PROJECT REPORT

PLANNING AND SCHEDULING OF OPERATING

ROOMS USING OPERATIONS RESEARCH
TECHNIQUES
 Report
On

PLANNING AND SCHEDULING OF OPERATING ROOMS USING OPERATIONS

RESEARCH TECHNIQUES

INDU 6111-Theory of Operations Research

Submitted to

Dr. Hossein Hashemi Doulabi

Department of Mechanical and Industrial Engineering

Concordia University
1455 de Maisonneuve Blvd. West
Montreal, Quebec H3G 1M8
CANADA

November 28, 2018

By

Student’s Full Name

Alireza Roueenfar
Amir Moghadasi
Seyed Ehsan Verady Esfahani
Azin Atashi
Ronak Mohajeriravani

Department of Mechanical and Industrial Engineering

Faculty of Engineering and Computer Science Concordia
University
Montreal, Quebec, Canada

ii
 ABSTRACT

Today’s highly competitive business environment makes operations research and, in particular,
linear programing a critical technique to enhance the competitiveness of businesses in any forms
through cost reduction and productivity increase. This study focused on operating rooms’
planning and scheduling optimization using the mathematical modeling techniques learned from
the Theory of Operations Research INDU 6111. This study, therefore, follows the framework and
is based on the deterministic mathematical model developed by Denton et al. by considering
additional constraints such as budget, overtime, type of operating rooms (i.e. heterogeneous),
weekly planning instead of daily planning, and after surgery recovery (i.e. use of ICU)
constraints. Furthermore, a set of hospitals were defined to add more complexity to the existing
model. The data required to conduct this study such as the durations of surgeries, the number of
surgeries per day, etc. were generated based on the appropriate probability distributions found in
the relevant literature. Other required data such as the fixed cost of opening an operating room,
the surgeons and staff’s cost, staff’s overtime cost, etc. were collected and in some cases estimated
form online resources. The Extensible Bin Packing Problem (EBP) is the reference model used
to model this study problem. The bins, items, amount of overloads, and relevant costs, therefore,
will be defined in order to mathematically model the main problem. The main limitation of this
study was the lack of available and reliable data which limits the findings to be interpreted within
the context of this study, and may compromises the reliability of the model. The findings of this
study, therefore, have limited theoretical implications for health-care providers and hospitals to
better manage their operating rooms while reducing costs and increasing patients’ satisfactions.
The developed model under this study was ran in CPLEX optimizer solver and resulted in an
optimal solution for the defined objective function and defined decision variables.

iii
 TABLE OF CONTENTS

ABSTRACT................................................................................................................................................. iii
TABLE OF CONTENTS ............................................................................................................................. iv
LIST OF TABLES ........................................................................................................................................ v
TABLE OF APPENDICES ......................................................................................................................... vi
1. INTRODUCTION............................................................................................................................... 7
1.1 Healthcare in Canada ............................................................................................................................ 7
1.2 Importance of Operating Rooms (ORs) ................................................................................................ 7
1.3 Study Motivation and Model Elements ................................................................................................ 8
1.4 Organization of this Document ............................................................................................................. 9
2. LITERATURE REVIEW................................................................................................................. 10
2.1 Operations Research ........................................................................................................................... 10
2.2 Healthcare in Canada .......................................................................................................................... 10
2.3 Criticality of Operating Rooms ........................................................................................................... 10
2.4 Challenges in Planning and Scheduling Operating Rooms ................................................................. 11
2.5 Classifications necessary for Planning and Scheduling Operating Rooms ......................................... 11
2.6 Common Methods for Planning Operating Rooms ............................................................................. 12
2.7 Previous Studies and Brief of this Study Highlights ........................................................................... 13
3. RESEARCH METHODS ................................................................................................................. 15
3.1 Model Description and Assumptions .................................................................................................. 15
3.2 Numerical Experiment ........................................................................................................................ 21
3.3 CPLEX Optimization Solver .............................................................................................................. 23
4. FINDINGS ......................................................................................................................................... 26
5. CONCLUSIONS ............................................................................................................................... 31
6. REFERENCES .................................................................................................................................. 33

iv
 LIST OF TABLES

Table 3.2.1 – Generated data for numerical experiment and their choice of selection
Table 4.1.1 – Solution Values for Decision variable Xrhd
Table 4.1.2 – Non-Zero Solution Values for Decision variable Yprhd
Table 4.1.3–Solution Values for Decision variable Orhd
Table 4.1.4– Non-Zero Solution Values for Decision variable Zpshd

v
 TABLE OF APPENDICES

Appendix “A”_”INDU 6111 Project Data .xls file”

Appendix “B”_”INDU 6111 Project Data Code .mod file”
Appendix “C”_”INDU 6111 Project Data .dat file”

vi
 1. INTRODUCTION

In this Section a brief introduction to the background of the study is presented continued with
motivation of the study and the organization of the document.

1.1 Healthcare in Canada

Healthcare spending in Canada (in 1997 dollars) has increased each year between 1975 and 2009,
from $39.7 billion to $137.3 billion, or per capita spending from $1,715 to $4089 [2]. In 2013 the
total reached $211 billion, averaging $5,988 per person [3]. Total spending in 2007 was equivalent
to 10.1% of the gross domestic product which was slightly above the average for OECD countries,
and below the 16.0% of GDP spent in the United States [5]. In 2009, the greatest proportion of
this money went to hospitals ($51B), followed by pharmaceuticals ($30B), and physicians ($26B)
[6]. Healthcare costs per capita vary across Canada with Quebec ($4,891) and British Columbia
($5,254) at the lowest level and Alberta ($6,072) and Newfoundland ($5,970) at the highest [26]. It
is also the greatest at the extremes of age at a cost of $17,469 per capita in those older than 80 and
$8,239 for those less than 1 year old in comparison to $3,809 for those between 1 and 64 years
old in 2007 [9]. In 2017, the Canadian Institute for Health Information reported that health care
spending is expected to reach $242 billion, or 11.5% of Canada's gross domestic product for that
year. Total health spending per resident varies from $7,378 in Newfoundland and Labrador to
$6,321 in British Columbia. Public drug spending increased by 4.5% in 2016, driven largely by
prescriptions for tumor necrosis factor alpha and hepatitis C drugs [10].

1.2 Importance of Operating Rooms (ORs)

The operating rooms have been considered to be among the most critical, and most expensive parts
of every hospital which account for around 40% of its total costs. Thus, effective planning and
scheduling the ORs would make great contributions to reducing the costs and improving the profits
of health-care organizations [11] [12] [13] [14].

