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View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by Lirias Scheduling operating rooms: achievements, challenges and pitfalls Samudra M, Van Riet C, Demeulemeester E, Cardoen B, Vansteenkiste N, Rademakers F. KBI_1608 Scheduling operating rooms: Achievements, challenges and pitfalls Michael Samudra · Carla Van Riet · Erik Demeulemeester · Brecht Cardoen · Nancy Vansteenkiste · Frank E. Rademakers Abstract In hospitals, the operating room (OR) Keywords Health care management · Surgery is a particularly expensive facility and thus effi- scheduling · Operating room planning · Review cient scheduling is imperative. This can be greatly supported by using advanced methods that are discussed in the academic literature. In order to 1 Introduction help researchers and practitioners to select new relevant articles, we classify the recent OR plan- Health care has a heavy financial burden for gov- ning and scheduling literature into tables using ernments within the European Union as well as patient type, used performance measures, deci- in the rest of the world. Additionally, while grow- sions made, OR supporting units, uncertainty, re- ing economies and newly emerging technologies search methodology and testing phase. Addition- could lead us to believe that supporting our re- ally, we identify promising practices and trends spective national health care systems might get and recognize common pitfalls when research- less expensive over time, data show that this is not ing OR scheduling. Our findings indicate, among the case. others, that it is often unclear whether an arti- For example, within the USA, the National cle mainly targets researchers and thus contributes Health Expenditure as a share of the Gross Do- advanced methods or targets practitioners and mestic Product (GDP) was 17.4% in 2013 [54]. consequently provides managerial insights. More- On the European continent, even though large dif- over, many performance measures (e.g., overtime) ferences exist across member states, health care are not always used in the correct context. Fur- expenditure as a share of the GDP was 8.7% in thermore, we see that important information that 2012 [193]. Hospitals are responsible for more would allow readers to determine whether the re- than one third of these expenditures [86]. ported research results are relevant to them is of- Within the hospital, considerable attention is ten missing. In order to avoid these pitfalls, we given to operating rooms (ORs) as they represent conclude that researchers need to state whether a significant segment of hospital costs [120]. Out they target researchers or practitioners, motivate of the many aspects of OR management, we focus the choice of the used performance measures and our attention on planning and scheduling prob- mention both setting and method specific assump- lems (the terms planning and scheduling are in this tions. article used interchangeably). Given the importance of OR scheduling, it is M. Samudra, C. Van Riet, E. Demeulemeester, B. Cardoen not surprising that many research groups from the Faculty of Economics and Business, KU Leuven operations research community provide solution E-mail: [email protected] ( ) approaches to the problems that affect it. Reviews B. Cardoen on this literature are important as they help re- Vlerick Business School, Faculty of Economics and Busi- searchers to select relevant articles for their re- ness, KU Leuven search setting and serve as a guide for practition- N. Vansteenkiste, F. Rademakers ers (e.g, hospital manager) to quickly find papers University hospital Leuven that can contain useful managerial insights. 2 M. Samudra, C. Van Riet, E. Demeulemeester, B. Cardoen, N. Vansteenkiste, F. Rademakers Additionally, reviews preferably cover the fol- Table 1 The graphs showing trends are based on papers in the third column, while the tables additionally include the lowing two important aspects. First, they help papers in the second column to identify promising practices and shows recent trends (i.e., hot topics). Second, they identify com- 2000-2003 2004-2014 mon pitfalls or important aspects to consider when Journal 24 137 doing researching in this field. To our knowledge, Proceedings 3 42 there is no recent review on OR planning that con- Other 0 10 siders these latter two aspects. Total 27 189 In order to cover these aspects, we define the following three research tasks. First, to classify the recent OR planning and scheduling literature investigate trends only from 2004 onwards as in (Sec. 3.1-3.7) using a simple, but comprehensive the preceding years not enough articles were pub- framework. For this task, we build up on the work lished to get reliable results (Table 1). carried out by Cardoen et al. [42] and Demeule- We define an article as “technical” if it con- meester et al. [60]. Second, to look for evolutions tains an algorithmic description of a method di- over time, common approaches and relations be- rectly