Production & Operations Management

Complex Engineering problem

Submitted to:
Prof. Dr. Muhammad Qaiser Saleem

Submitted by:
Group # 02
Muhammad Umar 2017-IM-10

M. Waleed Khan 2017-IM-11

Syed Sultan Shah 2017-IM-12

M. Anwar Hussain 2017-IM-13

M. Usman 2017-IM-15

Haider Ali Bhatti 2017-IM-16

M. Kamran 2017-IM-17

Department of Industrial and Manufacturing Engineering

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Contents
Title..................................................................................................................................................5
Problem Statement...........................................................................................................................5
Literature review..............................................................................................................................5
Methodology....................................................................................................................................7
Data Collection............................................................................................................................7
Forecasting...................................................................................................................................7
Qualitative Forecast.................................................................................................................8
Quantitative Forecast (5 Methods)...........................................................................................8
Exponential..............................................................................................................................9
Exponential smoothing with trend line..................................................................................10
Actual Demand Vs Forecasted Demand................................................................................11
Intermediate planning....................................................................................................................12
Sales and operations planning (S&OP)......................................................................................12
Aggregate Planning....................................................................................................................12
Aggregate Planning Guidelines.............................................................................................12
Aggregate Planning Strategy.....................................................................................................13
Inventory management...................................................................................................................13
................................................................................................................................................13
Varying the workforce size....................................................................................................15
Varying production rates through overtime or idle time.......................................................15
Subcontracting.......................................................................................................................15
Using part-time workers........................................................................................................15
Scheduling..................................................................................................................................15
Assumptions...............................................................................................................................15
Reliability...............................................................................................................................17
Responsiveness......................................................................................................................17
Competence............................................................................................................................17
Access....................................................................................................................................17
Courtesy.................................................................................................................................17
Communication......................................................................................................................18
Service Recovery.......................................................................................................................18

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Service Blue-print..........................................................................................................................19

Table 1 Literature review........................................................................................................5

Table 2 Data collection [3].....................................................................................................7
Table 3 Forecasting types [1]..................................................................................................8
Table 4 Exceptional smoothing forecasting [2]....................................................................10
Table 5 Inventory management data [4]..............................................................................14
Table 6 Scheduling of Hospital staff [4]..............................................................................16

Figure 1 Isolation centre.........................................................................................................7

Figure 2 Errors Indicators & Selection of Method.................................................................9
Figure 3 Actual demand........................................................................................................10
Figure 4 forecasting & its trend............................................................................................11
Figure 5 Actual & Forecasted demand.................................................................................11
Figure 6 Aggregate planning elements [1]............................................................................13
Figure 7 Categories of Covid patients [4].............................................................................13
Figure 8 Pareto analysis of inventory...................................................................................14
Figure 9 Service improvements elements.............................................................................17
Figure 10 Service recovery Elements...................................................................................18
Figure 11 Recommended Service blueprint [5]....................................................................19

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Title
Analysis of an Operations Management Scenario

Problem Statement

An operations manager at a local hospital (you may decide on a certain locality for the purpose)
is concerned for effective management of COVID Ward under his supervision. He not only
wants to assure the level of service but also wants to properly plan for the operations.
Considering it is a 10 beds ward with 4 consultants and 8 staff members, present your analysis of
the given scenario while aiming at the service quality and planning aspects for the coming
month. You may conduct relevant data search/literature review and take reasonable/justified
assumptions to address following
a) What may constitute service quality and how this may be assured
b) What could be probable aggregate plan(s)

Literature review

Table 1 Literature review

Operational considerations for case management of COVID-19 in health facility

and community
This study was focused on the optimum conditions provided to the Interim
COVID patients keeping in view protocols of safety of health workers. Guidance
To achieve the objective there must be no violation of public health. List
of the objectives that are mentioned in the study are: World Health
The public health objectives are to: Organization
 Stop, delay, and slow transmission of viruses and other 19 March
pathogens. 2020
 Handle all patients with the greatest degree of sensitivity, most
importantly severely ill ones.
 The epidemic is causing high economic costs, and we need to
minimize the economic impact it has.
An overview of strategic priorities based on transmission scenarios (No
cases, sporadic cases, cluster of cases, and community transmission) and
an overview of sudden interventions for public health, regardless of
scenarios, was provided.
‘Screening and triage’ and ‘Hub and spoke model’ are two Referral
pathways provided as optimal suggestions[2]

