The Impact of Variability and Patient Information on Health Care System Performance

In the delivery of health care services, variability in the patient arrival and service processes can cause excessive patient waiting times and poor utilization of facility resources. Based on data collected at a large primary care facility, this paper investigates how several sources of variability affect facility performance. These sources include ancillary tasks performed by the physician, patient punctuality, unscheduled visits to the facility's laboratory or X‐ray services, momentary interruptions of a patient's examination, and examination time variation by patient class. Our results indicate that unscheduled visits to the facility's laboratory or X‐ray services have the largest impact on a physician's idle time. The average patient wait is most affected by how the physician prioritizes completing ancillary tasks, such as telephone calls, relative to examining patients. We also investigate the improvement in system performance offered by using increasing levels of patient information when creating the appointment schedule. We find that the use of policies that sequence patients based on their classification improves system performance by up to 25.5%.     

Interventions for an Artemisinin‐based Malaria Medicine Supply Chain

Artemisinin combination therapy, the most effective malaria treatment today, is manufactured from an agriculturally derived starting material Artemisia annua. Artemisinin, the main ingredient in malaria medicines, is extracted from Artemisia leaves and used in the production of medicine for treating malaria. The artemisinin market has witnessed high volatility in the supply and price of artemisinin extract. A large fraction of malaria medicines for endemic countries in sub‐Saharan Africa is financed by the Global Fund to Fight AIDS, TB, and Malaria and the US President's Malaria Initiative. These agencies together with the World Health Organization, UNITAID, the United Kingdom Department for International Development and the Bill and Melinda Gates Foundation are exploring ways to increase the level of artemisinin production, reduce volatility of artemisinin prices, and improve overall access to malaria medicines for the population. We develop a model of the supply chain, calibrate the model using field data, and investigate the impact of various interventions. Our model shows that initiatives aimed at improving average yield, creating a support‐price for agricultural artemisinin, and a larger and carefully managed supply of semi‐synthetic artemisinin have the greatest potential for improving supply and reducing price volatility of artemisinin‐based malaria medicine.     

Toward an Effective Design of Behavioral Health Care Delivery: An Empirical Analysis of Care for Depression

A criticism of behavioral health care delivery is that it has largely missed the social determinants of behavioral health disorders and their diagnosis. Toward addressing this criticism, this study evaluates the delivery of behavioral health care as a part of primary care operations. Focusing on the treatment of depression, the study results show that: (i) primary care clinics operating in communities with superior social environment characteristics are associated with improved depression outcomes in the short term, and (ii) psychosocial resources (social and emotional support) and the built environment (man‐made resources and infrastructure to support human activity) of primary care clinics are associated with sustaining the improvement in depression outcome in the long term. Centering our attention on IT‐enabled, evidence‐based, and affordable primary care as mechanisms that can enable the integration of behavioral and medical care delivery, the results suggest that IT‐enabled and evidence‐based primary care are associated with improvements in depression outcomes. We also find that the effect of improving the affordability of behavioral health care delivery depends on the community's socioeconomic status. Primary care clinics in socioeconomically disadvantaged communities practicing cost‐containment are associated with improvements in depression outcomes, and, therefore, can contribute toward reducing disparities in behavioral health care delivery. Counter to our original expectations, we find that the effect of evidence‐based care on improvements on depression outcomes increases as the availability of medically trained behavioral health care specialists practicing in a community increases lending support to concerns that primary care clinics in resource‐rich communities obtain greater benefit from quality improvement interventions.     

二级供应链系统的三阶段协同订货模型

生产商-销售商联合生产库存系统是供应链的一个重要组成部分。但是目前协同条件下的相关订货策略具有明显的局限性,容易丢失真正的最优策略。本文利用边际分析法,通过改变销售商相邻两次订货量的大小来分析生产商和销售商库存费用的变化,发现销售商的订货量与系统库存费用变化量的确存在一定的规律。并且,进一步可以推导出该类系统的最优订货策略的订货量必须符合“三阶段”规律。根据该特点,只需设置各个阶段的初始订货量和订货次数等6个决策变量就可以构建订货策略的数学模型。该模型与直接求解的数学模型相比,不仅变量减少,而且其求解也相对简单。最后,利用各个文献中常用的两个实例仿真进行对比分析,验证了该策略确实能够找出其他策略丢失的最优解。     

考虑服务流的产品服务供应链网络均衡模型

产品服务供应链在向客户制造高质量产品的同时,也提供了产品全生命周期的专业服务,服务的嵌入增加了供应链协调的复杂性。考虑产品服务的双重需求,在分析各主体的运作行为的基础上,构建了包括多个制造商和多个销售商的多主体供应链网络;运用变分不等式刻画了制造商层、销售服务集成商层和需求市场的最优运作行为及其达成均衡的条件;最后,通过修正投影算法对数值算例进行了仿真。研究结果表明：产品服务供应链网络中的产品与服务均衡流相互影响,其中,服务水平直接影响到了产品需求;降低产品的售价将有利于服务价格和效益的提升。研究结论进一步印证了在产品服务供应链网络中承载于产品的服务将逐渐成为价值创造的主体。     

供应链、逆向供应链系统的定价策略模型

本文对基于单一制造商和单一零售商构成的供应链、逆向供应链系统进行了研究,应用博弈理论对供应链、逆向供应链系统的定价策略进行了分析,分别得出非合作博弈的均衡解和合作博弈的均衡解,进一步对各种定价策略的效率进行了分析.另外,给出了便于实际操作的协调方法.     

