Simulation Optimization for Medical Staff Configuration at Emergency Department in Hong Kong

Medical staff configuration is a critical problem in the management of an emergency department (ED) in Hong Kong (HK). Given the service requirements by HK government, it is imperative for the hospital managers to develop medical staff configuration in a cost-and-time-effective way. In this paper, the medical staff configuration problem in ED is modeled as minimizing the total labor cost while satisfying the service quality requirements. To solve this issue, we propose a highly efficient search method, called random boundary generation with feasibility detection (RBG-FD). The random boundary generation (RBG) is applied to efficiently identify good-quality solutions based on the objective value. The feasibility detection (FD) procedure is used to retain the probability of correct feasibility detection of each sampled solution at the desired level, which intrinsically allocates a reasonable number of simulation replications. To estimate the performance measures of the ED, a discrete-event simulation model is developed to reflect the patient flow. Using these techniques, the efficiency of identifying the optimal staff configuration can be significantly improved. A case study is performed in a public hospital in HK. The numerical results indicate significantly higher practicability and efficiency of the proposed method with different patient arrival rates and service constraints. Note to Practitioners This paper seeks to solve the problem of minimizing the medical staff cost constrained by certain service requirements [i.e., patients' waiting times for treatment] at an emergency department in Hong Kong. In our formulation, these service requirements are characterized by some stochastic constraints. Most of the existing random search methods concentrate on the computing efforts in the neighborhood of the best-so-far solutions in order to obtain good-quality solutions. Due to the special structure of this problem and ease of computing the objective values, we proposed an efficient random search approach that iteratively identifies a solution with a better objective value than that of the current best solution. Experimental studies demonstrate the significantly higher efficiency of this method. In order to obtain the same solution quality, it is able to reduce the computational time by 90% compared with some existing approaches in the literature.