A framework for integrated resource planning in surgical clinics

The problem under study is based on the challenges faced by the Orthopaedic Clinic at St. Olav’s Hospital in Trondheim, Norway. Variations in demand and supply cause fluctuating waiting lists, and it is challenging to level the activities between the clinic’s two units, the outpatient clinic and the operating theater, to obtain short waiting times for all activities. Based on these challenges, we describe and present a planning problem referred to as the Long-term Master Scheduling Problem (LMSP), where the objective is to construct an integrated Long-term Master Schedule (LMS) that facilitates short waiting times in both units. The LMS can be separated into two schedules, one cyclic high-level schedule, and one non-cyclic low-level schedule. The demand for outpatient clinic consultations and surgeries is stochastic, as are the waiting lists. To account for this, we propose a planning framework consisting of an optimization model to solve the LMSP, and a two-level planning procedure. In the planning procedure, we first solve the LMSP to construct the LMS for the upcoming planning horizon. Then, to adjust to the fluctuating waiting lists, we periodically refine the low-level schedule by solving a constrained LMSP. We also develop a simulation-based evaluation procedure to evaluate the planning framework in a real-life setting and use this to investigate different planning strategies. We find that imposing flexible, dynamic and agile planning strategies improve waiting time outcomes and patient throughput. Furthermore, combining the strategies yields additive improvements.