The objective of this class of decisions is to provide techniques that allow the use of existing resources in the most efficient way. These decisions are related to demand forecasting at medium and short terms, patient scheduling, staff scheduling, etc.
First of all, the demand forecasting is of huge importance due to the fact that it may influence almost all the operations management decisions ([Kamenetzky et al., 1982], [Kao and Tung, 1980], |Kao and Pokladnik, 1978]). Consequently, improving the methods of forecasting the
demand would improve the efficiency of the care delivery process. [Perskalla and Brailer, 1994] have presented the main forecasting techniques that have been used in health care settings based on the papers of [Harrington, 1977] and [Hogarth and Makridakis, 1977]. Through the demand forecasting, the health care structure can determine the skills of the workforce necessary to satisfy the demand. In order to guarantee the availability of these skills, health care structures must improve staff flexibility by increasing staff training and enhancing their skills [Li et al., 2002].
After that, the activities of the workforce must be scheduled. Indeed, most of works that deal with the workforce scheduling focuses on the nursing scheduling problem and especially in shift scheduling where shift schedules are developed on a daily basis for each nurse for four to eight weeks ahead to match between nursing staff availabilities and the expected workload among units [Ernst et al., 2004], [Pierskalla and Brailer, 1994]. Indeed, the objective of the shift scheduling consists in satisfying the patients’ needs at minimal costs. Despite this, the shift scheduling must develop personnel satisfaction by meeting the care givers’ preferences, allowing days off and distributing night and weekend shifts equitably among them. In addition, the shift scheduling must also respect the working regulations in the health care context for example the maximum length of a work shift, the number of day off per week, etc. Among the policies developed for this problem is the cyclic schedule within which all the nurses perform exactly the same shift (day on and day off).
The use of the material resources can also be scheduled so that the objectives of minimizing patient waiting times and maximizing the facilities’ utilization rates are reached. Different scheduling policies have then been developed in the literature. For example, [Murphy and Sigal, 1985] have developed a simulation model for the surgical center scheduling using the block scheduling method where a block time of a surgical operating room is booked to a surgeon or a group of surgeons. [Ritzpatrick et al., 1993] have also studied the first-come- first-served scheduling, variable and mixed block scheduling for the operating rooms where the variable block scheduling considers the fluctuation of the demand.
Another way that allows the improvement of the hospital costs’ performance is the patient scheduling which allows the matching of the demand with the supply of service available while satisfying both patients and health care givers [Fone et al., 2003]. Indeed, according to [Li et al., 2002], hospital must “develop guidelines to manage the issues of hospital inpatient admission, inpatient and outpatient surgical schedules based on expected length of stay and the mix of diagnosis related groups (DRG)”. This topic concerns the trade-off between patient
waiting times and staff utilization and thus allows the reduction of staffing costs and congestion in hospitals.
First, the outpatient scheduling involves fixing the times of the appointments in a given day as well as the duration of time between these appointments. Despite this, the outpatient scheduling includes determining the types of human resources who will be responsible for delivering care to the patients [Jun et al., 1999]. Three methods are used to design the appointment system: block scheduling ([Penneys, 2000]), modified block scheduling ([O’Keefe, 1985]) and individual scheduling ([Vissers and Wijngaard, 1979]). The difference between the two first scheduling is that in the first one, all patients are scheduled for one appointment time and then served on a first-come-first served (FCFS) basis while in the second scheduling, the day is partitioned into smaller blocks and smaller sets of patients are scheduled into those times [Pierskalla and Brailer, 1994]. Despite this, [Williams et al., 1967] have asserted that the block scheduling emphasizes on minimizing the care givers’ idle time whereas the objective of the modified block scheduling is to reduce the patient waiting time. Second, the inpatient scheduling whose objective consists in optimizing the trade-off between patient satisfaction and hospital efficiency is classified into three interrelated dimensions: the daily scheduling of elective admissions (elective admissions are those which occur as a consequence of referral to hospital by a general practitioner, medical consultant, a visit to the hospital outpatient department or a planned transfer from another hospital) and emergent admissions into the corresponding units of the hospital ([Kolesar, 1970]), the daily scheduling of inpatients to the corresponding units of the hospital for treatment or diagnoses through their stay ([Kuzdrall et al., 1981]) and the scheduling of the discharges of patients to their homes or other care delivery institutions ([Trivedi, 1980]). Nevertheless, according to [Pierskalla and Brailer, 1994], the shortcoming of the studies developed within this context is that they consider only the inpatient scheduling in a single service of the hospital without considering the other services such as radiology, laboratory, etc. by which the patient can pass during his stay within the hospital which would conduct to extend the length of stay unnecessarily. This can be explained by the relatively poor internal forecasting and information systems in the hospital.