Operational research in health services planning

Some of the characteristics which distinguish social planning from planning in the private sector, or in publicly owned industry, are identified. A survey of OR investigations (both tactical and strategic) in the area of health services planning supports the case that the mainstream OR contribution does violence to the nature of the system under study. In particular, problems are formulated in terms of (or transformed into) single objectives, to be optimized; aspects of the social world are subject to wholesale quantification, with resulting distortion; models make implausible data demands; project definition and execution reinforce the ‘scientisation’ of political debate; problems are formulated on the assumption of a single hierarchically powerful decision-maker; and problems are formulated as if they must be solved in toto at one point in time. It is suggested that we should look to the converse of these qualities for new directions in the application of operational research in social planning. Some examples are given of techniques and approaches, drawn both from within health services planning and from other areas, which exhibit these alternative characteristics.     

Theory and practice in OR and town planning: a continuing creative synergy?

The paper looks at the parallel experiences of OR and town (land use) planning since the Second World War. The existence of three ‘waves of enthusiasm’ for planning in the UK is noted: from 1947; from mid-1960s to 1979; and currently from 1990 to date. The significant mutually beneficial synergy between OR and town planning theory and practice during the second of these periods is recounted. Subsequent, current, and potential future developments are reviewed, and the implications for OR and (especially) town planning of a lack of awareness of this history are discussed.     

OR in strategic land-use planning

An important historic strategic application of OR has been in the field of land-use and development plan production. Changes in Government policy and legislation have led to varying levels of interest in plan production. Three post-war cycles of ‘enthusiasm for plans’ can be identified. Whilst the first was rooted very much in the Architectural Design tradition, the second led to significant developments in OR, with far wider application. Subsequent reduced Governmental enthusiasm for ‘Development Plan production’ led to considerable atrophy of relevant skills in the planning community, including those derived from OR. However, the current ‘third period of post-war enthusiasm for planning’, reinforced by environmental concerns, has revived the need for relevant skills. It is suggested that, whilst the deficit in skills and their application remains high, there are some encouraging signs. Moreover, substantial progress in the field of ‘soft OR’ offers opportunities to both the OR and planning communities.     

Multimethodology in series and parallel: strategic planning using hard and soft OR

This paper examines two distinct ways in which hard and soft operational research (OR) methodologies can be combined, in series and in parallel. Multimethodology in series is acknowledged as the simpler and more common approach. Multimethodology in parallel is identified as having the potential to provide significant benefits to projects in political, changing, or ‘wicked’ contexts that multimethodology in series cannot. Observations regarding these approaches to multimethodology are examined in light of an information systems strategic planning project in the Australian public sector. Two distinct methodologies were combined in the project: soft systems methodology and project management. These methodologies are based on the soft and hard paradigms, respectively. However, findings in this paper have the potential to be transferred to combinations of other hard and soft OR methodologies.     

The Blackett Memorial Lecture 18 November 1997

It is argued that movement toward the ‘control’ aspects of management should be effected to expand OR/MS activities beyond their present (almost exclusive) emphasis on ‘planning’ functions. This will involve increasing the amount of empirical-inferential approaches to research (based on ex-post data) as one way to help bring this about. Examples of such empirical-inferential research activities in OR/MS are supplied by reference to the early (founding) work of PMS Blackett and others on high-level policy problems during World War II. Extensions to the control function are evidenced in the work of Robert Fetter and others in the development of Diagnostic Related Groups on which the Prospective Payment Systems are based with large and important impacts on the health care delivery systems in the USA as well as other countries. Other examples covered include the use of OR concepts in the early ‘turnaround’ of Federal Express from failure to success. Other new methods will nevertheless be needed to extend and improve presently available OR/MS approaches. Some of these possibilities are illustrated with Data Envelopment Analysis. Ways to combine DEA with commonly used statistical methods are described to show how new and old methods may be combined to further enhance their power and range. Similar relations of DEA to other OR/MS approaches are now being studied, some of which are presently occurring with ‘fuzzy sets’ and ‘multiple objective programming.’     

Success and survival—a comment

It is proposed that consideration of the prospects for operational research should pay attention to changes, actual or projected, in the material base of its potential users. These include the IT revolution, the global restructuring of labour, de-layered management, smaller more autonomous business units, and privatisation of public services. It is argued that these developments have eroded OR's traditional institutional base, and are likely to continue to do so. Opportunities for offsetting gains are suggested in the areas of strategic analysis and of interaction support, both resting on the exploitation of participatory analytic methods. The ‘third’ or voluntary sector might also prove to have growth potential. Threats to the occupational cohesion and culture of OR are identified, together with some possible remedies.     

Frameworks of Inquiry: OR Practice Across the Hard—Soft Divide

The growing interest in understanding the practice of OR has, not unnaturally, tended to concentrate upon experience with those ‘soft’ methodologies which address both process and content management issues. This paper uses a detailed account of one practitioner's work in a ‘traditional’ area of OR (linear programming) to demonstrate how process-related issues are handled there, and argues that more extensive reporting of such conventional practice is essential for the health of the discipline. In particular, it suggests that an emphasis on discussing the development of working relationships between OR practitioners and their clients might usefully supplant the contemporary emphasis on the ‘project’.     

