Heuristic algorithms for a vehicle routing problem with simultaneous delivery and pickup and time windows in home health care

This paper addresses a vehicle scheduling problem encountered in home health care logistics. It concerns the delivery of drugs and medical devices from the home care company’s pharmacy to patients’ homes, delivery of special drugs from a hospital to patients, pickup of bio samples and unused drugs and medical devices from patients. The problem can be considered as a special vehicle routing problem with simultaneous delivery and pickup and time windows, with four types of demands: delivery from depot to patient, delivery from a hospital to patient, pickup from a patient to depot and pickup from a patient to a medical lab. Each patient is visited by one vehicle and each vehicle visits each node at most once. Patients are associated with time windows and vehicles with capacity. Two mixed-integer programming models are proposed. We then propose a Genetic Algorithm (GA) and a Tabu Search (TS) method. The GA is based on a permutation chromosome, a split procedure and local search. The TS is based on route assignment attributes of patients, an augmented cost function, route re-optimization, and attribute-based aspiration levels. These approaches are tested on test instances derived from existing VRPTW benchmarks.     

A matheuristic approach for solving a home health care problem

We deal with a Home Health Care Problem (HHCP) which objective consists in constructing the optimal routes and rosters for the health care staffs. The challenge lies in combining aspects of vehicle routing and staff rostering which are two well known hard combinatorial optimization problems. To solve this problem, we initially propose an integer linear programming formulation (ILP) and we tested this model on small instances. To deal with larger instances we develop a matheuristic based on the decomposition of the ILP formulation into two problems. The first one is a set partitioning like problem and it represents the rostering part. The second problem consists in the routing part. This latter is equivalent to a Multi-depot Traveling Salesman Problem with Time Windows (MTSPTW).     

A planning and routing model for patient transportation in health care

In this paper, a problem concerning both the planning of health care services and the routing of vehicles, for patients transportation is addressed. An integrated approach, based on the column generation technique, is proposed to solve the planning and routing problem. Preliminary results on real data show the effectiveness of the proposed approach.     

Selfish routing in public services

It is well observed that individual behaviour can have an effect on the efficiency of queueing systems. The impact of this behaviour on the economic efficiency of public services is considered in this paper where we present results concerning the congestion related implications of decisions made by individuals when choosing between facilities. The work presented has important managerial implications at a public policy level when considering the effect of allowing individuals to choose between providers. We show that in general the introduction of choice in an already inefficient system will not have a negative effect. Introducing choice in a system that copes with demand will have a negative effect.     

Using phase-type models to cost stroke patient care across health,social and community services

Stroke disease places a heavy burden on society, incurring long periods of time in hospital and community care, and associated costs. Also stroke is a highly complex disease with diverse outcomes and multiple strategies for therapy and care. Previously a modeling framework has been developed which clusters patients into classes with respect to their length of stay (LOS) in hospital. Phase-type models were then used to describe patient flows for each cluster. Also multiple outcomes, such as discharge to normal residence, nursing home, or death can be permitted. We here add costs to this model and obtain the Moment Generating Function for the total cost of a system consisting of multiple transient phase-type classes with multiple absorbing states. This system represents different classes of patients in different hospital and community services states. Based on stroke patients’ data from the Belfast City Hospital, various scenarios are explored with a focus on comparing the cost of thrombolysis treatment under different regimes. The overall modeling framework characterizes the behavior of stroke patient populations, with a focus on integrated system-wide costing and planning, encompassing hospital and community services. Within this general framework we have developed models which take account of patient heterogeneity and multiple care options. Such complex strategies depend crucially on developing a deep engagement with the health care professionals and underpinning the models with detailed patient-specific data.     

