Optimized appointment scheduling

In service systems, in order to balance the server’s idle times and the customers’ waiting times, one may fix the arrival times of the customers beforehand in an appointment schedule. We propose a procedure for determining appointment schedules in such a D/G/1-type of system by sequentially minimizing the per-customer expected loss. Our approach provides schedules for any convex loss function; for the practically relevant cases of the quadratic and absolute value loss functions appealing closed-form results are derived. Importantly, our approach does not impose any conditions on the service time distribution; it is even allowed that the customers’ service times have different distributions.     

Optimal appointment scheduling in continuous time: The lag order approximation method

We study appointment scheduling problems in continuous time. A finite number of clients are scheduled such that a function of the waiting time of clients, the idle time of the server, and the lateness of the schedule is minimized. The optimal schedule is notoriously hard to derive within reasonable computation times. Therefore, we develop the lag order approximation method, that sets the client’s optimal appointment time based on only a part of his predecessors. We show that a lag order of two, i.e., taking two predecessors into account, results in nearly optimal schedules within reasonable computation times. We illustrate our approximation method with an appointment scheduling problem in a CT-scan area.     

Evaluating the impact of operating conditions on the performance of appointment scheduling rules in service systems

The general practice in implementing an appointment scheduling rule (ASR) is to enforce a certain rule, such as “block appointment”, to schedule customer arrivals in service systems. The operating environments of service systems are expected to affect considerably the performance of a selected ASR. The objective of this paper is to evaluate the impact of the environmental factors which include probability of no-show (ρ), the coefficient of variation (C_ν) of service times, and the number of customers per service session (N). The extent to which a certain environmental factor affects the performance of ASR is examined to see if there is any ASR that performs well under most operating conditions. Under situations characterized by 27 different combinations of the factors ρ, C_ν, and N, the performance of nine scheduling rules are evaluated by a simulation study. The simulation results show that an ASR designed to reduce customer waiting time performs very well in most operating environments considered. One commonly used ASR in real-world service systems, which schedules several customers to arrive at the start of each service session, tends to induce long customer waiting time.     

A stochastic appointment scheduling system on multiple resources with dynamic call-in sequence and patient no-shows for an outpatient clinic

This research focuses on the stochastic assignment system motivated by outpatient clinics, especially the physical therapy in rehabilitation service. The aim of this research is to develop a stochastic overbooking model to enhance the service quality as well as to increase the utilization of multiple resources, like therapy equipment in a physical therapy room, with the consideration of patients’ call-in sequence. The schedule for a single-service period includes a fixed number of blocks of equal length. When patients call, they are assigned to an appointment time for that block, and an existing appointment is not allowed to be changed. In each visit, a patient might require more than one resource and a probability of no-show. Two estimation methods were proposed for the expected waiting and overtime cost with multiple resources: Convolution Estimation Method and Joint Cumulative Estimation Method for the upper and lower bound value; respectively. A numerical example based on a physical therapy room was used to show that this stochastic model was able to schedule patients for better profitability compared with traditional appointment systems based on four prioritization rules. The workload in each appointment slot was more balanced albeit more patients were assigned to the first slot to fill up the empty room.     

Dynamic multi-priority,multi-class patient scheduling with stochastic service times

Efficient patient scheduling has significant operational, clinical and economical benefits on health care systems by not only increasing the timely access of patients to care but also reducing costs. However, patient scheduling is complex due to, among other aspects, the existence of multiple priority levels, the presence of multiple service requirements, and its stochastic nature. Patient appointment (allocation) scheduling refers to the assignment of specific appointment start times to a set of patients scheduled for a particular day while advance patient scheduling refers to the assignment of future appointment days to patients. These two problems have generally been addressed separately despite each being highly dependent on the form of the other. This paper develops a framework that incorporates stochastic service times into the advance scheduling problem as a first step towards bridging these two problems. In this way, we not only take into account the waiting time until the day of service but also the idle time/overtime of medical resources on the day of service. We first extend the current literature by providing theoretical and numerical results for the case with multi-class, multi-priority patients and deterministic service times. We then adapt the model to incorporate stochastic service times and perform a comprehensive numerical analysis on a number of scenarios, including a practical application. Results suggest that the advance scheduling policies based on deterministic service times cannot be easily improved upon by incorporating stochastic service times, a finding that has important implications for practice and future research on the combined problem.     

Determination of optimal variable-sized multiple-block appointment systems

The single-block appointment system is the most common method of scheduling ambulatory care clinics today. Several studies have examined various appointment systems ranging from single-block appointments on one extreme to individual appointments on the other, and including mixtures of these such as multiple-block (m-at-a-time) and block/individual systems. In this paper we analyze a general single-server multiple-block system, one permitting blocks of variable size. In the analysis we use a dynamic programming approach, with some modifications to compensate for the non-Markov nature of the problem. Analytical results and approximations which significantly reduce the computational requirements for a solution are obtained. Examples demonstrate that under certain weightings of the criteria of waiting, idle, and overtime, the generality of the system considered here allows performance superior to that of other commonly used systems.     

