Health and Technology (2021) 11:445–469

https://doi.org/10.1007/s12553-021-00547-5

REVIEW PAPER

Healthcare scheduling in optimization context: a review

Zahraa A. Abdalkareem1,5 · Amiza Amir1 · Mohammed Azmi Al‑Betar2,3 · Phaklen Ekhan1 · Abdelaziz I. Hammouri4

Received: 18 November 2020 / Accepted: 5 April 2021 / Published online: 10 April 2021
© IUPESM and Springer-Verlag GmbH Germany, part of Springer Nature 2021

Abstract
This paper offers a summary of the latest studies on healthcare scheduling problems including patients’ admission scheduling
problem, nurse scheduling problem, operation room scheduling problem, surgery scheduling problem and other healthcare
scheduling problems. The paper provides a comprehensive survey on healthcare scheduling focuses on the recent literature.
The development of healthcare scheduling research plays a critical role in optimizing costs and improving the patient flow,
providing prompt administration of treatment, and the optimal use of the resources provided and accessible in the hospitals.
In the last decades, the healthcare scheduling methods that aim to automate the search for optimal resource management
in hospitals by using metaheuristics methods have proliferated. However, the reported results are disintegrated since they
solved every specific problem independently, given that there are many versions of problem definition and various data sets
available for each of these problems. Therefore, this paper integrates the existing results by performing a comprehensive
review and analyzing 190 articles based on four essential components in solving optimization problems: problem definition,
formulations, data sets, and methods. This paper summarizes the latest healthcare scheduling problems focusing on patients’
admission scheduling problems, nurse scheduling problems, and operation room scheduling problems considering these are
the most common issues found in the literature. Furthermore, this review aims to help researchers to highlight some devel-
opment from the most recent papers and grasp the new trends for future directions.

Keywords Heurstic · Metaheurstic · Meta-heurstics · Nurse scheduling · Patient admission scheduling · Patient to bed
assignment · Operating room scheduling · Operating theater · Surgery scheduling · Surgical scheduling · Physician
scheduling · Healthcare scheduling

1 Introduction population longevity will lead to a rising in demand for

medical services [2, 3]. However, increasing in demand for
Nowadays, healthcare optimization problems have received medical care, and the absence or shortage of it may cause
significant attention in order to provide more appropriate patients threatened lives, overworking manpower, patients
services at a lower cost [1, 2]. Moreover, it is imperative infection rates, and patients flow overcrowding [4].
and attracts many researchers’ attention due to the high cost A scheduling system could decrease patients waiting
and limitation of resources (e.g. medical supplies, equip- time, ease access to medical services and impact the qual-
ment, doctors, and staff) in the hospital. Without a doubt, ity of healthcare operations [1, 5]. In order to get feasible
healthcare scheduling is a challenge due to high constraints scheduling for any healthcare system, the hard and soft con-
and preferences, such as personnel requirements, resources straints have to be determined. Hard constraints could not be
limitation. Unlike any other institution, healthcare sectors violated whilst, the soft constraints integrated as a part of the
are working around the clock. However, the lack of staffing cost function and should be minimized.
and irregular working shifts leads to job dissatisfaction and Hence, enhancing, planning and scheduling procedures of
might influence patient satisfaction. Moreover, increasing hospital resources play a vital role in the improvement of the
hospital’s benefit and service quality delivered to patients.
An improved scheduling system is essential because it is
* Zahraa A. Abdalkareem a crucial role in reducing costs revenue, and for enhanced
[email protected]; accessibility to the healthcare system as well [6].
[email protected]

Extended author information available on the last page of the article

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446 Health and Technology (2021) 11:445–469

Fig. 1  Number of covered

article

In recent years, many reviews have been conducted in as “nurse scheduling”, “nurse rostering”, “patient admis-
healthcare scheduling considering the different scopes. for sion scheduling”, “patient to bed assignment”, “operating
instance, healthcare scheduling based data mining is dis- room scheduling”, “operating theater”, “surgery schedul-
cussed in [7]. The author provides a systematic review of the ing”, “surgical scheduling”, “physician scheduling”, and
literature that reflects an industrial engineering approach to healthcare scheduling with “heurstic” or “metaheurstics”
healthcare scheduling with an emphasis on the behaviour of “meta-heurstics”. For each article found, we performed a
the patients’ role in scheduling. An integrated hospital sched- forward and backward search to find additional manuscripts.
uling issue has been reviewed in [8]. The review has been We limited the review to papers that are written in English
done based on collects scientific papers related to integrated and are published from 2010 to 2020 (see Fig. 1). The search
hospital scheduling problems published between 1995 and procedure resulted in a set of 190 articles (see Fig.2), we
2016. In addition, operational research applicable to health- included papers that described the scheduling technique in
care was surveyed in [2]. One of the major contributions of healthcare, an overview of healthcare scheduling process
this work is to cover recent improvement issues in this area. which covers in this survey. We also included all papers that
In addition, there are several review papers dealing with described the effects of metaheuristics in scheduling health-
healthcare scheduling that include part of scheduling issues care decision-making in an optimization context.
such as [9], resource scheduling, operating room scheduling The organization of this survey is based on recent
[10, 11], and outpatient appointment scheduling [12]. research papers which provide optimization-based for the
Our contribution in this review paper is to compare and most common healthcare scheduling problems including
analyze all scientific work between 2010 -2020 in optimiza- definition and formulations, data sets, methods. The major
tion-based healthcare scheduling, focusing on metaheuris- part of the paper discussed the patient admission scheduling,
tic approaches. We investigate several versions of problem considering the recent problem found in the literature. We
definitions in the research of patient admission scheduling. also reviewed the problems in allocating nurse to shift; and
Furthermore, we also review the works available in solv- scheduling of operating room and surgery.
ing other healthcare scheduling, including nurse scheduling The importance and growth in using these optimization
problems and operating room scheduling/surgical schedul- methods revealed very effective results when used for health-
ing. Our review work centered around patient admission care scheduling problem. However, it is still possible to improve
scheduling research, nurse scheduling problems, and operat- the outcomes generated by present studies. Thus the research
ing room scheduling/surgical scheduling, considering these trends can be directed to investigate the applicability of other
problems are the most studied healthcare scheduling prob- optimization methods for healthcare scheduling problems. This
lems as described in Fig. 1 and 2. review has been analyzed based on optimization technique
We cover several articles written in English and published which especially based on heuristics, metaheuristic, hybrid
in peer reviewed journals, searched the databases covering metaheuristic to address any healthcare scheduling problem
several disciplines such as, Scopus, Google scholar for rel- such as patient admission, nurse scheduling/rostering, operat-
evant papers using combinations of relevant keywords such ing room scheduling/surgery scheduling, etc (see Table 1).

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Health and Technology (2021) 11:445–469 447

Fig. 2  Healthcare scheduling papers between 2010-2020

Thereby, we achieve a better understanding of this spec- 2 Patient admission scheduling problem
trum, point out some development from the most recent (PASP)
papers, summarise some of the existing methods and grasp
the new trends for future directions in this field. The organi- The Patient Admission Scheduling (PASP) is referred to
zation of the paper is as the following. Section 2 discusses assign patients to room in the hospital over a time horizons
patient admission scheduling problems, definition, versions, [13]. Patient admission scheduling is combinatorial optimi-
formulation, and data sets. Then, it is followed by Section 3, sation problem that is gaining a researchers concern in the
which describes the nurse rostering problem. Section 4 healthcare career. PASP support a decision makers at various
presents an operating room scheduling problem, and Sec- level such as long term (strategic level), med-term (tacti-
tion 5 briefly discusses other different healthcare optimiza- cal level), and short-term (operational level) in the health-
tion problems and solutions. Finally, Section 6 comprises care institutes [14], which determine whether the hospital’s
the the conclusion and future work directions. resources is ready for accepting patients through satisfactory
services.

Table 1  Other healthcare problem in optimization context 2.1 Definition of patient admission scheduling
Healthcare problems Scopus Google problem (PASP)
scholar
The Patient Admission Scheduling (PASP) is a problem of
Physician scheduling problem 14 6
scheduling patients within certain time slots in the hospi-
Home healthcare problem 20 21
tal to maximize both management competency, and patient
Telemedicine 6 3
comfort and safety, in addition to enhancing medical care