Evaluating soft OR: some reflections on an apparently ‘unsuccessful’ implementation using a Soft Systems Methodology (SSM) based approach

This paper reflects on a case study in which a soft OR problem structuring approach, based on Soft Systems Methodology (SSM), was used to help in the design of an information system for health service users providing care in the community in a part of the South and West Health Region in the UK. The paper reflects on why an apparently ‘successful’ structuring led to an apparently ‘unsuccessful’ implementation. As part of this reflective process, the paper makes a contribution to the soft OR literature by reviewing some of the approaches taken in the literature to the evaluation of success of problem structuring using soft OR. This review reveals a lack of evaluative criteria, a lack of clarity over the identification of users, and a failure to differentiate criteria associated with ‘structuring’ and ‘implementation’ issues. An evaluative framework is proposed, which is applied retrospectively to the case study.     

On the nature of OR: taking stock

This paper argues that OR, having reached its maturity, must now play to its strengths. In strategic terms this means competing in those areas where OR's core competences can be brought to bear. Using a competence model it is suggested that OR's core products are (i) the development and implementation of the quantitative, algorithmic ‘smart bits’ and (ii) the ‘helpful ways’ of managing intervention processes. These core products are supported and sustained by three core competences labelled process, analytic, and context. Individuals and small groups of practitioners develop ‘strands of practice’ and larger groups ‘webs of practice’ on the basis of their core competences. It is argued that this is giving rise to the emergence of three archetypes of OR service, namely the OR technical consultancy, the OR process consultancy, and the full service OR consultancy. Both the technical and process consulting are built around ‘strands of practice’ of individuals and find their natural home in small service providers. The full service OR consulting practice, in the past located in internal OR groups, will in the future be located within the large management consultancies, which are capable of managing ‘webs of practice’. The implications for the worlds of OR practice and academia are examined.     

Writing practitioner case studies to help behavioural OR researchers ground their theories: application of the mangle perspective

Behavioural research into the practice of OR needs to be grounded. Case studies written by practitioners can potentially help address this need but currently most do not. The paper explores a way of describing OR projects that place the emphasis on the ‘actors’ who provide the motivating force and the consequences of their actions. The ‘mangle’ perspective focuses on the dynamic intertwining of people, technology and concepts; this can provide the basis for an insightful narrative describing the reality of the project in terms of the planned approach, the problems met and the outcomes. Two examples are given, one of a conventional model building exercise, the second of a ‘soft OR’ intervention: both describe projects conducted by practitioners for commercial purposes. It is concluded that, by using the mangle perspective, the OR case writer can winnow the wheat from the chaff in order to write a succinct informative narrative, a narrative that could be utilized by behavioural OR (BOR) researchers. It is further concluded that BOR researchers should engage with ‘practice theory’ to deepen their understanding of what actually happens in projects.     

Beyond a System of Systems Methodologies

This paper describes a research programme which used the idea that there is a ‘system of systems methodologies’ to analyse the relationship between OR and other systems-based, problem-solving approaches, and to relate different systems methodologies to appropriate problem-contexts. The results are promising for those who wish to broaden the theoretical basis of OR in order to extend its domain of effective application. Further progress, however, depends upon reconstituting the research programme on surer theoretical foundations. Unless this is done, both the potential of the original work and its initial intent risk being lost. It is now necessary to go beyond ‘a system of systems methodologies’ and to embed that work in an explicit proposal for a critical management science.     

Overcoming the barriers: a qualitative study of simulation adoption in the NHS

This paper addresses a key issue in the health OR literature, namely the apparent failure of OR modelling to become embedded and widely implemented within healthcare organisations. The research presented here is a case study to evaluate the adoption of one particular simulation modelling tool, Scenario Generator (S:G), which was developed by the SIMUL8 Corporation in a PPI partnership with the UK's National Health Service (NHS) Institute for Innovation and Improvement. The study involved semi-structured interviews with employees of 28 Primary Care Trusts who had all been engaged in some way with the initiative, with participants classified as ‘Not Started’, ‘Given Up’ and ‘Actively Using’. This paper presents a brief summary of barriers and facilitators to the successful use of the S:G software, but its main purpose is to focus more broadly on factors influencing the successful adoption of simulation tools in general within healthcare organisations. The insights gained in this study are relevant to improving the uptake of OR modelling in general within the NHS.     

On the Nature of OR — Entering the Fray

In 1980 a seminar of operational researchers and practitioners from a variety of different countries concluded that there was a remarkable consensus about the way that the process of operational research and systems analysis should be understood and practised. Since then the development of new methods has continued apace, stimulated by interaction with the social sciences and paradigms other than natural science. This paper enters the debate, started in this journal, about the nature of OR's status as science or technology. It recognizes the historic claims of science on OR, but it suggests that for ‘private’ consumption, technology will prove more fruitful, and for ‘public’ consumption practitioners will increasingly adopt the label ‘consultant’. Ackoff's original six-step method of OR is updated to reflect current OR practice. The process suggested acknowledges the importance of context, socio-political factors and the growing role of facilitation.     