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Selection of the Forecasting Model in Health Care
It can be difficult to predict fluctuating patient volumes experienced by School of
hospital management. Our aim is to determine how well different Business,
forecasting techniques can accurately predict the number of patient beds Department
in obstetrics and gynecology departments. Various time series methods of
are used to analyze the data. Mean Absolute Percentage Error, Mean Management,
Absolute Deviation, and Mean Square Error measured forecast accuracy. Istanbul
A probability-forecasting model cannot be generalized to all hospitals or
University,
departments in this analysis. The exponential smoothing method with an
Turkey
alpha value of 0.5 is considered the best. One of the key point that was
mentioned in the study was there must be updated forecast every time,
because the data coming at different time or same time but from
different groups need different kind of analysis. [3]
Adapting hospital capacity to meet changing demands during the COVID-19
pandemic
The main purpose of this research work is to evaluate the conditions for Capacity
admitting patients for elective surgery under multiple admission levels management
of COVID patients. during Covid-
19
In methodology process, National Health Service (NHS) datasets and circumstances
literature research works were precisely analyzed to estimate and check BMC
hospital care capacity before the pandemic condition, focusing on Medicine 20
general and acute and critical care number of beds, staff members and April 2020
number of ventilators.

All elective surgery could be accurately conducted at normal Pre-

pandemic conditions provided, only if the daily number of COVID
patients containing CC beds could not exceed to 1550 in the whole
country of England. If the second interventions are not precisely
maintained, then elective surgery can only be done if the number of CC
beds not exceeds to 320.
[3]

Unless graph of COVID-19 hospitalizations falls, there is a continued

requirement to enhance level of critical care capacity in England country
with field hospitals and utilization of private hospitals.

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 Methodology
Data Collection
The given data is collected from the Field Isolation Centre Karachi from a Dr. Baakh who is
serving as a Front line to the Covid patients. The minimum numbers of patients were served in
the Isolation center were 110 and this number increased about 450 patients and the facilities
provided to them were 140 beds and 7 consultants & 14 staff members. The given data is
converted by using the ratios and proportions for the10 beds 4 consultants and 8 staff members.

Table 2 Data collection [3]

Sr Actual Demand of Patients per

Increase in Demand
No. month for 140 beds,7 consultants & Demand of patients per
Duration Months (%) 14 staff members 10 bed 4 consultants

1 11/1/2020 Nov Given 110.00 11.0

2 12/1/2020 Dec 25 137.50 13.8

3 1/1/2021 Jan 35 185.63 18.6

4 2/1/2021 Feb 30 241.31 24.1

5 3/1/2021 Mar 30 313.71 31.4

6 4/1/2021 April 35 423.51 42.4

7 5/1/2021 May ---- ---- -----

Figure 1 Isolation centre

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Forecasting
It is the art and science of predicting future events. Forecasting may involve taking historical
data (such as past sales) and projection them into the future with a mathematical model[1].
Forecasting is usually classified by the future time horizon that it covers. Time Horizons falls
into three categories:
1. Short range forecast
2. Medium range forecast
3. Long range forecast

Table 3 Forecasting types [1]

Short range Medium range Large range

Categories
forecast forecast forecast
1 year or generally From 3 months to 3
Time span More than 3 years
less than 3 months years
Useful in
Used for Used in
sales planning,
planning purchasing, planning for new
production planning,
job scheduling, products,
Applications Cash budgeting,
workforce levels, capital expenditures,
and analysis of
job assignments, facility location,
various operating
and production levels. and R&D
plans.

Forecasting Approaches:

There are two general approaches to forecasting just as there are two ways to tackle all decision
modeling:
Qualitative Forecast
 Jury of Executive opinion
 Delphi Method
 Sales for composite
 Market Survey

Quantitative Forecast (5 Methods)

 Native approach
 Moving Averages Time – Series
 Exponential smoothing

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  Trend projection
Associative Models
 Linear regression

Time Series models predict on the assumption that the future is a function of the past. In other
words, a time series is based on a sequence of evenly spaced (weekly, monthly, quarterly and so
on) data points. For example; if we are predicting sales of lawn mowers then we use the past
sales for lawn mowers to make the forecasts.
Associative Models predict the variable or factors that might influence the quantity being
forecast. For example, an associative model for lawn mower sales might use factors such as new
housing starts, advertising budget and competitors’ prices [1].

Figure 2 Errors Indicators & Selection of Method

Exponential

 Exponential smoothing is another weighted moving average method in which the data points are
weighted by using the exponential smoothing constant. The value of constant alpha lies between
& 0. This technique is useful because it gives the smooth forecast that is most probably
approaches the demand and this technique is also representing the least forecasting error.
 Greater value of α is useful when the demand is not stable it is fluctuated, whereas lower value of
α is useful when the actual demand is stable [1].

