The Effect of Integrated Scheduling and Capacity Policies on Clinical Efficiency

In outpatient healthcare clinics, capacity, patient flow, and scheduling are rarely managed in an integrated fashion, so a question of interest is whether clinic performance can be improved if the policies that guide these decisions are set jointly. Despite the potential importance of this issue, we find surprisingly few studies that look at how the allocation of capacity, paired with various appointment scheduling policies and different patient flow configurations, affects patient flow and clinical efficiency. In this paper, we develop an empirically based discrete‐event simulation to examine the interactions between patient appointment policies and capacity allocation policies (i.e., the number of available examination rooms) and how they jointly affect various performance measures, such as resource utilization and patient waiting time. Findings suggest that scheduling lower‐variance, shorter appointments earlier in the clinic (and, conversely, higher‐variance, longer appointments later) results in less overall patient waiting without reducing physician utilization or increasing clinic duration. Additionally, exam rooms exhibited classic bottleneck behavior: there was no effect on physician utilization by adding exam rooms beyond a certain threshold, but too few exam rooms were devastating to clinic throughput. Some significant interactions between these variables were observed, but were not influential to the level of managerial concern. Clinicians' intuition about managing capacity in healthcare settings may differ substantially from best policies.     

Time Consistency: Stationarity and Time Invariance

A sequence of experiments documents static and dynamic “preference reversals” between sooner‐smaller and later‐larger rewards, when the sooner reward could be immediate. The theoretically motivated design permits separate identification of time consistent, stationary, and time invariant choices. At least half of the subjects are time consistent, but only three‐quarters of them exhibit stationary choices. About half of subjects with time inconsistent choices have stationary preferences. These results challenge the view that present‐bias preferences are the main source of time inconsistent choices.     

Impact of Number of Interactions,Different Interaction Patterns,and Human Inconsistencies on Some Hybrid Evolutionary Multiobjective Optimization Algorithms*

We investigate the impact of the number of human–computer interactions, different interaction patterns, and human inconsistencies in decision maker responses on the convergence of an interactive, evolutionary multiobjective algorithm recently developed by the authors. In our context “an interaction” means choosing the best and worst solutions among a sample of six solutions. By interaction patterns we refer to whether preference questioning is more front‐, center‐, rear‐, or edge‐loaded. As test problems we use two‐ to four‐objective knapsack problems, multicriteria scheduling problems, and multiobjective facility location problems. In the tests, two different preference functions are used to represent actual decision maker preferences, linear and Chebyshev. The results indicate that it is possible to obtain solutions that are very good or even nearly optimal with a reasonable number of interactions. The results also indicate that the algorithm is robust to minor inconsistencies in decision maker responses. There is also surprising robustness toward different patterns of interaction with the decision maker. The results are of interest to the evolutionary multiobjective (EMO) community actively developing hybrid interactive EMO approaches.     

Hospital resident scheduling problem

This paper addresses the resident scheduling problem (RSP) at hospitals concerned with prescribing work-nights for residents while considering departmental staffing and skill requirements as well as residents' preferences. Three scenarios that represent most situations and account for various departmental requirements and needs are described. Although similar scheduling problems are considered in the literature, no analysis exists that adequately deals with the speciffic nature of this problem. The problem is modeled as a mixed-integer program and heuristic solution procedures are developed for the different identified scheduling scenarios. These procedures exploit the inherent network structure of the problem which is an important feature that enhances problem solvability. For the sake of comparison, the problem is also solved exactly via the CPLEX-MIP (version 6.0) package. The contribution of this work is important since many hospitals are still utilizing manual techniques in preparing their own schedules, expending considerable effort and time and yet contending with limited scheduling flexibility.     

Consistency of Higher Order Risk Preferences

Risk aversion (a second‐order risk preference) is a time‐proven concept in economic models of choice under risk. More recently, the higher order risk preferences of prudence (third‐order) and temperance (fourth‐order) also have been shown to be quite important. While a majority of the population seems to exhibit both risk aversion and these higher order risk preferences, a significant minority does not. We show how both risk‐averse and risk‐loving behaviors might be generated by a simple type of basic lottery preference for either (1) combining “good” outcomes with “bad” ones, or (2) combining “good with good” and “bad with bad,” respectively. We further show that this dichotomy is fairly robust at explaining higher order risk attitudes in the laboratory. In addition to our own experimental evidence, we take a second look at the extant laboratory experiments that measure higher order risk preferences and we find a fair amount of support for this dichotomy. Our own experiment also is the first to look beyond fourth‐order risk preferences, and we examine risk attitudes at even higher orders.     

