考虑患者回诊情况下的门诊科室调度优化

目前国内大型三甲医院最突出的问题就是资源稀缺,这些稀缺资源主要包括手术室、大型检查设备以及门诊科室等,造成患者严重的排队现象,从而导致患者等待时间过长,满意度下降。通过对哈尔滨市某大型医院进行调研,收集相关数据,研究在考虑患者回诊(即患者当天做完各项检查后又回到初次检查的门诊科室)情况下,对医生门诊科室的数量进行调度优化。利用排队论中的动态优先级对排队规则进行限定,同时引入前景理论中的价值函数,确立以最小化患者时间感知不满意度为主要目标,最小化医院运营成本为次要目标的多目标优化问题。并且分析了两个目标的权重参数变化对总体满意度的影响。建立相应的数学模型,利用模拟植物生长算法( plant growth simulation algorithm,简称PGSA)进行算法设计,通过MATLAB进行仿真,得出在有限度优先的排队规则下,能够更大程度的降低患者不满意度,同时保证较低的运营成本,证明了此研究的有效性和可行性。     

Locating specialized service capacity in a multi-hospital network

Multi-hospital systems have become very common in today’s healthcare environment. However, there has been limited published research examining the opportunities and challenges of pooling specialized services to a subset of hospitals in the network. Therefore, this paper considers how hospital networks with multiple locations can leverage pooling benefits when deciding where to position specialized services, such as magnetic resonance imaging (MRI), transplants, or neonatal intensive care. Specifically, we develop an optimization model to determine how many and which of a hospital network’s hospitals should be set up to deliver a specialized service. Importantly, this model takes into account both financial considerations and patient service levels. Computational results illustrate the value of optimally pooling resources across a subset of hospitals in the network versus two alternate approaches: (1) delivering the service at all locations and requiring each site to handle its own demand, or (2) locating the service at one hospital that handles all network demand.     

Competition under different reimbursement systems: The concept of an internet-based hospital management game

We have developed an internet-based management game to illustrate the economic and organisational decision-making process in a hospital by using discrete event simulation. Up to six hospitals compete against each other for inpatients with different disease categories and budget depending on hospital mission, regional health policy, inpatient reimbursement system (day-, case- and global-budget based) as well as labour and radiology technology market for 12 decision periods. Players can evaluate alternative actions for capacity planning as well as patient scheduling and control problems depending on different game situations. The uniqueness of COREmain hospital game consists of the internet-based framework, the combination of resource, process and financial result management, the competition of hospitals within a region and the consideration of different inpatient reimbursement systems. The deployment of this game in teaching, policy and research might improve policy making both at a hospital, regional and national level and also induce further research in these fields.     

Workforce staffing and scheduling: Hospital nursing specific models

Decisions relating to hospital nurse staffing and scheduling are among the most important decisions made in hospitals today. Staffing and scheduling choices must be made which will result in timely and high-quality care to patients. These choices are complicated by the requirement for round-the-clock staffing in many hospital nursing units, a severe nursing shortage, and an outcry from many quarters to cut costs of health care. In general, patients today are kept in hospitals only if they are in need of highly skilled nursing care. In this paper we present a review of some of the issues in health care currently influencing the hospital nurse staffing and scheduling environment. In addition, we review the literature that illustrates nurse manager's concerns, and approaches taken in the past by operations researchers to address those concerns. We present some data from a recent study of nurse managers in 31 hospitals that illustrates the complexity of the issues. We conclude with a discussion of future research directions in hospital nurse staffing and scheduling.     

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.     

New trends in machine scheduling

This review is concerned with new directions in deterministic machine scheduling theory. We study: resource constrained scheduling, scheduling tasks that require more than one machine at a time, scheduling with nonlinear speed-resource alloted functions, and scheduling in flexible manufacturing systems. The two features that distinguish the above problems are the use of resources in addition to the machines and new models for the processing of tasks. The study of these models was primarily motivated by their practical importance. In each case, we overview the existing results and present solution strategies for particularly chosen problems.     

Patient flow-based allocation of inpatient resources: A case study

The paper considers the allocation of inpatient resources such as beds, operating theatres and nursing staff to specialties within a hospital setting. It describes an allocation procedure that takes patient flows as its starting point and enables an evaluation of combined impacts on the different resources involved. The paper is written in the format of a case study, dealing with a hospital that had serious problems with the utilization of beds and was faced with many admission-stops. However, the method can be used to a wide range of resource management problems in hospitals and can contribute to improving flexibility in the use of hospital resources.     

单机最优分批排序的结构性质

A batch is a subset of jobs which must be processed jointly in either serial or parallel form. For the single machine, batching, total completion time scheduling problems, the algorithmic aspects have been extensively studied in the literature. This paper presents the optimal batching structures of the problems on the batching ways: all jobs in exactly N(arbitrary fix batch number and 1 < N < n) batches.     

