Adelina Gnanlet

Sequential and Simultaneous Decision Making for Optimizing Health Care Resource Flexibilities

Health care administrators commonly employ two types of resource flexibilities (demand upgrades and staffing flexibility) to efficiently coordinate two critical internal resources, nursing staff and beds, and an external resource (contract nurses) to satisfy stochastic patient demand. Under demand upgrades, when beds are unavailable for patients in a less acute unit, patients are upgraded to a more acute unit if space is available in that unit. Under staffing flexibility, nurses cross-trained to work in more than one unit are used in addition to dedicated and contract nurses. Resource decisions (beds and staffing) can be made at a single point in time (simultaneous decision making) or at different points in time (sequential decision making). In this article, we address the following questions: for each flexibility configuration, under sequential and simultaneous decision making, what is the optimal resource level required to meet stochastic demand at minimum cost? Is one type of flexibility (e.g., demand upgrades) better than the other type of flexibility (e.g., staffing flexibility)? We use two-stage stochastic programming to find optimal resource levels for two nonhomogeneous hospital units that face stochastic demand following a continuous, general distribution. We conduct a full-factorial numerical experiment and find that the benefit of using staffing flexibility on average is greater than the benefit of using demand upgrades. However, the two types of flexibilities have a positive interaction effect and they complement each other. The type of flexibility and decision timing has an independent effect on system performance (capacity and staffing costs). The benefits of cross-training can be largely realized even if beds and staffing levels have been determined prior to the establishment of a cross-training initiative.

Impact of productivity on cross-training configurations and optimal staffing decisions in hospitals

Cross-training of nursing staff has been used in hospitals to reduce labor cost, provide scheduling flexibility, and meet patient demand effectively. However, cross-trained nurses may not be as productive as regular nurses in carrying out their tasks because of a new work environment and unfamiliar protocols in the new unit. This leads to the research question: What is the impact of productivity on optimal staffing decisions (both regular and cross-trained) in a two-unit and multi-unit system. We investigate the effect of mean demand, cross-training cost, contract nurse cost, and productivity, on a two-unit, full-flexibility configuration and a three-unit, partial flexibility and chaining (minimal complete chain) configurations under centralized and decentralized decision making. Under centralized decision making, the optimal staffing and cross-training levels are determined simultaneously, while under decentralized decision making, the optimal staffing levels are determined without any knowledge of future cross-training programs. We use two-stage stochastic programming to derive closed form equations and determine the optimal number of cross-trained nurses for two units facing stochastic demand following general, continuous distributions. We find that there exists a productivity level (threshold) beyond which the optimal number of cross-trained nurses declines, as fewer cross-trained nurses are sufficient to obtain the benefit of staffing flexibility. When we account for productivity variations, chaining configuration provides on average 1.20% cost savings over partial flexibility configuration, while centralized decision making averages 1.13% cost savings over decentralized decision making.

Venture capital-backed foreign portfolio company's IPO

We contend that the likelihood of a new, foreign venture capital (VC) financed venture launching an IPO will be associated with the institutional characteristics of the ventures home country including the national system of innovation and cultural dimensions, such as masculinity and power distance, as well as the commercial potential of its industry segment, and the stage of investment. A hazard model examining a dataset of 485 US VC-backed ventures in the healthcare (biotech and medical) industry operating in 12 countries provided support for our hypotheses.

Helping Learners Recognize, Diagnose, and Unravel Incompetence Traps to Achieve Synergistic Exploration–Exploitation in Classroom

Sensemaking theory suggests that sensemaking may collapse when perception fails to detect weak signals of changes in the environment, cognition fails to appropriately categorize the new data coming from perception, and action fails to test the applicability of new concepts and schemas. Mindfulness–mindlessness theory warns us that routine practices based on low levels of exploration and exploitation may hinder performance. Finally, the theory of learning failure distinguishes between the traps of failure or overexploration and the traps of success or overexploitation. Combining and advancing these insights, we offer a typology of incompetence traps: (a) underexploration–underexploitation or mindlessness, (b) overexploration–underexploitation, and (c) overexploitation–underexploration. We examine their manifestations in perception, cognition, and action. Based on our analysis of how incompetence traps may hamper learning in management education, we give examples of how instructors may help students achieve synergistic exploration–exploitation via informed vision (combining depth and multiple perspectives); perceptive thinking (combining theoretical, constraint-savvy knowledge and practical, context-savvy knowledge); and mindful action (developing and refining new and existing capabilities).

Impact of non-homogenous distributor's preferred allocation on shortages in hospitals

Purpose – Hospitals procure high volumes of medical supplies through large distributors in order to leverage economies of scale. However, when shortages hit, hospitals incur high penalty costs by purchasing from secondary markets. In this paper, the authors counter the hospitals typical purchasing strategy that a collaborative relationship with a large, Tier I medical supply distributor is beneficial under all conditions. The paper finds that during shortages the more beneficial strategy is for the hospital to add a medium-sized, Tier II distributor who offers a transactional relationship and is willing to provide a “preferred allocation” in return for a pre-committed annual purchase contract. The paper aims to discuss these issues. Design/methodology/approach – The authors assume availability of order volume to be a stochastic process and formulate the problem as a two-stage stochastic programming model, with optimal allocation in the second stage. The authors analyze the first-stage objective function ...

Problem-solving and incompetence traps in service operations course

Problem-based learning through team projects and case analyses is as much an art as it is a science for business students. As novices, students frequently lack critical-thinking and problem-solving skills and consequently fall into incompetence traps that arise due to defective seeing (tunnel vision vs. blurred vision) and defective thinking (loose vs. oblivious thinking), resulting in fallacies of singularity, multiplicity, constraint neglect and context neglect. We argue that instructors, as experts, should help novice students escape from incompetence traps in a way adjusted to specific knowledge domains. We approach incompetence traps in areas of service operations as triggers of particular operational challenges and propose strategies that will help instructors teach students the art of problem solving and enhance their critical-thinking skills in business education.