Surgeries are in fact the most important process being held in health care industry not only in
financial aspects (cost of surgeries, resources, equipment, tools, operating rooms, etc.) but also in
operational terms and flow (patients satisfaction, resource utilization, planning, emergency
management, etc.). Therefore, it is quite clear that improving this process efficiency and

Page 7 of 34
effectiveness is an important goal in hospital management [1]. Being the most important process,
surgeries have also complexity and complication in nature due to their technicality, requirements
and conflicts and uncertain factors. The variation factor and uncertainties in surgeries is obvious;
emergency cases, unpredictable events, incidents during surgery, etc. In addition to such uncertain
environment, there is also a factor conflict in managing/performing surgery process like conflict
when a surgery is being planned; as an example, focus on reducing patients’ waiting time may
increase the overtime and over-utilization of resources [1].

1.3 Study Motivation and Model Elements

This study, therefore, will present an optimization model in order to minimize the cost of opening an
OR (Operating Room) based on the deterministic mathematical model developed by Denton et al.
[1] by considering additional constraints such as budget, overtime, type of operating rooms (i.e.
heterogeneous), weekly planning instead of daily planning, and after surgery recovery (i.e. use of
ICU) constraints. Additionally, a sensitivity analysis will be performed to study the effect of
changes in the constraints on the outcome.

Furthermore, a set of hospitals will be defined to add more complexity to the existing model. The
data required to conduct this study such as the durations of surgeries, the number of surgeries per
day, etc. will be generated based on the appropriate probability distributions found in the relevant
literature. Other required data such as the fixed cost of opening an operating room, the surgeons
and staff’s cost, staff’s overtime cost, etc. will be collected and in some cases estimated form online
resources.

The Extensible Bin Packing Problem (EBP) is the reference model used to model this study
problem. The bins, items, amount of overloads, and relevant costs, therefore, will be defined in
order to mathematically model the main problem. The main limitation of this study is the lack of
available and reliable data which limits the findings to be interpreted within the context of this
study and may compromises the reliability of the model.

The findings of this study, therefore, will have limited theoretical implications for health-care
providers and hospitals to better manage their operating rooms while reducing costs and increasing
patients’ satisfactions.
Page 8 of 34
1.4 Organization of this Document
The remainder of this study is organized as follows:
in §2, literature review of the concept
in §3, research methods including assumptions and the mathematical model of the problem and
basis of numerical experiments,
in §4, findings,
in §5, conclusions,
in §6, list of References.

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 2. LITERATURE REVIEW

In this Section the literature review of he study is presented, starting with the background concept
of the topic, relevant challenges, identification of problem type (i.e. classifications) and finally
description of extent of their consideration in this study.

2.1 Operations Research

Operations Research, a scientific method used to explore the problem of interest, understand the
current situation, and to make better decisions using mathematical models, has a long history in
increasing the productivity and efficiency of various organizations running in variety of areas such
as manufacturing, telecommunications, financial, construction, transportation, public services, and
health care [ 1 5 ] [ 1 6 ] .

2.2 Healthcare in Canada

In 2017, the Canadian Institute for Health Information reported that health care spending is
expected to reach $242 billion, or 11.5% of Canada's gross domestic product for that year. Total
health spending per resident varies from $7,378 in Newfoundland and Labrador to $6,321 in
British Columbia. Public drug spending increased by 4.5% in 2016, driven largely by prescriptions
for tumor necrosis factor alpha and hepatitis C drugs [10].

2.3 Criticality of Operating Rooms

The operating rooms have been considered to be among the most critical, and most expensive parts
of every hospital which account for around 40% of its total costs. Thus, effective planning and
scheduling the ORs would make great contributions to reducing the costs and improving the profits
of health-care organizations [11] [12] [13] [14].

From a bird’s eye view, this study focuses on the application of operations research in health
care industry, and in particular, on the planning and scheduling of operating rooms in health-care
providers or hospitals.

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2.4 Challenges in Planning and Scheduling Operating Rooms
There are numerous challenges in different aspect of the OR scheduling (i.e. utilization of the ORs
in most convenient way). These aspects could be categorized as per following [11]:

1. utilization of resources: an effective OR scheduling needs to take into consideration the optimal
use of not only human resources such as surgeons, nurses, staff, etc, but also facilities,
equipment and tools necessary to perform an operation. Note that this utilization includes
number/amount of usage of such resources according to their availability, priorities, sequence
of use, etc.

2. planning & further scheduling: It is quite clear that there are factors of uncertainty in OR
scheduling process such as the number and duration of a surgery (being the most significant
one), recovery time of a patient (as part of upstream activities), the intake process time of a
patient (as part of upstream activities), etc. which have both time/cost impact.

2.5 Classifications necessary for Planning and Scheduling Operating Rooms

For the first step of OR planning and scheduling, some basic classifications are described based
on surgery timing, diagnostic and performance perspectives, based on which OR planning may
commence [1].

From surgery timing perspective, there are three OR planning classifications based on patient’s
conditions (two of them may even be combined): elective, urgent and emergency. Elective OR
planning which include elective surgeries are the ones in which the surgery can be planned in
advanced and can be performed on an agreed date; such as cosmetic surgeries, certain common
surgeries and the like. Urgent surgeries are the surgeries in which there is no immediate need of
surgery, however, patient’s health condition does not allow the surgery to be postponed for long
(few days). Emergency surgeries are the class in which immediate surgery is required due to
health/safety condition of the patient. The Urgent and Emergency surgeries and be combined and
called non-elective surgeries collectively [1]. In this study the non-elective surgery processes are
not considered because they need to be presented by stochastic modeling.

Page 11 of 34
 From surgery diagnostic perspective, there are two very basic main types of surgery performance
again depending on patient’s condition; Outpatient, Inpatient. When a surgical procedure can be
performed in outpatient setting safely and utilizes the minimum resources (outpatient) or when
opening and preparing an Operating Room (OR)with full staff/equipment is necessary (inpatient)
[11]. In this study the Outpatient surgery processes are not considered because the objective is to
minimize the cost relevant to opening an OR which differs with nature of outpatient surgical
procedure.

From surgery performance perspective, there are three main phases; preoperative, perioperative
and postoperative [17]. Preoperative stage is the stage in which all preparation works are being
done for the patient to get to the OR such as paperwork, medication, examination, etc. In
perioperative stage, the patient is allocated to an OR and surgery is being done. Postoperative stage
is basically the recovery stage in which the surgery is finished, and patient is transferred for
recovery [1]. In this study the preoperative stage is not considered, because in this stage there is no
room (or significant room) for optimization, i.e. processes and resource utilization are routine and
standard.

