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Healthcare Systems


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also that waiting times greater than 90 minutes are not counted. Therefore, it is possible that the routes produced are fragmented, which implies a long amplitude. While a long break in the day is not disruptive, it is not desirable, and as such having a compact route is also a criterion of staff satisfaction.

Instance Number of beneficiaries Number of careworkers Number of services Beneficiary variations Careworkers variations Waiting time (h) Travel time (h) Execution time (s)
1 3 4 56 +1/-1 4. 2 3. 8 2. 2
2 11 5 85 +0/-1 +2/-3 4. 69 6. 49 2. 1
3 18 6 95 +2/-4 8. 41 5. 7 7. 6
4 26 8 156 +2/-7 +2/-3 1. 5 19.3 40.6
5 26 11 179 +6/-5 +2/-2 7. 15 6. 4 30.13
6 40 18 191 +8/-11 +8/-6 5. 83 1. 83 65.8
7 92 15 337 +7/-10 +3/-5 12. 0 21.3 101

      Time constraints turn out to be a scientific obstacle and can contribute to a substantial degradation of the schedule. A tool identifying the most impinging time constraints would make it possible to determine the services for which it would be advantageous to renegotiate the contractual hours with the beneficiaries.

      The proposed method is adapted to changes in the composition of staff and beneficiaries and to the strategic update; however, it is not necessarily adequate in the event of a one-off absence. Indeed, if a worker is temporarily unavailable, the organization does not always have a careworker available who is qualified to replace them at short notice. It is therefore necessary to overload the other careworkers and potentially shift the appointment times so as to be able to obtain a feasible solution. Respecting the continuity of care constraints becomes very restrictive and is no longer necessarily relevant. Moreover, as these absences are often unexpected, it is difficult in practice to upset the whole schedule at the last minute. Thus, it would be interesting to adapt our approach to the management of daily eventualities, by relaxing the constraints of continuity and by considering stability from a new angle: no longer that of continuity of care, but rather with the objective of impacting as few routes as possible, in order to meet operational requirements in the field.

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