A shift scheduling model for employees with different seniority levels and an application in healthcare

This paper addresses the problem of scheduling medical residents that arises in different clinical settings of a hospital. The residents are grouped according to different seniority levels that are specified by the number of years spent in residency training. It is required from the residents to participate in the delivery of patient care services directly by working weekday and weekend day shifts in addition to their regular daytime work. A monthly shift schedule is prepared to determine the shift duties of each resident considering shift coverage requirements, seniority-based workload rules, and resident work preferences. Due to the large number of constraints often conflicting, a multi-objective programming model has been proposed to automate the schedule generation process. The model is implemented on a real case in the pulmonary unit of a local hospital for a 6-month period using sequential and weighted methods. The results indicate that high quality solutions can be obtained within a few seconds compared to the manually prepared schedules expending considerable effort and time. It is also shown that the employed weighting procedure based on seniority levels performs much better compared to the preemptive method in terms of computational burden.     

Simulation modelling for contracting hospital emergency services at the regional level

Hospital emergency services are closely connected to demographic issues and population changes. The methodology presented here helps to assess the effects of the forecasted demand changes on the next-year emergency unit workloads. The objective of the study is to estimate the expected volume of emergency hospital services, as measured by the number and costs of medical procedures provided to patients, to be contracted by the Polish National Health Fund (NFZ) branch at the regional level to cover the forecasted demand. A discrete-event simulation model was developed to elaborate the credible forecasts of the function components, the fundamental elements of the contract values granted by the NFZ for emergency departments for the following year. Emergency department-level data were drawn from the NFZ regional branch registry to perform a statistical analysis of emergency services provided to patients in 17 admission units and emergency wards in 2010. The model results indicate that the predicted increase in two age groups, i.e., the youngest children and the older population, will have different effects on the number and value of hospital emergency services to be considered in the contracting policy. There is potential for a discrete-event simulation to support strategic health policy decision making at the regional level. The value of this approach lies in providing estimates for the what-if scenarios related to the prognosis of changing acute demand.     

A branch-and-price approach for integrating nurse and surgery scheduling

A common problem at hospitals is the extreme variation in daily (even hourly) workload pressure for nurses. The operating room is considered to be the main engine and hence the main generator of variance in the hospital. The purpose of this paper is threefold. First of all, we present a concrete model that integrates both the nurse and the operating room scheduling process. Second, we show how the column generation technique approach, one of the most employed exact methods for solving nurse scheduling problems, can easily cope with this model extension. Third, by means of a large number of computational experiments we provide an idea of the cost saving opportunities and required solution times.     

Simulation modeling for emergency bed requirement planning

Due to its highly stochastic nature and complex interaction between services involved, health care has been a demanding area of application for computer simulation. This paper includes details and results of a simulation study realized in the Surgical Emergency Department at Istanbul University School of Medicine. The purpose is to suggest new bed capacities to improve the current system, and also to provide the management with guidelines for their expansion plans. For this aim, arrival rates, treatment procedures, inpatient admittance, and service durations have been carefully analyzed and modeled. The model, coded in SLAM-II simulation language, has been run under several bed capacity scenarios, and resulting queueing and waiting patterns have been discussed in detail.Dedictated to Professor Nusret Fiek     

Managing the overflow of intensive care patients

Many hospitals in the Netherlands are confronted with capacity problems at their intensive care units (ICUs) resulting in cancelling operations, overloading the staff with extra patients, or rejecting emergency patients. In practice, the last option is a common choice because for legal reasons, as well as for hospital logistics, rejecting emergency patients has minimal consequences for the hospital. As a result, emergency patients occasionally have to be transported to hospitals far away. In this work, we propose a cooperative solution for the ICU capacity problem. In our model, several hospitals in a region jointly reserve a small number of beds for regional emergency patients. We present a mathematical method for computing the number of regional beds for any given acceptance rate. The analytic approach is inspired by overflow models in telecommunication systems with multiple streams of telephone calls. Simulation studies show that our model is quite accurate. We conclude that cooperation between hospitals helps to achieve a high acceptance level with a smaller number of beds resulting in improved service for all patients.     

A flexible MILP model for multiple-shift workforce planning under annualized hours

Flexibility in workforce planning is one of the best ways to respond to fluctuations of the demand. This paper proposes a flexible mixed integer linear programming (MILP) model to solve a multiple-shift workforce planning problem under annualized working hours. The model takes into account laws and collective agreements that impose constraints on overtime and holidays. We consider possible gradual hiring of full time and partial time workers. Several objectives are pursued such as balancing the workload of the employees or minimizing the workforce size. Computational experiments on a real life problem demonstrate the effectiveness of the model.     

