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Is the hospital lean? A mathematical model for assessing the implementation of lean thinking in healthcare institutions
Publication date: Available online 13 June 2017 Source:Operations Research for Health Care Author(s): Gopalakrishnan Narayanamurthy, Anand Gurumurthy Many academic and practice articles have been published in healthcare operations management literature documenting the experience of implementing lean thinking (LT) in healthcare institutions. But, none of them have developed a procedure for assessing the implementation of LT in healthcare institutions Lack of assessment procedures make it difficult to evaluate the progress made during the implementation of LT. The current study attempts to address this gap by developing ...
Source: Operations Research for Health Care - June 14, 2017 Category: Hospital Management Source Type: research

Assessment of forecasting models for patients arrival at Emergency Department
Publication date: Available online 24 May 2017 Source:Operations Research for Health Care Author(s): Miguel Carvalho-Silva, M. Teresa T. Monteiro, Filipe de Sá-Soares, Sónia Dória-Nóbrega The unpredictability of arrivals to the Emergency Department (ED) of a hospital is a great concern of the management. The existence of more complex pathologies and the increase in life expectancy originate a higher rate of hospitalization. The hospitalization of patients via ED upsets previously programmed services and some cancelations may occur. The Hospital’s ability to predict turnout variations in the arrivals to the ED i...
Source: Operations Research for Health Care - May 25, 2017 Category: Hospital Management Source Type: research

DRG system design: A financial risk perspective
Publication date: Available online 29 April 2017 Source:Operations Research for Health Care Author(s): Hans-Jakob Lüthi, Philippe K. Widmer A prospective hospital payment system induces a substantial financial risk for the provider that not only increases incentives for cost efficiency. If financial risk is not bounded at an equal level for all DRGs and patient cases, hospitals have incentives to minimize their risk level as well. This paper investigates its consequences and proposes a DRG-System redesign encompassing a fair (or risk-adjusted) compensation. We adjust the price of the provider such that the risk of a f...
Source: Operations Research for Health Care - April 30, 2017 Category: Hospital Management Source Type: research

Local search heuristics for a surgical case assignment problem
Publication date: Available online 27 April 2017 Source:Operations Research for Health Care Author(s): Catarina Mateus, Inês Marques, M. Eugénia Captivo This work is part of an ongoing project with a Portuguese public hospital, where the elective surgeries scheduling problem is studied. The administration of the hospital aims to achieve the targets set by the Portuguese Ministry of Health for surgical production and to ensure a surgical service with a high level of efficiency. However, hospitals do not have an elective surgeries scheduling system, so the surgeries are unsystematically scheduled and without respectin...
Source: Operations Research for Health Care - April 28, 2017 Category: Hospital Management Source Type: research

Demand-point constrained EMS vehicle allocation problems for regions with both urban and rural areas
Publication date: Available online 20 March 2017 Source:Operations Research for Health Care Author(s): Martin van Buuren, Rob van der Mei, Sandjai Bhulai Governments deal with increasing health care demand and costs, while budgets are tightened. At the same time, ambulance providers are expected to deliver high-quality service at affordable cost. Maximum reliability and minimal availability models guarantee a minimal performance level at each demand point, in contrast to the majority of facility location and allocation methods that guarantee a minimal performance that is aggregated over the entire ambulance region. As...
Source: Operations Research for Health Care - March 20, 2017 Category: Hospital Management Source Type: research

System dynamics simulation modeling of health information exchange (HIE) adoption and policy intervention: A case study in the State of Maryland
Publication date: Available online 23 February 2017 Source:Operations Research for Health Care Author(s): Emad A. Edaibat, Jason Dever, Steven M.F. Stuban In this paper, health information exchange (HIE) adoption barriers, challenges, influencing factors, and the impacts of policy interventions among ambulatory providers and acute-hospitals in the State of Maryland health care system are examined. The main areas discussed are HIE sustainability, financial benefits, return on investment, and the correlation between HIE and hospital readmission reductions. The proposed policies include financial incentives to adopt HIE ...
Source: Operations Research for Health Care - February 22, 2017 Category: Hospital Management Source Type: research

Dynamic, robust models to quantify the impact of decentralization in post-disaster health care facility location decisions
Publication date: Available online 31 January 2017 Source:Operations Research for Health Care Author(s): Luke Muggy, Jessica L. Heier Stamm We consider post-disaster health care facility location problems in which the need for facilities is not known until post-disaster, the need changes spatially and temporally as the response unfolds, and multiple organizations wish to open and close facilities over short time horizons based on dynamic needs and resource levels. In this context, accessibility, or the opportunity for individuals to receive services provided by facilities, and equity, or fairness, among individuals are...
Source: Operations Research for Health Care - January 30, 2017 Category: Hospital Management Source Type: research

