Within the framework of economic constraints and demographic changes which the health care sector is confronted to, the Home Health Care (HHC) which has been created sixty years ago, has known an important growth during this last decade. The main objective of this alternative to the traditional hospitalization consists in solving the problem of hospitals' capacity saturation by allowing earlier discharge of patients from hospital or by avoiding their admission while improving or maintaining the medical, psychological and social welfare of these patients. In this thesis, we are interested in the operations management within the HHC structures. In the first part of this thesis, we develop a qualitative analysis of the operations management in the HHC context. More specifically, we identify the complexity factors that operations management has to face up within this type of structures. For each complexity factor, we discuss how it can affect the organization of the care delivery. These factors pertain to the diversity of the services proposed, the location of care delivery, the uncertainty sources, etc. Thereafter, we survey operations management based models proposed in the literature within the HHC context. Based on this literature review, we identify several emerging issues, relevant from an organizational point of view, that have not been studied in the literature and thus represent unexplored opportunities for operations management researchers. In the second part of this thesis, we are interested in the partitioning of the area where the HCC structure operates into districts. This districting approach fits the policies of improvement of the quality of care delivered to patients and the working conditions of care givers as well as costs' reduction. We begin by proposing a classification of the different criteria that may be considered in the districting problem. We then propose two mathematical formulations for the HHC districting problem for which we consider criteria such as the workload balance, compactness, compatibility and indivisibility of basic units. After that, we present a numerical analysis of the computational experiments carried out on randomly generated instances to validate these two models. We also present two possible exploitations of these models and propose two extensions to these basic formulations. After formulating the problem with a static approach, we also develop a dynamic extension which allows the integration of the different variations that can be observed within the activities of an HHC structure from period to period. We then introduce a new partitioning criterion that concerns the continuity of care evaluated on the basis of two sub-criteria. Depending on the preferences of the decision-makers concerning the sub-criteria related to the continuity of care in the districting problem, we then distinguish three scenarios for which we propose the associated mathematical formulations.

Dans le cadre des contraintes économiques et des évolutions démographiques auxquelles doit faire face le secteur de la santé, l’Hospitalisation à Domicile (HAD) qui a été créée il y a une soixantaine d’années s’est largement développée en France durant cette dernière décennie. L’objectif principal de cette alternative à l’hospitalisation complète est de raccourcir les séjours hospitaliers voire même de les éviter en vue de remédier à l’engorgement des hôpitaux tout en améliorant les conditions de vie des patients. Dans cette thèse, nous nous intéressons à la gestion des opérations dans les structures d’HAD. Dans la première partie, nous développons une analyse qualitative de la gestion des opérations dans les établissements d’HAD. De façon plus détaillée, nous identifions les différents facteurs de complexité auxquels la gestion des opérations doit faire face dans ce type de structures. Ces facteurs peuvent concerner la diversité de l’offre des services, le lieu de production des soins, les sources d’incertitudes, etc. Nous présentons ensuite les travaux existants dans la littérature qui s’intéressent à la gestion des opérations dans les HADs. Sur la base de cette synthèse, nous identifions des pistes de recherche qui n’ont pas encore été traitées dans la littérature. Dans la deuxième partie, nous nous intéressons à la problématique de partitionnement géographique du territoire desservi par une structure d’HAD. Cette approche de partitionnement peut s’insérer dans une politique d’amélioration de la qualité du service des soins délivrés aux patients et des conditions de travail des équipes soignantes. Nous commençons d’abord par proposer une classification des différents critères utilisés dans la littérature pour modéliser ce problème. Nous proposons ensuite deux modèles de partitionnement prenant en compte un ensemble de critères tels que l’équilibre de la charge de travail, la compacité, la compatibilité et l’indivisibilité des unités de base. Nous présentons également quelques exploitations possibles de ces modèles et proposons deux extensions à la formulation de base. Après avoir formulé le problème avec une approche statique, nous développons également une extension dynamique qui permet d’intégrer les différentes variations pouvant être observées dans l’activité d’une HAD d’une période à l’autre. Nous introduisons un nouveau critère de partitionnement qui concerne la continuité des soins, évaluée sur la base de deux sous-critères. En fonction des préférences des décideurs par rapport à la prise en compte de la continuité des soins dans le problème de partitionnement, nous distinguons alors trois scénarii pour lesquels nous proposons les modèles associés / Within the framework of economic constraints and demographic changes which the health care sector is confronted to, the Home Health Care (HHC) which has been created sixty years ago, has known an important growth during this last decade. The main objective of this alternative to the traditional hospitalization consists in solving the problem of hospitals’ capacity saturation by allowing earlier discharge of patients from hospital or by avoiding their admission while improving or maintaining the medical, psychological and social welfare of these patients. In this thesis, we are interested in the operations management within the HHC structures. In the first part of this thesis, we develop a qualitative analysis of the operations management in the HHC context. More specifically, we identify the complexity factors that operations management has to face up within this type of structures. For each complexity factor, we discuss how it can affect the organization of the care delivery. These factors pertain to the diversity of the services proposed, the location of care delivery, the uncertainty sources, etc. Thereafter, we survey operations management based models proposed in the literature within the HHC context. Based on this literature review, we identify several emerging issues, relevant from an organizational point of view, that have not been studied in the literature and thus represent unexplored opportunities for operations management researchers. In the second part of this thesis, we are interested in the partitioning of the area where the HCC structure operates into districts. This districting approach fits the policies of improvement of the quality of care delivered to patients and the working conditions of care givers as well as costs’ reduction. We begin by proposing a classification of the different criteria that may be considered in the districting problem. We then propose two mathematical formulations for the HHC districting problem for which we consider criteria such as the workload balance, compactness, compatibility and indivisibility of basic units. After that, we present a numerical analysis of the computational experiments carried out on randomly generated instances to validate these two models. We also present two possible exploitations of these models and propose two extensions to these basic formulations. After formulating the problem with a static approach, we also develop a dynamic extension which allows the integration of the different variations that can be observed within the activities of an HHC structure from period to period. We then introduce a new partitioning criterion that concerns the continuity of care evaluated on the basis of two sub-criteria. Depending on the preferences of the decision-makers concerning the sub-criteria related to the continuity of care in the districting problem, we then distinguish three scenarios for which we propose the associated mathematical formulations.