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in the hospital. Patient admission scheduling problem is a Table 2  Soft constraints weight [17]
complex combinatorial problem [15]. Since the problem is Constraints Corre-
first formulated in [16], its solution enables the scheduling sponding
of patients allocated to specific beds in particular relevant weight
departments, fulfilling in an optimal way to the needs of the
Mandatory room properties 5.0
patients and ensures all the required medical restrictions.
Patient age should obey the maximum or minimum age 10
Usually, the assignment of patients to beds is executed by a of the department
centralized admission office, by contacting the departments Preferred room properties 2.0
several days prior for efficient patient admission. Some Preferred room category 0.8
hospitals control the admission of their patients without a Department specialism 1.0
central admission office, leaving the admission responsibil- Transfer rate 11
ity to the various respective departments. As in the second
case, an absence of the overall knowledge and information
of the departments may cause in not being occupied opti-
mally. There could be shortage of beds available for patients – HC1: The availability of the room ( Rj).
in some departments, but extra beds in other departments. – HC2: Admission ADi , discharge date DDi , and time
horizon for the elective patient should be fixed, and
2.2 PASP Formulation unchangeable.
– HC3: Time horizon should be continuous.
First, the Patient Admission Scheduling version (1) also – HC4: Two patients ( Pi1 , Pi2 ) cannot be allocated in the
called (original problem) has been introduced by [17], which same bed at the same time horizons.
entails the supposition that the dates for admission and dis- – HC5: Gender schema should be carried out.
charge are prior knowledge. In addition, each patient should – HC6: The patient should be allocated to a department
occupy at least one bed for a certain duration of time. The which is is acceptable to his/her age.
basic terminology of the problem can be described in the – HC7: Mandatory room properties should be available in
following: the assignment rooms.
– HC8: Quarantine policy for some patients who need to
1. Nigh: The variables representing time horizon for indi- be isolated, according to their illness requirement.
vidual patient located in the hospital
2. Admitted patients are patients that are effectively admit- Furthermore, the soft constraints for this problem could be
ted to the hospital and are assigned to a room and a bed. summarized as follow:
3. Patient: A person requiring healthcare in a hospital and
must be allocated a bedroom with a determined date of – SC1:Room preference, which indicates the patient pref-
admission and discharge. erence regarding room capacity such as(single, double,
4. Room: Every department possesses its specific room, ward, etc). These constraints might be considered, oth-
where each room possesses its specific capacity depend- erwise they should be penalized (Table 3) for the weight
ent upon the number of beds in it, which may be in the penalty.
form of single/twin/ward beds.
5. Specialism: Every individual department in the hospi-
tal is determined by a single or additional treatment. Table 3  Default values of the weights of the cost components [18]
Furthermore, individual rooms belonging to a specific Cost component Accounting Value
department possesses its own specific level of treatment
ranging from (1-3) dependent upon specific patient case. Missing room equipment (PRC1) per day, per patient 20
6. Transfer: Moving admitted patient from room to another Unsatisfied room preference (PRC2) per day, per patient 10
during her/his stay. Partial specialty level (PRC3) per day, per patient 20
Unsatisfied gender policy (PRC4) per day, per patient 10
The problems faced in the original version of PASP are Transfer (Tr) per patient 100
the adherence to some of the constraints, which is to break Delay (De) per day, per patient, 5
per priority
them up into hard and soft constraints categories, depending
Overcrowd Risk (Ri) per patient 1
on the level of impact on the patients. The patient admis-
Idle Operating Room Slots (IOS) per minute 10
sion scheduling problem constraints (original PASP) is as
Idle Room Capacity (IR) per day, per bed 20
follwing:
Overtime (ORO and ORTO) per minute 3

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– SC2: Preferred room properties, which represented some Every room in the hospital can be a single, twin room, or
medical equipment in the department, and staff such as a ward. The capacity of a room depends on the number of
nurses. beds available. A patient may want to occupy a specific
– SC3: Degree of specialism, in some cases, patients pre- room capacity, but might need to pay extra.
ferred to get medical treatment in departments that have – Specialism: Every patient in the hospital needs a specific
highest degree of specialism. treatment. Thus, the management office in the hospital
– SC4: Needed properties, some patients should assigned should distribute the patients according to their diseases.
to a room with special equipment’s. This constraints is However, a specific departments may be considered as
related to HC7. fully, partially qualified, or not qualified for the patients.
– SC5: Transfer, the unplanned transfers should be mini- It is considered as unreasonable to schedule a patient
mised. to a non-qualified department for the treatment of the
patient’s disease; whereas, allocating a patient to a par-
All soft constraints should be satisfied as much as possible, tially qualified department is acceptable. However this
and sometimes impossible to satisfy all the soft constraints. might maximize the cost function.
Otherwise, could be penalized the solution, the weight for – Room Feature: The quality in the room is depends on
each those constraints is as the following Table 2. its feature. Some of room have additional features such
as oxygen, telemetry, nitrogen, and television. Some
The objective function of Patient Admission Scheduling patients need/prefer certain specific features which are
(PASP) is to minimize all soft constraints, while satisfying case-dependent. Assigning a patient to a room without
the patients preferences, and respecting all the hard con- considering the needs is deemed to be an unfeasible solu-
straints to the problem, in order to obtain feasible solutions. tion, whereas missing the desired features will maximize
the objective function depending on the weight value of
2.2.1 Patient admission scheduling problem this element.
under uncertainty (PASU) version 2 – Room Gender Policy: Every individual room has a gen-
der policy. There are four policies (SG, Fe, Ma, All). Fe:
The PASU version involve in allocating room for each is for female patients only; Ma: is for male patients only;
patient upon a number of days equal to her/his stay period, SG: both genders can be accepted. But in the same day
starting in a day, not before the planned admission. The should be from the same gender. All: the same gender
extended version from PASP was proposed and formulated can be accepted at the same time, for example (intensive
by [13], However, it included several real-world features, care).
such as the presence of emergency patients, uncertainty in – Age Policy: Certain departments have age limits. For
stay lengths; and the possibility of delaying admissions. The example; the pediatrics department accepts patients
problem formulation considered many attributes in order to ranging from 0 to 12. PASU involved hard and soft con-
develop medical service in the hospital. It takes into consid- straints and have to be met. In this problem Department
eration the possibility that a patient’s stay can be extended. Specialism (DS), Room Features (RF), they are hard
The patient’s extended stay might affect the room schedul- for the missing qualification, or needed features, but soft
ing, and this may lead to overcrowding. The PASU problem for partial qualification and the desired feature. The hard
have several basic concepts [13]: constraints are:

– Day (planning horizon) : This entails the measurement of – HC1: Room capacity (RC), allocating two patients
time and is to denote the duration of the determined stay at the same bed simultaneously make the solution
of individual patient in the hospital; the set of sequential infeasible.
days taken into account in the problem is termed as the – HC2: Patient Age (PA), patients should be assigned
planning horizon. to a department that accept his/her age.
– Patient: A patient is the person who needs specific treat-
ments in the hospital and is required to stay in the hos-   The soft constraints are:
pital, the duration of the stay should be continuous. In
addition, two kinds of patients have been used in this ver- – SC1: Room Gender (RG), gender policy room should
sion, inpatients who are already admitted to the hospital, be fulfilled.
and a new patients, new patient refers to a patient who – SC2: Room Preference (RP), patient prefer to be
will be admitted. allocated room with special preference.
– Room/Department: Each room in the hospital belongs – SC3: Transfer (Tr), transfer inpatient from room to
to specific department depending on the patient’s needs. another during her stay is undesirable.

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– Delay (De): delay patients admission. unsuitability (PRS). The variable x represents the search
– Overcrowd Risk (OR): calculated a number of space of the problem. There are other variables to describe
patients who have been allocated for each room and the components of the objective function F. The variables
take the certain, potential attend overstay length of for the Room Preference (RP) management component is
some patients, and capacity of the room. shown in the mathematical expression below:

  All soft constraints have been correlated with weights, – fr,d,mr,d :1 if there is one female at least (resp.male) patient
based on its importance to the patients. The highest in room r in day d,0 otherwise.
weight is associated with SC3, transfer patients are add- – br,d :1 if there is both male and female patients in room r in
ing (100) to the objective function, the second-highest day d,0 otherwise. These new variables are related to the x
weight is for SC1, which is related to the gender policy and to each other by the following constraints:
for the patients, it is weighted (50) adding to the cost.
The rest are Department specialism, Room feature is
fr,d , ≥ xp,r ∀p ∈ Pf , r ∈ R, d ∈ Dp (4)
weighted (20), while Room Preference is (20). Finally,
Delay (De) is (2), and Overstay Risk is weighted (1). mr,d , ≥ xp,r ∀p ∈ Pm , r ∈ R, d ∈ Dp (5)

2.3 PASU formulation in mathematics br,d ≥ mr,d + fr,d − 1, ∀r ∈ R, d ∈ D (6)

The mathematical formulation for PASU is described and As well as the equation (4), and (5) establishing relation
formulated by [13], and for self- integration for this paper, between the auxiliary variables f and m to x, stating that
we introduce the mathematical formulation here. when there is a female (resp.male) patient in room, then all
the f (resp.male) variables corresponding to the days d ∈
1. P: is a set of all patients. Dp must be set to 1, whereas, constraints (d) relate both m
2. PF is a set of female. PM is a set of male patients. Where and f to b, in the way that if m and f are = 1 then b must be
⋃
PF PM = P. 1. For the constraint (OR) overcrowd risk components the
3. PH is a set of in-patients and rp is the room occupied by modeling is as follow:
in-patient where p ∈ PH yr,d :1 if room r risks to be overcrowded in day d, 0 other-
4. D: is a set of days. wise. So as to define the constraints that have relating y varia-
5. R: the set of rooms and cr is the capacity of room r ∈ R. bles to x, the following definition will complete the mathemati-
+
6. RSG : the subset of rooms with policy SG. Additionally cal expression. pd: is a set of patients that are possible to attend
we have to hospital in day d, which are the patients that existing in day
7. Dp: is a set of days in which a patient p ∈ P is present in d plus those present in day d − 1 with the risk of overstay. |Z|
the hospital. :the cardinally of a set Z. and z̄:the complement of variable z.
8. Pd : is a set of patients present in day d (i.e., set of The constraints relating y to x are the following:
patients p such that d ∈ Dp ). The main decision vari- ∑ (| | ) ( )
ables are the following: ̄ ≥ |P+d |−cr . 1 − yr,d ∀d ∈ D, r ∈ R
xp,r
+
| | (7)
p∈Pd

xp,r : 1 if patient p is assigned to room r, And 0 if not. The It’s worth noting when yr,d = 1 the variables xp,r can
constraints on the x variables are: (| be |
any
value. On the contrary, when yr,d = 0 then at least |P+d | − cr
∑ | |
xp,r = 1, ∀p ∈ P of the x include should take the value 0. Additionally the
(1)
r∈R objective function can computed as follow:

∑ F = FPRC + FRG + FOR (8)

xp,r ≤ cr , ∀d ∈ D, r ∈ R
(2)
p∈Pd The components of the objective function PRC,RG,and OR
is defined as follow:
xp,r ≤ Ap,r ∀p ∈ P, r ∈ R (3) ∑ | |
FPRC = Cp,r .Xp,r .|Dp | (9)
| |
The equations describes how the constraints are defined in p∈P,r∈R