Modeling chronic hepatitis B virus infections with survival probability metrics
Publication date: Available online 18 January 2017 Source:Operations Research for Health Care Author(s): Jeng-Huei Chen, Shin-Yu Chen, Hsing Paul Luh, Rong-Nan Chien Progressions of chronic diseases can be modeled as Markov processes. Frequently, the model parameters are concluded based on distinct short-term clinical studies because of the difficulty of observing the entire progression process in one clinical study. Though this piece-by-piece approach provides a global picture to the disease progression process, it could lead to unrealistic results under in-depth analysis. For instance, without careful calibration, ...
Source: Operations Research for Health Care - January 18, 2017 Category: Hospital Management Source Type: research

EMS call center models with and without function differentiation: A comparison
Publication date: Available online 6 January 2017 Source:Operations Research for Health Care Author(s): Martin van Buuren, Geert Jan Kommer, Rob van der Mei, Sandjai Bhulai In pre-hospital health care the call center plays an important role in the coordination of emergency medical services (EMS). An EMS call center handles inbound requests for EMS and dispatches an ambulance if necessary. The time needed for triage and dispatch is part of the total response time to the request, which, in turn, is a key performance indicator for the quality of EMS. Call center agents should perform the triage efficiently, so that ente...
Source: Operations Research for Health Care - January 6, 2017 Category: Hospital Management Source Type: research

A data-driven model of an emergency department
Publication date: Available online 22 November 2016 Source:Operations Research for Health Care Author(s): Ward Whitt, Xiaopei Zhang This paper develops an aggregate stochastic model of an emergency department (ED) based on a careful study of data on individual patient arrival times and length of stay in the ED of the Rambam Hospital in Israel, which was used in a large-scale exploratory data analysis by Armony et al. (2015). This data set is of special interest because it has been made publicly available, so that the experiments are reproducible. Our analysis confirms the previous conclusions about the time-varying ar...
Source: Operations Research for Health Care - November 22, 2016 Category: Hospital Management Source Type: research

On the performance of small-scale living facilities in nursing homes: A simulation approach
In this study a simulation model is developed to examine the performance of SSLFs, in terms of meeting the time preferences of their residents. We model scheduled care using historical data and unscheduled care using a Poisson-Gamma mixture model. The model is used to explore the impact of a change in demand characteristics, duration of care delivery, travel time, allocation flexibility, shifts, number of clients and allocation policy. The results show that to further improve the performance, the focus should lie on: (1) increasing the allocation flexibility of care workers and the number of clients per SSLF, and (2) time ...
Source: Operations Research for Health Care - October 24, 2016 Category: Hospital Management Source Type: research

Offload zone patient selection criteria to reduce ambulance offload delay
In this study we investigate why this is the case and use a continuous time Markov chain to evaluate how interventions can prevent congestion in the offload zone. Specifically we demonstrate conditions where the offload zone worsens offload delay and conditions where the offload zone can essentially eliminate offload delay. (Source: Operations Research for Health Care)
Source: Operations Research for Health Care - September 13, 2016 Category: Hospital Management Source Type: research

Coverage, survivability or response time: A comparative study of performance statistics used in ambulance location models via simulation optimization
Publication date: Available online 29 August 2016 Source:Operations Research for Health Care Author(s): Muhammad Adeel Zaffar, Hari K. Rajagopalan, Cem Saydam, Maria Mayorga, Elizabeth Sharer Rapid response to medical emergencies is one of the main goals of Emergency Medical Service (EMS) systems. Ability to provide timely response is affected by fleet size and the locations of the ambulances. Literature on ambulance location has been dominated by models which either maximize coverage, or guarantee coverage within some threshold. Recent work has shifted the objective from maximizing coverage to improving patient sur...
Source: Operations Research for Health Care - August 29, 2016 Category: Hospital Management Source Type: research

Reducing access times for radiation treatment by aligning the doctor ’s schemes
The objective of this study is to increase compliance to access time standards without extending resource capacities, by developing a methodology for optimizing resource capacity allocation in the radiotherapy care process. For radiotherapy, time division of resources over different activities particularly applies to the doctors, who carry out consultations and scan contouring. Time slots for these activities are typically set for each doctor in a cyclic weekly scheme. We develop an integer linear programming (ILP) model to design a weekly doctors’ scheme that minimizes the expected access times of all patient types in t...
Source: Operations Research for Health Care - July 20, 2016 Category: Hospital Management Source Type: research

A mathematical optimization model for efficient management of Nurses ’ Quarters in a teaching and referral hospital in Hong Kong
Conclusion The use of operations research methodologies is useful in enhancing workflow efficiency and resource utilization in healthcare. Through the employment of a data-driven and evidence-based methodology, buy-in from stakeholders could be obtained so that a new and enhanced workflow could be successfully implemented. (Source: Operations Research for Health Care)
Source: Operations Research for Health Care - July 20, 2016 Category: Hospital Management Source Type: research