The Centralization and Sharing of Information for Improving a Resilient Approach Based on Decision-Making at a Local Home Health Care Center

Round 1

Reviewer 1 Report

This article deals whith Home Care Routing and Scheduling Problem (HHCRSP). It aims to show that resilient strategies improves variations and disruptions management within HHCRSP. The topic is interesting and the article is easy to read.

One contribution of this article is the provided use case. The article has the potential to published in Applied Sciences. However, in my point of view, many points are unclear and must be clarified before acceptance.

The major ones :

1. Regarding lines 53, 54, 55 and 56 of section 1, the gap in the literature is loosely identified. Moreover, it is not explained why a robust approach is not sufficient and why is it necessary to develop a resilient approach. What about existing resilient approaches ? This must be clearly mentionned in the introduction section.

2. Also, it is not clear in the introduction what is the main contribution of this article. This must be clearly mentionned.

3. Regarding the literature review, you have mentionned different related works. But why these works are not enough or satisfactory to this problem ? What is missing and what is the contribution of this article ?

4. Regarding the section 3.3.1, the three appraoches are clearly presented. However, i do not understand why the first approach is resilient. Please provide some explanation.

5. Regarding line 326 of section 5, to effectively show the originality, the relevance and the significance of this approach, you should compare it to best existing robust approches and to best existing resilient approach. 

The minor ones :

1. Please check the affiliation of Cléa Martinez

2. You don't have any key word about information centralization and sharing. Also you don't have the word "resilient" in the title.

3. Regarding lines 60, 61, 62, and 63 of section 1, what is the third approach ?

4. The outline of the rest of the article is missing in the introduction.

5. Regarding line 73 of section 2, what do you mean by incompatibilies ?

6. Figure 1 must be explained to make it clearer, especially for non domain reader.

Author Response

Thank you for your review and comments. Above are our responses in red and the changes made to the manuscript in italics.

The major ones :

1. Regarding lines 53, 54, 55 and 56 of section 1, the gap in the literature is loosely identified. Moreover, it is not explained why a robust approach is not sufficient and why is it necessary to develop a resilient approach. What about existing resilient approaches ? This must be clearly mentionned in the introduction section.

We added some sentences and references to explain why a robust approach is not sufficient:
Robust approaches build efficient solutions as long as the uncertainties are bound within a defined interval [3], whereas resilient approaches propose policies to recover after a disruption. In the vehicle routing literature, stochastic routing problems are of-ten tackled with robust approaches such as chance-constrained programming (CCP), or resilient approaches such as stochastic programming with recourse (SPR). Gendreau et al. [4] argue that the objective functions in SPRs are more relevant than CCPs to solve a stochastic VRP. Moreover, a typical concern with robust approaches is that they can be too conservative, and thus too far from optimality for the nominal problem [5]. That is why robust solutions are effective against small variations but become useless against strong disruptions: it is then necessary to turn to resilient approaches.

About the existing resilient approaches, we explain why they do not answer our problem in the literature review:
Resilient approaches must then be deployed at the operational level to repair the routes in the case of high-impact disruption. Among the classic recourse strategies for stochastic VRP, most of them imply a return to the depot [29], which is not helpful for HHCRSP. Similarly, rescheduling strategies for routing problems may not be suited to HHC applications: Errico et al study two alternative strategies to solve a VRP with time windows and stochastic service times, which both imply skipping customers [30]. To the best of our knowledge, only three articles propose reactive and resilient solutions to counter high-impact disruptions in the field of HHC. Alves et al use a multi-agent system to deal with unexpected events, such as vehicle breakdown, where visits are dynamically reassigned to another vehicle [31]. Marcon et al use a similar two-level architecture with an off-line module that assigns caregivers to patients and an online multi-agent module that takes local decisions to optimize the routes [32]. No change in the caregiver-patient assignment is allowed, which prevents any collaboration in case of disruption, and none of these two articles take into account time windows. Yet, we consider temporal constraints as a key element to HHCRSPs because delays in care delivery may not only have an impact on the quality of care, but also on the satisfaction of the patient. In the study by Yuan et al, patients can cancel their appointments or require new visits during the execution of the routes, so they are re-optimized in real-time with a tabu-search, with the objective of minimizing deviations from the original plan [33]. The possibility of calling in additional workers and the cancellations of requests guarantee a stable workload. In our article, the perturbations on care durations have a major impact on the workload of the caregivers, and thus, on the feasibility of the routes and the quality of care.

2. Also, it is not clear in the introduction what is the main contribution of this article. This must be clearly mentionned.

This has been added to the introduction:
The two main contributions of the article are (1) creating a realistic case study based on home health care center interviews and making it available to the scientific community, and (2) proposing and analyzing by simulation a collaborative resilient approach based on centralization and information sharing to improve local decision-making when routes are disrupted.