PASU, equation (1) explains how the patient is assigned to

∑
the specified room, while equation (2) ensure the capacity of FRG = WRG .br,d
(10)
the room does not exceed the limits (RC). Finally, equation r∈RSG ,d∈D
(3) provides against infeasible assignments for patient-room

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∑
FOR = WOR .yr,d specialized in treatment for one type of patients such
(11) as pediatrics and geriatrics, only host patients from a
r∈R,d∈D
certain range of age, with minimum and maximum age
The equation (9) calculates the cost for patient-room assign- terms and conditions. While (Gender policy), refer to
ment, while equation (10) calculates the number of rooms four types of rooms in the hospital which are: D,F,M,
occupied by both male and female patients. The last equa- and N. The room from type D can accept patients from
tion (11) assesses the overcrowd risk. The PASU problem is both genders, but in the same day the patient should
modeled as Integer Linear Programming (ILP). In addition, be from the same gender. Type F only accepts female
it can be implemented in any general purpose Integer Pro- patients, whereas type M only accepts male patients.
gramming IP solver. In general the problem is modeled as Finally, room type N, accepts both genders, for
three dimensional matrix of decision variables z, zp,r,d = 0 instance, recovery rooms and the intensive care rooms.
if and only if patient p is in room r in day d. It is worth men- Dynamic Patient Admission Scheduling with Operating
tioning that the 1′ s in the matrix z are consecutive, and its Room Constraints, Flexible Horizon, and Patient delays
equal to patients stay length. are to assign a patient to a room in a department, and
the patient is currently present at the hospital, making
2.4 Dynamic patient admission scheduling the admission realistic, and the discharge of a patient
with operating room constraints, flexible from a room could be done later, depending on the
horizons, and patient delay (version 3) patient’s situation. The solution to this problem should
satisfy all of the hard constraints and categorized in
This version of patient admission scheduling problem this problem as:
engaged with operating room scheduling [18], it is presented
into two phases, patients admission constraints phase, and – HC1: Room capacity (RC), each room has a limited
operating room constraints phase. number of beds, thus, the number of patients cannot
The basic concept of the first phase is as following [18]: exceed the number of the rooms.
– HC2: Patient-Room Suitability (PRS), the assign-
– Patients: Is the main component in this problem, and ment of individual patient to a room must be a match
the patient should have an admission and discharge date, and appropriate to the patient’s needs and condition.
the duration between the admission and discharge date
is termed as the length of stay (LoS). Some patients may Hence, the cost function could be calculated based on the
need to extend their stay in the hospital, because of their violation of the following four soft constraints related to the
situation, and these extension is termed as overstay risk. patient’s admission problem. Patient-room cost (PRC), [18]
– Day: A day is a unit specifying the time spent by the generated a matrix that consists of an integer value termed as
patients in the hospital, where each patient should spent a Patient-Room Matrix. It explains the penalty of patient-to-
few continuous days. These days are termed as a planning room allocations. If the value in the matrix is 1, that signifies
horizon. that the room is not suitable for the patient. Meanwhile, if
– Room: A room belongs to a department, the quantity it has a positive value, it means that the room accepts the
of beds that can occupy a room is termed as capacity patient with penalty. Additionally, if it is 0, that signifies that
(typically one, two, four rooms, or a ward). The room it is matches the requirements, and it is a suitable fit. The
may have properties such as oxygen, nitrogen, telemetry, second constraints is Room gender (RG), based on the room
and TV). These properties may become preferences or types mentioned above, the room type N is the result of no
patients’ requirements. cost, whilst the room type D denotes that it can be occupied
– Specialty/Specialism: Ordinarily, patients usually need by both genders concurrently. However, there is a penalty
to get one type of treatment, whereas there are some imposed that is proportionate to the size of the smaller of
patients who might need more than one treatment and the two patients. The cost for rooms of type F and M are
those with special cases. In fact, each department in inclusive in the patients room matrix. The third constraints
the hospital is responsible for treating a specific dis- is Delay (De), the delay results with cost incurred depending
ease that needs different types of specialization but at on the length of the delay. The delay is usually undesirable
diverse levels of expertise. Three levels of specialists if the admission date is nearer, then the delay expense is
sets in the department, complete treatment (no penalty), multiplied by priority that is reciprocally proportionate to
partial treatment with a penalty, last level none, which the nearness of the admission day. Finally, Overcrowding
mean that the patient can not be treated in this depart- risk (Ri), additional penalty added for the cost function, if
ment. Beside the features mentioned above, there are the patient is to be discharged and needs to stay, and his/her
two polices, age and gender, some departments which room is fully occupied.

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The basic concept of the second phase (operating room not exceed the limitation of normal time that giving to it.
notions) is as follow: In some cases specialty goes overtime, this will lead to
Operating room scheduling is assigned specialities to the cost related to dedicated personnel, but not for all staff in
Master Surgical Schedule (MSS). Master surgical schedule the operating room. In contrast, other specialty may not
regularly repeated schedule [19], in which assigning one use the operating room full time, so this will balance the
specialist for the operating room for the duration of time occupancy. Also the total overtime of the rooms could
(typically each week). Patient admission scheduling problem be calculated by adding the next component called an
(version 3) has been bounded with operating room schedul- operating room total overtime in order to count the costs.
ing, and the basic notation for operating in this problem is Operating Room Total Overtime (ORTO): For any day,
as follow: the cost for the overall length surgeries in all specialties
including (urgent cases) should not exceed the total nor-
– Operating Room Slot: It is the smallest amount of time, mal time of the operating rooms.
in which the operating room could be reserved for one
specialty in that day. In any day in the scheduling plan- 2.5 Dynamic patient admission scheduling
ning for Master Surgical Schedule(MSS) an integer num- with operating room constraints, flexible
ber of operating room slots will be assigned a specialty. horizons, and patient delay (version 3)
In the same day/the operating room could be occupied formulation in mathematics
by different surgeon in the same specialty.
– Surgery Treatment: Each patient in the hospital is subject Mathematical formulation for this problem is extension for
to a special treatment. Some of them need to get surgery (PASU) problem version 2. However, The cost function for
of corresponding specialty. In this situation the day of this problem could be calculated according to various weight
the surgery (may be in the same day of admission or the based on the importance of the constraint for the patients.
next day after admission), so the expected length of the Tables 3 and 4 reports the weight of the cost components.
surgery should be fixed with the specialty. The assign-
ment is as long as subject to all the constraints that are 2.6 PASP Data sets versions
presented previously (RC,PRS,PRC,RG,De,Ri) and for
the operating room there are additional constraints: Oper- The original data set which belong to the first version of the
ating Room Utilization(ORU): In each day and specialty, problem1 is firstly reported by [17]. The data set consists of
there is a limited time specified by the (MSS), where the 13 instances as shown in Table 3. The instances 1 to 6 have
total length for each surgery belonging to the specialty equal time slots of 14 days. While, the instances 7 to 12
should not exceed the limit. This condition is considered have the time slots between 14 to 91 days. All the patients
as a hard constraint, and its effect on the search space of in these instances are in need of only one specific treatment,
the problem. Meanwhile, [18] is only covered the admis- but in instance 13, the patients need multiple treatments dur-
sion day of a patient; the problem of sequencing operat- ing the patients’ stay. This signifies that the instance 13 is
ing room slots in diverse operating rooms and surgeries more complex than others. In addition, this data set which
within each OR slot is not included in this problem. In reported by [15, 17] describes the original data set features
addition, the length of emergencies for patient is not take including all present patients, even those whose admis-
in consideration in the computation of the utilization for sion and discharge dates are the same day. Figure 3 give an
the ORU constraint. Further more the total occupation example description of the data set. The data set involved
should be lower than the capacity. So there is another two-stage, first stage describes the rooms in the hospital,
constraint, should take in consideration that deals spe- including room name, capacity, type (mean type of patients
cifically with this issue, which is Operating Room Total gender, which occupied the room), specialist for each room,
Utilization (ORTU): In each day the total length of all finally the room properties. Second stage represented the
surgeries including urgent cases and belong to the same patients needed/preference feature. Starting with patient id,
specialty should not exceed the capacity of the operat- age, gender, duration of stay. Then the department and spe-
ing rooms. The ORU and ORTU​ constraints cover only cialist need for each patient, room capacity preferred by the
the total length of slots. In reality, this length is divided patient, finally the needed and preferred properties.
into normal time and overtime. Normal time can be used The second data set type is generated by [13], the
freely, whilst overtime is allowed but should be mini- author created and designed a data generator that is able
mized. To model this situation, the problem includes a to generate realistic data for a huge set of varying sizes.
cost component soft for the overtime work. Operating
Room Overtime (ORO): for each day and specialty, the
total length of surgeries with the same specialty must 1
https://​people.​cs.​kuleu​ven.​be/​wim.​vancr​oonen​burg/​pas/

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Health and Technology (2021) 11:445–469 453