2.6 Common Methods for Planning Operating Rooms

The planning and scheduling of an OR may be done through two common methods; block-booking
and open-booking. Block-booking is a system of planning in which the hospital assigns necessary
times in specific ORs to individual surgeon (or surgical team) in a periodic scheduling manner (eg:
every week or every month) so that each surgeon will be able to fit their cases in their own assigned
block times. In open-booking system, however, surgeons are not able to or may submit cases ONLY
on a day before surgery and therefore accepted cases will be scheduled based on their priority and
to the limit of capacity. For better understanding, an open-booking case might be case in which the
patient is travelling to a certain hospital to go under surgery and their case acceptance (candidacy
for surgery) is only certain once they arrive to the hospital and hospital examination procedure is
performed on them. Considering that the inconvenience of patient returning again for the surgery,
the hospital tries to offer the surgery after mentioned examination and patient’s candidacy
acceptance [11]. This study covers optimization of block-booking planning type above, as long as
they are elective and inpatient surgeries due to planning horizon of the model.

Page 12 of 34
It is clear that regardless of the basic type of any surgery that may need to be performed, the ORs
are the same from facilities, staffing and scheduling perspectives, meaning that in each hospital,
ORs are situated individually in hospital building but mostly share common facilities such as
medical resources, sterilization, storages, consumables, camera centers, intake resources, recovery
area/resources and etc and also share certain staffs such as nurses, surgeons, assistants,
anesthesiologist, etc. The basic categorization of ORs only differ them in degree of certain resource
utilization but maintaining the main resources. It can be seen that the cost of opening an OR is very
high and it is also clear that the main part of it belongs to labor cost relevant to staffing the OR plus
upstream & downstream activities. Such staffing cost is divided in two separate categories of fixed
and variable overtime costs which respectively represent the total cost of opening an OR for a fixed
planned duration (usually 8 hours) and the extra time that an OR may need to remain opened beyond
its planned fixed time [11].

2.7 Previous Studies and Brief of this Study Highlights

In terms of modeling, there are numerous papers on the subject. Starting from classification of OR
planning, there are some papers in which the differentiation between inpatient/outpatient surgeries
are made whereas in others both groups are treated the same. In a paper by Adan and Vissers [18],
such differentiation can be assumed to be made in modeling in which outpatients are treated as
inpatients with a length of stay of one day [19].

With respect to surgery timing (i.e. elective and non-elective) numerous studied were made as well
to find the most optimal way of treating the matter; Wullink et al. [20], studied the efficiency of
reserving ORs for non-elective surgeries by running discrete-event simulation and concluded that
they found that the overtime and OR utilization was significantly improved when the capacity was
spread over multiple ORs [19].

Some papers also considered the urgency and priority of patients, like Elena Tefani and Angela
Testi paper [21] in which in addition to considering patients waiting time (elapsed time since
patient’s arrival) in objective function, there is an emergency (urgency coefficient) to note and
incorporate patients condition in giving them priority.

Page 13 of 34
In terms of objective function, different papers studied different objectives, one aspect being the
ones dealing with financial aspects, i.e. minimization of OR opening cost, maximizing patients’
satisfaction, minimization of patients waiting time and the like. There are cases in which the
objectives are integrated and/or are implicit in modeling constraints (i.e. minimizing idle time in
between surgeries of one specific OR and consequently minimizing waiting time of surgery team is
implicit in maximizing utilization of that specific OR) [1] .

In review of the previous studies, the focus is mainly on the model developed by Denton et al. [11]
in which a multiple-OR scheduling problem is presented with focus on stochastic scheduling and
advance planning as per the following: a stochastic optimization model is presented for assignment
of surgeries to Operating Rooms on a specific day and the planning. The objective function is a
minimization function with elements of fixed cost and variable cost of overtime when Operation
rooms remain open more than their planned session (OR planning and scheduling is modeled for
surgeries-to-OR allocation on night before surgeries and the perioperative phase and there are no
considerations for the postoperative phase of surgery).

It is also worth mentioning that presented mathematical model in Denton et al. [11] can be viewed
as extensions of the deterministic and extensible bin-packing problem. Extensible bin-packing is a
variation of bin packing problem in which the number of bins to use is specified as part of the input,
and bins may be extended to hold more than the usual unit capacity. The cost of a bin is one if it is
not extended, and the size if it is extended [22].

In this study a constraint, relevant to postoperative phase, is included in the model in model, by
which a decision making for allocation of surgeries to ORs be affected (considering planning
horizon under this study is weekly). For this constraint the model presented by Elena Tefani and
Angela Testi paper [21] here below is developed: a 0–1 linear and a heuristic algorithm are presented
and the problem is modeled focusing on assignment of wards and ORs in a given planning horizon
with set of patients to be operated each day. Practical constraints such as surgery duration, maximum
overtime, patient length of stay (LOS), available equipment, number of surgeons, number of stay
and ICU beds, are also considered. The objective function also includes prioritization in patients’
assignments. In this study, prioritization for allocation of surgeries is not considered.

Page 14 of 34
 3. RESEARCH METHODS

In this Section all considerations and assumptions are described in detail (with all relevant choice
of selections), followed by the mathematical model. This Section also includes numerical
experiment and relevant analysis.

3.1 Model Description and Assumptions

As mentioned in Section 2 of this project report, a model based on Denton et al. [11] is developed
and further completed by model presented in Elena Tefani and Angela Testi paper [21], both for
allocation of surgeries to operating room but with different objectives, constraints and analysis.
The very basis of the model is the Extensible Bin Packing (EBP) problem in which the Bins
represents the ORs and the items represent the surgeries. Size of the Bin is the time an OR can
stay opened and duration of surgeries are size of items. It is clear that the overtime can be defined
(in EBP as any time that an OR shall stay opened beyond its standard time).

Based on all above and as a result, deterministic mathematical model is presented which
minimizes the total cost of opening an operating room including both the fixed costs of opening
an operating room and the variable costs such as staff, and overtime costs considering following
assumptions:

1) in this study the non-elective surgery processes are not considered because they need to be
presented by stochastic modeling (time of arrival of patients, their classification, duration of
stay, etc. are unknown for advanced planning). It is worth mentioning that there are two ways
known to treat the concept; one is to reserve a capacity in certain ORs for such non-elective
surgeries in advance (or sometimes even partial capacity of an OR session), another approach is
to define a slack variable in mathematical modeling to the number of ORs of elective surgeries
which allows for non-elective surgeries to be scheduled in between two elective surgeries.
Although it is clear that reserving OR capacities lead to low utilization of dedicated rooms, the
non-elective surgery processes are not considered in model under this study based on
explanation of the first paragraph [1].

