Staff Planning for Hospitals with Implicit Cost Estimation and Stochastic Optimization

Abstract

W e consider the anesthesiologist staff planning problem for operating services departments in large multi-specialty hospitals without limit on anesthesiologist supply, where the planner makes monthly and daily decisions to minimize total costs. Each month the staff planner decides the number of anesthesiologists on regular duty and an on-call consideration list for each day of the following month. In addition, each day, the staff planner decides how many on-call anesthesiologists to call for the following day. Total costs consist of explicit and implicit costs. Explicit costs include the costs of calling an anesthesiologist and overtime costs. These costs are specified by the organization. Implicit costs encompass costs of not calling an on-call anesthesiologist and under-utilizing an anesthesiologist, and these have to be deduced from past decisions. We model the staff planning problem as a two-stage integer stochastic dynamic program. We develop structural properties of this model and use them in a sample average approximation algorithm constructed to solve this problem. We also develop a procedure to estimate the implicit costs, which are included in this model. Using data from the operating services department at the UCLA Ronald Reagan Medical Center, our model shows the potential to reduce overall costs by 16%. We provide managerial insights related to the relative scale of these costs, hiring decisions by service, sensitivity to cost parameters, and improvements in the prediction of the booked time durations.

Association Between the Community Prevalence of COVID-19 and Daily Unscheduled Absences of Anesthesiologists, Nurse Anesthetists, and Residents in an Academic Anesthesia Department

“…Such results are relevant to hospitals (such as the one studied) where there are no anesthesia practitioners available to work on a per diem basis on short notice. However, there are practices, especially in large metropolitan areas, where the total number of anesthesiologists or nurse anesthetists available for such scheduling are substantial [ 14 ]. Earlier, Rath showed the best way to contract and pay while achieving the optimal balance between being called to work versus not being used [ 14 ].…”

“…However, there are practices, especially in large metropolitan areas, where the total number of anesthesiologists or nurse anesthetists available for such scheduling are substantial [ 14 ]. Earlier, Rath showed the best way to contract and pay while achieving the optimal balance between being called to work versus not being used [ 14 ].…”

Scheduling staff for ambulatory anaesthesia

“…Some anaesthesia groups may have the workforce conditions studied by Rath and Rajaram [2 ▪▪ ]. They evaluated a large anaesthesia group with no practical limit to the supply of anaesthesia practitioners.…”

“…The planner knows the anaesthesia practitioners’ availability to work on each date [2 ▪▪ ]. The planner knows the probability distribution among days of the workloads of each of the ambulatory surgery centres’ rooms [2 ▪▪ ]. The vast majority of rooms will be covered by regularly scheduled practitioners.…”

“…For the occasional outlier days, inherently fewer than half, the on-call practitioners would be notified to work clinically the day before surgery. Logically, from a long-term perspective, the implicit cost of the practitioner being available, if needed, but not called in exceeds the explicit cost of calling in the practitioner and paying them for patient care [2 ▪▪ ]. The impact of using the statistical approach, rather than relying on intuition and experience [14], is to have more practitioners regularly scheduled, with fewer working, if needed.…”