Fig. 3  Example for PASP original version data set

The generator accepts parameters such as: the number single-day-cases to give opportunity for a complex to be
of patients, departments, days, rooms, and features. solved. The data set consists of 9 families of 50 instances
Randomized instances generated according to preset dis- each. The data set entities is divided into three varying sizes
semination related to varying features like the duration in terms of the number of patients and the planning horizons.
of the stay, the room capacity, the number of specialism, By observing this data set, on the doubling of number of
and others. Meanwhile, the generator is not designed for days, the number of patients is equally doubled in order to
keep the average occupancy balanced. Tables 5 and 6 reports
the data set features.
Table 4  Data set 1
Instances Bed Room Patients Planning 2.7 PASP‑based optimization methods
horizons
The ways that are presented by the researchers to optimize
1 286 98 693 14
the patient admission scheduling can be classified into two
2 465 151 778 14
types of search methodologies and solution technique. There
3 395 131 757 14
are many scheduling techniques available for solving patient
4 471 155 782 14
admission scheduling problem (PASP). The work done by
5 325 102 631 14
[17], local search called tabu search hybrid engaged with
6 313 104 726 14
token ring and a variable neighborhood descent approach,
7 472 162 770 14
has been applied to assign a patient to bed in the hospital.
8 441 148 895 21
Randomly generated data set have been used to evaluate the
9 310 105 1400 28
proposed method. The method needs more be investigated
10 308 104 1575 56
due to the complexity of this problem and could also be
11 318 107 2514 91
expanded further in terms of considered emergency admis-
12 310 105 2750 84
sions, and intensive care department. Moreover, another
13 multi specialism 368 125 907 28
local search have been applied by [20] to tackle PASP,

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Table 5  Data set 2 [13] Family Depts Rooms Features Patients Specialism Days

Small Short 4 8 4 50 3 14
Small Mid 4 8 4 100 3 28
Small Long 4 8 4 200 3 56
Med Short 6 40 5 250 10 14
Med Mid 6 40 5 500 10 28
Med Long 6 40 5 1000 10 56
Large Short 8 160 6 1000 15 14
Large Mid 8 160 6 2000 15 28
Large Long 8 160 6 4000 15 56

simulated annealing hybrid with local search and get the an optimization technique in order to minimize the patients’
best known results. The method was tested on data set 1; waiting time. To evaluated this approach data is collected
the author excluded one constraint, which is transfer patients from 966 medical test for specific duration (4 month). This
form one room to another. method has been focused on one aspect of the patient’s
A hyper heuristic approach has been used to tackle two admission, which is imagine clinic.
combinatorial optimization problem, the patient admission Certain methods were developed using various types of
scheduling problem and the nurse rostering problem [15]. metaheurstics such as in [23] the author introduced a Bioge-
Applying hyper heuristic is not appropriate, if the occupancy ography (BBO) algorithm which is population based meta-
bed rate is increased in the hospital, which is due to the fix heuristic to address PASP problem. The proposed method
admission date. Moreover, the method has not considered evaluated its performance through the utilization instances
the intensive care patients, patients who need isolation, from dataset 1. The result of BBO needs to be investigated
patients on waiting lists. On another hand, theses two prob- further because it has reached a stagnation state earlier and
lems could be integrated together and come up with new ver- could utilize all instances instead of only (1-6). In addition,
sion of PASP. The method was tested on a new benchmark an exact method was used by [24], the proposed method
data set introduced by the author. utilized column generation based heurstic incorporated with
Two Integer linear programming models (ILP) has been dynamic constraint aggregation, and new mathematical for-
developed for tackling a day- to- day planning process for mulation for PASP problem was introduced. In this method,
(PASP) problem [21]. This work is an extension of the work six instances were used from data set 1 to evaluate the
done by [20], and similar to [13]. The main contribution is method. The proposed method obtained good result in term
by adding random registration date and predicted leaving of accuracy for small instances (1-5 instances). An exact
date. The first model calculate for determining the optimal method could be used to solve small instances, for large
assignment for patients who have just arrived, while the instances, the approach needs further investigation. Another
second model calculate for forthcoming, but planned, arriv- metaheurstic was proposed by [25] known as an adaptive
als. Hence, the performances of these models are compared non-linear deluge algorithm to address patient admission
with each other. The result shows that the second model is scheduling PASP. The result of this approach was compared
superior to the first in all conditions. In this method the over- with other algorithms in literature, and was found to obtain
crowed risk and the delayed in admission are not considered. superior results through the utilization of the six instances
In addition, [22] introduced meta-heuristics algorithm out of 13 from data set 1.
for tackling appointment scheduling problem in an imag- Furthermore, [14] proposed a metaheurstic approach
ing clinic. A discrete-event simulation model bound with using large neighborhood search by utilizing simulated

Table 6  Data set 3 Family Rooms Depts OR Specs Treats Patients Days

Short1 25 2 2 9 15 391−439 14
Short2 50 4 4 18 25 574−644 14
Short3 75 6 5 23 35 821−925 14
Long1 25 2 2 9 15 693−762 28
Long2 50 4 4 18 25 1089−1169 28
Long3 75 6 5 23 35 1488−602 28

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Health and Technology (2021) 11:445–469 455

annealing for solving dynamic patient admission schedul- population-based metaheurstic called harmony search algo-
ing problem. This method is based on [13], and tested using rithm. The method has been tested on 6 instances of data
450 instances from data set 2. The result demonstrated an set 1 and compare with other metaheurstic approaches. The
improvement for the small and medium instances and much proposed method needs more enhancement and should be
faster than the work done by [13], while for large instances tested on the rest of the data set.
there is a need for further improvement. In the work done by [32] the author proposed an exact
In similar context, [26] studied a dynamic patient-to-room method to address PASP. A new mathematical formulation
assignment planning by expanded the PASP proposed by bulit up, and mixed integer programming has been utilized
[17]. In this method, two outline Integer linear program- with parameter free, and without pre- processing phase. The
ming ILP models for solving this problem. The developed proposed approach tested on (1-13) instances from data set
method engaged in certain testing using benchmark data set 1, and proof an optimal results for 2 of the instances and
with some extension on its parameters, such as registration 9 new best result have been reported. Recently [33] revis-
date and expected departure and also explicit the emer- ited and extend biogeography-based optimization algorithm
gency patients. The result of these two models showed a (BBO) to tackle PASP. The author introduced a selection
more superior performance by the second model under all technique called guided bed selection to enhance the ability
circumstances. Two methods known as Fix-and-Relax (FR) of BBO and increased the diversity. Modified BBO yield
and Fix- and-Optimize (FO) has been conducted by [27] better results than simple BBO using 6 instances from the
to solve (PASP). These two methods are based on heurstic original data set. On the other hand, [34] have studied the
using mixed integer programming. The problem is divided effect of compatible between short term and long term
into two sub-problem based on time frame, and then the (strategic) in context dynamic patient admission scheduling
sub-problem are optimized. It entails the decomposition with problem which proposed by [18]. The results of this method
the consideration of LoS, preference. The solution that was using Dantzig-Wolfe decomposition and column generation
generated by the first method (FR) was used as input to the get better results for 26 instances out of 30.
second method (FO). The proposed method that used (12)
instances out of (13) from the data set 1 obtained promising 2.8 Discussion
feasible result at a faster rate of less than 3 minutes com-
parable with the state-of-arts. Recently [28] introduced an The problem of optimizing patients admission scheduling
offline patient admissions scheduling problem under uncer- has received attention recently. Patients scheduling in opti-
tainty with new suggestion on how to set the weight for the mization can be considered from different side of aspects,
constraints. The method was tested on small short families (short,med,long) term scheduling, patients group, and
from data set. This method was developed based on pre- methods which can be used to tackle such problem. Patient
vious work of the same author [29] which proposed three admission scheduling problem has been aroused at all levels
optimization models based matheuristic called (FiNeMat) of hospital planning and scheduling. Generally, most studies
for solving patient to bed assignment which considered it have focused on the operational level more than the tactical
as a sub-task from PASP [17]. In this work the author gives and strategical level. The operational level is also called the
a guideline on how to set up the penalty values for the soft decision support level by assigning one task to resources
constraints. Moreover, [30] presented a newly metaheurstic in the hospital. There is fewer scheduling system that uses
approach known as Late Acceptance Hill Climbing Algo- multiple level of decisions. The compatibility between all
rithm (LAHC) to address PASP problem. LAHC type of decision level very challenging problem and the studies on
meta-heurstic and considered as a one-point solution tech- it is not rather vast and need to be further investigation.
nique. The proposed method involves two steps: the first Moreover, the patients have been classified into groups,
step includes the generation of the initial feasible solution elective patients and non-elective patients, elective patients
utilizing the room oriented-based approach whilst, the sec- have been widely studied in the literature which used a his-
ond step entailed the embedment of three neighbourhood torical data from the hospital and scheduling the patients
structures inside the LAHC-based PASP component for the according to fixed data (statically). Non-elective patients
extended enhancement of the initial resolution generated at refer to the patients whose the admission and discharge dates
the beginning step. The suggested algorithm was assessed are unknown, such as emergency patients or uncertainty
utilising the dataset 1. The result showed that the technique patients (dynamically). However, scheduling uncertainty is
outperformed numerous other existing techniques from the a complex task and there are few studies on scheduling the
literature using 1-6 instances out of 13. The main purpose uncertainty patients. It should be noted that most studies on
behind the scheduling method is in the reduction of the elective patients and neglect the problems arose in non-elec-
patient waiting time, and in the hospital resource utiliza- tive patients. Static PASP optimality are open challenges and
tion enhancement. Moreover, [31] tackled PASP using a still most of the researchers focusing on the short data set

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Table 7  Summaries of PASP versions, methods, patients, and data sets

Name of method PASP versions Category Data set References

Tabu search version 1 Metaheurstics Randomly generated [17]

One hyper-heuristic version 1 Heuristic Newly generated data set [15]
Late accepting hill climbing version 1 Metaheurstics Data set 1 [30]
Local search version 1 Metaheuristic Data set 1 [20]
Simulated annealing with neighborhood structure version 2 Metaheuristic Data set 2 [13]
Local search version 3 Metaheuristic Data set 3 [18]
Tabu search version 1 Metaheuristic Data set 1 [17]
Markov decision process and dynamic programming version 2 Heuristics Data set 2 [35]
FiNeMath version 1 Metaheuristic Data set 1 [29]
Biogeography based optimization version 1 Metaheuristic Data set 1 [23]
None linear great deluge version 1 Metaheuristic1 Data set 1 [25]
Large neighborhood search version 2 Metaheuristic Version 1 [14]
Column generation approach version 1 Heuristic Data set1 [24]
Mixed integer programming version 1 Exact Data set1 [27]
Mixed integer programming version 1 Exactc Data set 1 [32]
Column generation version 2 Heurstics Data set 3 [36]

