Managing daily surgery schedules in a teaching hospital: a mixed-integer optimization approach

Background: This study examined the daily surgical scheduling problem in a teaching hospital. This problem relates to the use of multiple operating rooms and different types of surgeons in a typical surgical day with deterministic operation durations (preincision, incision, and postincision times). Teaching hospitals play a key role in the health-care system; however, existing models assume that the duration of surgery is independent of the surgeon's skills. This problem has not been properly addressed in other studies. We analyze the case of a Spanish public hospital, in which continuous pressures and budgeting reductions entail the more efficient use of resources. Methods: To obtain an optimal solution for this problem, we developed a mixed-integer programming model and user-friendly interface that facilitate the scheduling of planned operations for the following surgical day. We also implemented a simulation model to assist the evaluation of different dispatching policies for surgeries and surgeons. The typical aspects we took into account were the type of surgeon, potential overtime, idling time of surgeons, and the use of operating rooms. Results: It is necessary to consider the expertise of a given surgeon when formulating a schedule: such skill can decrease the probability of delays that could affect subsequent surgeries or cause cancellation of the final surgery. We obtained optimal solutions for a set of given instances, which we obtained through surgical information related to acceptable times collected from a Spanish public hospital. Conclusions: We developed a computer-aided framework with a user-friendly interface for use by a surgical manager that presents a 3-D simulation of the problem. Additionally, we obtained an efficient formulation for this complex problem. However, the spread of this kind of operation research in Spanish public health hospitals will take a long time since there is a lack of knowledge of the beneficial techniques and possibilities that operational research can offer for the health-care system.

Analysing the complexity of the model-based decision making processes within the industrial management context

PURPOSE The decision-making process plays a key role in organizations. Every decision-making process produces a final choice that may or may not prompt action. Recurrently, decision makers find themselves in the dichotomous question of following a traditional sequence decision-making process where the output of a decision is used as the input of the next stage of the decision, or following a joint decision-making approach where several decisions are taken simultaneously. The implication of the decision-making process will impact different players of the organization. The choice of the decision- making approach becomes difficult to find, even with the current literature and practitioners’ knowledge. The pursuit of better ways for making decisions has been a common goal for academics and practitioners. Management scientists use different techniques and approaches to improve different types of decisions. The purpose of this decision is to use the available resources as well as possible (data and techniques) to achieve the objectives of the organization. The developing and applying of models and concepts may be helpful to solve managerial problems faced every day in different companies. As a result of this research different decision models are presented to contribute to the body of knowledge of management science. The first models are focused on the manufacturing industry and the second part of the models on the health care industry. Despite these models being case specific, they serve the purpose of exemplifying that different approaches to the problems and could provide interesting results. Unfortunately, there is no universal recipe that could be applied to all the problems. Furthermore, the same model could deliver good results with certain data and bad results for other data. A framework to analyse the data before selecting the model to be used is presented and tested in the models developed to exemplify the ideas. METHODOLOGY As the first step of the research a systematic literature review on the joint decision is presented, as are the different opinions and suggestions of different scholars. For the next stage of the thesis, the decision-making process of more than 50 companies was analysed in companies from different sectors in the production planning area at the Job Shop level. The data was obtained using surveys and face-to-face interviews. The following part of the research into the decision-making process was held in two application fields that are highly relevant for our society; manufacturing and health care. The first step was to study the interactions and develop a mathematical model for the replenishment of the car assembly where the problem of “Vehicle routing problem and Inventory” were combined. The next step was to add the scheduling or car production (car sequencing) decision and use some metaheuristics such as ant colony and genetic algorithms to measure if the behaviour is kept up with different case size problems. A similar approach is presented in a production of semiconductors and aviation parts, where a hoist has to change from one station to another to deal with the work, and a jobs schedule has to be done. However, for this problem simulation was used for experimentation. In parallel, the scheduling of operating rooms was studied. Surgeries were allocated to surgeons and the scheduling of operating rooms was analysed. The first part of the research was done in a Teaching hospital, and for the second part the interaction of uncertainty was added. Once the previous problem had been analysed a general framework to characterize the instance was built. In the final chapter a general conclusion is presented. FINDINGS AND PRACTICAL IMPLICATIONS The first part of the contributions is an update of the decision-making literature review. Also an analysis of the possible savings resulting from a change in the decision process is made. Then, the results of the survey, which present a lack of consistency between what the managers believe and the reality of the integration of their decisions. In the next stage of the thesis, a contribution to the body of knowledge of the operation research, with the joint solution of the replenishment, sequencing and inventory problem in the assembly line is made, together with a parallel work with the operating rooms scheduling where different solutions approaches are presented. In addition to the contribution of the solving methods, with the use of different techniques, the main contribution is the framework that is proposed to pre-evaluate the problem before thinking of the techniques to solve it. However, there is no straightforward answer as to whether it is better to have joint or sequential solutions. Following the proposed framework with the evaluation of factors such as the flexibility of the answer, the number of actors, and the tightness of the data, give us important hints as to the most suitable direction to take to tackle the problem. RESEARCH LIMITATIONS AND AVENUES FOR FUTURE RESEARCH In the first part of the work it was really complicated to calculate the possible savings of different projects, since in many papers these quantities are not reported or the impact is based on non-quantifiable benefits. The other issue is the confidentiality of many projects where the data cannot be presented. For the car assembly line problem more computational power would allow us to solve bigger instances. For the operation research problem there was a lack of historical data to perform a parallel analysis in the teaching hospital. In order to keep testing the decision framework it is necessary to keep applying more case studies in order to generalize the results and make them more evident and less ambiguous. The health care field offers great opportunities since despite the recent awareness of the need to improve the decision-making process there are many opportunities to improve. Another big difference with the automotive industry is that the last improvements are not spread among all the actors. Therefore, in the future this research will focus more on the collaboration between academia and the health care sector.