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 Table 4 Exceptional smoothing forecasting [2]

Sr Increase in
Actual Demand of Actual Demand Exponential
No Patients per month for of patients per smoothing
Demand
. 140 beds,7 consultants 10 bed 4 Forecasting with
Duration Months (%) & 14 staff members consultants a=0.5

1 11/1/2020 Nov Given 110.00 11.0 11.0

2 12/1/2020 Dec 25 137.50 13.8 11.0

3 1/1/2021 Jan 35 185.63 18.6 12.4

4 2/1/2021 Feb 30 241.31 24.1 15.5

5 3/1/2021 Mar 30 313.71 31.4 19.8

6 4/1/2021 April 35 423.51 42.4 25.6

7 5/1/2021 May ---- ---- ----- 34.0

Exponential smoothing with trend line

Demand of patients per 10 beds

50.0
ADemands of patients

42.4
40.0
31.4
30.0 24.1
18.6
20.0 13.8
11.0
10.0
0.0
Nov Dec Jan Feb Mar April May
Months

Demand of patients per 10 beds

Figure 3 Actual demand

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 Exponential smoothing Forecasting with a=0.5
40.0
Demands of patients 35.0 34.0

30.0
25.6
25.0
19.8
20.0
15.5
15.011.0 11.0 12.4
10.0
5.0
0.0
Nov Dec Jan Feb Mar April May
Months

Exponential smoothing Forecasting with a=0.5

Linear (Exponential smoothing Forecasting with a=0.5)

Figure 4 forecasting & its trend

Actual Demand Vs Forecasted Demand

Actual Demand Vs forecasted Demand

45.0 42.4
40.0
34.0
35.0 31.4
Demand of patients

30.0 25.6
24.1
25.0
18.6 19.8
20.0 15.5
15.0 13.8 12.4
11.0
11.0 11.0
10.0
5.0
0.0
Nov Dec Jan Feb Mar April May
Months

Demand of patients per 10 beds

Exponential smoothing Forecasting with a=0.5

Figure 5 Actual & Forecasted demand

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Intermediate planning
Intermediate planning is medium term planning, the duration of the intermediate planning is
about 3-18 months. The main purpose of the intermediate planning is to be consistent with the
top management long range plans and strategy.
Sales and operations planning (S&OP).

 Intermediate planning will work well if it can develop the coordination between the
forecasted demand and the functional area and supply chain of the organization under the
constraints and limitations of resources. This coordinated planning effort has evolved into
a process known as sales and operations planning (S&OP) [1].
 S&OP receives input from a variety of sources both internal and external to the firm.
Because of the diverse inputs, S&OP is typically done by cross-functional teams that
align the competing constraints [1].
 S&OP also determines which plan is feasible & which plan is not feasible. If this plan is
not supported in short run, it will be difficult to fulfil the plans and all the activities have
done are useless & if this plan is not supported in long run, then it will require some
strategic changes. The output of S&OP is called an aggregate plan [1].

Aggregate Planning
It is an intermediate term used for planning decision. It is the process of planning the quantity
and timing of output over the intermediate time horizon. Within this range, the physical facilities
are assumed to be fixed for the planning period. Therefore, fluctuations in demand must be met
by varying labor and inventory schedule. Aggregate planning seeks the best combination to
minimizing costs.
Aggregate Planning Guidelines
 Determine corporate policy regarding controllable variables
 Use a good forecast as a basis for planning
 Plan in proper unit of capacity
 Maintain the stable workforce
 Maintain needed control over inventories
 Maintain flexibility to change
 Respond to demand in a controlled manner
 Evaluate planning on a regular base

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Aggregate Planning Strategy

Figure 6 Aggregate planning elements [1]

Inventory management

Figure 7 Categories of Covid patients [4]

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Table 5 Inventory management data [4]

Inventory Unknown Mild to Severe Case Critical Case Total

Moderate
Rate
Patients and 2 17 10 5 34
their
Percentage 5% 50% 30% 15% 100%
Medicine Can-Sino Bio Can-Sino Bio AstraZeneca AstraZeneca -
Vaccine, Vaccine, Vaccine, Vaccine,
Sino-pharm Sino-pharm Sino-pharm
Vaccine Vaccine Vaccine
Target 18 and above 18 and above 18 and above 40 and above -
Audience
Price of 7500 3900 310 310 12020
Medicine
(PKR)
Total price 15000 66300 3100 1550 85950
of medicine
Time none (2-3) (5-10) (10-20) - 
utilized on
bed (days)

Inventory Items Monthly Cost of Total Cost Percentage

Demand Component (PKR) (%)
(PKR)
Pulse Oximeter 11 2000 22000 0.007
Patient monitor 10 65,000 650000 0.193
oxygen cylinders 11 2,000 22000 0.007
Electrocardiograph 10 250,000 2500000 0.741
COVID testing kits 80 2,000 160000 0.047
surgical mask 700 10 7000 0.002
Surgical Gloves 500 30 15000 0.004