(1-6), due to the complexity of the rest. However, instance optimization model. Nurse rostering is N/P hard problem
13 only addressed in three articles because the patients which involves two steps; the first step is to determine
need to be treated in multi departments. Dynamic version the number of staff to be scheduled, and second step is to
of this problem get less attention, and also many researchers allocate them in the time horizon for the schedule. The
focused on the small families and medium data sets. Patient following section will give further details about this par-
admission scheduling problem integrated with other health- ticular problem including its definition, mathematical for-
care resources such as nurse, physician, and operating room mulation, versions, and finally the data set types for each
could be improved the services in the hospital for future version.
challenge work.
From an algorithmic point of view, patient admission
scheduling problem versions were handled using different 3.1 Nurse scheduling problem definition
heuristics, metaheuristic, or exact method. The researchers
have to develop new algorithms for handling this problem. The problem in nurse scheduling is so entrenched in the
The Table 7 summarizes the patient admission scheduling healthcare system, which is considered as under resource
problem versions, approaches, and data sets. scheduling in healthcare, entailing the scheduling of a per-
sonnel [38] or staff in the hospital, by balancing the work-
load and preferences. The nurse scheduling problem entails
3 Nurse rostering problem NP hard optimization problem which is set through the allo-
cation of a group of differing skilled nurses to various kinds
Nurse rostering problem is a type of staff scheduling issues of shifts as shown in Table 8, over a predefined schedul-
[37]. It is defined as a procedure to organize a time table ing time [39]. To obtain the feasible scheduling, the hard
that satisfies the demand of each person without con- constraint should be achieved, while the soft constraints are
flict [37]. Nurse rostering have adjudged to be particu- allowed, however will be penalized. Nurse scheduling pref-
larly complex and difficult optimization problem. Many erence should be maximized, and the overall cost should be
researchers attempt to solve this problem using a different minimized.

Table 8  Nurse scheduling type Shift type Mon Tue Wed Thu Fri Sat Sun
shifts [40]
Morning 3 3 3 3 3 3 3
Afternoon 3 3 3 3 3 3 3
Night 2 2 2 2 2 2 2

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Health and Technology (2021) 11:445–469 457

Table 9  Nurse regulation

Regulation Description

Maximum number of assignments Total number of shifts the nurse can be given
Minimum number of assignments Minimum number of rotation for each nurse
Maximum number of consecutive working days Total number of consecutive working days for each nurse
Maximum number of consecutive free days Total number of consecutive free days for each nurse
Minimum number of consecutive free days Minimum consecutive free days for each nurse
Maximum number of consecutive working weekends Total number of consecutive working weekend days for each nurse
Maximum number of working weekends in four weeks Total number of consecutive working weekend days for each nurse per month
The number of days off after a series of night shifts complete Set it “true” if a nurse has to work on all days in a working weekends
weekends
Identical shift types during the weekend Set it “true” if a nurse is assigned to task at the same rotation on all days of a
working weekend
unwanted shift patterns For example, if the nurse preferred morning shifts

3.2 Nurse rostering problem versions 3.3 NRP Datasets versions

Nurse rostering problem has been widely studied in the There are several data set type publicly available for NRP.
last decades. The first version has been run in 2002, However, most of them are real world data, first of them
and then in 2007 an extension model was developed in KAHO data sets https://​people.​cs.​kuleu​ven.​be/​pieter.​smet/​
order to provide the researchers with various models and nurse​ro, represented instances of six wards in two differ-
increase the real world constraints. Recently in 2010, ent Belgian hospitals. These wards include three different
(INRC-I) has been expanded and later (INRC-II). The scenario’s: normal, overload and absence. The first scenario
next section will illustrated (INRC-I) and (INRC-II) in represents a usual working case with average working condi-
details. tions. The second scenario offers unexpected condition, for
example when there is a disaster or an unexpected absence
case. On the other hand, the second data set type belongs to
3.2.1 NRP version1 (INRC‑I) the First International Nurse Rostering Competition (INRC-
2010) prepared by the research group at the University of
The first international competition (INRC-I) [41] was Udine in Italy and the Second International Nurse Rostering
established in 2010, based on two influential competi- Competition (INRC-II), all instances and data set could be
tion ITC2002, ITC2007 [42]. The generic model in this find https://m
​ obiz.v​ ives.b​ e/i​ nrc2/?p​ aged=2​ 0. NSPLib http://​
problem is how to allocate a nurse in a shift subject to www.​proje​ctman​ageme​nt.​ugent.​be/​resea​rch/​data/​reald​ata is
several numbers of constraints. The objective function of another data but it is not derived from real data,but its con-
this problem is to minimize all the soft constraints and structed with that problem generator. Nottingham datasets
this will lead to reduced penalties. The NRP description [43] which has been provided by Nottingham university
is [41]: which, established a website consist of a wide range of data
sets from world wide hospitals. Additionally, the UK data
– Roster: List which is made for several days for each set [43] which is the earlier one that is obtained from the
ward in the healthcare institution. UK hospital and consists of 411 preprocessed valid shift
– Shift/rotation types: Appointed a nurse with specific patterns.
skill based on period of time.
– The number of nurses required for each day and for 3.4 NRP‑based Optimization Methods
each type of shift is provided.
– A series of arrangements reflecting the nurses ’ work NRP typically considers staff scheduling problem [44]
regulation. Every nurse performs precisely according Numerous researchers give special attention to nurse sched-
to a contract. A contract should provide a rules of the uling and attempts to optimize it in order to achieve a work-
work as shown in Table 9: able roster that has positive scheduling quality. Recently,

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[45] proposed directed Bee Colony algorithm which is used achieved. In addition, [52] tackled NRP by utilized local
to address NRP. The researchers utilized a multi-objective search method (SA) based on a large neighborhood. The
mathematical programming model and adapted a Multi- proposed method tested on INRC-II and getting better results
Objective Directed Bee Colony Optimization (MODBCO). in small instances (4-8) weeks whilst, for large instance are
The performance of this algorithm is evaluated using worst in comparing with [51]. Moreover, [53] developing
INRC2010. A set of 69 different cases of various sized data two heuristic algorithms to solve NRP in a radio logical
sets are chosen, and 34 out of 69 instances obtained the best technologist rosters in the research hospital. Decision tree
results. Furthermore, [46] proposed a hybrid harmony search method and greedy search algorithm has been integrated
algorithm with hill climbing as a resolution in addressing with bat algorithm and particle swarm in order to generate
the greatly limited nurse rostering problem (NRP). This a feasible solution. This method has a limitation in consid-
method utilizes hill climbing to empower its exploitation in ering a scheduling for long period. Fix-and-Relax (F and
the search space. Moreover, the harmony memory consid- R) and Fix-and-Optimize based simulated annealing, are
eration in the harmony search algorithm is through replace- two methods has been utilized by [54] to tackle NRP. The
ment by random selection scheme along side the global method has been tested on 24 available data set, and has
best concept of particle swarm optimization, in order to been reported seven new best-known results. In Table 10
accelerate the convergence rate. The result of this technique summaries of NRP and various version with its method,
demonstrated that the proposed method obtained five new datasets, and categories
best outcomes in relations to the quality of the solution, and
time necessities. In addition, [39] offered another method to 3.5 Discussion
address NRP. The author introduced harmony search algo-
rithm with a modification in its operators, replacing random The problem of optimization Nurse rostering (NRP) has
selection with the global-best selection of Particle Swarm become a major topic for scholar among the personnel sched-
Optimization in memory consideration operator to enhance uling problems. It become an attractive problem for many
convergence speed. In order to develop a local utilization in optimization researchers. Nursing shortages are a significant
this method, multi-pitch adjustment procedures were added. and multifaceted problem in healthcare systems and in optimi-
The result of this method proved that harmony search algo- zation field is crucial. Many researchers have tackled the prob-
rithm have the ability to solve the NRP using INRC2010 lems with different techniques such as exact methods, heuris-
data set. Furthermore [47] proposed hybrid Artificial Bee tic procedures and metaheuristics. Nurse rostering problem is
Colony algorithm to address NRP. The author replaced the an open research challenge in operational level using various
bee phase by hill climbing method in order to rise up the metaheuristics approaches. Hybridization of metaheuristics
exploitation. The performance of this algorithm is evaluated with local search show the ability to solve NRP [47], Due to
using INRC-I. For two instances the proposed method has the ability to balance the exploration and exploitation.
had good results. Nurse rostering problem has been studied with a different
In the work done by [48], the author proposed an integer type of constraints, features and evaluated in various coun-
programming techniques to solve NRP. On the other hand, tries [43] using different real hospital data sets. Most stud-
[49] solved a dynamic version of NRP which was formulated ies have focused on the data sets (INRC-I), and INRC2010.
for the second nurse rostering competition (INRC-II). In There is a limitation of creating real data sets from hospitals
this proposed method two solvers were created, which were from different countries, this belongs to the privacy for the
dependent on Mixed Integer Linear Programming (MILP) hospitals. INRC-II dynamic version has limited studies due
and Simulated Annealing respectively. The first solver was to its complexity and the multi-stage scenario. Most studies
based on the exact method using the MILP solver CPLEX (v. for INRC-II focused on the small instances (4-8) weeks for
12.5), Meanwhile the second solver was implemented using this problem. Nurse scheduling problem could be developed
EasyLocal++ (v.3). In addition [50] had also solved the further by taking in consideration, each country conditions.
dynamic version for NRP. The researchers have added a new Integrating between nurse scheduling and other healthcare
expansion to the problem in the version of additional con- problem such as patients scheduling, physician scheduling
straints to address incomplete data, and have used an integer could enhance the performance of the medical institution.
programming model to solve the problem. The experimen-
tal result using this approach had shown an improvement
on the basic model outcome, and had attained competitive 4 Operating room scheduling
outcome in comparison to the contest finalists competition.
The work done by [51], branch-and-price procedure engaged Operating room theatre plays a significant part in the health
with large-neighborhood-search framework has been used care sector, because of its major impact on hospital perfor-
to solve INRC-II. The results in large instances has been mance. Operating room requires a special combination of

