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Case—Pediatrician Scheduling at British Columbia

Women’s Hospital
Steven Shechter

To cite this article:

Steven Shechter (2023) Case—Pediatrician Scheduling at British Columbia Women’s Hospital. INFORMS Transactions on
Education 24(1):40-42. https://doi.org/10.1287/ited.2021.0266cs

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 INFORMS TRANSACTIONS ON EDUCATION
Vol. 24, No. 1, September 2023, pp. 40–42
https://pubsonline.informs.org/journal/ited ISSN 1532-0545 (online)

Case

Pediatrician Scheduling at British Columbia Women’s Hospital

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Steven Shechtera
a
Operations and Logistics Division, Sauder School of Business, University of British Columbia, Vancouver, British Columbia V6T 1Z2, Canada
Contact: steven.shechter@sauder.ubc.ca, https://orcid.org/0000-0002-2282-185X (SS)

Received: May 31, 2021
Revised: September 28, 2021; November
11, 2021; November 15, 2021
Accepted: November 16, 2021
Published Online in Articles in Advance:
March 11, 2022
Open Access Statement: This work is licensed under a Creative Commons Attribution 4.0 International
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as “INFORMS Transactions on Education. Copyright © 2022 The Author(s). https://doi.org/10.1287/ited.
2021.0266cs, used under a Creative Commons Attribution License: https://creativecommons.org/
licenses/by/4.0/.”

https://doi.org/10.1287/ited.2021.0266cs

Copyright: © 2022 The Author(s)

Keywords: scheduling • mixed integer programming • binary integer programming • big-M • soft constraints • goal programming •
multiobjective optimization

1. Introduction 2. Scheduling Details

British Columbia Women’s Hospital (BCWH) is one of
the busiest maternity care centres in Canada, delivering
over 7,000 babies per year. It provides care to women
from the Vancouver area as well as those experiencing
high-risk pregnancies from anywhere in British Columbia.
In addition to all of the regularly scheduled doctors and
staff at BCWH, at every hour of every day, there is also a
pediatrician on call, available to attend all deliveries
(required at all C-sections and any vaginal deliveries
involving risk factors or complications), examine newborn
babies on the postpartum ward when issues arise, and
look after infants admitted to the neonatal intensive care
unit with a variety of medical issues (e.g., severe jaundice,
feeding difficulties, blood sugar issues).
Meg, the lead scheduler for the on-call pediatric
group, seeks your help to develop a computerized
scheduling tool. The current scheduling process is man-
ual and extremely labor intensive (no pun intended).
Meg typically spends up to 20 hours finalizing each
schedule, going through several iterations and back-
and-forth communications with the team of pediatri-
cians. It can be challenging enough to find a feasible
schedule, let alone one that everyone is satisfied with.
For example, there is often disagreement around how
the shifts are scheduled and how equitable the schedule
is (e.g., the day/night shift distribution). This is an emo-
tionally draining process, as Meg tries to make all of her
colleagues happy. Furthermore, she often absorbs shifts
that her colleagues do not want or can no longer do just
to avoid further iterations and potential conflict. In sum-
mary, the current process wastes a lot of Meg’s time,
and she would love to automate the scheduling process.
Pediatricians are scheduled in four-week cycles, with
each schedule typically released at the start of the pre-
vious cycle (i.e., four weeks in advance).1 Pediatricians
on call are assigned to either a day shift (7:30 a.m.–5:30
p.m.) or a night shift (5:30 p.m.–7:30 a.m.), with each
shift requiring exactly one pediatrician. For each of the
4*7*2  56 shifts per cycle, Meg chooses someone from
a pool of 15 pediatricians.
Based on discussions, Meg indicates that some system
constraints are “must-haves,” whereas others would be
“nice-to-haves.” The former, known as “hard con-
straints,” are based on safety and quality regulations
and/or strong preferences the pediatric group has. The
nice-to-haves, also known as “soft constraints,” would be
ideal to satisfy if possible, as they improve pediatricians’
work-life balance. However, the group understands and
accepts that some violations of these constraints may be
necessary to achieve a workable schedule. The hard and
soft constraints are summarized as follows:
2.1. Hard Constraints
a. Every shift must have exactly one pediatrician.
b. Pediatricians have a predetermined number of
shifts they are supposed to work each cycle (with the
sum over all pediatricians equaling the 56 shifts of the
four-week cycle). Meg provides that information in a
separate Excel file that comes with this case.
c. Pediatricians cannot work back-to-back shifts (i.e.,
no one works 24 hours in a row).
d. Pediatricians cannot work consecutive night shifts
(i.e., someone assigned to work Tuesday night cannot

