Integrated Planning in Hospitals: A Review

TL;DR

This review tackles the complexity of planning scarce hospital resources by surveying the Operations Research and Management Science literature on vertically integrated planning across multiple hospital resources. It introduces a three-level taxonomy of integration, analyzes publication trends, resource emphases, modeling methods, and uncertainty treatment, and assesses real-world implementability. The authors find a notable shift toward fully integrated Level-3 approaches since the early 2010s, with operating theaters and medical staff as central elements, but observe a persistent gap between methodological work and practical adoption and a relative neglect of non-patient-facing resources. Uncertainty modeling and data usage are prevalent, yet improvements in linking models to hospital information systems and broader system-wide integration remain critical. The study provides a structured mapping of the field and points to promising directions, including staff-focused integration, inclusion of supply chains, and greater emphasis on real-world deployment.

Abstract

Efficient planning of scarce resources in hospitals is a challenging task for which a large variety of Operations Research and Management Science approaches have been developed since the 1950s. While efficient planning of single resources such as operating rooms, beds, or specific types of staff can already lead to enormous efficiency gains, integrated planning of several resources has been shown to hold even greater potential, and a large number of integrated planning approaches have been presented in the literature over the past decades. This paper provides the first literature review that focuses specifically on the Operations Research and Management Science literature related to integrated planning of different resources in hospitals. We collect the relevant literature and analyze it regarding different aspects such as uncertainty modeling and the use of real-life data. Several cross comparisons reveal interesting insights concerning, e.g., relations between the modeling and solution methods used and the practical implementation of the approaches developed. Moreover, we provide a high-level taxonomy for classifying different resource-focused integration approaches and point out gaps in the literature as well as promising directions for future research.

Figures (15)

• Figure 1: Number of publications over time (per year and 3 year moving average). The moving average for year $t$ considers the years $t-1$, $t-2$, and $t-3$.
• Figure 2: Number of publications as a 3 year moving average distinguished by level of integration. Level 2 is omitted due to the low number of publications.
• Figure 3: Absolute frequencies of considered resources overall. App./Admiss. and Rooms are used to abbreviate patient appointments / admissions and examination / treatment rooms, respectively. Diagnostics is used as an umbrella term for radiology, imaging services (CT, MRI, X-Ray), and laboratory, while Other summarizes all further resources that occurred too infrequently to warrant a separate listing (clinical services, elevators, logistics, outpatient clinics, physiotherapy, and sterilization services).
• Figure 4: Absolute frequencies of considered resources distinguished by their importance (primary, non-primary).
• Figure 5: 3 year moving averages of the numbers of publications that do / do not consider OT or medical staff.