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Health and Technology (2021) 11:445–469 459

Table 10  Summaries of NRP versions, methods,categories, and data sets

Method NRP verssion Category Dataset Reference

Local search weekly shift patterns Metaheurstics ORTEC01 [55]

local search/large neighbourhood INRC-II (static) Metaheurstics INRC-II competition datasets (hidden [52]
instances)
Column generation Shift Scheduling Heurstics standard benchmark data sets [56]
Harmony search/Great deluge UKMMC (real world) Metaheurstics Malaysia Medical Center data [57]
bat algorithm/particle swarm optimi- radio-logical technologists’ shifts Heuristics [53]
zation
Simulated Annealing/MIP - Metaheurstic New generated dataset [54]
Tabu Search Specific scheduling/ hospital in Metaheurstics 5real datasets [58]
Canada
Evolutionary algorithm and ABC Chinese NRP Metaheurstic N/A [59]
Great deluge INRC-I Metaheurstic INRC-2010 [60]
Harmony Search Algorithm/Hill Medical Center of Universiti Metaheurstics real-world NRP [61]
climbing Kebangsaan
Ant colony/ hill climbing Malaysian hospital Metaheurstic Real data [62]
Harmony search/greedy local search ORTEC NRP Metaheurstics 12 real-world [63]
Haramony search INRC-I Metaheurstics INRC2010 [64]
Greedy algorithm/Simulated Annea- Malaysia Medical Cente Heurstics Real data from UKM medical center [65]
lin
Cyber swarm algorithm Multi-Objective NRP Metaheurstic ZDT [66]
Hyper heurstic INRC-I aheurstics INRC-2010 [67]
Ant colony weekly schedules in a large U.K. Metaheurstic nchmark i [68]
hospita
Bee Colony INRC-I Metaheurstic INRC2010 [45]
Harmony search/artificial immune Metaheurstic INRC2010 ANROM/INRC-2010 [69]
systems t
Mixed Integer LinearProgramming/ INRC-II(dynamic) Metaheurstic N/A [49]
Simulated Annealing,

personnel and equipment. In addition, each surgery requires scheduling definitions, [72] has been described the operat-
preparation, before and after the surgery. So, the operating ing room scheduling as “sequence of job/activities to allo-
room theatre consists of two parts, namely the preopera- cate in the operating room”. The operating room is the ulti-
tive and the postoperative [70]. Managing/scheduling the mate important part of the hospital; it represents the source
operating room theatre is extremely difficult due to its con- of income and expense for hospitals. The operating room
straints, and the preferences of the stakeholders. Moreover, has an immense significance with other hospital resources,
the resources limitations, and the increase in demand for sur- and represent approximately 40% from the hospital income
gical services have to lead to improved approaches to room [73]. “The OR schedule is a patient flow management tool,
scheduling, by applying different approaches to manage the and it assists the flow of other hospital resources, such as
operating room theatre. The next sections will explicate the equipment, instrumentation, and ancillary hospital staffing
operating room scheduling extensively. resources” [74]. In addition [74] defined the operating room
scheduling as a central system where the operating room is
4.1 Operating room scheduling problem definition run by operation room leadership team, functioning as an
efficient instrument, for the transmission of real-time patients
The operating theatre scheduling also called surgery sched- flow and resources data of all departments, including the care
uling consists of two parts; the operating room and the of surgical patients. Hence operating room scheduling allows
recovery room [71]. The Operating Theater (OT) involves the coordination of resources in the hospital such as surgeons,
the required resources for surgeries. These include per- anesthesiologists, nurses, technicians, and ancillary staff to be
sonnel such as nurses, surgeons, anaesthetists and others, allocated in the appropriate technicians, and ancillary staff to
meanwhile, others involve facilities such as equipment, pre- be allocated in the appropriate way. On the other hand [75]
operative holding units, multiple ORs, post-anaesthesia care defined the Operating Room Surgical Schedule in his arti-
units, and intensive care. There are varying operating room cle as the assignment of a surgical operation to an operating

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room, according to a different type of factors such as room or full-day length) are made. Block scheduling is a particular
availability, weekly working hours, doctor’s preferences, and open scheduling matter.
operating room capabilities.
The main goal for each hospital is the high-quality service Modified block scheduling strategy This model is modified
deliverance for patients, therefore there is an essential require- to obtain two types of scheduling: Firstly, by reserving some
ment for the boosting of operating room/department achieve- operating rooms opening hours while others are left open,
ment through optimal resources usage. The operating room and secondly, by freeing unused time blocks determined
surgery scheduling is to distribute the operation start time and previously.
allocate the resources for scheduled surgeries, taking into con- Practically the block scheduling and modified block
sideration the multiple constraints in order to obtain the entire scheduling has been widely applied in hospitals [1]. Moreo-
surgery flow, the existence and accessibility of resources, and ver, this model is more flexible and provides an opportunity
the specializations and credentials of the staff [76]. to re-use free time slots of operating room scheduling [78].
Operating room theatre could be classified into different
levels, according to patients type (elective, emergency), upon
decision level such as (short, mid, long) term, or according to 4.3 OR Advanced scheduling (version 1)
management procedures (block scheduling, open scheduling,
or modified block scheduling) [77]. In this study, the primary Advanced scheduling entails the surgery date establishment
emphasis is on the short term of the operating room scheduling process for scheduling elective patients, which implicates a
which is split up to advance scheduling and allocation scheduling. future event occurrence [79]. Advanced scheduling also has
been diverse to dynamic and static scheduling based on the
4.2 Operating room scheduling versions surgery settings [80]. However, the dynamic type refers to
the patients who given a surgery date at consultation time.
Operating room scheduling at operational decision level is Whereas, the static type based on the patients waiting list.
called surgical case scheduling problem (SCSP). There are Advanced scheduling of the operating room is segregated
mainly two scheduling versions of Operating Room Schedul- into two categories, dependent on the type of constraints.
ing, namely: Advanced scheduling and Allocation schedul- The first constraints which are the total available operating
ing. Advance scheduling is the procedure of establishing a room, while the rest of the constraints are determined by the
patient’s (elective) surgery date and aim to get patients sat- available resources such as staff, and equipment.
isfaction (minimize patients waiting time), while allocation
scheduling involves the setting of the operating room and
the process initiation time on the particular surgery day. This 4.4 Allocation scheduling (version 2)
literature focused on the operating room planning, in which
the scheduling of the patients needs two essential procedures Allocation scheduling also has other name called interven-
to be carried out; firstly, the assignment of patients to the tion scheduling, and surgical case scheduling. Allocation
operation room as (advanced scheduling), and secondly, the scheduling is to set the starting time of the operation and the
determination of the sequence of surgeries in each operating resources are required for utilization. Allocation scheduling
room block by the allocation schedule. Generally, each hos- generates feasible scheduling for the operating room for each
pital has determined one of the following strategies which surgery per day with the assumption is that all patients in the
have been classified by Fei et al to establish a surgery sched- hospital and ready for surgery [79].
uling procedure. The first group of strategy encompasses
an open scheduling strategy, block scheduling strategy, and 4.5 Operating room scheduling mathematical
modified block scheduling strategy [1]. formulation

Open scheduling strategy or “any workday” model of The mathematical formulation of operating room planing
scheduling on OR scheduling entails no reservation in the and scheduling are presented in the huge majority of papers
time slot for a specific surgeon, and any workday option for presented by [1, 81, 82]. This review will consider the math-
surgeons. Additionally, this model is constraint-free [78]and ematical formulation as it is modelled by [82] as advanced
follow the prioritization of chronology sequencing, starting scheduling formulation. Lets (R) is the operating rooms,
from the earliest patient time-in strategy. and (r = 1, ..., R). Q be a set of patients, ( q = 1, ..., Q ), and
patients are scheduled in a set of time blocks,b = 1, ..., B ,
Block scheduling strategy surgeons or the appointment of in a set of days,d = 1, ..., D in a set of weeks, w = 1, ..., W .
a collective of surgeons assigned to a grouped time blocks, The patients possess a priority coefficient Uq utilized in the
where the organization of surgical patients (usually half-day determination of the sum of weighted waiting times, and

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Health and Technology (2021) 11:445–469 461