The Institute for Operational Research: An Initiative to Extend the Scope of OR

One of the aims in forming the Institute for Operational Research (IOR) in 1963 was to expand the fields of application of OR and to reverse the tendency, then evident, for it to settle down as a mainly in-house, industrial activity deriving its strength from mathematics and the hard sciences, with little research content of its own. The paper outlines the early work done at IOR in pursuit of this mission, especially in multi-organizational settings such as city and regional planning, health services and the building industry. This leads into discussion of the conditions under which the work was done, the style of ‘action-research’ that evolved, its influence at the time, and its relevance to the different circumstances of the present day.     

Analysing factors affecting the choice of emergent human resource capital

Ever since the announcement that UK higher education (HE) fees were to increase up to £9000, many universities have expressed concern about how to attract the best students while offering choice and promoting student mobility through broader access. This in turn has led to questioning how such complexity might be modelled using sophisticated operational research (OR) techniques. Because higher education institutions (HEIs) are now beginning to compete ‘against’ rather than ‘with’ each other, potential students are paying increased attention to where and what they will study, as well as graduate opportunities after their degree. Hence, the quality of education services becomes increasingly vital for HEIs in order to attract potential students. This study seeks to develop a framework of those factors affecting international (non-EU) students’ choice of institution. A number of factors were identified and collated from the existing literature providing a solid foundation on which to base this research. A survey approach was utilised to determine the importance of identified factors based on data collected from students of two different types of institutions (a university and a feeder institution). Through a better understanding of factors such as social influence, financial and career opportunities, universities should be well placed to construct models underpinned by OR principles that will promote scenario modelling and planning within HE.     

Cooperation between strands of practice: challenges and opportunities for the renewal of OR

Collaboration between OR groups following different ‘strands of practice’, namely adhering to different ways of conducting OR practice, is difficult. We demonstrate the existence of this problem in two contexts. Firstly, we found several different strands of practice within an independent, entrepreneurial OR firm. Though these strands had the potential to be highly complementary, their co-existence within one firm led to serious tensions and their potential synergy has not yet been realised. When the independent OR firm achieved successful renewal by transforming one of their strands of practice into a new approach to projects, this very success created a new set of competitive challenges. Secondly, an independent OR consulting firm working with a client's internal research group found that the latter's approach conflicted with its own, resulting in an unsuccessful project. We conclude that the ‘micro-level’ problems of collaboration between individual practitioners and between groups, though largely neglected in the OR literature, can be serious impediments to success and renewal of OR practice.     

A multi-period stochastic portfolio optimization model applied for an airline company in the EU ETS

This paper aims to set up and solve a multi-period stochastic portfolio optimization model from an airline company’s point of view, considering all the specific European Union Emissions Trading Scheme (EU ETS) regulatory, managerial and trading constraints (i.e. physical constraints). Our contribution to existing academic literature is multiple. As the first ever case, we apply this technique to the aviation sector, a newly included sector within the EU ETS. More than mainly incorporating physical and technical (‘engineering’) features and focusing on short-term planning issues, we particularly address financial features and focus on mid-term planning issues. Therefore, instead of using spot prices, we run Monte Carlo simulations of correlated geometric Brownian motions (GBM) for traded futures prices of various emission allowance types for different CO₂ delivery time periods. We thereby specifically refer to the existing exchange-traded emission allowance types EU Emission Allowance (EUA) and Certified Emission Reduction (CER). By implementing actually valid and real-world-oriented regulatory constraints for EU ETS, namely managerial and trading constraints, our model implies a real-life application. We also highlight the possibility of banking and borrowing of emission allowances between CO₂ compliance periods, which is a crucial regulatory feature of EU ETS.     

Soft with a hard centre: discrete-event simulation in facilitation

Discrete event simulation is normally described as a ‘hard’ OR technique. This may not, however, always be the case. An example of a simulation of a user support helpline is described which, it is argued, has many of the traits of a ‘soft’ OR intervention. In particular, the study involved a facilitated discussion around a simulation model about possible improvements to a problem situation. The nature of the intervention is considered from both a methodological and paradigmatic perspective, and conclusions are drawn about where the intervention lies on a ‘hard’ to ‘soft’ continuum. It is argued that ‘soft’ issues need to be subsumed into the prescribed methodology for discrete-event simulation.     

Integrating long-term care insurance purchase decisions with saving and investment for retirement

Risk related to long-term care (LTC) is high for the elderly. Planning for LTC is now regarded as the ‘third leg’ of retirement planning. In this paper, planning for LTC is integrated with saving and investment decisions for an integrated approach to retirement planning. Optimal LTC insurance purchase decisions are obtained by developing a trade-off between post-retirement LTC costs and LTC insurance premiums paid and coverage received. Integrating insurance purchase with wealth evolution, consisting of saving and investment decisions, allows addressing affordability issues.Two-way branching models are used for the stochastic health events and asset returns. The problem, formulated as a nonlinearly constrained mixed-integer optimization problem, is solved using a heuristic. Sensitivity analyses are performed for initial health and wealth status. Some important aspects of an individual’s behavioral preferences are also addressed in this framework to provide more robust decision support.