Steady state results for the M/M(a,b)/c batch-service system

The transportation system considered in this paper has a number of vehicles with capacity constraint, which take passengers from a source terminal to various destinations and return to the terminal. The trip times are considered to be independent and identically distributed random variables with a common exponential distribution. Passengers arrive at the terminal in accordance with a Poisson process. The system is operated under the following policy: when a vehicle is available and there are at least ‘a’ passengers waiting for service, then a vehicle is dispatched immediately. A recursive algorithm is derived to obtain the steady-state probability P(m, j) that there are m idle vehicles and j waiting passengers in the queue. Analytical expressions have been derived for passenger queue length distribution, average passenger queue length, the r-th moment of passenger waiting time in the queue, service batch size distribution and the average service batch size, all in terms of P(0,0).     

The use of relative priorities in optimizing the performance of a queueing system

Relative priorities in an n-class queueing system can reduce server and customer costs. This property is demonstrated in a single server Markovian model where the goal is to minimize a non-linear cost function of class expected waiting times. Special attention is given to minimizing server’s costs when the expected waiting time of each class is restricted.     

Improving appointment scheduling for medical screening

We investigate the optimization of appointment scheduling forbreast cancer screening, using the fact that a woman's attendanceprobability can be predicted. The methodology used applies tomedical screening in general. The results of the mathematical investigation presented in thispaper include a new formula for the cost of a screening session,a probabilistic model of rebooking appointments, a model ofattendance probability as a function of previous performance,and a heuristic cost optimization procedure. Breast Test Wales have improved efficiency by introducing heavilyoverbooked sessions for patients who are unlikely to attend.We use simulation modelling and insights from probability theoryto confirm the gain achieved by the Wales procedure and to assessthe further gain achievable by optimization of appointment scheduling.It is found that a gain in throughput of at least 10% can beobtained by optimizing appointment scheduling for screeningsessions, in particular by inviting patients in decreasing orderof attendance probability, and by overbooking near the end ofthe session. This avoids the need to set up dedicated sessionsfor poor attenders. Another possibility is to book patientswho change their appointment time, and who are therefore verylikely to attend, into dedicated sessions. The provision of appointment scheduling software with a built-insimulation and optimization module along the lines describedin this paper could enable radiographers to tailor appointmentscheduling for each area and so to schedule appointments veryefficiently.     

Workload and Waiting Time Analyses of MAP/G/1 Queue under D-policy

We study the workload (unfinished work) and the waiting time of the queueing system with MAP arrivals under D-policy. The D-policy stipulates that the idle server begin to serve the customers only when the sum of the service times of all waiting customers exceeds some fixed threshold D. We first set up the system equations for workload and obtain the steady-state distributions of workloads at an arbitrary idle and busy points of time. We then proceed to obtain the waiting time distribution of an arbitrary customer based on the workload results. The M/G/1/D-policy queue will be investigated as a special case.     

A polynomial time algorithm for makespan minimization on one machine with forbidden start and completion times

We consider the problem of scheduling independent jobs on a single resource under a special unavailability constraint: a set of forbidden instants is given, where no job is allowed to start or complete. We show that a schedule without idle time always exists if the number of forbidden instants is less than the number of distinct processing times appearing in the instance. We derive quite a fast algorithm to find such a schedule, based on an hybridization between a list algorithm and local exchange. As a corollary minimizing the makespan for a fixed number of forbidden instants is polynomial.     

Clinic scheduling models with overbooking for patients with heterogeneous no-show probabilities

Clinical overbooking is intended to reduce the negative impact of patient no-shows on clinic operations and performance. In this paper, we study the clinical scheduling problem with overbooking for heterogeneous patients, i.e. patients who have different no-show probabilities. We consider the objective of maximizing expected profit, which includes revenue from patients and costs associated with patient waiting times and physician overtime. We show that the objective function with homogeneous patients, i.e. patients with the same no-show probability, is multimodular. We also show that this property does not hold when patients are heterogeneous. We identify properties of an optimal schedule with heterogeneous patients and propose a local search algorithm to find local optimal schedules. Then, we extend our results to sequential scheduling and propose two sequential scheduling procedures. Finally, we perform a set of numerical experiments and provide managerial insights for health care practitioners.     

Convergence of a queueing system in heavy traffic with general patience-time distributions

We analyze a sequence of single-server queueing systems with impatient customers in heavy traffic. Our state process is the offered waiting time, and the customer arrival process has a state dependent intensity. Service times and customer patient-times are independent; i.i.d. with general distributions subject to mild constraints. We establish the heavy traffic approximation for the scaled offered waiting time process and obtain a diffusion process as the heavy traffic limit. The drift coefficient of this limiting diffusion is influenced by the sequence of patience-time distributions in a non-linear fashion. We also establish an asymptotic relationship between the scaled version of offered waiting time and queue-length. As a consequence, we obtain the heavy traffic limit of the scaled queue-length. We introduce an infinite-horizon discounted cost functional whose running cost depends on the offered waiting time and server idle time processes. Under mild assumptions, we show that the expected value of this cost functional for the n-th system converges to that of the limiting diffusion process as n tends to infinity.     