3. Regarding the literature review, you have mentionned different related works. But why these works are not enough or satisfactory to this problem ? What is missing and what is the contribution of this article ?

The need of building a resilient solution was set out in our response to comment 1. We added sentences to clarify our positioning in relation to the three papers with resilient approaches that we had identified as mentioned before (comment 1).

4. Regarding the section 3.3.1, the three appraoches are clearly presented. However, i do not understand why the first approach is resilient. Please provide some explanation.

Indeed, the first approach is not resilient, it is to compare the other two with it (hence its number 0). A few sentences have been changed to better explain (thank you for this remark because we believe that the paper is now more comprehensible):

• In the abstract: We model, analyze and compare two resilient approaches to deal with these disruptions: a distributed collaborative approach and a centralized collaborative approach, where we propose a centralization and sharing of information to improve local decision-making.
• In the introduction: Two different approaches are analyzed and compared to a baseline approach using discrete event simulation, including an empirical approach modeling what is done to-day in the home health care centers interviewed, and a new approach based on the centralization and sharing of information between caregivers to improve local decision-making.
• In the methods: Two different resilient approaches, represented in Figure 4 as a complement to the previous figure, are compared to a baseline approach without any collaboration: a distributed collaborative approach (the one used today by the nursing care structures interviewed), and a centralized collaborative approach.
• In the conclusion: Then, we model two different resilient approaches to counter the high impact disruptions encountered by caregivers on their routes. Hence, we analyze and compare to a baseline approach the existing solution and a proposal for centralization and sharing of information to improve local decision-making.

5. Regarding line 326 of section 5, to effectively show the originality, the relevance and the significance of this approach, you should compare it to best existing robust approches and to best existing resilient approach. 

As identified in section 2 (Literature Review), robust approaches are not relevant to tackle big perturbations (i.e. disruptions). Resilient approaches for the VRP are not always suited to HHCRSP problems, as stated in the following sentences:
Among the classic recourse strategies for stochastic VRP, most of them imply a return to the depot [29], which is not helpful for HHCRSP. Similarly, rescheduling strategies for routing problems may not be suited to HHC applications: Errico et al study two alternative strategies to solve a VRP with time windows and stochastic service times, which both imply skipping customers [30].

As for the articles on the HHCRSP that propose resilient approaches, we identified several missing key features in the problems they tackle (see answer to comment 1) that are directly bound to the method we built. Therefore, we feel like the comparison with their method would be difficult. To assess the quality of our approach, we chose to compare the quality of the solutions we obtained to the quality of the baseline solutions.

The minor ones :

1. Please check the affiliation of Cléa Martinez

The affiliation has been changed, thank you.

2. You don't have any key word about information centralization and sharing. Also you don't have the word "resilient" in the title.

That's right, the keyword "information sharing" has been added and the title has been changed, thank you!

New title: Centralization and sharing of information to improve a resilient approach based on local decision-making in a home health care center

3. Regarding lines 60, 61, 62, and 63 of section 1, what is the third approach ?

We changed the sentences referring to the three approaches since the first one is not resilient, so there is one baseline approach and two resilient approaches as explained before (comment 4).

4. The outline of the rest of the article is missing in the introduction.

We did not put it in the initial submission because the article has a classic structure. We added the following sentence to clearly state the outline:
The paper is organized as follows. Section 2 is dedicated to the review of literature on publications related to the topic. Then, Section 3 describes the use case, and the de-sign of experiments (resilient approaches and disruptions). Section 4 presents the results and analysis. Finally, Section 5 concludes and proposes avenues for further re-search.

5. Regarding line 73 of section 2, what do you mean by incompatibilies ?

Incompatibilities refer to what (Chaieb et al., 2020) call “refusal reasons”: for different reasons, there may be contradicting preferences leading to a refusal from the caretaker or the patient.

Chaieb, M., Jemai, J., Mellouli, K., 2020. A decomposition - construction approach for solving the home health care scheduling problem. Health Care Manag Sci 23, 264–286. https://doi.org/10.1007/s10729-019-09479-z

6. Figure 1 must be explained to make it clearer, especially for non domain reader.

An explanation has been added:
A robust solution is therefore used to absorb a variation, and a resilient approach is used to counter a disruption, as represented in Figure 1: a robust solution in blue on the left absorbs the variations (represented by σ in orange) around the mean value μ, so these variations do not affect the performance indicators on the bottom, protected by this solution. On the right, the disruption has an impact on these indicators and that is why a resilient approach is necessary to return to a "normal" operating state.

Reviewer 2 Report

   The study addresses an important organizational problem related to the skilful reconciliation of the interests of the organization with the public interest through the use of scientific achievements. In order to solve the adopted problem, an algorithmic method of optimizing non-institutional care for stakeholders of a nursing home was used. The proposed method should improve the effectiveness of health care for a group of elderly people and reduce the operating costs of a care institution. Organizational innovation in the sphere of planning the routes of care personnel has been verified through specific simulations and adopted algorithms. The obtained results negated the functioning system of personnel organization according to the route schedule and became the basis for centralized coordination of their activities in the field.