Page 15 of 34
2) in this study the Outpatient surgery processes are not considered because the objective is to
minimize the cost relevant to opening an OR which differs with nature of outpatient surgical
procedure.
3) in this study the preoperative stage is not considered, because in this stage there is no room
(or better say significant room) for optimization, i.e. processes and resource utilization are
routine and standard.
4) this study covers optimization of block-booking planning type, as long as they are elective and
inpatient surgeries due to planning horizon of the model.
5) this study considers multi OR availability (in line with assumptions above) and takes into
account the type (exclusivity) of specific patients’ conditions when assigning them (their
surgery) to ORs. For better understanding, let’s consider that a patient needs to be operated in
a very specific type of OR like being equipped with robotic tools, or being under special
treatment of sterilizing for special infectious surgeries, etc. This matter reflects in model under
this study as defining subset of ORs and a binary input variable to allow allocation of patients
(i.e. surgeries) to their respective appropriate ORs.
6) this study considers multi OR availability (in line with assumptions above) in a pool of
hospitals and not only one hospital. This assumption considers a global budget of pooled
hospitals since it is the budget that determine the total OR time available [1]. Usually
healthcare institutions receive limited amount of budget from ministry of health and
accordingly they have to make their decisions under this budget constraint. Also, multiple
hospitals are considered in optimization problem because usually hospitals in a city first works
under universal healthcare system in Canada, therefore, they can pool their resources and they
can share their operating room capacities, and it allows to maximize the number of patients
scheduled, and they can minimize the number of operating rooms required to schedule for the
same number of patients.
7) this study considers a planning horizon of one week, meaning that at beginning of each week
the block & open bookings of ORs (in line with assumptions above) are planned for the
surgeries of whole week.
8) this study considers both perioperative phase and postoperative phase. The consideration of
postoperative phase (i.e. utilization of downstream units which in this study is limited to Ward
bed or ICU (if necessary due to patient’s medical condition)) is important because the decision
Page 16 of 34
 made today, is impacted by the decision made in previous days. For instance, if a patient stays
in the ICU bed for more than five days, the decision that is made today, would require to
consider the amount of time that the patient requires from five days ago.
9) amount of budget, number of Hospitals, number of ORs and length of OR sessions available
for elective surgeries, number of available downstream units, number of patients requiring
surgeries, duration of surgeries, are all known and invariable during planning horizon.
10) the model under this study, does not cover any uncertainties such as length of stay, duration
of surgeries and the like.

Notations:
Sets:
P p ∈ P, index for surgeries(patients), P = {1, …, p}.
R r ∈ R, index for operating rooms (ORs), R = {1, …, r}.
D d ∈ D, index for days of a week, D = {1, …, d}.
H h ∈ H, index for hospitals, H = {1, …, h}.
S s ∈ S, index for type of downstream units, S = {1, …, s} (1: ICU, 2: Ward bed).

Inputs:
ch fixed cost to open an OR in hospital h (equal for all ORs in all 3 hospitals due to hospitals regulations)
c' h variable cost per unit time for overtime hours (to keep an OR open past time T) in hospital h
(equal for all ORs in all 3 hospitals due to hospitals regulations, also we should consider that c′h is always
greater than unit value of ch if we consider ch unit value = )
dp duration for surgery (patient) p
T planned session length for each OR (equal for all ORs in all 3 hospitals due to hospitals regulations)
m Total budget considered for opening ORs and overtime hours in all 3 hospitals
bh Total budget considered for overtime hours in hospital h (Also we should consider that b for each
hospital should be less than total budget m (bh<m))

nshd available number of downstream rooms type s in hospital h on day d

aps binary input variable representing whether the surgery (patient) p needs downstream unit type
a'pr binary input variable representing whether the surgery (patient) p needs to be gone to which type of
operating room r
fhd the number of available operating rooms in hospital h on day d
T' the maximum overtime possible for each operating room (let’s say 2 hours, equal for all ORs in all
hospitals due to hospitals regulations)
βp binary input variable representing whether the patient needs downstream unit type 1 (ICU)

Page 17 of 34
Decision variables:
Xrhd binary decision variable representing whether OR r is opened in hospital h on day d
Yprhd binary decision variable representing whether surgery (patient) p is allocated to OR r of hospital h
on day d
Orhd decision variable representing overtime for OR r in hospital h on day d (hours)
Zpshd binary decision variable representing whether surgery (patient) p is allocated to downstream unit s
of hospital h on day d
Objective function:

min (𝑐ℎ 𝑋𝑟ℎ𝑑 + 𝑐′ℎ 𝑂𝑟ℎ𝑑 )

∈ ∈ ∈

Constraints:
subject to:

∀ r∈ Rp , h ∈ H, d ∈ D and
𝑑 𝑌 ≤𝑇𝑋 +𝑂 Pr = { p ∈ P | a′pr =1} , (1)
∈
Rp = { r ∈ R | a′pr =1}

𝑌𝑝𝑟ℎ𝑑 = 1 (2)
∀ p∈ P
∈ ∈ ∈

𝑌 ≤𝑋 ∀ p∈ P , r∈ Rp , h ∈ H, d ∈ D (3)

𝑂 ≤ 𝑇′ 𝑋 ∀ r∈ R , h ∈ H, d ∈ D (4)

𝑐′ℎ 𝑂𝑟ℎ𝑑 ≤ 𝑏ℎ
∀ h∈H (5)
∈ ∈

′
𝑐ℎ 𝑋𝑟ℎ𝑑 + 𝑐 ℎ 𝑂𝑟ℎ𝑑 ≤𝑚 (6)
∈ ∈ ∈

𝑍 ≤𝑛 ∀ s∈ S , h ∈ H, d ∈ D and
(7)
∈ Ps = { p ∈ P | aps =1}

𝑍 ≤𝑌 ∀ p∈ P , r∈ Rp , s ∈ S, h ∈ H, d ∈ D (8)

𝑋 ≤𝑓 ∀ h ∈ H, d ∈ D (9)
∈

𝑍 =1 ∀ h ∈ H, d ∈ D (10)
∈

Page 18 of 34
 𝑌 + 𝑌 ≤𝑛 ∀ r∈ Rp , h ∈ H, d ∈ D, s=2 (ward
(11)
∈ 𝑝∈ 𝑃𝑟 𝑙 ∈ 𝐷:𝑙<𝑑 bed) and Rp = { r ∈ R | a′pr =1}

𝛽 𝑌 + 𝛽 𝑌
∀ r∈ Rp , h ∈ H, d ∈ D, s=1 (ICU)
∈ 𝑝∈ 𝑃𝑟 𝑙 ∈ 𝐷:𝑙<𝑑 (12)
and Rp = { r ∈ R | a′pr =1}
≤𝑛

Xrhd Yprhd Zpshd ∈ { 0,1} ∀ p∈ P , r∈ R , h ∈ H, d ∈ D, s ∈ S (13)

Orhd ≥0 ∀ r∈ Rp , h ∈ H, d ∈ D (14)

The objective function, minimizes the total cost of opening all types of operating rooms in all
three hospitals in relevant defined planning horizon, including both the fixed costs of opening
ORs and the variable costs of overtime.

