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This paper develops a two-stage planning procedure for master planning of elective and emergency patients while allocating at best the available hospital resources. Four types of resources are considered: operating theatre, beds in the medium and in the intensive care units, and nursing hours in the intensive care unit. A tactical plan is obtained by minimizing the deviations of the resources consumption to the target levels of resources utilization. Some capacity is reserved for emergency care. To deal with the deviation between actually arriving patients and the average number of patients on which the tactical plan is based, we consider the option of planning a higher number of patients (overplanning). To adapt the tactical plan to the actual stream of elective patients, we also consider flexibility rules. Overplanning and flexibility leads to a weekly schedule of elective patients. This schedule is modified to account for emergency patients. Scheduled elective patients may be cancelled and emergency patients may be sent to other hospitals. Cancellations rules for both types of patients rely on the possibility to exceed the available capacities. Several performance indicators are defined to assess patient service/dissatisfaction and hospital efficiency. Simulation results show a trade-off between hospital efficiency and patient service. We also obtain a rank of the different strategies: overplanning, flexibility and cancellation rules.Keywords: operation theatre planning, intensive and medium care, emergency and elective patients, overplanning, cancellation rules, operational schedule of patients, master surgical schedule.

Cardiothoracic surgery planning involves different resources such as operating theatre time, beds, IC beds and nursing staff. In the daily practice of the Thorax Centre case study setting, the planning focuses on optimal use of operating theatre time, though the performance of the Thorax Centre as a whole is often more limited by other resources. For operating theatres a master surgical schedule is used to allocate operating theatre resources at tactical level for a longer period. Operational schedules at weekly level are derived from this master schedule. Within cardiothoracic surgery different categories of patients can be distinguished based on their requirement of resources. The mix of patients operated is, therefore, an important decision variable for the Thorax Centre to manage the use of these resources. In this paper we will consider the planning problem at the tactical level to generate a master surgical schedule that realises a given target of patient throughput and optimises an objective function for the utilisation of resources. The problem can be mathematically approached by mixed integer linear programming, which we already demonstrated in a previous paper. The specific topic of the current paper is to investigate the influence of using a stochastic instead of a deterministic length of stay. We will discuss the new mathematical model developed for this planning problem. The results obtained by the model indicate that we can generate master surgical schedules with a better performance on target utilization levels of resources by considering the stochastic length of stay.

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Purpose – The purpose of this paper is to show that market dynamics can significantly influence the lifecycle and value of a supply chain finance (SCF) arrangement. Design/methodology/approach – Based on a review of scientific and trade literature, the authors construct a model of market dynamics for reverse factoring, a specific type of SCF arrangement. The authors assume that firms’ participation in a reverse factoring arrangement is determined by the direct benefits they can derive from it. The authors analyse the model by means of simulation in system dynamics. Findings – The authors identify the following market factors as key for direct benefits: competition, interest rates, receivables volumes, and firms’ working capital goals. The authors find that reverse factoring can yield direct benefits for all supply chain participants, but that these benefits are highly sensitive to market conditions. Research limitations/implications – The model is stylized, but this study shows the need for further research on the dynamic aspects of SCF arrangements. Practical implications – The authors show that supply chain actors should carefully consider the expected evolution of market factors when deciding on participation in a reverse factoring arrangement. Originality/value – Existing research on SCF arrangements almost exclusively considers a static context, where market factors take fixed, known values. The authors provide the first study that links the direct benefits of SCF arrangements to dynamic, interacting market factors. The authors utilize system dynamics, a methodology well-suited to the analysis of such settings, to show that a comprehensive assessment of SCF arrangements cannot neglect the evolutionary perspective.

This paper studies the two-echelon capacitated vehicle routing problem with time windows. The first echelon consists of transferring freight from depots to intermediate facilities (i.e., satellites), whereas the second echelon consists of transferring freight from these facilities to the final customers, within their time windows. We propose two pathbased mathematical formulations for our problem: (1) in one formulation, paths are defined over both firstand second-echelon tours, and (2) in the other one, the firstand second-echelon paths are decomposed. Branch-and-price-based algorithms are developed for both formulations. We compare both formulations and solution methods on a comprehensive set of instances and are able to solve instances up to five satellites and 100 customers to optimality. This paper is the first paper in the literature that solves such large instance sizes.

Hospitals and health care institutions are facing the challenge of improving the quality of their services while reducing their costs. The current study presents the application of operations management practices in a dermatology oncology outpatient clinic specialized in skin cancer treatment. An interesting alternative considered by the clinic is the implementation of a one-stop-shop concept for the treatment of new patients diagnosed with basal cell carcinoma. This alternative proposes a significant improvement in the average waiting time that a patient spends between the diagnosis and treatment. This study is focused on the identification of factors that influence the average throughput time of patients treated in the clinic from the logistic perspective. A two-phase approach was followed to achieve the goals stated in this study. The first phase included an integrated approach for the deterministic analysis of the capacity using a demand-supply model for the hospital processes, while the second phase involved the development of a simulation model to include variability to the activities involved in the process and to evaluate different scenarios. Results showed that by managing three factors: the admission rule, resources allocation and capacity planning in the dermato-oncology unit throughput times for treatments of new patients can be decreased with more than 90 %, even with the same resource level. Finally, a pilot study with 16 patients was also conducted to evaluate the impact of implementing the one stop shop concept from a clinical perspective. Patients turned out to be satisfied with the fast diagnosis and treatment.