Complexity as a Contract Design Factor: A Human‐to‐Human Experimental Study

Despite being theoretically suboptimal, simpler contracts (such as price‐only contracts and quantity discount contracts with limited number of price blocks) are commonly preferred in practice. Thus, exploring the tension between theory and practice regarding complexity and performance in contract design is especially relevant. Using human subject experiments, Kalkancı et al. (2011) showed that such simpler contracts perform effectively for a supplier interacting with a computerized buyer under asymmetric demand information. We use a similar set of experiments with the modification that a human supplier interacts with a human buyer. We show that human interactions strengthen the supplier's preference for simpler contracts. We find that suppliers have fairness concerns even when they interact with computerized buyers. These fairness concerns tend to be even stronger when suppliers interact with human buyers, particularly when the complexity of the contract is low. We also find that suppliers are more prone to random decision errors (i.e., bounded rationality) when interacting with human buyers. In the absence of social preferences, Kalkancı et al. identified reinforcement and bounded rationality as key biases that impact suppliers' decisions. In human‐to‐human experiments, we find evidence for social preference effects. However, these effects may be secondary to bounded rationality.     

Illustration of a Method to Incorporate Preference Uncertainty in Benefit–Cost Analysis

Benefit–cost analysis is widely used to evaluate alternative courses of action that are designed to achieve policy objectives. Although many analyses take uncertainty into account, they typically only consider uncertainty about cost estimates and physical states of the world, whereas uncertainty about individual preferences, thus the benefit of policy intervention, is ignored. Here, we propose a strategy to integrate individual uncertainty about preferences into benefit–cost analysis using societal preference intervals, which are ranges of values over which it is unclear whether society as a whole should accept or reject an option. To illustrate the method, we use preferences for implementing a smart grid technology to sustain critical electricity demand during a 24‐hour regional power blackout on a hot summer weekend. Preferences were elicited from a convenience sample of residents in Allegheny County, Pennsylvania. This illustrative example shows that uncertainty in individual preferences, when aggregated to form societal preference intervals, can substantially change society's decision. We conclude with a discussion of where preference uncertainty comes from, how it might be reduced, and why incorporating unresolved preference uncertainty into benefit–cost analyses can be important.     

震后初期应急物资配送的模糊多目标选址-多式联运问题

针对震后初期应急物资配送系统优化问题,考虑应急物资需求模糊情况下应急物资配送中心选址和应急物资多式联运安排的集成决策,以应急物资配送总时间最短和受灾点应急物资未满足的总损失最小为目标,建立了一个震后应急物资配送的多目标选址-多式联运问题优化模型,设计了一种采用二维编码的非支配排序多目标遗传算法,并对该算法进行了复杂性分析。算例分析结果表明:该算法可以在得到Pareto前沿的同时,根据决策者偏好在Pareto前沿面上给出各种优化决策方案。     

When Are Local Incentive Constraints Sufficient?

We study the question of whether local incentive constraints are sufficient to imply full incentive compatibility in a variety of mechanism design settings, allowing for probabilistic mechanisms. We give a unified approach that covers both continuous and discrete type spaces. On many common preference domains—including any convex domain of cardinal or ordinal preferences, single‐peaked ordinal preferences, and successive single‐crossing ordinal preferences—local incentive compatibility (suitably defined) implies full incentive compatibility. On domains of cardinal preferences that satisfy a strong nonconvexity condition, local incentive compatibility is not sufficient. Our sufficiency results hold for dominant‐strategy and Bayesian Nash solution concepts, and allow for some interdependence in preferences.     

Ambiguity and Second‐Order Belief

Anscombe and Aumann (1963) wrote a classic characterization of subjective expected utility theory. This paper employs the same domain for preference and a closely related (but weaker) set of axioms to characterize preferences that use second‐order beliefs (beliefs over probability measures). Such preferences are of interest because they accommodate Ellsberg‐type behavior.     

