Collaborative Operating Room Planning and Scheduling

Abstract

Operating rooms (ORs) play a substantial role in hospital profitability, and their optimal utilization is conducive to containing the cost of surgical service delivery, shortening surgical patient wait times, and increasing patient admissions. We extend the OR planning and scheduling problem from a single independent hospital to a coalition of multiple hospitals in a strategic network, where a pool of patients, surgeons, and ORs are collaboratively planned. To solve the resulting mixed-integer dual resource constrained model, we develop a novel logic-based Benders’ decomposition approach that employs an allocation master problem, sequencing sub-problems for each hospital-day, and novel multistrategy Benders’ feasibility and optimality cuts. We investigate various patient-to-surgeon allocation flexibilities, as well as the impact of surgeon schedule tightness. Using real data obtained from the General Surgery Departments of the University Health Network (UHN) hospitals, consisting of Toronto General Hospital, Toronto Western Hospital, and Princess Margret Cancer Centre in Toronto, Ontario, Canada (who already engage in some collaborative resource sharing), we find that on average, collaborative OR scheduling with traditional patient-to-surgeon allocation flexibility results in 6% cost-savings, while flexible patient-to-surgeon allocation flexibility increases cost-savings to 40%, and surgeon schedule tightness can impact costs by 15%. The collective impact of our collaboration and patient flexibility results in between 45% and 63% savings per surgery. We also use a game theoretic approach to fairly redistribute the payoff acquired from a coalition of hospitals and to empirically show coalitional stability among hospitals. Data and the online supplement are available at https://doi.org/10.1287/ijoc.2017.0745 .

Hospital-wide therapist scheduling and routing: Exact and heuristic methods

“…An aggregated approach is followed in which patients' therapy jobs or surgeries are assigned to start times. This approach is similar to Schimmelpfeng et al (2012), Griffiths et al (2012), Roshanaei et al (2017a) and Roshanaei et al (2017b).…”

“…The difference with our work is, however, that their algorithm checks infeasibilities based on the multidimensional knapsack problem whereas we check individual therapists' routes. Roshanaei et al (2017a) and Roshanaei et al (2017b) focus on multi-hospital surgical case scheduling for operating rooms. The authors model the problem using Integer Programming and use a logic-based Benders' method to solve it.…”

“…Thirdly, with respect to the constraints, the model combines the approaches of Schimmelpfeng et al (2012) and Griffiths et al (2012) by considering a number of real-world constraints such as precedence constraints, time windows, breaks for therapists and preferences of patients. Finally, with respect to the solution approach, Roshanaei et al (2017a) and Roshanaei et al (2017b) are most relevant because of the cutting planes applied to the mathematical program while in our problem, the application area is different and we have both a routing and a scheduling problem.…”

Multiple Resource Surgical Case Scheduling Problem: Ant Colony System Approach

“…Also, the optimization of the utilization in OR has received more attention among other resources. There are few studies in the literature that takes into account both OR and surgeon utilization (Roshanaei et al, 2017, HashemiDoulabi et al, 2016, Fei et al, 2009, Jebali et al, 2006. To the best of our knowledge, there is no research in the literature that models the SCS in order to optimize all resources in the OR for the surgery as we research.…”

Why do surgeons schedule their own surgeries?

“…Similarly, there is long-standing evidence that the centralization of resource management operations yields substantial benefits, such as in the pooling of inventory (e.g., Benjaafar, Cooper, & Kim, 2005;Berman, Krass, & Mahdi Tajbakhsh, 2011). Several studies demonstrate that significant cost reductions can be achieved when an organizations' scheduling activities are centralized (Batun, Denton, Huschka, & Schaefer, 2011;Roshanaei, Luong, Aleman, & Urbach, 2017). The application of these techniques to hospital operations has led to improvements in emergency services (Dickson, Singh, Cheung, Wyatt, & Nugent, 2009), better medication management (Nayar, Ojha, Fetrick, & Nguyen, 2016), and more efficient use of a hospitals' OR time (Singh, Remya, Shijo, Nair, & Nair, 2014).…”