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.

In sickness and in health: protecting and supporting public investment in Europe. Bruegel Policy Contribution 2014/02, February 2014

The long-term decline in gross public investment in European Union countries mirrors the trend in other advanced economies, but recent developments have been different: public investment has increased elsewhere, but in the EU it has declined and even collapsed in the most vulnerable countries, exaggerating the output fall. The provisions in the EU fiscal framework to support public investment are very weak.The recently inserted ‘investment clause’ is almost no help. In the short term, exclusion of national co-funding of EU-supported investments from the fiscal indicators considered in the Stability and Growth Pact would be sensible. In the medium term, the EU fiscal framework should be extended with an asymmetric ‘golden rule’ to further protect public investment in bad times, while limiting adverse incentives in good times. During a downturn, a European investment programme is needed and the European Semester should encourage greater investment by member states with healthy public finances and low public investment rates. Reform and harmonisation of budgeting, accounting, transparency and project assessment is also needed to improve the quality of public investment.

U.S. overseas loans, and grants, and assistance from international organizations.

Latest issue consulted: 1945/90.

Costs and problems of completing the interstate highway system; report to the Congress.

Mode of access: Internet.

Immigration literature : abstracts of demographic, economic, and policy studies /

Mode of access: Internet.

Financial management for transit: a handbook. Final report.

Mode of access: Internet.

Participant materials for financial management of state highway safety programs.

National Highway Traffic Safety Administration, Washington, D.C.

Comparison of budget request to 1961-63 biennium executive budget.

Caption title.

Condition rating survey manual : state system condition rating survey (CRS).

The Illinois Department of Transportation (IDOT), through the Office of Planning and Programming (OPP), conducts a Condition Rating Survey (CRS) to assess pavement condition on its approximate 16,000 mile state highway system. The CRS is an important tool to assist the Department with its pavement management activities. A CRS value indicates the current condition of a pavement. CRS is a factor in highway program development, provides an opportunity to review the highway network, provides overall condition of the state highway system, gives input into the legislative/budgeting process and allows calculation of pavement needs.

Annual evaluation report on programs administered by the U.S. Office of Education.

Report year ends June 30.

Improving congressional control of the budget : hearings ... Ninety-third Congress, first session.

Hearings held Apr. 2-Aug. 1, 1973, on S. 40, 565, 703, 758, 846, 905, 1030, 1213, 1215, 1392, 1414, 1516, 1541, 1641, 1648, 2049, S. Con. Res. 19, and amendment no. 444 to S. 1541.

Principles of Navy budget : self-instructional learning unit.

Cover title.

Uses of State Administered Federal Education Funds; Annual Report of the U.S. Commissioner of Education

Issued as HEW publication

Une simple amélioration ou une modernisation radicale? La réforme de l'administration de la Commission Européenne

If the need for change and improvement in the Commission’s ways of working became evident as of 1979, the reform process began with the Santer Commission. Although the public management reform seems to focus on reducing personnel and expenses, it goes further in the sense of modernization: budgetary reforms aim at budgeting results and performance; emphasis is put on individual responsibility and evaluation and on a more flexible approach to personnel management, strategic planning, and transfer of authority.

"Action at a distance":accounting inscriptions and the reporting of episodes of clinical care

This paper reports on an aspect of the implementation of a sophisticated system of Casemix Budgeting within a large public hospital in New Zealand. The paper examines the role of accounting inscription in supporting a system of “remote” management control effected through the Finance function at the hospital. The paper provides detailed description and analysis of part of the casemix technology in use at the research site. The implementation of clinical budgeting through the Transition casemix system will be examined by describing an aspect of the casemix system in detail. The design and use of management reporting is described. Reporting to different levels of management and for differing parts of the organisation are discussed with particular emphasis on the adoption of traditional analysis of costs using standard costing and variance analysis techniques.