Knowledge-based schedule formulation and maintenance under uncertainty.

This paper is concerned with the dual sequential problems of (1) determining an acceptable personnel schedule over a specified time period, and (2) adjusting that schedule during the course of its execution in reaction to daily changes in both demand and available personnel. The first problem is schedule formulation; the second sequential problem is schedule execution. A rule-based, hierarchical system has been developed for first modeling and then solving both the schedule formulation and the schedule execution problems as a two-phase dependent process. The system is applied to the scheduling and staffing of nurses. A double-blind evaluation was conducted, which ascertained the quality of the resultant schedules in terms of maintainability, coverage, and personal satisfaction. The evaluation indicates that for units on which personnel changes have occurred, the prototype appears to perform as well as human schedulers.

Cost-benefit of laboratory computer systems.

The benefits and costs of a computer laboratory information system have been evaluated in three military hospitals, using a pre- and postimplementation comparison of time spent by laboratory and medical staff on information-handling activities, turnaround time for laboratory results, and staff perceptions of performance. The evaluation indicates that the laboratory information system is very cost-effective. A major benefit is the reduction in nursing staff time required to obtain laboratory test status and results.

Hill-Burton compliance attainable for most healthcare facilities.

To qualify for Hill-Burton funds, healthcare facilities must provide uncompensated services to people unable to pay and must prove fulfillment of this requirement. As a result, healthcare facilities incur administrative costs in compliance with Hill-Burton regulations. Are these administrative costs a significant portion of operating costs? In a recent study, it was determined that on average, actual estimated costs per facility were below the target estimate. However, it was also determined that small facilities, especially long-term and "other," do find compliance more burdensome.

Cost effectiveness of laboratory instrument/computer interface.

A method for determining when, and for which laboratory instruments, direct interfacing with a computer is cost-effective is presented. Differences between automatic and manual inputting of laboratory test results are discussed, and costs and benefits of on-line instrumentation are analyzed. A complete theoretical model for analyzing projected benefits is described, along with a simplified version based on estimates of the time involved for both manual and automated systems.

The Bedford-Stuyvesant/Crown Heights demonstration project.

The Bedford-Stuyvesant/Crown Heights demonstration project in Brooklyn, New York, provided Federal and New York State funds to offset the deficits of three hospitals and three freestanding health centers while the six institutions worked to improve service quality and financial viability of the local health care system. The demonstration project resulted in a merger between two of the participants: at the end of 1982, the Jewish Hospital and Medical Center of Brooklyn and St. John's Episcopal Hospital of Brooklyn merged to form Interfaith Medical Center.