Department of Industrial Engineering, Sharif University of Technology, Tehran 1365-11155, Iran.
Faculty of Mathematics, Otto-Von-Guericke-University, 39106 Magdeburg, Germany.
Int J Environ Res Public Health. 2021 Jan 21;18(3):900. doi: 10.3390/ijerph18030900.
In recent years, the management of health systems is a main concern of governments and decision-makers. Home health care is one of the newest methods of providing services to patients in developed societies that can respond to the individual lifestyle of the modern age and the increase of life expectancy. The home health care routing and scheduling problem is a generalized version of the vehicle routing problem, which is extended to a complex problem by adding special features and constraints of health care problems. In this problem, there are multiple stakeholders, such as nurses, for which an increase in their satisfaction level is very important. In this study, a mathematical model is developed to expand traditional home health care routing and scheduling models to downgrading cost aspects by adding the objective of minimizing the difference between the actual and potential skills of the nurses. Downgrading can lead to nurse dissatisfaction. In addition, skillful nurses have higher salaries, and high-level services increase equipment costs and need more expensive training and nursing certificates. Therefore, downgrading can enforce huge hidden costs to the managers of a company. To solve the bi-objective model, an ε-constraint-based approach is suggested, and the model applicability and its ability to solve the problem in various sizes are discussed. A sensitivity analysis on the Epsilon parameter is conducted to analyze the effect of this parameter on the problem. Finally, some managerial insights are presented to help the managers in this field, and some directions for future studies are mentioned as well.
近年来，卫生系统管理是政府和决策者关注的主要问题。家庭保健是为发达社会的患者提供服务的最新方法之一，它可以满足现代人的个性化生活方式和预期寿命的增长。家庭保健路径和调度问题是车辆路径问题的广义版本，通过添加医疗保健问题的特殊特征和约束条件，将其扩展为一个复杂的问题。在这个问题中，有多个利益相关者，例如护士，提高他们的满意度非常重要。在这项研究中，开发了一个数学模型，通过添加最小化护士实际和潜在技能之间差异的目标，将传统的家庭保健路径和调度模型扩展到降级成本方面。降级可能导致护士不满。此外，熟练的护士有更高的工资，而高级服务会增加设备成本，并需要更昂贵的培训和护理证书。因此，降级可能会给公司的管理者带来巨大的隐性成本。为了解决这个双目标模型，提出了一种基于 ε-约束的方法，并讨论了模型的适用性及其在各种规模下解决问题的能力。对 ε 参数进行了敏感性分析，以分析该参数对问题的影响。最后，提出了一些管理方面的见解，以帮助该领域的管理者，并提到了一些未来研究的方向。
