IEMS 13 4th Industrial Engineering and Management Symposium 1

Operating Room Scheduling under

Uncertainty
Fabrcio Sperandio

, Bernardo Almada-Lobo

, Jose Luis Borges

Faculty of Engineering, University of Porto

1 The Challenge
The current nancial crisis has been forcing governments to reduce public expenditure on a dramatically
speed. In particular, the healthcare area, which has been experiencing a steady rise of costs in the last
few years, now faces exceptionally challenging budget restrictions. However, an indiscriminate cut of
healthcare budget would impair quality of care. This situation requires careful analysis, process reengi-
neering and suitable decision support tools to help decision makers to reduce costs without impacting
quality of care.
In this context, hospitals take the largest share of national healthcare budgets. Moreover, the Op-
erating Room (OR) is a key hospital department, representing the largest cost and revenue center. Its
eective management impacts several hospital Key Performance Indicators (KPIs), such as: number of
patients waiting for a surgery, mean waiting time, average length of stay, and case mix index. Thus, it is
imperative to improve OR eciency, being able to maintain current KPIs values on a budget constrained
scenario.
This work tackles the surgery scheduling problem at the operational level. It consists on selecting
elective surgeries from the waiting list and scheduling them to specic operating rooms and days across
the week. In the last decade, this problem has received great attention from the scientic community.
However, it still represents an open issue, with a few recognized gaps remaining. In particular, the lack of
approaches to address the uncertainty inherent to the problem constitutes one of the main gaps, and also
one of the main reasons for poor scheduling performance. The uncertainty comes from multiple sources,
such as: emergency arrivals, variable surgery durations, variable length of stay, sta delays, equipment
failures and materials shortage. One of the reasons why the uncertainty remains an open issue is the
high computational cost of combining a combinatorial and a stochastic problem. This work proposes a
simulation optimization approach to reduce the computational cost, allowing operating room scheduling
under uncertainty to be used in practice.
2 The Methodology
This work applies techniques from the simulation optimization area to solve the OR scheduling problem.
In the last years, this area has been one of the most exciting areas within the computer simulation eld,
mainly because the exponential increase in computer power and memory. The literature on simulation
optimization presents a large portfolio of algorithms and statistical procedures, specially designed to ad-
dress combinatorial problems under uncertainty, which have not been applied to OR scheduling problems.
In fact, just a small set of them appears in the OR literature.
The general simulation optimization approach combines optimization and simulation modules. The
rst contains a search procedure responsible for generating alternative solutions for the combinatorial
problem, while the later is responsible for estimating the performance of each alternative solution un-
der uncertainty. In specic, this work proposes a multi-objective Genetic Algorithm (GA) as a search
procedure combined with a Discrete Event Simulation (DES) model to estimate the performance of
each alternative weekly OR schedule. Additionally, a statistical Ranking & Selection (R&S) procedure
called Optimal Computing Budget Allocation (OCBA) links the two modules, managing the number of
simulation replications required to estimate the performance of each alternative solution, reducing the
computational cost.
In order to evaluate the performance of the proposed approach, a set of experiments comparing it with
a deterministic version of the GA was conducted. The deterministic version, instead of using a DES,
uses analytic functions to calculate scheduling performance metrics, which are used to select the best
alternatives. Next, the best solutions found by the deterministic and stochastic approaches are evaluated
2 IEMS 13 4th Industrial Engineering and Management Symposium
using the DES model, estimating their actual performance in reality. The DES estimates performance
on three dimensions: number of surgeries performed, OR utilization rate and overtime (number of extra
hours). Each of the dimensions is an estimative of the execution of the plan. Results show that weekly
OR schedules generated by the stochastic approach have better estimated execution performance in
comparison with the traditional deterministic approach. In other words, this solution approach is able
perform more surgeries, with a higher estimated OR utilization rate, but with less overtime. In order
to reduce the overtime, the solutions generated by the stochastic approach take advantage of a portfolio
eect, achieved by mixing surgeries according to their variance on surgery duration.
3 The value to Society
The proposed approach is able to generate robust weekly operating room schedules, which are able to
perform better under uncertainty. In other words, hospitals are able to perform more surgeries, while
reducing the risk of incurring in additional overtime costs. Moreover, it enables hospitals to optimize the
utilization of resources, both in terms of operating rooms and required sta. These measures have a direct
impact on society, both in social and nancial dimensions. From the social perspective, it contributes
to reduce the number of patients waiting for a surgery and the mean waiting time. From the nancial
perspective, it contributes for saving costs in additional working hours, helping public hospitals to reduce
their decit, and overtake the nancial crisis without compromising quality of care.