Constraint (1) regulates the capacity constraint relevant to duration of each surgery (for each OR
type r in each hospital h and on each day d, so that its duration may go beyond the planned session
length for OR type r with corresponding value of Orhd (i.e. overtime for OR r in hospital h on day
d). This constraint also respects patients’ specific required type of OR (relevant subset 𝑟 ∈ 𝑅
where Rp= {r ∈ R | a′ pr =1}).

Constraint (2) guarantees that for each patient (surgery), ONLY ONE surgery (patient) p is
allocated to any available/relevant OR r of hospital h on day d, while respecting patients specific
required type of OR (relevant subset 𝑟 ∈ 𝑅 where Rp = {r ∈ R | a′ pr =1} guarantees such concept).

Constraint (3) ensures allocation of surgery (patient) p to OR r of hospital h on day d is done

ONLY WHEN OR r is opened in hospital h on day d

Constraint (4) guarantees, WHEN OR r is opened in hospital h on day d, that amount of overtime
for OR r in hospital h on day d be always less than the maximum overtime possible for each
operating room (let’s say 2 hours, equal for all ORs in all 3 hospitals due to hospitals regulations)

Constraint (5) assures that in each hospital, total overtime cost of ORs opened in all days, is within
(less than/ equal to) total budget considered for overtime hours of that hospital.

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Constraint (6) guarantees that sum of total fixed cost of opening all ORs and total overtime costs
of surgeries in all hospitals on all days (objective function) is within the total global allocated
budget; i.e. total budget considered for opening ORs and overtime hours in all 3 hospitals.

Constraint (7) guarantees that for each downstream unit in each hospital on each day, total number
of surgery (patient) p allocated ONLY to available number of downstream rooms type s in hospital
h on day d, while respecting patients specific required type of downstream unit (relevant subset
𝑝 ∈ 𝑃 where 𝑃 = {p ∈ P | aps =1} guarantees such concept).

Constraint (8) ensures allocation of surgery (patient) p to downstream unit s of hospital h on day
d is done ONLY WHEN surgery (patient) p is allocated to OR r of hospital h on day d (note that
with reference to constraint (3),” ONLY WHEN OR r is opened in hospital h on day d” is already
respected).

Constraint (9) guarantees that, for each hospital, on each day, total number of ORs opened in
hospital h on day d are less than equal to the number of available operating rooms in hospital h on
day d.

Constraint (10) guarantees that guarantees that, for each hospital, on each day, ONLY ONE
surgery (patient) p is allocated to any available downstream unit s of hospital h on day d, respecting
patients specific required type of downstream unit (relevant subset 𝑝 ∈ 𝑃 where 𝑃 = {p ∈ P | aps
=1} guarantees such concept).

Constraint (11) assures that for specific downstream unit type 2 (i.e. ward bed) of each specific
OR, in each hospital on each day, total number of surgery (patient) p allocated to OR r of hospital
h on day d plus total number of existing(*)1patients are less than/ equal to available number of

(*)
“existing” is treated as patients already occupying ward beds on days before d in mathematical model under this study. This is
treated as defining the range of summation over “ 𝑎 ∈ 𝐷: 𝑙 < 𝑑 “

(**)
“existing” is treated as patients already occupying ICUs on days before d in mathematical model under this study. This is

Page 20 of 34
downstream rooms type 2 (i.e. ward bed) in hospital h on day d.

Considering the mathematical modeling of this constraint, it is important to note that this
constraint limits the number of patients who can be operated on each day in each specific OR of
each hospital, to availability of Ward bed in that specific hospital on that specific day. In other
words, if there are no available ward beds, surgery allocation will not take place and therefore
patient will not be operated.

Constraint (12) similarly to constraint (11), assures that for specific downstream unit type 1 (i.e.
ICU) of each specific OR, in each hospital on each day, total number of surgery (patient) p
allocated to OR r of hospital h on day d plus total number of existing(**) patients are less than/
equal to available number of downstream rooms type 1 (i.e. ICU) in hospital h on day d.

Considering the mathematical modeling of this constraint, it is important to note that this
constraint first check whether the patient who can be operated on each day in each specific OR of
each hospital needs downstream unit type 1 (ICU) and if yes, the model limits the number of such
patients to availability of ICU in that specific hospital on that specific day. In other words, when
a patient’s needs to be hospitalized in ICU and there are no available ICU, surgery allocation will
not take place and therefore patient will not be operated.

Constraint (13) definition of binary decision variables of the problem.

Constraint (14) non-negativity of decision variable of the problem.

3.2 Numerical Experiment

The presented model in Section 3.2 of this project report has been numerically experimented based
on assumed/generated numeric values summarized with their choice of selection in table below:

treated as defining the range of summation over “𝑙 ∈ 𝐷: 𝑙 < 𝑑 “

Page 21 of 34
 numeric value (in
parameter definition choice of selection
units)

P p ∈ P, index for surgeries(patients) n=100 constant number

R r ∈ R, index for operating rooms (ORs) R={1,2,3} constant number

D d ∈ D, l ∈ D: l<d, index for days of a week D={1,2,…,5} constant number

H h ∈ H, index for hospitals H={1,2,3} constant number

s ∈ S, index for type of downstream units (Ward bed,

S ICU)
S={1,2} constant number

random numbers based on uniform

fixed cost to open an OR in hospital h (equal for all 4.6k, 4.8k,3.6k
ch ORs in all 3 hospitals due to hospitals regulations)
distribution in generated in excel
USD
[4k-6k] USD

variable cost per unit time for overtime hours (to keep
c'h an OR open past time T) in hospital h
1012, 900, 675 USD hourly rate: ∗ 1.5

random numbers based on normal

ref: xls sheet distribution in generated in excel
dp duration for surgery (patient) p
Duration_of_surgeries (mean 180, std.dev. 60, min 45,
max 600) minutes