40
 Shechter: Pediatrician Scheduling
INFORMS Transactions on Education, 2023, vol. 24, no. 1, pp. 40–42, © 2022 The Author(s)
be scheduled to work that Monday or Wednesday
night).
e. Pediatricians cannot be scheduled for more than
two shifts in a given weekend (weekend shifts are
Friday night, Saturday day and night, and Sunday day
and night).
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f. Pediatricians should not be scheduled on any shifts
they requested off. These requests are also provided in
the Excel file.
Also, BCWH recently instituted a Pediatrician of the
Week (POW) process in which one pediatrician serves
in a lead role each week (considered as Monday
through Sunday). As it relates to scheduling, the fol-
lowing are hard constraints around the POW process:
g. Each week requires one pediatrician to serve as
POW.
h. The POW must cover (at least) the following shifts:
Tuesday day, Thursday day, and Saturday night.
i. No one serves as the POW more than once in a
four-week cycle.
j. Each pediatrician has a designated number of times
they should be the POW over the course of the year
(also indicated in the Excel sheet). Therefore, anyone
who has already completed their requirements should
not be assigned as POW for any week in the current
planning cycle.
2.2. Soft Constraints
a. Pediatricians prefer not to work on consecutive
weekends.
b. In addition to the hard constraint of pediatricians
not working consecutive night shifts, they also prefer
not to work night shifts two days apart (e.g., if someone
works Monday night, then ideally they do not work
the Saturday night two days prior nor the Wednesday
night two days later).
c. Pediatricians prefer not to work more than two
evening shifts in a given work week.
d. The pediatric group seeks equity in day versus
night shifts; that is, each pediatrician’s workload
should ideally be evenly split between day and night
shifts during the cycle.
3. An Optimization Approach
A mathematical optimization problem has three main
components: (1) an objective, (2) decision variables,
and (3) constraints. The natural decision variables for
this problem are which pediatricians to assign to
which shifts, for each of the 56 shifts in the cycle, as
well as which pediatrician should be designated as
the POW each of the four weeks. We described the
41
constraints of the problem in the previous section. But
what is the objective?
For reasons outside the scope of the problem (e.g.,
seniority, training, research versus clinic time), the
total number of shifts expected of each pediatrician
over the year, and for the next cycle in particular, has
already been determined. There are no financial con-
siderations to be considered at this point, so in some
sense this is a problem without any natural objective
(e.g., “maximize profit” or “minimize cost”).
Meg tells you that she simply wants a schedule
that meets all of the hard constraints and comes as
close to meeting the soft constraints as possible. A
common way to solve problems with hard and soft
constraints is to relax the soft constraints in a way
that allows them to be violated while introducing
penalties for violations in an objective function. We
illustrate this concept through a different problem
before asking you to apply these ideas to the present
case.
Consider a small-sized version of the famous “Diet
Problem” (Stigler 1945, Dantzig 1990). This version
will be completely unrealistic but will illustrate the
concept of soft constraints and how to incorporate
them into an objective function. Assume someone eats
only two foods each day, apples and bananas. Their
daily goal is to consume 2,500 calories, 30 grams of
fiber, 70 mg of vitamin C, and 3,400 grams of potas-
sium. They are not concerned about costs; they just
want to come “as close as possible” to satisfying their
goals. In fact, there are so many examples of this “goal
satisfaction” objective in practice that they form their
own special class of optimization problems, known as
“Goal Programming.”
The following table provides the contribution of
apples and bananas (per 100 g) to the different goals
and the ideal totals for each of them.
Goal Apples (100 g) Bananas (100 g) Total
Calories 52 89 2,500
Dietary fiber (g) 2.4 2.6 30
Vitamin C (mg) 4.6 8.7 70
Potassium (mg) 107 358 3,400
Not surprisingly, the implied system of four equa-
tions with two unknowns has no feasible solution. By
softening the nominal requirement of meeting all
goals exactly, we can formulate a problem that yields
a feasible solution but penalizes the amount by which
the goals are violated. Specifically, letting x1 and x2 be

