Secondary Titles (1)
- John & Esther Reese Professor
Industry Expertise (2)
Areas of Expertise (3)
Service Operations Management
Supply Chain Management
W. Michael & William D. Wells Life Sciences Faculty Fellow (professional)
2013 to present
Kimball Faculty Fellow (professional)
2003 to 2013
Outstanding Senior Editor Award (professional)
2012 Decision Sciences
Outstanding Associate Editor Award (professional)
2007 Decision Sciences
Two Best Paper Awards (professional)
Decision Sciences Institute
Indiana University: Ph.D., Operations Management 1990
Indiana University: MBA, Business Administration 1986
Purdue University: B.S., Undergraduate Studies 1984
Blocking in Healthcare Operations: A New Heuristic and an ApplicationProduction and Operations Management
2011 We consider the problem of optimal capacity allocation in a hospital setting, where patients pass through a set of units, for example intensive care and acute care (AC), or AC and post-acute care. If the second stage is full, a patient whose service at the first stage is complete is blocked and cannot leave the first stage. We develop a new heuristic for tandem systems to efficiently evaluate the effects of such blocking on system performance and we demonstrate that this heuristic performs well when compared with exact solutions and other approaches presented in the literature. In addition, we show how our tandem heuristic can be used as a building block to model more complex multi-stage hospital systems with arbitrary patient routing, and we derive insights and actionable capacity strategies for a real hospital system where such blocking occurs between units.
The Impact of Variability and Patient Information on Healthcare System PerformanceProduction and Operations Management
2011 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%.
Strategies for Addressing the Nursing Shortage: Coordinated Decision Making and Workforce FlexibilityDecision Sciences
2010 In this article, we present strategies to help combat the U.S. nursing shortage. Key considerations include providing an attractive work schedule and work environment—critical issues for retaining existing nurses and attracting new nurses to the profession—while at the same time using the set of available nurses as effectively as possible. Based on these ideas, we develop a model that takes advantage of coordinated decision making when managing a flexible workforce. The model coordinates scheduling, schedule adjustment, and agency nurse decisions across various nurse labor pools, each of differing flexibility levels, capabilities, and costs, allowing a much more desirable schedule to be constructed. Our primary findings regarding coordinated decision making and how it can be used to help address the nursing shortage include (i) labor costs can be reduced substantially because, without coordination, labor costs on average are 16.3% higher based on an actual hospital setting, leading to the availability of additional funds for retaining and attracting nurses, (ii) simultaneous to this reduction in costs, more attractive schedules can be provided to the nurses in terms of less overtime and fewer undesirable shifts, and (iii) the use of agency nurses can help avoid overtime for permanent staff with only a 0.7% increase in staffing costs. In addition, we estimate the cost of the shortage for a typical U.S. hospital from a labor cost perspective and show how that cost can be reduced when managers coordinate.
The Value of Virtual Pooling in Dual Sales Channel Supply ChainsEuropean Journal of Operational Research
2009 Recently the most significant growth in online retailing has been attributed to traditional offline retailers extending their brands online. Unfortunately, there is little research addressing the value of better information in retail/e-tail organizations. To fill this gap, this paper examines how investing in the continuous monitoring of online demands and inventory positions can provide economic benefit for companies that handle both in-store and online sales. Specifically, we develop and evaluate two dynamic assignment policies that incorporate real time information to specify which of a firm's e-fulfillment locations will handle each of its Internet sales. Computational results indicate that investing in dynamic assignment capability can reduce system cost (holding, backorder, and transportation) by as much as 8.2% over the optimal static policy. The percentage of sales occurring online plays a critical role in determining the magnitude of the benefit.
Reexamining the Nurse Scheduling Problem: Staffing Ratios and Nursing ShortagesDevision Sciences
2006 Legislators at the state and national levels are addressing renewed concerns over the adequacy of hospital nurse staffing to provide quality care and ensure patient safety. At the same time, the well-known nursing shortage remains an ongoing problem. To address these issues, we reexamine the nurse scheduling problem and consider how recent health care legislation impacts nursing workforce management decisions. Specifically, we develop a scheduling model and perform computational experiments to evaluate how mandatory nurse-to-patient ratios and other policies impact schedule cost and schedule desirability (from the nurses' perspective). Our primary findings include the following: (i) nurse wage costs can be highly nonlinear with respect to changes in mandatory nurse-to-patient ratios of the type being considered by legislators; (ii) the number of undesirable shifts can be substantially reduced without incurring additional wage cost; (iii) more desirable scheduling policies, such as assigning fewer weekends to each nurse, have only a small impact on wage cost; and (iv) complex policy statements involving both single-period and multiperiod service levels can sometimes be relaxed while still obtaining good schedules that satisfy the nurse-to-patient ratio requirements. The findings in this article suggest that new directions for future nurse scheduling models, as it is likely that nurse-to-patient ratios and nursing shortages will remain a challenge for health care organizations for some time.