Health Sciences Centre (HSC) in Winnipeg is the major healthcare facility serving Manitoba, Northwestern Ontario, and Nunavut. An evaluation of HSC’s adult surgical patient flow revealed that one major barrier to smooth flow was their Operating Room (OR) scheduling system. This thesis presents a new two-stage elective OR scheduling system for HSC, which generates weekly OR schedules that reduce artificial variability in order to facilitate smooth patient flow. The first stage reduces day-to-day variability while the second stage reduces variability occurring within a day. The scheduling processes in both stages are mathematically modelled as multi-objective optimization problems. An attempt was made to solve both models using lexicographic goal programming. However, this proved to be an unacceptable method for the second stage, so a new multi-objective genetic algorithm, Nondominated Sorting Genetic Algorithm II – Operating Room (NSGAII-OR), was developed. Results indicate that if the system is implemented at HSC, their surgical patient flow will likely improve. / October 2008

Health Sciences Centre (HSC) in Winnipeg is the major healthcare facility serving Manitoba, Northwestern Ontario, and Nunavut. An evaluation of HSC’s adult surgical patient flow revealed that one major barrier to smooth flow was their Operating Room (OR) scheduling system. This thesis presents a new two-stage elective OR scheduling system for HSC, which generates weekly OR schedules that reduce artificial variability in order to facilitate smooth patient flow. The first stage reduces day-to-day variability while the second stage reduces variability occurring within a day. The scheduling processes in both stages are mathematically modelled as multi-objective optimization problems. An attempt was made to solve both models using lexicographic goal programming. However, this proved to be an unacceptable method for the second stage, so a new multi-objective genetic algorithm, Nondominated Sorting Genetic Algorithm II – Operating Room (NSGAII-OR), was developed. Results indicate that if the system is implemented at HSC, their surgical patient flow will likely improve.

Health Sciences Centre (HSC) in Winnipeg is the major healthcare facility serving Manitoba, Northwestern Ontario, and Nunavut. An evaluation of HSC’s adult surgical patient flow revealed that one major barrier to smooth flow was their Operating Room (OR) scheduling system. This thesis presents a new two-stage elective OR scheduling system for HSC, which generates weekly OR schedules that reduce artificial variability in order to facilitate smooth patient flow. The first stage reduces day-to-day variability while the second stage reduces variability occurring within a day. The scheduling processes in both stages are mathematically modelled as multi-objective optimization problems. An attempt was made to solve both models using lexicographic goal programming. However, this proved to be an unacceptable method for the second stage, so a new multi-objective genetic algorithm, Nondominated Sorting Genetic Algorithm II – Operating Room (NSGAII-OR), was developed. Results indicate that if the system is implemented at HSC, their surgical patient flow will likely improve.

Time series forecasting and modeling are challenging problems during the past decades, because of its plenty of properties and underlying correlated relationships. As a result, researchers proposed a lot of models to deal with the time series. However, the proposed models such as Autoregressive integrated moving average (ARIMA) and artificial neural networks (ANNs) only describe part of the properties of time series. In this thesis, we introduce a new hybrid model integrated filter structure to improve the prediction accuracy. Case studies with real data from University of Kentucky HealthCare are carried out to examine the superiority of our model. Also, we applied our model to operating room (OR) to reduce the inefficiency cost. The experiment results indicate that our model always outperforms compared with other models in different conditions.

Balancing trade-offs between production cost and holding cost is critical for production and operations management. Utilization of an operating room affects production cost, which relates to makespan, and patient flowtime affects holding cost. There are trade-offs between two objectives, to minimize makespan and to minimize flowtime. However, most existing constructive heuristics focus only on single-objective optimization. In the current literature, NEH is the best constructive heuristic to minimize makespan, and LR heuristic is the best to minimize flowtime. In this thesis, we propose a current and future deviation (CFD) heuristic to balance trade-offs between makespan and flowtime minimizations. Based on 5400 randomly generated instances and 120 instances in Taillard’s benchmarks, our CFD heuristic outperforms NEH and LR heuristics on trade-off balancing, and achieves the most stable performances from the perspective of statistical process control.

The efforts to improve health care delivery usually involve studies and analysis of patient populations and healthcare systems. In this dissertation, I present the research conducted in the following areas: identifying patient groups, improving treatments for specific conditions by using statistical as well as data mining techniques, and developing new operation research models to increase system efficiency from the health institutes’ perspective. The results provide better understanding of high risk patient groups, more accuracy in detecting disease’ correlations and practical scheduling tools that consider uncertain operation durations and real-life constraints.

Improved utilization of scarce resources such as health care personnel is necessary to address well-known problem of long waiting times within the health care. Implementing mathematically modeled scheduling in the operating theatre has the potential to result in more efficient allocation of resources and financial gains. Despite the promising results, the adoption rate of such models is low. This thesis examines the impact of a mixed-integer linear programming model using an overlapping strategy. We perform a computational experiment where both sequential and parallel schedules are produced with real surgery data from an orthopedic department at a Swedish university hospital. The generated schedules are compared against each other in measurements of cost productivity. Statistical analysis shows that there is a statistical significant difference between the two schedules, favoring the optimized schedule. The results further suggest that three operating rooms and four surgery teams is the most optimal combination of the 18 combinations analyzed, where operating rooms and surgery teams varies between 1-4 and 1-6, respectively.

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