∑∑∑∑[
delays over all patients. The coefficient is utilized to distin- objD =min( m1 (Ddw − Aq)
guish between inpatient and emergency patients. The coeffi- q b d w
cient is used to distinctive between inpatient and emergency ]
+m2 (Ddw − Dq ) Xqbdw Uq )+ +
patients.
Let Aq be the release time for the surgery of each patient. ∑ [ ]
Let Dq due time for the surgery of each patient. Dq- Aq be ( m3 (Dq − Aq ) + m4 ((D ∗ W + 1) − Dq )
the clinical case for individual patient that will decrease if q∶Dq ⩽D∗W
∑∑∑ (12)
the patient does not receive his/her surgical services. Con- (1 − Xqbdw )Uq ).
versely, when compared with the elective patients, the emer- b d w
gency patients delays will result in a higher penalty on the
objective function. Thus,the advance emergency patients ∑∑∑∑
+ m5 (Q − Xqbdw )
arrival predication be ,q ∈ P ∪ I q b d w
∑∑∑
+ m6 ( nsdw ) (13)
Notations The operating room planning and scheduling
s d w
notations are presented by [82] as the following: P is the ∑∑∑
elective patients index, (p = 1, ..., P) P is represent the num- + m7 ( obdw )
b d w
ber of the elective patients. i represented the non-elective
patients (i = 1, ..., I) where I is elective patients number. q Subject to:
indicate to the elective and non elective patients (q = 1, ..., Q) ∑∑ ∑
where Q(= P + 1) is the total number of patients. r refers to Xqbdw ⩽ 1∀q
(14)
operating rooms (r = 1, ..., R), R R is the operating rooms w d b∈BE dw⧵EQ =e∨BQ
e q qdw

number. b indicates the blocks (b = 1, ..., B),B is the total

operating rooms blocks. s surgeon indicator (s = 1, ..., S), and ∑
̄tq Xqbdw ⩽ (ybdw Cbdw ) + O + bdw∀b, d, w
S is the number of surgeons. e refer to expertise(e = 1, ..., E) (15)
q
,.E is the number of expertise d denotes the number of days
in a week (d = 1, ..., D), D is the number of days. w number
obdw ⩽ Omax
b ∀b, d, w (16)
of weeks (w = 1, ..., W), W denotes the number of weeks.
∑∑ ∑ [ ]
Parameter Cbdw block (b) capacity in day (d) in a week (w). ∈ BRrdw ̄tq Xqbdw ⩽ (ybdw Cbdw + obdw ∀d, w, r
Ybdw parameter occupation of block (b). ̄tq surgery duration q b b∈BRrdw
expectation for the patient q. Aq releasing time for the (17)
patientq surgery. Dq a sufficient time for patient q surgery. ∑
∈ BR obdw ⩽ Omax ∀d, w, r (18)
Uq clinical priority factor of patient. mj in the objective func-
b
tion the weight term j (j = 1, ..., 7). BEedw a number of blocks
that are assigned to expertise e in day d in week w. EqQ exper- ∑
tise which patient q needs (EqQ = 1, ..., E). BRrdw is a group of Ddw ⩾ Aq xqbdw ∀q, d, w (19)
blocks that are assigned to room r in day d in a week w. Sp
p

denotes the surgeon assigned to operate patient p ∑

Xpbdw ⩽ nsdw ∀p ∶ Spp = s, ∀s, d, w (20)
(Sp = 1, ..., S). BQ is set of blocks that the patient undergo
p
qdw b
surgery in day d in week w. Omax b
overtime permitted by each
block. Omax overtime permitted by each operating room. ∑ ∑
r Xpbdw ⩽ Nsmax ∀s, d, w
Nsmax The total number of surgeries allowed in that day by a p
b
(21)
p∶sp =s
surgeon. Ddw is calculated by D ∗ (w − 1) + d ,total number
of waiting days by patient during the planning hori-
zon(D ∗ W). Decision variables: Xq bdw = 1 if the patient q xqbdw ∈ 0, 1∀q, b, d, w (22)
is scheduled undergo surgery in block b in day d in week w;0
otherwise. Obdw is the amount of overtime of block b in day nsdw ∶ integer∀s, d, w (23)
d in week w. nsdw = 1 if the surgeon s is scheduled for surgery
in day d in week w;0 otherwise. The mathematical formula- obdw ⩾ 0∀b, d, w (24)
tion for operating room scheduling using deterministic
approaches is generated according to the mean value of sur-
gery duration as follow:

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Table 11  Experimental design for real-life instance generation [83] a weekly operating theater surgery scheduling using open
Problem parameter Values considered Number of values scheduling strategy has been proposed by [1]. The objec-
tives of this work is in the maximization of the operating
Specialty (p) CHI, ORT, ENT, GYN, PLA, ∣ p ∣= 11 rooms usage, and the minimization of the operating theatre
URO, EYE, THO, ONC,
overtime expenditure, in addition to the minimization of the
NEU, MIX
unanticipated idle time among surgical patients. The solu-
Number of ORs(j) 5, 10, 15, 20, 25, 30, 35, 40 ∣ j ∣= 8
tion procedure in this work is distinguished into two phases,
Load (𝛼) 0.80,0.85,...,1.2 ∣ A ∣= 10
the first phase involves the assignment of a specific date for
Total instance= 880
surgeon to each patient, and that the surgeons are free to
assign his case in the time block. Next, the daily scheduling
is determined in order to fix the operation sequence and takes
4.6 Operating room scheduling data sets into consideration the recovery beds that are available. The
proposed method is characterized by a set-partitioning inte-
Operating room scheduling problems have been studied by ger-programming model, and where the solution is arrived
various researchers and tested based on different data sets through a column-generation-based heuristic process. The
up on their countries hospital. To the best of our knowl- second phase which entails the daily scheduling problem
edge, no commonly utilized test sets were identified for is outlined as a two-staged hybrid flow-shop model, that
other healthcare scheduling issues, such as the issue of sur- is resolved by a hybrid genetic algorithm, utilizing a Tabu
gical scheduling. In this review, we have presented a data set search procedure for executing local search. A evaluation of
which has been introduced by [83], which involved (20,880) the proposed method has been done with different actual sur-
instances with small family subset instances which involved gery schedules based on Belgian university hospital data. The
(146) instances. This data set was generated based on real results showed lesser idle time between the surgical cases as
life data from Dutch hospitals (11 surgical specialties), the derived from the surgery schedules, in addition to the greater
experimental design for real-life instance generation shown operating rooms usage, with minimal overtime. Furthermore
in Table 11. Whilst, Table 12 presents the statics outcomes, [84] proposed a novel two-stage stochastic mixed-integer pro-
and the experiment design for the generation of theoreti- gramming model to solve surgery schedules across multiple
cal instances shown in Table13 https://​www.​utwen​te.​nl/​en/​ operating room under uncertainty has been developed by
choir/​resea​rch/​Bench​markO​RSche​duling/​intro​ducti​on. [84]. The main idea in this paper observes the enablement
of numerous operations to be completed simultaneously,
4.7 Operating room scheduling in optimization because of the availed presence of various operating room,
aid and support from other surgeons, especially from the
The literature in scheduling operating room has a wide range principal staff surgeon. It described the benefit behind the
of methodologies that fit with optimization domain. Various sharing of resources among the surgeons. The summaries of
heurstics and metaheurtics has been applied to tackle oper- all optimization algorithm and data sets with categorize is
ating room scheduling problem. In this context, constructed illustrated in (Table 14)

Table 12  Statistics of the Specialty short Specialty full name Surgery types Surgery
outcome name realiza-
tions

CHI General surgery 149 931

ENT Otolaryngology 146 11,986
EYE Ophthalmic surgery 91 7953
GYN Obstetric and gynecologic surgery 60 4116
MIX Remaining specialties, such as colorectalsurgery, pediat- 173 46,938
ric surgery, traumasurgery, vascular surgery, etc.
NEU Neurological surgery 47 2832
ONC Surgical oncology 43 6466
ORT Orthopedic surgery 133 7618
PLA Plastic surgery 73 3022
THO Thoracic surgery 28 224
URO Thoracic surgery
Total 1018 108,11

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Health and Technology (2021) 11:445–469 463

Table 13  Shows the experiment design for the generation of theoreti- years [104] solved the surgical scheduling procedures by
cal instances [83] applying a discrete event simulation model in the first
Problem parameter Values considered Number of values stage, that evaluated the 12 varying sequencing and patient
appointment time-setting, including expected patient wait-
Case mix profile (p) 0,1,..,16 ∣ 17 ∣= 17
ing time, in addition to the expected surgical suite over-
Number of ORs (j) 5, 10, 15, 20, 25, 30, ∣ j ∣= 8
time as per day. In the second stage, a bi-criteria genetic
35, 40
algorithm (GA) was utilized to evaluate whether there are
Load(𝛼) 0.80,0.85,..,1.20 ∣ A ∣= 10
more superior solutions can be obtained for the single-day
Total instance param- 1360
eters scheduling problem. Moreover, the efficiency of the bi-cri-
teria genetic algorithm in the event of a the surgery date
change was investigated. In addition, [105] considered the
application of operational surgery scheduling problems at a
4.7.1 Surgery scheduling problem in optimization medium sized Norwegian hospital. In the study, the execu-
tion of the scheduling planning for day scheduling, with the
Surgical scheduling problem was resolved using different weekly scheduling and admission planning was discussed.
optimization method. Some of those researchers used deter- The proposed method used a generalized model for surgery
ministic models, whereas others used stochastic method. In scheduling problems. The equalization of computational
the optimization field, there are several researchers who loads between a construction and an enhancement method
applied different techniques to solve this problem. In recent was achieved through the implementation of a parented

Table 14  Summaries of OR method,version,data sets,categories

Method Version Data set Categories Ref.

