| It has been a challenge for operating room(OR) management to deal with the contradiction between the ever increasing surgery demand and the shortage in medical staff resources in recent years. Nowadays, the increasing surgery demand along with the aging population, and the prevailing nurse shortage problem due to the high working pressure have become the outstanding contradiction of operation room(OR)’s operation management. It has been a focus to several parties including the government, hospitals, patients, and medical staff. The optimized surgery scheduling as well as the efficient resource allocation is the key to solve such problem and can finally enhance satisfaction on both healthcare service of hospital and job of medical staffs. And the current research mainly focuses on individual surgery scheduling and nurse rostering. Although the individual optimization study can significantly improve the efficiency of the scheduling and the utilization of resources, but it can’t fundamentally solve the common problem of the operation quantity fluctuation and the nurse overtime phenomenon.This paper refers to the decision system modeling method used in manufacturing system modeling –GRAI. The GRAI method is applied to model the hospital’s OR decision-making system. Using the GRAI grid, and the GRAI net modeling tools, an OR operation management decision-making model is built in this paper. Through the visual decision process model by such GRAI grid and GRAI net, the whole decision making process can be analyzed, and the hidden problems can be diagnosed. On the basis of the detected problems, we further suggest the solutions, and propose a new GRAI grid of the time domain-based integrated decision system of OR, which introduces a medium-term integrated decision-making center and a short-term surgeries collection decision center. The medium-term integrated decision center is used to solve the operation problems and the nurse shift problem, and the short-term collection decision center is used to determine the operation day patients and operation resources specific matching problem.According to the new GRAI grid and GRAI net of the proposed time domain-based integrated decision system, a medium-term and a short-term integrated decision model are refined. The medium-term integrated decision model, considering the elective surgery, the nurse shift scheduling, the daily arrangement of specialty, the deadline, the nurse regulations, the preferences and other hard and soft constraints is proposed and is solved using the ant colony algorithm with an improved double layers of surgeries and nurses. In the short-term integrated decision-making model, a complete three stages procedure and the multiple resources involved are covered, and several additional constraints based on the actual situation of domestic hospital OR are further combined with a non-linear integer programming with an objective of minimizing the operation room cost. The ant colony algorithm is designed to solve such short-term surgery scheduling problem. We collect real operation data from hospital and build several test cases to evaluate the proposed approach. The computational results show that the medium-term and short-term integration model have different degree of improvement on several measurement indicators in OR operation management. |