planned session length for each OR (equal for all ORs

T in all 3 hospitals due to hospitals regulations)
480 minutes constant number

Total budget considered for opening ORs and

m overtime hours in all 3 hospitals
80 k USD constant number

Total budget considered for overtime hours in hospital

bh h
5 k USD constant number

available number of downstream rooms type s in 5 ICUs

nshd hospital h on day d
constant number
10 Ward beds
binary input variable representing whether the surgery random 0-1 values in excel for
ref: xls sheet
aps (patient) p needs downstream unit type s in hospital h randomly distribution of patients
on day d Downstream_Units
needing ICU
random 0-1 values in excel for
binary input variable representing whether the surgery
ref: xls sheet Hospital randomly distribution of special
a'rp (patient) p needs to be gone to which type of operating
room r of hospital h on day d Costs case surgeries to three types of
ORs

the number of available operating rooms in hospital h constant number, for each day in
fhd on day d
5
each hospital
the maximum overtime possible for each operating
T' room (equal for all ORs in all 3 hospitals due to 120 minutes constant number
hospitals regulations)
random 0-1 values in excel for
binary input variable representing whether the patient ref: xls sheet
βp needs downstream unit type 1 (ICU)
randomly distribution of patients
Downstream_Units
needing ICU
Table 3.2.1 – Generated data for numerical experiment and their choice of selection where applicable

Page 22 of 34
3.3 CPLEX Optimization Solver
In order to put the above data in practice, the model file of the full mathematical model in below
is provided and have been run on CPLEX model for obtaining the results. The choice of CPLEX
as optimization solver is its accessibility for students and the fact of being under the coverage of
course materials.

Notes/ consideration for coding: due to CPLEX coding requirements in .mod file, the following
changes in name of parameters are applied:
a. dp is replaced by dup
b. c' h is replaced by coh

c. T' is replaced by TO

d. a'pr is replaced by kpr

e. βp is replaced by ip

Declaration of data structure Declaration of decision variables

range P = 1..p; int m = …; dvar boolean X [R][H][D] = …
range R = 1..r; int T = … dvar boolean Y [P][R][H][D] = …
range D = 1..d; int T' = … dvar float+ O [R][H][D] = …
range H = 1..h; dvar boolean Z [P][S][H][D] = …
range S = 1..s; float c [H] = …
float c' [H] = …
int p = …; float d [P] = …
int r = …; float b [H] = …
int d = …; float a [P][S] = …
int h = …; float a' [P][R] = …
int s = …; float f [H][D] = …
float β [P] = …

int u = …
int v = …
int w = …

int n[1..s*h*d] = ...;

int nArray[u in 1..s, v in 1..h,w in 1..d] =
n[w+d*(v-1)+h*d*(u-1)];
execute {
writeln(nArray);
};
Page 23 of 34
 Objective function
minimize sum (r in R ,h in H , d in D) c[h]*X[r][h][d] +co[h]*O[r][h][d];
Set(s) of Constraints
subject to {
//1
forall (r in R: k[p][r] == 1, h in H , d in D)
sum (p in P: k[p][r] == 1) du[p] * Y[p][r][h][d] <= T * X[r][h][d] + O[r][h][d];
//2
forall (p in P)
sum (r in R: k[p][r] == 1, h in H , d in D) Y[p][r][h][d] == 1;
//3
forall (p in P , r in R: k [p][r] == 1, h in H , d in D)
Y[p][r][h][d] <= X[r][h][d];
//4
forall (r in R , h in H , d in D)
O[r][h][d] <= TO * X[r][h][d];
//5
forall (h in H)
sum (r in R , d in D) co [h] * O[r][h][d] <= b[h] ;
//6
sum (h in H , r in R , d in D) c[h] * X[r][h][d] + co [h] * O[r][h][d] <= m;
//7
forall (s in S , h in H , d in D)
sum (p in P: a [p][s] == 1) Z[p][s][h][d] <= n[s*h*d];
//8
forall (p in P , r in R: k [p][r] == 1, s in S , h in H , d in D)
Z[p][s][h][d] <= Y[p][r][h][d];
//9
forall (h in H , d in D)
sum (r in R) X[r][h][d] <= f[h][d];
//10
forall (h in H , d in D)
sum (p in P: a [p][s] == 1) Z[p][s][h][d] == 1;
//11
forall (r in R: k [p][r] == 1, h in H , d in D, s in S)
sum (p in P: k [p][r] == 1) Y[p][r][h][d] + sum (p in P: k[p][r] == 1, l in D: l<d)
Y[p][r][h][d] <= n[s*h*d];
//12
forall (r in R: k [p][r] == 1, h in H , d in D, s in S)
sum (p in P: k [p][r] == 1) i [p] * Y[p][r][h][d] + sum (p in P: k [p][r] == 1, l in D:
l<d) i [p] * Y[p][r][h][d] <= n[s*h*d];
}
The .mod file stated above is Appendix “B”_”INDU 6111 Project Data Code .mod file” of this
project report.

Page 24 of 34
It is worth mentioning that the above declared structures in .mod file were all given a numerical
value either internally or externally (link to an excel worksheet) in relevant .dat file with details
described here below:

p = 100;
h = 3;
r = 3;
d = 5;
s = 2;
T = 480;
TO = 120;
u = 2;
v = 3;
w = 5;

SheetConnection sheet("Alireza.xlsx");

c from SheetRead(sheet,"'Hospital_Costs'!C4:C6");
co from SheetRead(sheet,"'Hospital_Costs'!D4:D6");
du from SheetRead(sheet,"'Duration_of_surgeries'!C3:C102");
m from SheetRead(sheet,"'Budget'!A2:A2");
b from SheetRead(sheet,"'Budget'!B2:B4");
n from SheetRead(sheet,"'Downstream'!D2:D31");
a from SheetRead(sheet,"'Downstream_Units'!B5:C104");
k from SheetRead(sheet,"'Hospital_Costs'!C10:E109");
f from SheetRead(sheet,"'Hospital_Costs'!F3:J5");
i from SheetRead(sheet,"'Downstream_Units'!B5:B104");

The .dat file stated above is Appendix “C”_”INDU 6111 Project Data .dat file” and the excel file
containing generated data to which the above declared parameters are linked to, is Appendix
“A”_”INDU 6111 Project Data .xls file”of this project report.

Page 25 of 34
 4. FINDINGS

Based the data and structures presented in Section 3.3, the configuration model was run in CPLEX
optimization solver. Relevant solution and further analysis are described in detail in this Section
of the Project Report.

For sake of reference, this model which is solved by CPLEX, includes both integer and real
variables and is generally known as mixed integer-linear programs (MILP).