Local search Integrated with PASP [18]

Genetic Algorithm/ILP Operating room+anesthesia recov- Randomly generated Metaheurstic/exact [85]
ery bed
Monte Carlo/greedy local search Advanced scheduling OR 10 generated instances heuristic [86]
Mixed integer programming Uncertainty OR scheduling real data stochastic/Heuristic [87]
Ant Colony Optimization Multi-objective OR data from Cancer Center metaheuristic [88]
Genetic algorithm is Allocation scheduling N/A Metaheurstics [89]
Genetic Algorithm/Particle swarm Multi constraints OR real data from public hospital Metaheurstic [90]
Column generation Integrated OR model Real data Heuristic [91]
Grey Wolf/VNS O Integrating 3 stage OR data base 2017 Meta heuristic [36]
Simulated Annealing/Tabu search Operating Theater Room Three real datasets/Scottish Heuristic/metaheuristics. [92]
hospital
Column Generation/Local Branch- Surgical Case re-Planning and Real data Heuristics [93]
ing Scheduling problem
Mixed-integer linear programming OR/elective surgery Real data/Iraq Heurstics [94]
Scheduling surgery in OR/ Real data Heurstic, [95]
Advanced scheduling
Hybrid genetic algorithm/local OR surgery scheduling real data/hospitalin China Metaheurstics [96]
search
Ant colony Surgery scheduling/Open schedul- Generated five test cases Metaheurstics [76]
ing
Genetic Algorithm OR N/A Metaheuristic [97]
Uncertain single OR Random generated dataset heuristic [98]
Genetic Algorithm/local search Surgeries assignment problems 20 instances randomly generated Metaheurtstic [99]
Genetic algorithm OR scheduling Randomly generated Metaheurstic [100]
OR/Advanced scheduling Real data/San Martino University Metaheurstic [101]
Hospita
Bees Algorithm/Simulated aneal- Master Surgery Scheduling Prob- Real data/San Martino University Metaheurstic [102]
ing lem/ Surgical Case Assignment Hospital
Problem
Local search Surgical case assignment real instances/Portuguese Heuristics [103]

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464 Health and Technology (2021) 11:445–469

model solution using an on-line learning. The result of this is assigned to time block, and finally the last minute adjust-
algorithm showed an excellent performance traversing vari- ment (if required). Surgery scheduling problem has been
ous problem categories. In the same context, [85] has been addressed by various approaches and considered elective/
proposed two exact and metaheurstic method to scheduling uncertain patients. Tackling elective and emergency patients
surgery in operating room integrated with post-anesthesia in surgery scheduling is limited. Several articles consider
recovery beds. Table 3 presents the surgery scheduling the problem separately, while others have used integrated
problem and the respective methods employed and patients models [122]. Most studies have focused on surgery schedul-
categories. ing integrated with other healthcare scheduling such as with
operating room [108], patient scheduling [116], physician
4.8 Discussion scheduling [77]. The integrating between surgery schedul-
ing with different healthcare problem could provide high-
Operating rooms are an important and expensive sector in quality services, and minimizing overtime cost. Developing
the most hospitals [70]. Thus, various studies have been con- multi decision healthcare scheduling system which combines
ducted on scheduling and planning of the operating room between surgery scheduling, operating room planning, and
under operational, tactical [119], strategic levels, which con- physician scheduling is better to address a real-life situation
cerned as a decision level for operating rooms. and balancing hospital resource utilization.
Various solution procedures have been utilized to tackle
this problem, heuristic and metaheuristic methods have been
intensified in the literature in the context of optimization. 5 Other healthcare scheduling and planning
Due to the high constraints problem could not be solved problems
using the exact method. The uncertainty in scheduling tech-
niques are the most difficult task, and they are more concrete, In healthcare scheduling problems many problems receive
since, the uncertainty in time frame is the most interest- less attention by researchers, in this section will surveyed
ing topic. Operating room scheduling integrated with other and give an overview of other healthcare scheduling such as
healthcare services such as patient [13] scheduling, nurse scheduling physicians [123–125], home healthcare [126–128],
[120] is limited. However, the integration between an oper- telemedicine scheduling [129]. Physician scheduling is a real-
ating room with other systems in the hospital will enhance world problem which arises in hospitals, physician scheduling
the hospital performance and will lead to improving the hos- is a type of staff schedules with more complex regulation.
pitalization services (Table 14) summaries recent methods, Physician scheduling is defined as assigning a physician to
versions and categories. Moreover, most studies have pay duty such as surgeries, clinics, scopes, calls, administration
particular attention to elective patients than on, non-elective and others over time slots /shifts according to planning hori-
patients. Urgent patients and emergency patients get less zons with different types of preferences and constraints [125].
attention (Table 15). Furthermore, surgery scheduling prob- Physician scheduling problem have two roster planning cyclic/
lem involved three forms of scheduling [121], first the sur- ad-hoc which refer to planning period must be reconstructed
geon is assigned by hospital administration, then the surgeon because physicians may have different work rosters each

Table 15  SSP References method Uncertain/Elective

[106] Stochastic programming Uncertainty

[107] Integer programs −
[108] stochastic linear program Uncertainty
[109] branch-and-price exact solution algorithm
[110] branch-and-bound algorithm −
[111] heuristics and local search elective
[112] stochastic dynamic programming elective
[113] mixed integer linear formulation and light robustness approach elective
[114] integer linear programming model elective
[115] stochastic dynamic programming model elective
[104] heuristics- discrete event simulation model- bi-criteria GA elective
[116] local search,integer programming,binary programming elective/emergency
[117] discrete-event model uncertain
[118] Discrete Event Dynamic System elective

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Health and Technology (2021) 11:445–469 465

week. Where as cyclic planning refer to set models for doc- and other healthcare scheduling problem. The objective of all
tors, with or without weekly rotation. Planning and scheduling scheduling systems in optimization aspect is to reduce the
in physician problem has been arouse in a three decision level cost and patient’s waiting time and maximize the resources
(strategic, tactical and operational planning). However, physi- efficiency. The quality of the solution is dependent upon the
cian scheduling is represented by day-to-day scheduling, in cost function which is involved in the summation of the soft
which the physician is given various duties [77]. Scheduling constraints. In addition, this review summarized all schedul-
physician problems have been studied by different researchers ing systems on healthcare, and are supported by most suc-
such as [125] who proposed a mathematical programming cessful algorithms, which have used a diverse spectrum of
models to solve a master physician scheduling problem. In search methodologies. We noticed that several latest sophis-
addition [123] and [130] had proposed a mix integer linear ticated systems obtained significant results. Furthermore, the
programming for solving this problem. In addition [131] stud- metaheuristics algorithms involved in the local search meth-
ied the scheduling of physicians in the pediatric intensive care ods and population-based method, have been highlighted
unit (PICU) too. On the other hand [77] integrated physicians in this paper. However, the major successful algorithms are
and surgery scheduling for the purpose of solving operating from nature-inspired algorithms, which proved their ability to
room scheduling problems by using mix integer linear pro- solve N/P hard problem. This is due to their ability to explore
gramming. Furthermore, [132] had described physician prob- the search space, especially swarm-based algorithms. The
lems in a case study, in Swedish public hospitals. Moreover challenges for future research direction are to:
[133] had presented the problem from the perspectives of US
hospitals. The author have studied different types of physician 1. Utilized other metaheuristic algorithms such as a swarm-
scheduling using different priorities. Besides that, [134] had based algorithm for solving healthcare scheduling prob-
studied the problem by using a case hospital from the King lems in order to obtain better results.
Khalid University a Hospital in the Kingdom of Saudi Arabia. 2. Study and analysed the robustness of each algorithm that
Home healthcare scheduling another healthcare complex opti- has been applied to each problem.
mization problem which has been grown in various decision 3. Build a scheduling system for the hospital, which covers
levels, such as assigning staff or scheduling shifts [135]. For the entire hospital dynamically.
instance, various sets of nurses could be allocated to different 4. Focusing on particular real-world problems on health-
clients which are located in diverse areas. Therefore, various care such as telemedicine which will help during a dis-
constraints, requirements, and preference should be consid- aster such as COVID 19 pandemic.
ered, such as nurse expertise, clients requirements, and nurse 5. We can also be adapting big data analytic methods in
working time. However, balancing the expertise of nurses and order to get real data sets for different scheduling sys-
customers is a standard function of home healthcare schedul- tems, by focusing on the most complex situations such
ing optimization and the selection of skills considered varies as COVID 19 pandemic and get historical data for a
based on the needs of the client and the particular regulatory number of patients and nurse shift as well as physician
environment. The major solution method of home healthcare scheduling, to come up with new data sets regarding
scheduling has been done using metaheurstic algorithm [136, those problems.
137]. Recently the field of telemedicine has attracted a mul- 6. Most studies focus on the elective patients more than
titude of researchers because it provides a new platform for other patients type, further research direction could be
patients to access the healthcare services. It provides medical on scheduling triage, emergency, urgent patients could
care for patients in distant remote areas such as villages that be an interesting topic if it is integrated with other sched-
need outreach services. uling techniques problems such as physician scheduling
and nurse scheduling.
7. Integrated scheduling system which involved patients,
6 Conclusion and future work nurse, physician, and operating rooms could improve
the service quality for the medical system.
In this survey paper, we address healthcare scheduling prob-
lem as an optimization problem. Scheduling in healthcare
is segregated into two types; personnel and resources. This Declarations
review on healthcare scheduling has identified the areas of
healthcare scheduling such as patient admission scheduling, Conflict of Interest The authors declare that they have no conflict of
interest.
nurse rostering problem, operating room scheduling problem

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Affiliation

Zahraa A. Abdalkareem1,5 · Amiza Amir1 · Mohammed Azmi Al‑Betar2,3 · Phaklen Ekhan1 · Abdelaziz I. Hammouri4

3
* Mohammed Department of Information Technology , Al-Huson University
College Al-Balqa Applied University , P.O. Box 50,
Azmi Al‑Betar
Al‑Huson, Irbid, Jordan
[email protected]
4
Department of Computer Information Systems , Al-Balqa
* Abdelaziz I. Hammouri
Applied University , 19117, Al‑ Salt, Jordan
[email protected]
5
Department of Islamic English studies , Alimam Aladham
1
Faculty of engineering technology /Department of Computer university college , Baghdad, Iraq
Engineering, University Malaysia Perlis, Kanger 02600,
Arau, Perlis, Malaysia
2
Artificial Intelligence Research Center (AIRC) College
of Engineering and Information Technology , Ajman
University , Ajman, UAE

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