Insights and decision support for home health care services in times of disasters

Central European Journal of Operations Research - Home health care (HHC) services are of vital importance for the health care system of many countries. Further increases in their demand must be...     

Stochastic programming based capacity planning for semiconductor wafer fab with uncertain demand and capacity

Capacity planning is a challenging problem in semiconductor manufacturing industry due to high uncertainties both in market and manufacturing systems, short product life cycle, and expensive capital invest. To tackle this problem, this paper proposes a scenario-based stochastic programming model which considers demand and capacity uncertainties via scenarios, where the overall equipment efficiency is employed to describe the uncertain capacity for the first time. Based on the decentralized structure of tool procurement, production, stockout, and inventory decision-making processes, recourse approximation strategies are presented with varying degree of information share. The computational experiments show that the resulting tool set is robust enough to cope with the changes in capacity with the expected profits being maximized for different scenarios, and the scheme can generate pretty good solutions in reasonable computational time.     

Uncertainty and value of information when allocating resources within and between healthcare programmes

A two-stage stochastic mathematical programming formulation has been developed to optimally allocate resources within and between healthcare programmes when there is an exogenous budget and the parameters of the healthcare models are variable and uncertain. This formulation solves the optimal resource allocation problem and calculates the expected value of acquiring additional information to resolve the uncertainties within the allocation. It is shown that the proposed formulation has several advantages over the chance constrained and robust mathematical programming methods.     

A branch and bound based heuristic for makespan minimization of washing operations in hospital sterilization services

In this paper, we address the problem of parallel batching of jobs on identical machines to minimize makespan. The problem is motivated from the washing step of hospital sterilization services where jobs have different sizes, different release dates and equal processing times. Machines can process more than one job at the same time as long as the total size of jobs in a batch does not exceed the machine capacity. We present a branch and bound based heuristic method and compare it to a linear model and two other heuristics from the literature. Computational experiments show that our method can find high quality solutions within short computation time.     

Robust surgery loading

We consider the robust surgery loading problem for a hospital’s operating theatre department, which concerns assigning surgeries and sufficient planned slack to operating room days. The objective is to maximize capacity utilization and minimize the risk of overtime, and thus cancelled patients. This research was performed in collaboration with the Erasmus MC, a large academic hospital in the Netherlands, which has also provided historical data for the experiments. We propose various constructive heuristics and local search methods that use statistical information on surgery durations to exploit the portfolio effect, and thereby to minimize the required slack. We demonstrate that our approach frees a lot of operating room capacity, which may be used to perform additional surgeries. Furthermore, we show that by combining advanced optimization techniques with extensive historical statistical records on surgery durations can significantly improve the operating room department utilization.     

Dynamic multi-appointment patient scheduling for radiation therapy

Seeking to reduce the potential impact of delays on radiation therapy cancer patients such as psychological distress, deterioration in quality of life and decreased cancer control and survival, and motivated by inefficiencies in the use of expensive resources, we undertook a study of scheduling practices at the British Columbia Cancer Agency (BCCA). As a result, we formulated and solved a discounted infinite-horizon Markov decision process for scheduling cancer treatments in radiation therapy units. The main purpose of this model is to identify good policies for allocating available treatment capacity to incoming demand, while reducing wait times in a cost-effective manner. We use an affine architecture to approximate the value function in our formulation and solve an equivalent linear programming model through column generation to obtain an approximate optimal policy for this problem. The benefits from the proposed method are evaluated by simulating its performance for a practical example based on data provided by the BCCA.     

Optimal patient and personnel scheduling policies for care-at-home service facilities

In this paper we study the problem of personnel planning in care-at-home facilities. We model the system as a Markov decision process, which leads to a high-dimensional control problem. We study monotonicity properties of the system and derive structural results for the optimal policy. Based on these insights, we propose a trunk reservation heuristic to control the system. We provide numerical evidence that the heuristic yields close to optimal performance, and scales well for large problem instances.