Panel Size and Overbooking Decisions for Appointment‐Based Services under Patient No‐Shows

Many service systems that work with appointments, particularly those in healthcare, suffer from high no‐show rates. While there are many reasons why patients become no‐shows, empirical studies found that the probability of a patient being a no‐show typically increases with the patient's appointment delay, i.e., the time between the call for the appointment and the appointment date. This paper investigates how demand and capacity control decisions should be made while taking this relationship into account. We use stylized single server queueing models to model the appointments scheduled for a provider, and consider two different problems. In the first problem, the service capacity is fixed and the decision variable is the panel size; in the second problem, both the panel size and the service capacity (i.e., overbooking level) are decision variables. The objective in both cases is to maximize some net reward function, which reduces to system throughput for the first problem. We give partial or complete characterizations for the optimal decisions, and use these characterizations to provide insights into how optimal decisions depend on patient's no‐show behavior in regards to their appointment delay. These insights especially provide guidance to service providers who are already engaged in or considering interventions such as sending reminders in order to decrease no‐show probabilities. We find that in addition to the magnitudes of patient show‐up probabilities, patients' sensitivity to incremental delays is an important determinant of how demand and capacity decisions should be adjusted in response to anticipated changes in patients' no‐show behavior.     

应急期间服务运作系统能力的采购和恢复模型

分析了大型服务运作系统应急期间的能力应急管理模式,围绕系统内部能力恢复和外部能力采购,综合考虑社会惩罚成本,以应急期间的总成本最小为目标构建了相应的数学模型。通过数值仿真得到4个重要的管理学结论,对社会管理部门的应急政策制定以及运作系统本身在应急期间的科学决策均具有重要的指导意义。     

基于多目标加权灰靶决策模型的节能服务公司选择研究

用能方对节能服务公司（Energy Service Company,ESCO）的选择关系到合同能源管理（Energy Performance Contracting,EPC）能否顺利实施。从用能方的角度,采用灰色系统理论中的多目标加权灰靶决策模型,对存在多决策目标的ESCO选择问题进行研究。通过层次分析法确定ESCO的11个决策目标的决策权数,根据综合效果测度值的比较,最终实现最优对策的选择。本文为用能方的ESCO选择问题提供了一种新的思路。     

技术型企业链式“绩效一薪酬”管理模式探析

技术型企业拥有的大部分是知识型员工,由于知识型员工具有较高的自主性和创造性,也就使得技术型企业绩效考核和薪酬管理很难进行。为了解决技术型企业人力资源管理中遇到的难题,本文以X企业为例,探索构建出一个以企业战略为出发点、以企业架构为切入点、以绩效体系为关键点、以薪酬管理为落脚点的“绩效一薪酬”管理模式。     

A Supply Chain with a Service Requirement for Each Market Signal

We study a single‐period two‐stage service‐constrained supply chain with an information update. The buyer has two procurement opportunities with the second one after observing a market signal, which updates the demand forecast. He also commits to a service level after observing the market signal. We derive his optimal ordering decisions and show that the critical market signal, the optimal first‐stage order quantity, and the optimal expected profit are monotone with respect to the target service level. We also discuss the impact of the forecast quality on the optimal decisions. We show that the optimal first‐stage order quantity may not be monotone with respect to information accuracy, as is in the case without the service constraint. In addition, we extend our analysis to the situation when an order cancellation is allowed upon the observation of the market signal. We also compare the results obtained for the problems with and without an order cancelation. Finally, we discuss the supply chain coordination issue and find that a buyback contract can also coordinate the supply chain in the presence of the service constraint.     