A heuristic algorithm for the hospital health examination scheduling problem

This study considers the problem of health examination scheduling. Depending on their gender, age, and special requirements, health examinees select one of the health examination packages offered by a health examination center. The health examination center must schedule all the examinees, working to minimize examinee/doctor waiting time and respect time and resource constraints, while also taking other limitations, such as the sequence and continuity of the examination procedures, into consideration. The Binary integer programming (BIP) model is one popular way to solve this health examination scheduling problem. However, as the number of examinees and health examination procedures increase, solving BIP models becomes more and more difficult, if not impossible. This study proposes health examination scheduling algorithm (HESA), a heuristic algorithm designed to solve the health examination scheduling problem efficiently and effectively. HESA has two primary objectives: minimizing examinee waiting time and minimizing doctor waiting time. To minimize examinee waiting time, HESA schedules the various parts of each examinee’s checkup for times when the examinee is available, taking the sequence of the examination procedures and the availability of the resources required into account. To minimize doctor waiting time, HESA focuses on doctors instead of examinees, assigning waiting examinees to a doctor as soon as one becomes available. Both complexity analysis and computational analyses have shown that HESA is very efficient in solving the health examination scheduling problem. In addition to the theoretical results, the results of HESA’s application to the concrete health examination scheduling problems of two large hospitals in Taiwan are also reported.     

Waiting times in queues with relative priorities

This paper determines the mean waiting times for a single server multi-class queueing model with Poisson arrivals and relative priorities. If the server becomes idle, the probability that the next job is from class-i is proportional to the product between the number of class-i jobs present and their priority parameter.     

Introducing competition in healthcare services: The role of private care and increased patient mobility

We study the operational implications from competition in the provision of healthcare services, in the context of national public healthcare systems in Europe. Specifically, we study the potential impact of two alternative ways through which policy makers have introduced such competition: (i) via the introduction of private hospitals to operate alongside public hospitals and (ii) via the introduction of increased patient choice to grant European patients the freedom to choose the country they receive treatment at. We use a game-theoretic framework with a queueing component to capture the interactions among the patients, the hospitals and the healthcare funders. Specifically, we analyze two different sequential games and obtain closed form expressions for the patients’ waiting time and the funders’ reimbursement cost in equilibrium. We show that the presence of a private provider can be beneficial to the public system: the patients’ waiting time will decrease and the funders’ cost can decrease under certain conditions. Also, we show that the cross-border healthcare policy, which increases patient mobility, can also be beneficial to the public systems: when welfare requirements across countries are sufficiently close, all funders can reduce their costs without increasing the patients’ waiting time. Our analysis implies that in border regions, where the cost of crossing the border is low, “outsourcing” the high-cost country’s elective care services to the low-cost country is a viable strategy from which both countries’ systems can benefit.     

Parallel machine scheduling problems with a single server

In this paper, we consider the problem of scheduling jobs on parallel machines with setup times. The setup has to be performed by a single server. The objective is to minimize the schedule length (makespan), as well as the forced idle time. The makespan problem is known to be NP-hard even for the case of two identical parallel machines. This paper presents a pseudopolynomial algorithm for the case of two machines when all setup times are equal to one. We also show that the more general problem with an arbitrary number of machines is unary NP-hard and analyze some list scheduling heuristics for this problem. The problem of minimizing the forced idle time is known to be unary NP-hard for the case of two machines and arbitrary setup and processing times. We prove unary NP-hardness of this problem even for the case of constant setup times. Moreover, some polynomially solvable cases are given.     

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.     

Johnson’s rule,composite jobs and the relocation problem

Two-machine flowshop scheduling to minimize makespan is one of the most well-known classical scheduling problems. Johnson’s rule for solving this problem has been widely cited in the literature. We introduce in this paper the concept of composite job, which is an artificially constructed job with processing times such that it will incur the same amount of idle time on the second machine as that incurred by a chain of jobs in a given processing sequence. This concept due to Kurisu first appeared in 1976 to deal with the two-machine flowshop scheduling problem involving precedence constraints among the jobs. We show that this concept can be applied to reduce the computational time to solve some related scheduling problems. We also establish a link between solving the two-machine flowshop makespan minimization problem using Johnson’s rule and the relocation problem introduced by Kaplan. We present an intuitive interpretation of Johnson’s rule in the context of the relocation problem.     

基于满意度的预约门诊排队策略研究

为了推进预约挂号服务在医院有效的应用,本文结合实际情形,提出了病人满意度度量的新指标——加权病人等待时间,建立了以最大化病人满意度为目标的排队模型,并分析了医院目前常用的两种预约排队策略:不同优先级预约排队策略与时间段优先型预约排队策略。通过两种预约策略的比较,得到后者优于前者;通过预约与非预约策略的比较,得到预约策略优于非预约策略。在此基础上,对两种预约策略进行优化分析,求解出两种预约策略分别对应的最佳预约与非预约病人比例。最后,通过数值分析说明了应用预约策略对改善病人等待满意度的合理性及有效性,并对应用预约策略达到更好的满意度提出了可行建议。