related to OR scheduling. Some articles tween the different classification fields (Sec. 3.1- are missing this algorithmic component and in- 3.8). Third, to identify the common pitfalls (e.g., stead provide managerial insights. Those articles information that we found missing in some arti- are excluded from the classification tables, as not cles) and to develop guidelines that can help re- all classification fields apply to them, but some searchers to avoid them (Sec. 4.1-4.3). of their insights are mentioned in the text. The The purpose of the remaining sections is to ex- quantitative descriptions provided in Sec. 3.1-3.8, plain the research method (Sec. 2.1), to position which give insights into the changing trends set by this paper in the existent group of reviews (Sec. the research community, are exclusively based on 2.2), to introduce the classification fields (intro- the technical contributions. duction of Sec. 3), to discuss the limitations of this The majority of the included articles are re- study (Sec. 4.4) and to describe our main conclu- cent publications (Fig. 1). This reflects the trend sions (Sec. 5). that the amount of published technical articles has been increasing significantly in the recent ten 2 Search Method and Other Reviews years. We do not include topics related to business In Sect. 2.1, we introduce the procedure that we process reengineering, the impact of introducing used to identify relevant articles. In Sect. 2.2, we new technologies, facility design or long-term OR discuss the structure and scope of reviews written expansion. Also, articles that deal with appoint- on similar topics and position our review within ment scheduling are excluded from this review. the context of this existing literature. This is the case as some of the basic assumptions that apply to appointment scheduling are not valid for surgery scheduling. For a review on appoint- 2.1 Search Method ment scheduling, we refer to [48]. We searched the databases Pubmed and Web of Science for relevant articles, which are written 2.2 Other Reviews in English and appeared in 2000 or afterwards. Search phrases included combinations of the fol- In the past 60 years, a large body of literature on lowing words: operating, surgery, case, room, the- OR planning and scheduling has been published. atre(er), scheduling, planning and sequencing. We The literature has been structured and reviewed searched in both titles and abstracts and in addi- by several authors, using a variety of classification tion checked the complete reference list of any techniques and frameworks. We grouped these re- already found article. As we endeavored to con- views based on their scope and structure (Table 2). duct the search process in an unbiased way, we be- Based on the scope of the literature review, we lieve we have obtained a set of articles that objec- distinguish between three levels. The first level tively represents the literature on OR planning. At purely focuses on the OR department (including the end of the search procedure, we identified 216 the post-anesthesia care unit (PACU) and the in- technically oriented papers. Note that we chose to tensive care unit (ICU)). The second level targets Scheduling operating rooms: Achievements, challenges and pitfalls 3 Number of literature based on general areas of concern, such 33 published articles as cost containment. Other reviews structure the literature on the basis of managerial or functional levels [207] and problem characteristics, e.g., the type of the arrival process [110]. Most literature reviews are not only reference points to articles, but also point out topics for fu- ture research. Guerriero and Guido [105] conclude that the three hierarchical levels are rarely stud- 0 ied together and argue that the tactical level has received increased attention in the last ten years. 2004 2009 2014 In contrast, Hans and Vanberkel [112] argue that future research should focus more on the tactical Fig. 1 The number of published technical articles in OR scheduling has been growing over the last decade level. the OR together with other areas that can be of in- Also, May et al. [179] make suggestions and terest in a hospital such as bed planning [26] or argue that it might be promising to broaden the patient flow planning. The third level covers OR focus from operations research techniques to the management in the broader context of patient care economic and project management aspects of and therefore often includes different care services surgery scheduling. Additionally, Vissers et al. [128]. [262] suggest to put a larger emphasis on the mul- In some of the literature reviews articles are tidisciplinary aspects of patient flow control sys- classified based on the three hierarchical decision tems and suggest to experiment with the effect of levels: strategic (long-term), tactical (medium- grouping patients in new ways, such as based on term) and operational (short-term).

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