|dc.description.abstract||Nowadays health care organizations experience an increasing pressure in order to provide their services at the lowest possible costs as a response to the combination of restrictive budgets, increasing waiting lists, and the aging of the population. In general, hospital resources are expensive and scarce, being the operating theatre the most critical and expensive resource. In most hospitals, the operating theatre is a complex system composed of operating rooms (ORs) together with their specialized equipment, preoperative and postoperative facilities and, finally, a diversity of human resources, including surgeons, anesthetists, nurses, etc. To handle such complexity, decisions related to operating theatre management are usually decomposed into three hierarchical decision levels, i.e.: strategic, tactical and operational.
At the strategic level, hospital managers set the volume and the mix of surgeries that will be performed over a long-term horizon (typically, a year) to keep up acceptable size of waiting lists while achieving cost targets, thus making long-term decisions related to the dimensioning of surgical facilities (e.g. build new ORs, adding new recovery beds, etc.), the hiring of surgical staff (e.g. surgeons, nurses, etc.), the purchase of novel surgical devices, and the amount of operating theatre resources required by surgical specialties to perform their surgeries (OR time, number of beds, etc.). Once decisions at strategic level have been made, the operating theatre resources are allocated over a medium-term planning horizon (ranging from few weeks to 6 months) in the tactical level. Since the OR is both a bottleneck and the most expensive facility for most hospitals, surgical specialties are first assigned to OR days (i.e. a pair of an OR and a day) over the planning horizon, until the OR time allocated to each surgical specialty in the strategic level is reached. Then, the above assignment defines aggregate resource requirements for specialties, such as the demand of nurses, drugs, diagnostic procedures, laboratory tests, etc. Finally, the working shifts of human resources and their workload (e.g. the number of surgeries allocated to each surgeon) are defined over the medium-term planning horizon in order to achieve the volume of surgeries set by hospital managers. Finally, the surgical schedule is determined over a short-term planning horizon (ranging from few days to few weeks) at the operational level. The operational level is usually solved into two steps. The first step involves the determination of the date and the OR for a set of surgeries in the waiting list; while in the second step, a sequence of surgeries for each OR within each day in the planning horizon is obtained. Note that only a set of surgeries will be performed during the planning horizon due to capacity constraints (both facilities and human resources). The decomposition of the operational level into the two aforementioned steps intends to reduce the complexity of the resulting problem, although the quality of the so-obtained surgery schedule may be reduced due to the high interdependence among these two steps, being the integrated approach a popular topic of research. At the operational level, a feature greatly influencing the performance is the uncertainty in the surgical activities, as frequently large discrepancies between the scheduled duration and the real duration of the surgeries appear, together with the availability of the resources reserved for emergency arrivals. Despite the importance and the complexity of these hierarchical levels, decisions in practice are usually made according to the decision makers’ experience without considering the underlying optimization problems. Furthermore, the lack of usage of decision models and solution procedures causes the decision makers to consume long times on performing management tasks (e.g. determine the surgical schedule, react to unforeseen events, carry out what-if analyses, etc.), instead of healthcare tasks. The context discussed above stresses the need to provide healthcare decision makers with advanced operations research techniques (i.e. models and solution procedures) in order to improve the efficiency of the operating theatre resources and the quality of the healthcare services at the operational level. This Thesis is aimed at this goal.||es