Context,Cultural Bias,and Health Risk Perception: The “Everyday” Nature of Pesticide Policy Preferences in London,Calgary, and Halifax

Risk perception and the cultural theory of risk have often been contrasted in relation to risk‐related policy making; however, the local context in which risks are experienced, an important component of everyday decision making, remains understudied. What is unclear is the extent to which localized community beliefs and behaviors depend on larger belief systems about risk (i.e., worldviews). This article reports on a study designed to understand the relative importance of health risk perceptions (threat of harm); risk‐related worldviews (cultural biases); and the experiences of local context (situated risk) for predicting risk‐related policy preferences regarding cosmetic pesticides. Responses to a random telephone questionnaire are used to compare residents’ risk perceptions, cultural biases, and pesticide bylaw preferences in Calgary (Alberta), Halifax (Nova Scotia), and London (Ontario), Canada. Logistic regression shows that the most important determinants of pesticide bylaw preference are risk perception, lack of benefit, and pesticide “abstinence.” Though perception of health risk is the best single predictor of differences in bylaw preferences, social factors such as gender and situated risk factors like conflict over chemical pesticides, are also important. Though cultural biases are not important predictors of pesticide bylaw preference, as in other studies, they are significant predictors of health risk perception. Pesticide bylaw preference is therefore more than just a health risk perception or worldview issue; it is also about how health risk becomes situated—contextually—in the experiences of residents’ everyday lives.     

Representing Preferences with a Unique Subjective State Space

We extend Kreps' (1979) analysis of preference for flexibility, reinterpreted by Kreps (1992) as a model of unforeseen contingencies. We enrich the choice set, consequently obtaining uniqueness results that were not possible in Kreps' model. We consider several representations and allow the agent to prefer commitment in some contingencies. In the representations, the agent acts as if she had coherent beliefs about a set of possible future (ex post) preferences, each of which is an expected‐utility preference. We show that this set of ex post preferences, called the subjective state space, is essentially unique given the restriction that all ex post preferences are expected‐utility preferences and is minimal even without this restriction. Because the subjective state space is identified, the way ex post utilities are aggregated into an ex ante ranking is also essentially unique. Hence when a representation that is additive across states exists, the additivity is meaningful in the sense that all representations are intrinsically additive. Uniqueness enables us to show that the size of the subjective state space provides a measure of the agent's uncertainty about future contingencies and that the way the states are aggregated indicates whether these contingencies lead to a desire for flexibility or commitment.     

An Initial Assessment of Effective Preference Assessment Intervals Among Employees

Previous research has shown that employee preferences for tangible items may change significantly from one month to the next. Although a 1-month interval may be too long to wait between preference assessment administrations, no guidelines exist with regard to how often to assess employee preference. This study examined changes in preference as measured by two different preference assessments across four different time intervals. We measured preference stability by assessing changes in designations of high- and low-preference items from one assessment to the next. Only the 1-week interval indicated no changes in item designation from high preference to low preference or low preference to high preference. These data suggest that if tangibles are used, preferences may need to be assessed over time.     

A MARKET UTILITY‐BASED MODEL FOR CAPACITY SCHEDULING IN MASS SERVICES

Only a small set of employee scheduling articles have considered an objective of profit or contribution maximization, as opposed to the traditional objective of cost (including opportunity costs) minimization. In this article, we present one such formulation that is a market utility‐based model for planning and scheduling in mass services (MUMS). MUMS is a holistic approach to market‐based service capacity scheduling. The MUMS framework provides the structure for modeling the consequences of aligning competitive priorities and service attributes with an element of the firm's service infrastructure. We developed a new linear programming formulation for the shift‐scheduling problem that uses market share information generated by customer preferences for service attributes. The shift‐scheduling formulation within the framework of MUMS provides a business‐level model that predicts the economic impact of the employee schedule. We illustrated the shift‐scheduling model with empirical data, and then compared its results with models using service standard and productivity standard approaches. The result of the empirical analysis provides further justification for the development of the market‐based approach. Last, we discuss implications of this methodology for future research.     

