and phase type service

We consider a discrete time single server queueing system in which arrivals are governed by the Markovian arrival process. During a service period, all customers are served exhaustively. The server goes on vacation as soon as he/she completes service and the system is empty. Termination of the vacation period is controlled by two threshold parameters N and T, i.e. the server terminates his/her vacation as soon as the number waiting reaches N or the waiting time of the leading customer reaches T units. The steady state probability vector is shown to be of matrix-geometric type. The average queue length and the probability that the server is on vacation (or idle) are obtained. We also derive the steady state distribution of the waiting time at arrivals and show that the vacation period distribution is of phase type.     

Questionnaire design improvement and missing item scores estimation for rapid and efficient decision making

In this paper we consider a single-server, cyclic polling system with switch-over times and Poisson arrivals. The service disciplines that are discussed, are exhaustive and gated service. The novel contribution of the present paper is that we consider the reneging of customers at polling instants. In more detail, whenever the server starts or ends a visit to a queue, some of the customers waiting in each queue leave the system before having received service. The probability that a certain customer leaves the queue, depends on the queue in which the customer is waiting, and on the location of the server. We show that this system can be analysed by introducing customer subtypes, depending on their arrival periods, and keeping track of the moment when they abandon the system. In order to determine waiting time distributions, we regard the system as a polling model with varying arrival rates, and apply a generalised version of the distributional form of Little??s law. The marginal queue length distribution can be found by conditioning on the state of the system (position of the server, and whether it is serving or switching).     

An EOQ model for deteriorating items with time varying demand and partial backlogging

In the classical economic order quantity model, it is often assumed that the shortages are either completely backlogged or completely lost. However, in some inventory systems, it is more reasonable to assume that the backlogging rate is dependent on the length of the waiting time for the next replenishment. The longer the waiting time is, the smaller the backlogging rate would be. In this paper, we focus on the effect of the backlogging rate on the economic order quantity decision. Numerical examples are presented to illustrate the model.     

Rational Abandonment from Tele-Queues: Nonlinear Waiting Costs with Heterogeneous Preferences

We consider the modelling of abandonment from a queueing system by impatient customers. Within the proposed model, customers act rationally to maximise a utility function that weights service utility against expected waiting cost. Customers are heterogeneous, in the sense that their utility function parameters may vary across the customer population. The queue is assumed invisible to waiting customers, who do not obtain any information regarding their standing in the queue during their waiting period. Such circumstances apply, for example, in telephone centers or other remote service facilities, to which we refer as tele-queues. We analyse this decision model within a multi-server queue with impatient customers, and seek to characterise the Nash equilibria of this system. These equilibria may be viewed as stable operating points of the system, and determine the customer abandonment profile along with other system-wide performance measures. We provide conditions for the existence and uniqueness of the equilibrium, and suggest procedures for its computation. We also suggest a notion of an equilibrium based on sub-optimal decisions, the myopic equilibrium, which enjoys favourable analytical properties. Some concrete examples are provided to illustrate the modelling approach and analysis. The present paper supplements previous ones which were restricted to linear waiting costs or homogeneous customer population.     

Simple Heuristics for the Vehicle Routeing Problem with Soft Time Windows

We describe three simple heuristics for the vehicle routeing problem with customer time windows that can be violated by paying appropriate penalties. The customer demands are known, and a homogeneous fleet of vehicles stationed at a single depot is considered. The penalty payable to a customer is assumed to be a linear function of the amount of time window violation. Upper limits are imposed on both the penalty payable and the waiting time allowed at any customer. At each customer in a route, the PC-based heuristics simultaneously determine the actual time to begin service, and the next customer to serve. To achieve this, each heuristic uses different measures to compare the cost of waiting and penalty payable, with the benefit obtained by leaving immediately for the next customer. Computational results on a set of benchmark problems show that the procedure is efficient and enables significant reduction in the number of vehicles required and/or the total route distances while controlling both customer penalties and waiting times.     

Online-optimization of multi-elevator transport systems with reoptimization algorithms based on set-partitioning models

We develop and experimentally compare policies for the control of a system of k elevators with capacity one in a transport environment with ? floors, an idealized version of a pallet elevator system in a large distribution center of the Herlitz PBS AG in Falkensee. Each elevator in the idealized system has an individual waiting queue of infinite capacity. On each floor, requests arrive over time in global waiting queues of infinite capacity. The goal is to find a policy that, without any knowledge about future requests, assigns an elevator to each request and a schedule to each elevator so that certain expected cost functions (e.g., the average or the maximal flow times) are minimized. We show that a reoptimization policy for minimizing average squared waiting times can be implemented to run in real-time (1 s) using dynamic column generation. Moreover, in discrete event simulations with Poisson input it outperforms other commonly used policies like multi-server variants of greedy and nearest neighbor.     

Expansions for Joint Laplace Transform of Stationary Waiting Times in (max,+)-linear Systems with Poisson Input

We give a Taylor series expansion for the joint Laplace transform of stationary waiting times in open (max,+)-linear stochastic systems with Poisson input. Probabilistic expressions are derived for coefficients of all orders. Even though the computation of these coefficients can be hard for certain systems, it is sufficient to compute only a few coefficients to obtain good approximations (especially under the assumption of light traffic). Combining this new result with the earlier expansion formula for the mean stationary waiting times, we also provide a Taylor series expansion for the covariance of stationary waiting times in such systems.It is well known that (max,+)-linear systems can be used to represent stochastic Petri nets belonging to the class of event graphs. This class contains various instances of queueing networks like acyclic or cyclic fork-and-join queueing networks, finite or infinite capacity tandem queueing networks with various types of blocking, synchronized queueing networks and so on. It also contains some basic manufacturing models such as kanban networks, assembly systems and so forth. The applicability of this expansion technique is discussed for several systems of this type.     

Polling systems with state-dependent setup times

We analyze a polling system with multiple stations (queues) attended by a cycling server, in which a setup occurs only when the queue that is polled by the server has one or more customers present. Although such systems are appropriate for modeling numerous manufacturing and telecommunication systems, their analysis is not well developed in the literature. We provide an exact analysis for the 2 station model and present two approximation schemes to determine the mean station waiting times for models with 3 or more stations. We show that some approximate models which have been proposed in the literature for providing upper bounds on the mean station waiting times do not always yield upper bounds. Extensive numerical tests indicate that a simple average of the two approximation schemes yields a close estimate of the true mean station waiting time. This average-of-approximations procedure appears to be robust for a large range of parameter values.Research supported in part by the Natural Sciences and Engineering Research Council of Canada under grant OGP0045904.Research supported in part by the National Science Foundation under grant DMI-9500471.     

Recursive equations in finite Markov chain imbedding

In this paper, recursive equations for waiting time distributions of r-th occurrence of a compound pattern are studied via the finite Markov chain imbedding technique under overlapping and non-overlapping counting schemes in sequences of independent and identically distributed (i.i.d.) or Markov dependent multi-state trials. Using the relationship between number of patterns and r-th waiting time, distributions of number of patterns can also be obtained. The probability generating functions are also obtained. Examples and numerical results are given to illustrate our theoretical results.