A dual bin-packing approach to scheduling surgical cases at a publicly-funded hospital

Publicly-funded hospitals are typically allocated an annual budget by the government based on the number of enrollees in the region. Given tight budget constraints, the capacity of resources is fairly fixed. Such hospitals strive to maximize the utilization of their resources through continuous improvement and optimization techniques. We address a surgical case scheduling problem experienced at a publicly-funded hospital and conceptualize this multi-period, multi-resource, priority-based case scheduling problem as an unequal-sized, multi-bin, multi-dimensional dual bin-packing problem. A mixed integer programming model and a heuristic based on the first fit decreasing algorithm are presented. Resource availability, case priorities, and variation in surgery times are key features included in our model. Our proposed approach led to substantial savings, 20% reduction in number of days and up to 20% increase in operating room utilization, when compared to real schedules obtained from the surgical department at a publicly-funded hospital.     

Suitability and managerial implications of a Master Surgical Scheduling approach

Operating room (OR) planning and scheduling is a popular and challenging subject within the operational research applied to health services research (ORAHS). However, the impact in practice is very limited. The organization and culture of a hospital and the inherent characteristics of its processes impose specific implementation issues that affect the success of planning approaches. Current tactical OR planning approaches often fail to account for these issues. Master surgical scheduling (MSS) is a promising approach for hospitals to optimize resource utilization and patient flows. We discuss the pros and cons of MSS and compare MSS with centralized and decentralized planning approaches. Finally, we address various implementation issues of MSS and discuss its suitability for hospitals with different organizational foci and culture.     

Using resource scarceness characteristics to solve the multi-mode resource-constrained project scheduling problem

In the past decades, resource parameters have been introduced in project scheduling literature to measure the scarceness of resources of a project instance. In this paper, we incorporate these resource scarceness parameters in the search process to solve the multi-mode resource constrained project scheduling problem, in which multiple execution modes are available for each activity in the project. Therefore, we propose a scatter search algorithm, which is executed with different improvement methods, each tailored to the specific characteristics of different renewable and nonrenewable resource scarceness values. Computational results prove the effectiveness of the improvement methods and reveal that the procedure is among the best performing competitive algorithms in the open literature.     

Trading grid services – a multi-attribute combinatorial approach

The Grid is a promising technology for providing access to distributed high-end computational capabilities. Thus, computational tasks can be performed spontaneously by other resources in the Grid that are not under the user’s control. However, one of the key problems in the Grid is deciding which jobs are to be allocated to which resources at what time. In this context, the use of market mechanisms for scheduling and allocating Grid resources is a promising approach toward solving these problems. This paper proposes an auction mechanism for allocating and scheduling computer resources such as processors or storage space which have multiple quality attributes. The mechanism is evaluated according to its economic and computational performance as well as its practical applicability by means of a simulation.     

Solving routing problems with pairwise synchronization constraints

Pairwise route synchronization constraints are commonly encountered in the field of service technician routing and scheduling and in the area of mobile care. Pairwise route synchronization refers to constraints that require that two technicians or home care workers visit the same location at exactly the same time. We consider constraints of this type in the context of the well-known vehicle routing problem with time windows and a generic service technician routing and scheduling problem. Different approaches for dealing with the problem of pairwise route synchronization are compared and several ways of integrating a synchronization component into a metaheuristic algorithm tailored to the original problems are analyzed. When applied to benchmark instances from the literature, our algorithm matches almost all available optimal values and it produces several new best results for the remaining instances.

     

An integrated approach for scheduling health care activities in a hospital

To effectively utilise hospital beds, operating rooms (OR) and other treatment spaces, it is necessary to precisely plan patient admissions and treatments in advance. As patient treatment and recovery times are unequal and uncertain, this is not easy. In response, a sophisticated flexible job-shop scheduling (FJSS) model is introduced, whereby patients, beds, hospital wards and health care activities are respectively treated as jobs, single machines, parallel machines and operations. Our approach is novel because an entire hospital is describable and schedulable in one integrated approach. The scheduling model can be used to recompute timings after deviations, delays, postponements and cancellations. It also includes advanced conditions such as activity and machine setup times, transfer times between activities, blocking limitations and no wait conditions, timing and occupancy restrictions, buffering for robustness, fixed activities and sequences, release times and strict deadlines. To solve the FJSS problem, constructive algorithms and hybrid meta-heuristics have been developed. Our numerical testing shows that the proposed solution techniques are capable of solving problems of real world size. This outcome further highlights the value of the scheduling model and its potential for integration into actual hospital information systems.     