42 INFORMS Transactions on Education, 2023, vol. 24, no. 1, pp. 40–42, © 2022 The Author(s)
the quantity of apples and bananas consumed each
day, respectively (in hundreds of grams each), we can
formulate the diet problem as follows:


4
min (wui ui + woi oi )
i1
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subject to
52x1 + 89x2 + u1 − o1  2500, (1)
2:4x1 + 2:6x2 + u2 − o2  30, (2)
4:6x1 + 8:7x2 + u3 − o3  70, (3)
107x1 + 358x2 + u4 − o4  3400:
(4)
(all variables non-negative)
Note that the primary decision variables (x1 and x2 for
apples and bananas, respectively) do not appear in
the objective function; because we are not considering
the cost of obtaining them, they just appear in the goal
constraints around total calories, fiber, vitamin C, and
potassium, respectively (Equations (1)–(4)). The ui and
oi variables in those constraints represent the amount
by which the left-hand side is under or over the right-
hand-side target, respectively. The objective function
allows for different penalties for being under versus
over the right-hand side of each constraint. For exam-
ple, wu1 is the penalty per calorie under the calorie tar-
get, whereas wo1 is the penalty per calorie above it.
The objective function in combination with the fact
that the ui and oi variables are nonnegative make it so
that at most one of ui and oi will be positive for each
constraint i. If one cares about being under versus
over equally, then by setting wui  woi  1 for each i,
the objective function minimizes the sum of absolute
differences between the left- and right-hand sides of
all constraints. If instead one sets wui  woi  1=bi for
each i, the objective function minimizes the sum of
Shechter: Pediatrician Scheduling
absolute proportional differences between the left- and
right-hand sides.
Although the point of this example was the develop-
ment of the formulation above, you may be wondering
what the solution is. By letting wui  woi  1=bi for each
i, Solver indicates that this individual should consume
327 grams of apples and 852 grams of bananas per day.
In doing so, they will meet their fiber and potassium
goals exactly, fall short of their calories goal by 63%,
and exceed their vitamin C goal by 27%. The 63% short-
fall on calories may be a surprising and unreasonable
outcome. This suggests that we may want to consider a
nonlinear cost function for the deviations. If we con-
sider a piecewise linear convex cost structure, we can
still solve the problem as a linear program. Further dis-
cussion of this extension is beyond the scope of this
case.
Acknowledgments
I thank Drs. Megan Kilvert and Shawn George, pediatri-
cians at British Columbia Women’s Hospital who over-
see scheduling, for their input on the process. I also
thank Jake Zhang, a 2019 graduate of the masters in
business analytics program at the University of British
Columbia, for his work on developing the scheduling
tool described in the case. Finally, I thank the reviewers
and editors for their constructive feedback on the case
materials.
Endnote
1
This case presents several, but not all, of the details surrounding
on-call scheduling at BCWH. Also, some details are simplified with-
out sacrificing important considerations in the scheduling process.
References
Dantzig G (1990) The diet problem. Interfaces 20(4):43–47.
Stigler G (1945) The cost of subsistence. J. Farm Econom. 27(2):303–314.