Figure 8 Pareto analysis of inventory

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Varying the workforce size
From above forecasting it can be concluded that the demand of the patients increasing
continuously so they require the extra workforce to deal with them so that they can hire the extra
doctors and working staff to serve the patients of Covid wards it can safe their cost of training.
Varying production rates through overtime or idle time
In the given scenario it is possible do not hire the extra doctors and working staff, their working
schedule can be changed and now they can serve 12hrs/day rather than 8hrs/ day in this case they
require more benefits that can be costly.
Subcontracting
Subcontracting is the most important part because the hospital has some boundaries in which it is
located, even we can increase our facilities but it has some limit so the hospitals can do
subcontracting with some other hospitals to share their facilities that includes wards, beds,
testing labs, oxygen cylinders & personal protective equipment
Using part-time workers
Part-time workers can be the option but they require the special training & their dedication to the
work also matters.
Scheduling
Assumptions
 Scheduling is done for the month of May.
 There is total 34 patients for the month of May.
 Their staying time in hospital approximately 7 days
 Hospital works 24/7
 We are provided with 4 consultants and 8 staff members

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 Table 6 Scheduling of Hospital staff [4]

Covid Ward Scheduling

Availability Availability (24/7)

Aggregate planning
Available 4 doctors 8 staff members
Workforce
Forecasted 34 patients available
demand
Of patients
Shifts Tim Staff Week # Week # Week # Week #
ing members 01 02 03 04
Shift # 01 7 1 senior 3 4 5 1
a.m. doctor patients patients patients patient
Day shift
to +
3 2 nurses

Scheduling Master
p.m.
Shift # 02 3 2junior 4 1 2 5
p.m. doctors patients patient patients patient
Evening
s
to +
shift
11 3 nurses
p.m.
Shift # 03 11 1 senior 3 1 2 3
p.m. doctor patients patient patients patient
Night shift
s
to +
7 3 nurses
a.m.

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Improvement in service quality

Figure 9 Service improvements elements

Reliability
Reliability involves consistency of performance and dependability. It means that the firm
performs the service right the first time and that the firm honors its promises. So, it is necessary
to the paramedic staff to perform their duties correctly because the patient’s dissatisfaction
means it can cause some sever consequences.
Responsiveness
Responsiveness concerns the willingness or readiness of employees to provide service. It
involves timeliness of service.

Competence
Competence means the availability of the required skills & knowledge to perform the service
because if one of them is not present then it may cause the patient dissatisfaction.
Access
Access involves approachability and ease of contact. It is more important because some ethical
issues are there that resist the lower men to get their rights. Everyone has a right to consult the
doctors without any extra charges & private appointments.
Courtesy
Courtesy involves politeness, respect, consideration, and friendliness of contact personnel
(including receptionists, telephone operators, etc.).

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Communication
Communication means keeping patients informed in language they can understand and listening
to them. It may mean that the company has to adjust its language for different patients increasing
the level of sophistication with a well-educated patient and speaking simply and plainly with a
novice.
Service Recovery
Sometimes all things are working well customers are being satisfied and the organization
working up-to the mark but sometimes some unfavorable conditions rise like safety stock ran
out, computer system crashed or the unavailability of paramedic staff so in this condition service
recovery strategy is used.

Figure 10 Service recovery Elements

So, it is necessary to follow the order and after notify make sure that the patient. problem is
listened and solved properly and get some feedback from him

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Service Blue-print

Figure 11 Recommended Service blueprint [5]

References

[1] J. Heizer, B. Render and C. Munson. (2016). Operations Management sustainability and
Supply chain Management. Publication: Pearson. ISBN 10: 0-13-413042-1
[2] Ruth McCabe, Nora Schmit Paula Christen, Alessandra Dheeya Shevanthi Nayagam,
Marisa Miraldo, Paul Aylin Alex, Bottle Pablo N. Perez-Guzman, Azra C. Ghani, Neil M.
Ferguson, Peter J. White and Katharina Hauck. Adapting hospital capacity to meet changing
demands during the COVID-19 pandemic (2020).
[3] School of Business, Department of Management, Istanbul University, Turkey. Selection of
the Forecasting Model in Health Care (2016).
[4] Interim Guidance by World Health Organization Operational considerations for case
management of COVID-19 in health facility and community 19 March 2020.
[5] Yi Y, Li X, Ouyang Y, Lin G, Lu G, et al. (2016) Discriminant analysis forecasting model of
first trimester pregnancy outcomes developed by following 9,963 infertile patients after in vitro
fertilization. Fertil Steril 105: 1261-1265.

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