Bakgrund och problem: En tilltagande globaliseringen, teknisk utveckling och ökad konkurrens har gjort att företag behöver anpassa sig till den föränderliga miljön för att förbli lönsamma och konkurrenskraftiga. Projekt är ett effektivt sätt att anpassa sig till en föränderlig och osäker omvärld. Därför har det skett en ökning av antalet projekt som bedrivs, samtidigt som en allt högre andel projekt misslyckas på grund av faktorerna i projektets miljö som orsakar komplexitet i projektet. Komplexiteten behöver således hanteras för att kunna driva projektet framåt.  Syfte: Syftet med studien är att identifiera hur faktorerna i projektets föränderliga miljö orsakar komplexitet samt att skapa bättre förståelse för hur faktorerna hanteras i projektstyrningen. Vidare är det praktiska syftet att skapa vägledning och insikt i hur företag kan hantera komplexiteten som orsakas av dessa faktorer.  Metod: Forskningsstrategin är baserad på ett kvalitativt tillvägagångssätt med en abduktiv ansats. Forskningsdesignen bygger en insamling av empiriska data genom semi-strukturerade intervjuer på sex olika verksamheter, där fallen består av både traditionella branscher där det traditionella projektstyrningsidéerna kan tänkas dominera och modernare företag som tar avstamp i mer agila projektstyrningsmetoder.  Slutsats: Studiens resultat visade att komplexitetsfaktorerna i slutändan påverkar en eller flera variabler i projekttriangeln, som är tid, kostnad och kvalitet/resultat. Komplexitetsfaktorerna som identifierades är begränsad tid, begränsade resurser, intressenternas inflytande, kompetensbrist, motstånd för förändring, lagar och regleringar samt teknisk utveckling. Studiens resultat visade också på att komplexitetsfaktorerna hanteras genom effektivare kommunikation, långsiktighet, effektiv planering, samt viljan att förändras. / Background and problem: Increasing globalization, technological development and increased competition have made it necessary for companies to adapt to the changing environment in order to remain profitable and competitive. Projects are an effective way to adapt to a changing and uncertain world. Therefore, there has been an increase in the number of projects carried out, at the same time as an increasing proportion of projects fail due to the factors in the project environment that cause complexity in the project. The complexity thus needs to be managed in order to be able to drive the project forward.  Purpose: The purpose of the study is to identify how the factors in the project's changing environment cause complexity and to create a better understanding of how the factors are handled in project management. Furthermore, the practical purpose is to create guidance and insight into how companies can handle the complexity caused by these factors.  Method: The research strategy is based on a qualitative approach with an abductive approach. The research design builds a collection of empirical data through semi-structured interviews of six different companies, where the cases consist of both traditional industries where the traditional project management ideas may dominate and modern companies that are based on more agile project management methods.  Conclusion: The results of the study showed that the complexity factors ultimately affect one or more variables in the project triangle, which are time, cost and quality/results. The complexity factors identified are limited time, limited resources, stakeholder influence, lack of competence, resistance to change, laws and regulations and technical development. The results of the study also showed that the complexity factors are managed through more efficient communication, strategic and effective planning and the willingness to change.

Through a history of more than 50 years, the results of mathematical models have shown that controller workload is being driven by the complexity involved in the airspace environment. Part of this complexity is prompted by the dynamical behavior of traffic patterns. From the results of models describing controller’s workload, it is observed that predictability decreases the complexity. Therefore, the general idea behind this topic is to analyze how a specific notion of predictability influences the controller’s workload. This specific notion in this research is a type of automation that aircraft benefit from. In a more specific sense, the goal of this research was to analyze how the controllers handle the air traffic in different complex situations when exposed to different automation levels. The following dilemmas are focused through this work: - Information visualization of controllers’ interaction with radar screen - Quantification of dynamics of air traffic patterns - Modeling and quantification of controllers’ workload First, in order to have a grasp of the controllers’ interaction with the air traffic patterns, the controllers’ activities on the radar screen have been visualized in chapter 2. The visualization results for different automated conditions have been analyzed. Based on such analysis the criteria for problem space has been addressed and the main research question is identified. Next in chapter 3, the airspace complexity caused by air traffic flow has been studied and a set of known complexity factors are quantified using a novel calculation approach. With a logistics perspective toward airspace complexity, to calculate each complexity factor, a mathematical formulation has been used and the effects of each corresponding factor on controllers’ workload are addressed. Then in chapter 4, a novel approach toward modeling controller’s workload is presented. After implementing the model on 18 different scenarios, a model for controller’s workload has been developed in which around 60 percent of the en-route air traffic complexity values and around 80 percent of terminal air traffic complexity values could be well-matched with the workload values. From statistical point of view, the results are very much acceptable for experiments in which human factors are involved. Cognitive load has not been considered in the workload model which is the focus of a future work. Later on in chapter 5, the results for each complexity factor as well as workload models are analyzed and discussed for each sector separately. Based on the airspace complexity results, areas where traffic situation had become complex were identified and the controller’s response to different situations are discussed. For each complexity factor as well as workload, the results for three different scenarios featuring different automation levels for two en-route and terminal sectors are compared. At last in chapter 6, the main ideas are discussed, thesis conclusions are presented and possible future work is suggested.