含服务水平约束的可控提前期供应链Staekelberg模型与协调机制研究

为了有效地缩短订货提前期与降低库存成本,首先从Stackelberg主从对策角度建立了含服务水平约束的可控提前期供应链库存优化模型,提出了该模型的求解算法;然后从集中决策角度建立了另一类含服务水平约束的可控提前期供应链库存优化模型,并提出该模型的求解算法。利用数值分析对两类模型的优化效果进行比较,结果表明:集中决策模式下的优化效果明显优于Stackelberg主从对策模式下的优化效果,但在缺乏合理的激励机制情形下,供应链各参与方未必有足够积极性接受集中决策模式。为此,提出一种库存费用分担机制来激励供应链各参与方接受集中决策模式。     

供应链物流运作能力计划模型与分析

考察了某种产品供应链系统的一次性物流运作过程,建立了这个系统的物流能力动态规划模型。针对供应链中物流运作能力的流通量指标进行了较为深入的理论分析,探讨了使得系统成本最小化的最优物流能力及系统各阶段需配置的流通量。最优物流能力策略体现为两个关键量,即下界和上界。如果可得输入量小于下界则选择不开展物流;如果可得输入超出了下界,物流能力可以足够大但不超过上界。运用数学归纳法对优化结果进行了证明,并结合算例检验了模型的效果。     

考虑服务约束的第三方仓库收益与设计优化模型

第三方仓库作为服务提供商, 主要以期望收益最大化为目标, 但是必须满足一定的顾客服务标准。针对高需求环境, 考虑顾客服务水平约束, 提出了一个基于排队论的随机设计优化模型以使仓库的期望收益最大化。采用动态优化算法对模型求解, 选取实例进行了数值实验。结果显示, 模型的优化设计显著地提高了高需求环境下该第三方仓库的期望收益。在此基础上, 找到了服务约束的可行范围和有效范围, 为决策者制定服务标准提供了依据。     

两阶段生产系统的DEA效率评价模型

数据包络分析(DEA)作为一种数学规划方法,已经被广泛用来评价一个决策单元相对于其它决策单元的效率。经典的DEA模型把决策单元看作一个“黑箱”,对决策单元的内部运行机制不作深入的研究。本文以一个两阶段生产系统为例,从生产系统的内部过程出发,提出一个基于DEA的模型以合理评估该决策单元的相对效率。本文提出的模型实质上是一类特殊的网络DEA模型,其评价原理有别于已有的研究成果,但确实有助于管理者确定生产过程(如供应链)的非有效来源及其效率改进方向。     

考虑环境属性约束的平行结构DEA模型

针对平行结构DEA模型在构造虚拟参考单元时没有考虑任何约束可能存在低估效率的情况,通过加入决策单元的环境属性对现有的平行结构模型进行了改进,从而在组合为虚拟参考单元的子决策单元之间添加必要的约束,使得模型所得的效率值更具现实意义。最后,将改进后的平行结构模型应用于中国各省份污染治理效率评价问题,从实证角度验证了模型的合理性和有效性。     

开放系统不同成本企业博弈定价模型

基于不同成本企业地位不等的前提,建立并比较了封闭系统不同成本企业的竞争博弈价格模型和合作博弈价格模型。分析了在开放系统,理性企业即不采用竞争博弈价格的原因--收益较低,又不采用合作博弈价格的原因--高价格吸引新企业进入。在竞合价格和临界价格概念基础上,建立了开放系统定价模型,并分析了影响临界价格高低的因素及竞合价格能使企业保持相对较高的利润又对新企业不产生吸引力。最后通过算例分析验证了该模型。     

基于交易成本理论的IT外包风险控制策略研究综述

IT外包在过去10年中迅速发展,但潜藏着巨大的风险.为了更好地管理风险,对现有研究成果做了全面的梳理、归纳和提炼,将风险控制策略进一步分类为2个子系统:①主要策略子系统,包括合同机制、关系治理、组织整合、控制机制和动态成本监控;②辅助策略子系统,包括引入第三方专业机构、外包决策优化、不同的管理模式、标准化工具.这2个子系统为建立企业ITOR策略研究的方法论提供了良好的基础,有助于丰富企业ITOR管理理论.     

企业知识管理系统柔性与环境不确定性的匹配度计算模型

旨在为进行企业知识管理系统(EKMS)柔性的评价与决策提供量化工具。分析了EKMS柔性的组成、环境不确定性的主客观因素及EKMS柔性与环境不确定性匹配的涵义,提出了EKMS柔性与环境不确定性的评价指标体系及测度方法,在此基础上借鉴空间几何概念设计了EKMS柔性与环境匹配度的计算方法及判断准则,最后给出了算例。     

可变产能的按订单装配系统库存和生产决策研究

本文基于一个ATO 生产商的实践,考虑一个需求不确定并具有子装配件的单周期ATO 系统,为了应对较长的采购提前期和有限产能的挑战,生产商可以在得到确定的需求之前提前采购零件,装配子装配件以至于最终产品。由于产品物料清单结构中存在子装配件作为可选的中间件,因此完全使用零件和使用子装配件装配最终产品的不同,造成装配能力在时间上具有可变性。我们对此问题建立了利润最大化模型,分析在上述ATO 环境中的最优库存和生产决策。通过一系列最优解的性质,我们得到了该问题的有效解决方法。