Análisis de reflectores en MatLab

Sabor, Software de Análisis de BOcinas y Reflectores, es una herramienta didáctica la cual es utilizada en los laboratorios de la escuela para realizar prácticas de la asignatura Antenas y Compatibilidad Electromagnética, esta herramienta da a los alumnos una visión gráfica de lo que se enseña en clase de teoría de lo que son los campos en las aperturas de los reflectores. El proyector pretende sustituir al primer Sabor , ya que se queda obsoleto debido al sistema operativo, ya que funciona solo para Windows XP y con ordenadores de 32 bits, y también realizar mejoras y corregir errores de la versión anterior. El proyecto se ha desarrollado en Matlab que es un software matemático con grandes ventajas en cuanto a cálculo, desarrollo gráfico, y a la creación de nuevos algoritmos en su propio lenguaje y además está disponible para las plataformas Unix, Windows, Mac OSX y GNU/Linux. El objetivo del proyecto ha sido implementar, al igual que las versiones anteriores, cinco tipos de reflectores, como son: Parabólico, Offset, Cassegrain y los dos Dobles Offset, Cassegrain y Gregorian, y han sido analizados con un alimentador ideal ,cos-q, y por último los resultados obtenidos se han comparado con las versiones anteriores de Sabor, como son Sabor 3.0 y el primer Sabor. El proyecto consta de partes muy bien diferencias como son :  La interpretación correctas de las formulas que se han utilizado para la realización de este proyecto ,dichas formulas han sido las dadas por el proyecto fin de carrera titulado Sabor3.0 de Francisco Egea Castejón.  GUIDE, the graphical user interface development environment, con el que se creó: GUI, graphical user interface, que es la parte de Matlab dedicada a crear interfaces de usuario , herramienta utilizada para crear nuestras distintas ventanas dedicadas para la obtención de datos para analizar los distintos reflectores y para mostrar por pantalla los distintos resultados.  Programación Orientada a Objetos de Matlab y sus distintas propiedades como son la herencia lo cual es muy útil para ocupar menos memoria ya que con un único método podemos realizar distintos cálculos con los distintos reflectores, objetos, solo cambiando las propiedades de cada objeto  Y por último ha sido la realización de validación de los resultados con la ayuda de las versiones anteriores de Sabor, que están detallados en el capítulo 5 y la unión con bocinas del proyecto fin de carrera Análisis de Bocinas en Matlab de Javier Montero. Por otra parte tenemos las mejoras realizadas a las antiguas versiones como son: realización de registros que el usuario puede guardar y cargar con las distintas variables, también se ha realizado un fichero .txt en el que consta la amplitud del campo con su respectiva theta para que el usuario pueda visualizarlo en cualquier plataforma gráfica de datos como por ejemplo exel. ABSTRACT. Sabor, Software de Análisis de BOcinas y Reflectores, is a teaching tool, which is used to do laboratory practice in the subject of Antennas y Compatibilidad Electromagnética, this tool gives students a graphic view of the knowledge that are given in theory class in regard to aperture field of reflectors. This project intend to replace the first Sabor, because it is outdated, due to the operating system, because Sabor works only with Widows XP and computer with 32 bits, and to make improves and correct errors that were detected in the last version of Sabor too. This project has been carried out in Matlab, which is a mathematical software with high-level language for numerical computation, visualization and application development, and furthermore it is available to different platforms such as Unix, Windows ,Mac OSX and GNU/Linux This project has focused on implementing, the same as last versions, five kind of reflectors, such as : Parabolic, Offset, Cassegrain and two offset dual reflector Cassegrain y Gregorian ,and these were analysed with a cos-q ideal feed, and finally the results were checked with the versions of Sabor, as well as Sabor 3.0 and the first Sabor. This project consist of four parts:  The correct interpretation of the formulas , which were used to do this project, from the final project Sabor3.0 by Francisco Egea Castejón.  GUIDE, the graphical user interface development environment, tool that was used to create : GUI, graphical user interface, part of Matlab dedicated to create user interface.  Object Oriented Programming of Matlab and different properties like inheritance, that is very useful for saving memory space because with only one method we can analyse different kind of reflectors, object, only change the properties of the object.  At finally, the results were contrasted with the results from the previous versions and the link reflectors with horns from the final project Análisis de Bocinas en Matlab by Javier Montero. On the other hand, we have the improvements such as: registers and .txt file. The registers are used by user to save and load different variables and .txt file is useful because it allows to the user plotting in different platforms for example exel.