Based on the solution result obtained after running the CPLEX, the Optimal Solution for Objective
Function is 69000 USD (// solution (optimal) with objective 69000). Also, the solution for
each of the Decision Variables are as per following:

Xrhd binary decision variable representing whether OR r is opened in hospital h on day d

R (size H (size D (size R (size H (size D (size

3) 3) 5) Value 3) 3) 5) Value
1 1 1 1 2 2 4 0
1 1 2 0 2 2 5 0
1 1 3 1 2 3 1 0
1 1 4 1 2 3 2 0
1 1 5 1 2 3 3 0
1 2 1 1 2 3 4 0
1 2 2 1 2 3 5 0
1 2 3 1 3 1 1 0
1 2 4 1 3 1 2 0
1 2 5 1 3 1 3 0
1 3 1 1 3 1 4 0
1 3 2 1 3 1 5 0
1 3 3 0 3 2 1 0
1 3 4 1 3 2 2 0
1 3 5 1 3 2 3 0
2 1 1 0 3 2 4 0
2 1 2 1 3 2 5 0
2 1 3 0 3 3 1 0
2 1 4 0 3 3 2 0
2 1 5 0 3 3 3 1
2 2 1 0 3 3 4 0
2 2 2 0 3 3 5 0
2 2 3 0 - - - -
Table 4.1.1 – Solution Values for Decision variable Xrhd

Page 26 of 34
 Yprhd binary decision variable representing whether surgery (patient) p is allocated to OR r
of hospital h on day d

P (size 100) R (size 3) H (size 3) D (size 5) Value

1 2 1 2 1
2 1 1 3 1
3 2 1 2 1
4 3 3 3 1
5 3 3 3 1
6 1 2 2 1
7 3 3 3 1
8 1 2 5 1
9 2 1 2 1
10 2 1 2 1
11 1 1 4 1
12 3 3 3 1
13 2 1 2 1
14 1 2 1 1
15 2 1 2 1
16 3 3 3 1
17 2 1 2 1
18 3 3 3 1
19 3 3 3 1
20 2 1 2 1
21 3 3 3 1
22 1 2 4 1
23 2 1 2 1
24 3 3 3 1
25 3 3 3 1
26 2 1 2 1
27 2 1 2 1
28 3 3 3 1
29 3 3 3 1
30 1 1 1 1
2
Table 4.1.2 – Non-Zero Solution Values for Decision variable Yprhd

2Due to space constraint, ONLY non-zero solution values of Yprhd are presented above and complete solution is in
excel file Appendix “A”_”INDU 6111 Project Data .xls file” of this project report.
Page 27 of 34
 Yprhd binary decision variable representing whether surgery (patient) p is allocated to OR r
of hospital h on day d

P (size 100) R (size 3) H (size 3) D (size 5) Value

31 3 3 3 1
32 2 1 2 1
33 3 3 3 1
34 3 3 3 1
35 3 3 3 1
36 1 3 1 1
37 1 1 1 1
38 2 1 2 1
39 1 2 2 1
40 3 3 3 1
41 2 1 2 1
42 2 1 2 1
43 1 1 1 1
44 3 3 3 1
45 1 3 2 1
46 2 1 2 1
47 3 3 3 1
48 3 3 3 1
49 2 1 2 1
50 3 3 3 1
51 3 3 3 1
52 2 1 2 1
53 1 3 1 1
54 2 1 2 1
55 1 3 4 1
56 1 3 5 1
57 3 3 3 1
58 2 1 2 1
59 3 3 3 1
60 2 1 2 1
61 3 3 3 1
62 2 1 2 1
63 3 3 3 1
64 2 1 2 1
65 3 3 3 1
3
continue Table 4.1.2– Non-Zero Solution Values for Decision variable Yprhd

3Due to space constraint, ONLY non-zero solution values of Yprhd are presented above and complete solution is in
excel file Appendix “A”_”INDU 6111 Project Data .xls file” of this project report.
Page 28 of 34
 Yprhd binary decision variable representing whether surgery (patient) p is allocated to OR r
of hospital h on day d

P (size 100) R (size 3) H (size 3) D (size 5) Value

66 2 1 2 1
67 2 1 2 1
68 2 1 2 1
69 3 3 3 1
70 3 3 3 1
71 2 1 2 1
72 1 2 1 1
73 2 1 2 1
74 2 1 2 1
75 2 1 2 1
76 3 3 3 1
77 3 3 3 1
78 2 1 2 1
79 2 1 2 1
80 2 1 2 1
81 2 1 2 1
82 3 3 3 1
83 1 2 3 1
84 3 3 3 1
85 3 3 3 1
86 3 3 3 1
87 3 3 3 1
88 3 3 3 1
89 3 3 3 1
90 2 1 2 1
91 3 3 3 1
92 1 1 1 1
93 3 3 3 1
94 1 2 1 1
95 2 1 2 1
96 3 3 3 1
97 2 1 2 1
98 2 1 2 1
99 2 1 2 1
100 1 1 5 1
4
Y
continue Table 4.1.2– Non-Zero Solution Values for Decision variable prhd

4Due to space constraint, ONLY non-zero solution values of Yprhd are presented above and complete solution is in
excel file Appendix “A”_”INDU 6111 Project Data .xls file” of this project report.
Page 29 of 34
 Orhd decision variable representing overtime for OR r in hospital h on day d (hours)

R (size H (size D (size R (size H (size D (size

3) 3) 5) Value 3) 3) 5) Value
1 1 1 4.938271605 2 2 4 0
1 1 2 0 2 2 5 0
1 1 3 0 2 3 1 0
1 1 4 0 2 3 2 0
1 1 5 0 2 3 3 0
1 2 1 5.555555556 2 3 4 0
1 2 2 0 2 3 5 0
1 2 3 0 3 1 1 0
1 2 4 0 3 1 2 0
1 2 5 0 3 1 3 0
1 3 1 7.407407407 3 1 4 0
1 3 2 0 3 1 5 0
1 3 3 0 3 2 1 0
1 3 4 0 3 2 2 0
1 3 5 0 3 2 3 0
2 1 1 0 3 2 4 0
2 1 2 0 3 2 5 0
2 1 3 0 3 3 1 0
2 1 4 0 3 3 2 0
2 1 5 0 3 3 3 0
2 2 1 0 3 3 4 0
2 2 2 0 3 3 5 0
2 2 3 0 - - - -
Table 4.1.3–Solution Values for Decision variable Orhd
Zpshd binary decision variable representing whether surgery (patient) p is allocated to downstream
unit s of hospital h on day d

P S H D P S H D
(size (size (size 3) (size 5) Value (size (size (size 3) (size 5) Value
100) 2) 100) 2)
2 2 1 3 1 45 2 3 2 1
6 2 2 2 1 55 2 3 4 1
8 2 2 5 1 56 2 3 5 1
11 2 1 4 1 83 2 2 3 1
16 2 3 3 1 94 2 2 1 1
22 2 2 4 1 99 2 1 2 1
36 2 3 1 1 100 2 1 5 1
43 2 1 1 1 - - - - -
5
Table 4.1.4– Non-Zero Solution Values for Decision variable pshd
Z

5Due to space constraint, ONLY non-zero solution values of Zpshd are presented above and complete solution is in
excel file Appendix “A”_”INDU 6111 Project Data .xls file” of this project report.
Page 30 of 34
 5. CONCLUSIONS

Surgeries are in fact the most important process being held in health care industry not only in
financial aspects (cost of surgeries, resources, equipment, tools, operating rooms, etc.) but also in
operational terms and flow (patients satisfaction, resource utilization, planning, emergency
management, etc.). Therefore, it is quite clear that improving this process efficiency and
effectiveness is an important goal in hospital management. Being the most important process,
surgeries have also complexity and complication in nature due to their technicality, requirements
and uncertain factors [1].

