Research On Physician Resource Collaborative Optimization Problems For Outpatient Departments

With the processing of the healthcare reform and the aging population in China,the society and the market require that the management level of Chinese medical service institutions should have a higher improvement.As a result,hospitals,as important social medical service institutions,are under tremendous pressure.However,current,the operation mode and management mechanism of hospitals in China are still at a backward level,which makes the low effective utilization of the medical service resources and further worsens the contradiction between the demand for medical services and limited medical resources.Especially in outpatient departments,the service quality of the department would directly affect the public’s recognition of the hospital due to the outpatient department is an essential platform for hospitals to the public in providing medical treatment services.Outpatient physicians are the bottleneck resource in the outpatient department,while the current inefficient management strategies worse the situation of the shortage,burnout,and overload of physicians.Such a phenomenon seriously hinders improving hospitals’ service abilities and the construction of modern hospitals.Therefore,we explore the rationality and scientificity of the management of outpatient physicians from four different decision-marking perspectives,to improve the utilization of outpatient physicians and to make significant progress for the management level of Chinese medical services.Based on the summaries and reviews of the existing related literature on physician scheduling problems,and the analysis of the perspectives of hospitals,physicians,and patients,respectively,this dissertation proposes various scenarios,including the imbalance-matched between the qualifications of physicians and the types of services,the re-consultation behaviors of patients,the multiple branches for large hospitals,and the multiple working scenes.This dissertation formulates the mathematical model for each scenario and develops a series of advanced hybrid algorithms based on the exact and heuristic algorithms.The effectiveness and superiorities of the proposed algorithms are verified through a few numerical experiments.The specific research contents and innovation of this dissertation are as follows.(1)An integrated physician scheduling problem considering the multiple qualifications of physicians and the multiple types of outpatient services in outpatient departments is studied and formulated in the corresponding physician planning and scheduling optimization model.For patients,the demands of patients for the different types of outpatient services are considered;For hospitals,the operating revenue and costs are considered in the studied problem;For physicians,the requirements of a better work pattern are considered;For outpatient service,the matching between the qualifications of physicians and the types of services is considered.A heuristic algorithm combining the integrated planning and scheduling heuristic and Variable Neighborhood Search algorithm is developed to solve this studied problem.The physician planning results can be obtained from the encoding of the proposed algorithm and the integrated planning and scheduling heuristic can be applied to get the physician scheduling results.Finally,the performance of the proposed algorithm is verified based on several numerical experiments.(2)An integrated service planning and physician scheduling problem considering reconsultation are studied.This problem is investigated to address physician overload due to without considering the re-consultation of patients in actual outpatient department scenarios.Moreover,integrated service planning and physician scheduling can balance the demand of patients and physicians avoiding causing a shortage or overload of physicians.Such consideration aims to provide better medical services to the public and guarantee the working rights of physicians.The formulated optimization model of the studied problem also considers the demands of hospitals,patients,and physicians.A Column-Generation-based Variable Neighborhood Search Algorithm is developed to tackle the studied problem,which decomposes the proposed model based on the theory of model decomposition of the Column Generation algorithm.The decomposed models are updated and solved iteratively by the Column Generation heuristic framework,and the proposed Variable Neighborhood Search algorithm is embedded in the framework to help to solve the decomposed models.The numerical experimental results verify the performance of the proposed algorithm.(3)The physician scheduling problem in the outpatient department of large hospitals with multiple branches is studied.The problem aims to tackle the problems and challenges of physician planning and scheduling in the large hospital due to the multiple branches.Besides,for each branch,the medical staff scheduling problem is also considered in the studied problem.The objective of the formulated integrated physicians and medical staff scheduling optimization model is to consider the satisfaction and fairness of physicians.A hybrid Sine Cosine and Variable Neighborhood Search algorithm based on Iterated Hungarian algorithm is developed for the studied problem.The proposed Iterated Hungarian algorithm is applied to obtain the scheduling of physicians and medical staff,respectively.The solution updating mechanism of the proposed algorithm is designed based on combining the specific search characteristics of the Sine Cosine and Variable Neighborhood Search algorithm.In the numerical experimental section,the comparison experimental results show that the proposed algorithm outperforms other compared algorithms in solution stability and efficiency.(4)The physician scheduling problem with considering the multiple working scenes in outpatient departments is studied.This problem is derived from the real-world situation where outpatient physicians are required to accomplish different types of tasks in different scenes and studied the whole qualifications of physicians in the department.Besides,the corresponding physician scheduling optimization model is formulated and the complexity of the problem is demonstrated.To solve this problem,a novel Variable Neighborhood Search algorithm based on the Dynamic Programming algorithm is proposed.The Dynamic Programming algorithm is applied to obtain the best task property list for each physician with a specific qualification which can improve the optimality of the proposed algorithm.A variety of neighborhood structures are designed based on the specific features of the studied problem and adopted into the search mechanism of the Variable Neighborhood Search algorithm.Finally,a few numerical experiments verify that the proposed algorithm can get high-quality solutions in an efficient time.This dissertation systematically analyzes and studies the physician scheduling problem in outpatient departments,covering four realistic scenarios,and formulating the corresponding optimization models.A series of efficient optimization algorithms are proposed for the corresponding problem under different scenarios.The study of the dissertation provides theoretical guidance and decision support for hospitals and other medical service organizations to solve personnel scheduling problems,and promotes the research of scientific and refined management of hospital personnel management.It is worth noting that how to use the outpatient data to drive the management of physicians is a major challenge,and for further work,it is needed to consider the uncertainties in the processes of physicians scheduling from both physician and patient perspectives,and to apply the theory of organizational behavior to guide the management of physicians.