作业车间的模糊动态调度问题研究

本文针对作业车间的模糊动态调度问题,给出了该问题的生产系统描述、建模,给出了基于工件到达时间三角模糊数的计算确定重调度时段划分点的模糊动态调度策略,通过一种基于时间分解的策略将作业车间的模糊动态调度问题转化为一系列不一定被完全执行的静态模糊子调度问题求解。针对模型的求解给出了改进的G&T算法,将改进的基于关键路径的邻域交换技术引入遗传算法变异算子的设计,改善了算法解的局部寻优能力。仿真实验结果表明,本文给出的作业车间模糊动态调度模型是正确的,提出的算法有效,且动态调度策略具有鲁棒性。     

一种考虑动态时间窗的满载问题模型及算法

针对时间约束在满载问题中的复杂性,建立了一个考虑装载时间和次序的具有动态时间窗的满载车辆调度模型,并给出了一个基于动态构造原理的启发式算法。该模型和算法改进了以往满载问题中对时间窗的考虑,使得求解更具有实际派车意义,并且该算法通过参数调整,经过少量迭代即可快速求得最小化总成本的满意解。     

WHO IS ‘BEHAVIORAL’? COGNITIVE ABILITY AND ANOMALOUS PREFERENCES

In this paper, we ask whether variation in preference anomalies is related to variation in cognitive ability. Evidence from a new laboratory study of Chilean high‐school students with similar schooling backgrounds shows that small‐stakes risk aversion and short‐run discounting are less common among those with higher standardized test scores. The relationship with test scores survives controls for parental education and wealth. We find some evidence that elementary‐school GPA is predictive of preferences measured at the end of high school. Two laboratory interventions provide suggestive evidence of a possible causal impact of cognitive resources on expressed preferences.     

Scheduling arc shut downs in a network to maximize flow over time with a bounded number of jobs per time period

We study the problem of scheduling maintenance on arcs of a capacitated network so as to maximize the total flow from a source node to a sink node over a set of time periods. Maintenance on an arc shuts down the arc for the duration of the period in which its maintenance is scheduled, making its capacity zero for that period. A set of arcs is designated to have maintenance during the planning period, which will require each to be shut down for exactly one time period. In general this problem is known to be NP-hard, and several special instance classes have been studied. Here we propose an additional constraint which limits the number of maintenance jobs per time period, and we study the impact of this on the complexity.     

Uncovering the Distribution of Motorists' Preferences for Travel Time and Reliability

We apply recent econometric advances to study the distribution of commuters' preferences for speedy and reliable highway travel. Our analysis applies mixed logit to combined revealed and stated preference data on commuter choices of whether to pay a toll for congestion‐free express travel. We find that motorists exhibit high values of travel time and reliability, and substantial heterogeneity in those values. We suggest that road pricing policies designed to cater to such varying preferences can improve efficiency and reduce the disparity of welfare impacts compared with recent pricing experiments.     

Analysis of Travel Times and CO2 Emissions in Time‐Dependent Vehicle Routing

Due to the growing concern over environmental issues, regardless of whether companies are going to voluntarily incorporate green policies in practice, or will be forced to do so in the context of new legislation, change is foreseen in the future of transportation management. Assigning and scheduling vehicles to service a pre‐determined set of clients is a common distribution problem. Accounting for time‐dependent travel times between customers, we present a model that considers travel time, fuel, and CO₂ emissions costs. Specifically, we propose a framework for modeling CO₂ emissions in a time‐dependent vehicle routing context. The model is solved via a tabu search procedure. As the amount of CO₂ emissions is correlated with vehicle speed, our model considers limiting vehicle speed as part of the optimization. The emissions per kilometer as a function of speed are minimized at a unique speed. However, we show that in a time‐dependent environment this speed is sub‐optimal in terms of total emissions. This occurs if vehicles are able to avoid running into congestion periods where they incur high emissions. Clearly, considering this trade‐off in the vehicle routing problem has great practical potential. In the same line, we construct bounds on the total amount of emissions to be saved by making use of the standard VRP solutions. As fuel consumption is correlated with CO₂ emissions, we show that reducing emissions leads to reducing costs. For a number of experimental settings, we show that limiting vehicle speeds is desired from a total cost perspective. This namely stems from the trade‐off between fuel and travel time costs.