In this Project Report a model based on Denton et al. [1] and Angela Testi paper [21] model was
developed focusing on optimization (minimization) of cost of opening Operating Rooms, based
on a 5-day planning horizon which incorporated additional constraints to include the global
budgeting of hospitals, respecting (subset assignment) of surgeries (patients) to special and
specific Operating Rooms and accepting any such assignment in case of availably of Downstream
resources.

A Numerical Experiment was performed based on data generated for global cost minimization of
three hospitals, each having five Operating Rooms on each day of week (of three kinds), each
having an overtime budget constraint and downstream resources constraints. 100 patients were
considered as input with global budget of 80,000 USD for 8-hour session time of each Operating
Room as normal working hours and maximum allowable overtime of 2 hours.

The result brought opening of certain Operating Rooms of certain hospitals in specific days of
week with total minimum cost of 69,000 USD (including fixed cost and overtime).

For sakeof clarity, the optimal value of objective function (i.e. 69,000 USD) is the global budget
of three hospitals to open their Operation Rooms during 5 working days of the week for 100
patients requiring surgery, considering each patient’s need for being operated in a specific kind of
Operationg Room (infectious, robotic or ordinary) while accepting assignments of surgeries to
Operating Rooms for patients for whom the Downstream services are available (Downstream
services being Ward bed or ICU).
Page 31 of 34
Although the effort made under this Project Report was to incorporate everyday routine and
practical constraints in already presented models, there are still some cases which could be
considered for further developments which add to the complexity. Some examples include:

- Patients’ (surgeries’) assignment prioritization

- Surgery sequencing

- Possibility of simultaneous operations

Page 32 of 34
 REFERENCES

[1] Q. Li, Multi-objective Operating Room Planning and Scheduling, A Dissertation Presented in Partial
Fulfillment of the Requirements for the Degree Doctor of Philosophy.

[2] p. Canadian Institute for Health Information (CIHI), "Wikipedia," [Online]. Available:
https://en.wikipedia.org/wiki/Healthcare_in_Canada#cite_note-39.

[3] C. I. f. H. I. H. S. i. 2. (CIHI), "Wikipedia," [Online]. Available:

https://en.wikipedia.org/wiki/Healthcare_in_Canada#cite_note-39. [Accessed 27 May 2018].

[4] C. I. f. H. I. (CIHI), 2013. [Online]. Available:

https://en.wikipedia.org/wiki/Healthcare_in_Canada#cite_note-39.

[5] p. 5. Canadian Institute for Health Information (CIHI), "Wikipedia," [Online]. Available:
https://en.wikipedia.org/wiki/Healthcare_in_Canada#cite_note-39.

[6] C. News, "Wikipedia," 19 11 2009. [Online]. Available:

https://en.wikipedia.org/wiki/Healthcare_in_Canada#cite_note-39. [Accessed 03 01 2015].

[7] p. Canadian Institute for Health Information (CIHI), "Wikipedia," [Online]. Available:
https://en.wikipedia.org/wiki/Healthcare_in_Canada#cite_note-39.

[8] p.-1. Canadian Institute for Health Information (CIHI), "Wikipedia," [Online]. Available:
https://en.wikipedia.org/wiki/Healthcare_in_Canada#cite_note-39.

[9] p. x. Canadian Institute for Health Information (CIHI), "Wikipedia," [Online]. Available:
https://en.wikipedia.org/wiki/Healthcare_in_Canada#cite_note-39.

[10] C. I. f. H. Information, "Wikipedia," 7 11 2017. [Online]. Available:

https://en.wikipedia.org/wiki/Healthcare_in_Canada#cite_note-39. [Accessed 8 11 2017].

[11] A. J. M. H. J. B. a. T. R. H. B. T. Denton, ""Optimal Allocation of Surgery, Blocks to Operating Rooms

Under Uncertainty,"," Operations Research, Vols. vol. 58, no. 4, p. p. 802–816, 2010.

[12] A. B. H. A. a. P. L. A. Jebali, "Operating rooms scheduling," Int. J. Production Economics, vol. 99, pp.
52-62, 2006.

[13] J. V. a. A. V. B. Denton, "Optimization of surgery sequencing and scheduling decisions under

uncertainty," Health Care Management Science, Vols. 10, no. 1, pp. 13-24, 2007.

[14] C. B. R. B. M. G. M. S. C. S. a. K. W. G. Sagnol, "Robust allocation of operating rooms: A cutting plane

approach to handle lognormal case durations," European Journal of Operational Research, vol. 271, pp.
420-435, 2018.

[15] F. S. Hillier and G. J. Lieberman, Introcustion to Operations research, vol. 10th, New York: McGraw-
Hill, 2015.

[16] W. Winston, Operations Research: Applications and Algorithms, Brooks/Cole, 2004.

[17] D. a. K. A. Pham, "Surgical case scheduling as a generalized job shop scheduling," 2008.

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[18] I. A. a. J. Vissers., "Patient mix optimisation in hospital admission planning: A case study," International
Journal of Operations and Production Management, , vol. 22 (4), pp. 445-461, 2002.

[19] E. D. J. B. …. Brecht Cardoen, Operating room planning and scheduling: A literature review,
DEPARTMENT OF DECISION SCIENCES AND INFORMATION MANAGEMENT (KBI).

[20] M. V. H. E. H. J. v. O. M. v. d. L. a. G. K. G. Wullink, "Closing emergency operating rooms improves

effciency," Journal of Medical Systems, , vol. 31, pp. 543-546, 2007.

[21] C. I. f. H. I. (. p.55, "Wikipedia," [Online]. Available:

https://en.wikipedia.org/wiki/Healthcare_in_Canada#cite_note-39.

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