    Organizational innovation has been well justified in the content of the article with the possibility of its analysis by interested parties. In the context of shaping the system's resistance to disturbances, in the opinion of the reviewer, the solution proposed by the authors of the study is too optimistic. In practice, there are disruptions in the work of mobile operators and failures of individual equipment. The requirements of system resilience specify that an innovative method should be the basis for developing an optimized route plan, and central coordination of the work of caregivers should be a factor strengthening the system. I submit these issues for the consideration of the authors of the study.

 

   In the opinion of the reviewer, the article is suitable for publication in the discussed form.

Author Response

Thank you for your review, it is much appreciated. The solution may seem optimistic but it comes very close to what is deployed in the field today while improving it and proposing other avenues of research. We added a sentence in the avenues of research to mention the technological obstacles to real-time communication in practice:
However, online scheduling would raise the question of the reliability of real-time communication between the HHC center and the caregivers, which today remains an obstacle to the use of these digital tools in practice.

Reviewer 3 Report

This is a clear and well-written paper that provides a strong case example for resilient approaches to routing and scheduling problems. Some specific recommendations are:

1. The 2 scenarios and sub-scenarios may be better summarized in a table or using numbered points. In reading, it was necessary to refer back to the descriptions multiple times to clarify which was which.

2. Line 284 should refer to Figure 7.

3. The suggestions for managers are welcome, although brief given the space dedicated to analysis. I suggest expanding these suggestions and clarifying what is meant by each.

A more general comment is that whole there is discussion of real-time tools, it is unclear how these may be used in practice by caregivers and managers. The analysis is complex and the implications for improvements in service may not be immediately obvious to the layperson. As such, some discussion on how caregivers and managers may perceive the use of complex tools for case management may be warranted.  Oftentimes, IT tools are suggested based on clear research benefits, but these aren't born out in practice.

Author Response

Thank you for your review and comments. Above are our responses in red and the changes made to the manuscript in italics.

This is a clear and well-written paper that provides a strong case example for resilient approaches to routing and scheduling problems. Some specific recommendations are:

1. The 2 scenarios and sub-scenarios may be better summarized in a table or using numbered points. In reading, it was necessary to refer back to the descriptions multiple times to clarify which was which.

The approaches are already numbered (0, 1-1, 1-2, etc.), a summary table of approaches and sub-approaches has been added to clarify that:

Table 1. Approaches and sub-approaches with their name.

Approaches
0	Baseline (not a resilient approach)
1-X	Distributed collaborative approach (existing)
2-X	Centralized collaborative approach (innovative)
Sub-approaches	When I help a colleague, which care visit should I take?
X-1	The closest to me
X-2	Next on the schedule
X-3	The last of the schedule

2. Line 284 should refer to Figure 7.

Indeed, it has been changed.

3. The suggestions for managers are welcome, although brief given the space dedicated to analysis. I suggest expanding these suggestions and clarifying what is meant by each.

The explanations have been added based on the results of the previous part:

As regards managerial insights, we recommend that home health care centers:

• Promote the centralization and sharing of information between caregivers to improve mutual aid. The three resilient “2-X” sub-approaches outperforms the “1-X” ones according to both the total number of late arrivals, the total time of late arrival, and especially the number of routes finishing before the target end time;
• In cases of mutual assistance between two caregivers, the helper must take the care visit closest to them. Among the three resilient sub-approaches studied, those whose rule is to take the next care visit closest to the helper (the "X-1" sub-approaches) are those that reduce the number of delays and the total time of delay.

A more general comment is that whole there is discussion of real-time tools, it is unclear how these may be used in practice by caregivers and managers. The analysis is complex and the implications for improvements in service may not be immediately obvious to the layperson. As such, some discussion on how caregivers and managers may perceive the use of complex tools for case management may be warranted. Oftentimes, IT tools are suggested based on clear research benefits, but these aren't born out in practice.

This is indeed a very interesting point, and we discussed it with the caregivers and care coordinators during the various interviews we conducted: in practice, they may not all be ready to change their way of working, but it is certain that some of them (in particular the youngest who are used to computer tools) do not see any inconvenience. In addition, the problem of disruptions that strongly impact routes is poorly managed today, and home health care centers are therefore willing to use technology to help them. We added a sentence in the avenues of research to mention the technological obstacles to real-time communication in practice:
However, online scheduling would raise the question of the reliability of real-time communication between the HHC center and the caregivers, which today remains an obstacle to the use of these digital tools in practice.

Round 2

Reviewer 1 Report

The clarity of the article has been improved. I therefore suggest the acceptation of this article for publication in Applied Sciences.