Scheduling medical students to teaching hospitals

This paper describes a scheduling technique that has been successfully used to allocate medical students to the teaching hospitals affiliated with a university. The problem is to schedule individuals so that (i) every student is assigned a preferred sequence of medical activities in specific hospitals, and (ii) the difference between the maximum number of students allowed at each available hospital-medical activity-period position and those allocated to these positions is both nonnegative and approximately the same. The contribution of the present work is in the formulation of the problem, and the resulting ease with which good solutions to large-scale scheduling problems can be generated. The mathematical formulation of the problem is presented first and subsequently, the solution strategy is described. The results for two large medical classes at the University of Montreal are also presented.     

Properties of multi-mode resource-constrained project scheduling problems with resource vacations and activity splitting

This paper presents results from an extensive computational study of the multi-mode resource-constrained project scheduling problem when activities can be split during scheduling under situations where resources may be temporarily not available. All resources considered are renewable and each resource unit may not be available at all times due to resource vacations, which are known in advance, and assignment to other finite duration activities. A designed experiment is conducted that investigates project makespan improvement when activity splitting is permitted in various project scenarios, where different project scenarios are defined by parameters that have been used in the research literature. A branch-and-bound procedure is applied to solve a number of small project scheduling problems with and without activity splitting. The results show that, in the presence of resource vacations and temporary resource unavailability, activity splitting can significantly improve the optimal project makespan in many scenarios, and that the makespan improvement is primarily dependent on those parameters that impact resource utilization.     

An adaptive search for the response time variability problem

The Response Time Variability Problem (RTVP) is an NP-hard combinatorial scheduling problem, which has recently been reported and formalised in the literature. This problem has a wide range of real-world applications in mixed-model assembly lines, multi-threaded computer systems, broadcast of commercial videotapes and others. The RTVP arises whenever products, clients or jobs need to be sequenced in such a way that the variability in the time between the points at which they receive the necessary resources is minimised. We propose a greedy but adaptive heuristic that avoids being trapped into a poor solution by incorporating a look ahead strategy suitable for this particular scheduling problem. The proposed heuristic outperforms the best existing methods, while being much faster and easier to understand and to implement.     

Survey on fuzzy shop scheduling

The real life scheduling problems often have several uncertainties. The solutions of these problems can provide deeper insights to the decision maker than those of deterministic problems. Fuzzy set theory as most important tool to model uncertainty represents an attractive tool to aid research in the production management. Since to the best of our knowledge, there is not a comprehensive review on the fuzzy scheduling literature, the goal of this paper is to provide an extensive review for the fuzzy machine scheduling which it covers more than 140 papers. For this purpose, first, this paper classifies and reviews the literature according to shop environments, including single machine, parallel machines, flowshop, job shop and open shop. Then the reviewed literature is quantified and measured. At the end the paper concludes by presenting some problems receiving less attention than the others and proposing some research opportunities in the field.     

A (0–1) goal programming model for scheduling the tour of a marketing executive

This paper addresses the problem of scheduling the tour of a marketing executive (ME) of a large electronics manufacturing company in India. In this problem, the ME has to visit a number of customers in a given planning period. The scheduling problem taken up in this study is different from the various personnel scheduling problems addressed in the literature. This type of personnel scheduling problem can be observed in many other situations such as periodical visits of inspection officers, tour of politicians during election campaigns, tour of mobile courts, schedule of mobile stalls in various areas, etc. In this paper the tour scheduling problem of the ME is modeled using (0–1) goal programming (GP). The (0–1) GP model for the data provided by the company for 1 month has 802 constraints and 1167 binary variables. The model is solved using LINDO software package. The model takes less than a minute (on a 1.50 MHz Pentium machine with 128 MB RAM) to get a solution of the non-preemptive version and about 6 days for the preemptive version. The main contribution is in problem definition and development of the mathematical model for scheduling the tour.     

The utility of returns to scale in DEA programming: An analysis of Michigan rural hospitals

In 1984, Banker, Charnes, and Cooper introduced the capability of using data envelopment analysis to assess increasing, decreasing, or constant returns to scale. This analysis would appear to make an important contribution to the health care field because of the regulatory environment within which the industry exists and the competition among hospitals for additional services and capacity. In many states, hospitals must submit a “certificate of need” to prove eligibility to add capacity or services. Agency administrators at the state level should analyze each hospital's production performance to determine the effectiveness of resource utilization. Residents of a state where hospitals are regulated need to know the effectiveness of agencies in allowing resources to be properly allocated to hospitals. Returns to scale analysis can help provide answers to these concerns. We examine Michigan rural hospitals and propose a simple, yet logical procedure for evaluating returns to scale for technically inefficient hospitals.