Centralized versus distributed sterilization service: A location-allocation decision model

The concept of "networking'' has become central to the reform of healthcare systems. The objective is to reduce costs while improving the quality of service. This paper deals with the problem of sterilization service configuration within a hospital network. Two alternatives are considered: (1) each hospital in the network maintains its sterilization service in-house; (2) a central sterilization service ensures this function for all hospitals in the network. This decision is based on a location-allocation model of the sterilization service. A Mixed Integer Linear Program (MILP) is proposed to find the optimal configuration of the sterilization service (centralized vs. distributed), the optimal location and the optimal capacity of the centralized sterilization service over a multi-period planning horizon. The objective is to minimize costs related to transportation, production and resource acquisition and transfer. A solution method based on the addition of appropriate customized cuts to the original MILP is then proposed. The proposed models are applied to 30 scenarios extracted from a real-life case study. The obtained results show that the considered problem can be solved to optimality for moderate size scenarios with the use of commercial MILP solvers and the addition of the proposed customized cuts to the original model. Further analysis was conducted and pointed out how network configuration is sensitive to the number of human and material resources available in each hospital of the network. (C) 2013 Elsevier Ltd. All rights reserved.