Routing & Scheduling of Home Health Care Services

Demographic shifts, changes in family structure, the desire to ‘grow old at home’ and cost benefits are just some reasons why the demand for home health care (HHC) services is likely to continue to increase substantially over the next years. Within HHC operations, various interesting research question exists. A recent review article on HHC routing and scheduling showed a highly diverse field of research with problems settings directly derived from real-world operations.

Together with my co-author, Patrick Hirsch, we focused on 44 recent articles in this field, which were further classified in articles dealing with single-period or multiple-period problems. The following factors find special attention in recent literature:

Assignments (e.g., visiting time windows and nurse-patient assignment)

In HHC, visits are often time-critical and require certain skills. Therefore, time windows are mainly implemented in solution algorithm indicating at what time a service has to be started. Additionally, skills of nurses are matched with patient requirements, considering both medical as well as social and language skills.

Workload Balance (i.e. each nurse should work approximately the same amount of time or according to the contracted working hours)

In contrast to traditional vehicle routing problems, staff members play a major role in HHC routing and scheduling literature. Different preferences concerning working hours, time and skills have to be considered. One factor of special interest is workload balance. This requires solution procedure to focus on a fair distribution of routes instead of simply identifying the best overall solutions.

Working regulations (i.e. maximum working hours and break regulations)

In order to enable operations and to allow the implementation of developed solution procedures in real-world operations, various working and break regulations have to be considered. These include maximum working hours of staff members as well as mandatory break regulations stating if and at what time breaks have to be scheduled.

Continuity of Care (i.e. a patient should be visited by the same nurse over multiple visits)

Beside staff members, patients requirements are of high importance. Continuity of care implementation in HHC routing and scheduling literature range from limiting the number of staff members allowed to visit a single patients to scheduling visits at constant times over multiple days of a week.

Precedence and Synchronization (e.g., multiple staff members are required to perform a single service, either in a given order or simultaneously)

Precedence and synchronization substantially further increase the complexity of planning operations. Due to interdependencies between multiple staff members (i.e. if two or more members have to meet at a given place, a delay further impacts other ones), altering routing and scheduling plans requires special attention.

Conclusion

Home health care routing and scheduling offers a wide range of highly interesting and complex research questions. While excellent work has been done in this field, various topics still require investigation. These include work on robust optimization, integrated multi-level solution procedures as well as a higher focus on social and environmental sustainability in the development of HHC routing and scheduling systems.

References:
–          Fikar, C, Hirsch, P (2017) Home Health Care Routing and Scheduling: A Review. Computers & Operations Research 77, 86-95. DOI http://dx.doi.org/10.1016/j.cor.2016.07.019, , Kudos: http://goo.gl/3QKNBN
–          Fikar, C, Juan, AA, Martinez, E, Hirsch, P (2016) A discrete-event driven metaheuristic for dynamic home service routing with synchronised trip sharing. European Journal of Industrial Engineering 10(3), 323-340. DOI: http://dx.doi.org/10.1504/ejie.2016.076382, Kudos: http://goo.gl/4pCAms
–          Fikar, C, Hirsch, P (2015) A matheuristic for routing real-world home service transport systems facilitating walking, Journal of Cleaner Production 105, 300-310. DOI: http://dx.doi.org/10.1016/j.jclepro.2014.07.013, Kudos: http://goo.gl/JcIKwb

An overview of available data and benchmark instances for HHC routing and scheduling optimization procedure is available here.

Image: BOKU (Martin Gerzabek)