Tactical resource allocation and elective patient admission planning in care processes

Tactical planning of resources in hospitals concerns elective patient admission planning and the intermediate term allocation of resource capacities. Its main objectives are to achieve equitable access for patients, to meet production targets/to serve the strategically agreed number of patients, and to use resources efficiently. This paper proposes a method to develop a tactical resource allocation and elective patient admission plan. These tactical plans allocate available resources to various care processes and determine the selection of patients to be served that are at a particular stage of their care process. Our method is developed in a Mixed Integer Linear Programming (MILP) framework and copes with multiple resources, multiple time periods and multiple patient groups with various uncertain treatment paths through the hospital, thereby integrating decision making for a chain of hospital resources. Computational results indicate that our method leads to a more equitable distribution of resources and provides control of patient access times, the number of patients served and the fraction of allocated resource capacity. Our approach is generic, as the base MILP and the solution approach allow for including various extensions to both the objective criteria and the constraints. Consequently, the proposed method is applicable in various settings of tactical hospital management.

[1]  James R. Jackson Comments on "Jobshop-Like Queueing Systems" , 2004, Manag. Sci..

[2]  C. Cannon,et al.  Critical pathways : a review. Committee on Acute Cardiac Care, Council on Clinical Cardiology, American Heart Association. , 2000, Circulation.

[3]  Peter Brucker,et al.  Resource-Constrained Project Scheduling , 2012 .

[4]  Gabriel M Leung,et al.  Waiting time and doctor shopping in a mixed medical economy. , 2004, Health economics.

[5]  R. Anthony,et al.  Planning and Control Systems: A Framework for Analysis , 1965 .

[6]  Rolf H. Möhring,et al.  Resource-constrained project scheduling: Notation, classification, models, and methods , 1999, Eur. J. Oper. Res..

[7]  Asha Seth Kapadia,et al.  Predicting course of treatment in a rehabilitation hospital: A Markovian model , 1985, Comput. Oper. Res..

[8]  L. Barreto,et al.  Umbilical hernia , 2013 .

[9]  Emilio Cerdá,et al.  Waiting Lists for Surgery , 2013 .

[10]  Erik Demeulemeester,et al.  Capacity of Clinical Pathways—A Strategic Multi-level Evaluation Tool , 2008, Journal of Medical Systems.

[11]  Sander M. Bohte,et al.  Adaptive resource allocation for efficient patient scheduling , 2009, Artif. Intell. Medicine.

[12]  Jeffrey S T Barkun Waiting lists for surgery. , 2002, Canadian journal of surgery. Journal canadien de chirurgie.

[13]  Elliott N. Weiss,et al.  A Stochastic Service Network Model with Application to Hospital Facilities , 1981, Oper. Res..

[14]  M. Carter,et al.  Surgical process scheduling: a structured review. , 1997, Journal of the Society for Health Systems.

[15]  Peter J. H. Hulshof,et al.  A framework for health care planning and control. , 2011 .

[16]  Sally McClean,et al.  A non-homogeneous discrete time Markov model for admission scheduling and resource planning in a cost or capacity constrained healthcare system , 2010, Health care management science.

[17]  Johann Hurink,et al.  A master surgical scheduling approach for cyclic scheduling in operating room departments , 2008, OR Spectr..

[18]  Kirk R. Karwan,et al.  Multi-Level Strategic Evaluation of Hospital Plans and Decisions , 1992 .

[19]  Brian T. Denton,et al.  Optimal Allocation of Surgery Blocks to Operating Rooms Under Uncertainty , 2010, Oper. Res..

[20]  R. Hall,et al.  Patient flow : reducing delay in healthcare delivery , 2006 .

[21]  S. Elkhuizen,et al.  Using computer simulation to reduce access time for outpatient departments , 2007, BMJ Quality & Safety.

[22]  Peter J. H. Hulshof,et al.  A Framework for Healthcare Planning and Control , 2012 .

[23]  Murray J. Côté,et al.  Patient flow and resource utilization in an outpatient clinic , 1999 .

[24]  Vernon Ning Hsu,et al.  Scheduling patients in an ambulatory surgical center , 2003 .

[25]  Paul Gemmel,et al.  Admission scheduling in acute care hospitals: does the practice fit with the theory? , 1999 .

[26]  Elias Willem Hans,et al.  Resource Loading by Branch-and-Price Techniques , 2001 .

[27]  Cherian Samuel,et al.  Supply chain dynamics in healthcare services. , 2010, International journal of health care quality assurance.

[28]  Peter Brucker,et al.  Complex Scheduling , 2006 .

[29]  Ben Wang,et al.  Managing Patient Service in a Diagnostic Medical Facility , 2006, Oper. Res..

[30]  Andreas Klinkert,et al.  Surgical case scheduling as a generalized job shop scheduling problem , 2008, Eur. J. Oper. Res..

[31]  Gerhard Wullink,et al.  Resource loading under uncertainty , 2005 .

[32]  Randolph W. Hall,et al.  Handbook of healthcare system scheduling , 2012 .

[33]  James R. Jackson,et al.  Jobshop-Like Queueing Systems , 2004, Manag. Sci..

[34]  Jan Vissers,et al.  Patient mix optimisation and stochastic resource requirements: A case study in cardiothoracic surgery planning , 2009, Health care management science.

[35]  Sally C. Brailsford,et al.  OR in healthcare: A European perspective , 2011, Eur. J. Oper. Res..

[36]  W. H. M. Zijm,et al.  Towards intelligent manufacturing planning and control systems , 2000, OR Spectr..

[37]  Elizabeth Olmsted Teisberg,et al.  How physicians can change the future of health care. , 2007, JAMA.

[38]  Emre A. Veral,et al.  OUTPATIENT SCHEDULING IN HEALTH CARE: A REVIEW OF LITERATURE , 2003 .

[39]  E N Weiss,et al.  An iterative estimation and validation procedure for specification of semi-Markov models with application to hospital patient flow. , 1982, Operations research.

[40]  Stephen C. Graves,et al.  A Tactical Planning Model for a Job Shop , 1986, Oper. Res..

[41]  Solon Venâncio de Carvalho,et al.  Markov decision process applied to the control of hospital elective admissions , 2009, Artif. Intell. Medicine.

[42]  Dimitris Bertsimas,et al.  Restless Bandits, Linear Programming Relaxations, and a Primal-Dual Index Heuristic , 2000, Oper. Res..