11,044 research outputs found
Taxonomic classification of planning decisions in health care: a review of the state of the art in OR/MS
We provide a structured overview of the typical decisions to be made in resource capacity planning and control in health care, and a review of relevant OR/MS articles for each planning decision. The contribution of this paper is twofold. First, to position the planning decisions, a taxonomy is presented. This taxonomy provides health care managers and OR/MS researchers with a method to identify, break down and classify planning and control decisions. Second, following the taxonomy, for six health care services, we provide an exhaustive specification of planning and control decisions in resource capacity planning and control. For each planning and control decision, we structurally review the key OR/MS articles and the OR/MS methods and techniques that are applied in the literature to support decision making
A survey of health care models that encompass multiple departments
In this survey we review quantitative health care models to illustrate the extent to which they encompass multiple hospital departments. The paper provides general overviews of the relationships that exists between major hospital departments and describes how these relationships are accounted for by researchers. We find the atomistic view of hospitals often taken by researchers is partially due to the ambiguity of patient care trajectories. To this end clinical pathways literature is reviewed to illustrate its potential for clarifying patient flows and for providing a holistic hospital perspective
Improvement of outpatient service processes based on BRP theory and information technology: a case study of the University of Hong Kong-Shenzhen Hospital
JEL Classification: M15 – IT Management, I12 – Health ProductionCurrently, due to some irrational allocation of medical and healthcare resources,
a considerable proportion of state-of-the-art medical equipment and talented medical
personnel are concentrated in large urban hospitals. This situation is particularly
common in 3A hospitals (3A hospitals are hospitals which are equipped with more
than 501 beds, can provide medical and healthcare services with high-level specialty
to various regions and with scores higher than 900 according to the grading standard),
which are often crowded with patients. According to the normal outpatient process,
patients need to undergo a prolonged procedure from registration, treatment,
laboratory test, diagnosis to drug dispensing. Often patients have to spend a long time
waiting for treatment, receiving tests and paying for medical care. The congestion of
patients at certain time-consuming processes allows doctors little time to check and
treat patients thoroughly. As a result, doctors are often unable to make accurate and
comprehensive diagnosis.
Considered the window of a hospital, outpatient service is extremely important.
Whether the design of its process is reasonable and whether its management is able to
maximize interests for patients will directly affect the hospital’s medical level, and
even its social benefits and reputation. Therefore, it has become a major issue for a
hospital achieves to optimize the business process of its outpatient service.
Outpatient process, as a core business process of a hospital, is critical to
improving the quality of its medical service, upgrading its performance and
minimizing its operating costs. Therefore, re-designing the outpatient process of a
hospital can help enhance its comprehensive strength by endowing it with a core
competence. In addition, the hospital will be impelled to provide patients with more
convenient medical services with higher quality and lower price.
This work conducts a case study on The University of Hong Kong-Shenzhen
Hospital (HKU-SZH), which was the first to implement an outpatient appointment
registration system. This thesis gives an anatomy of the outpatient process of the
hospital through various methods and theories, such as literature review, field research,
expert consultation, Business Process Reengineering Theory and Information
technology, aiming to identify objectives and strategies of the case hospital in
improving its outpatient process. The study consists of:
- An investigation into the current situation of HKU-SZH’s outpatient
registration process: through questionnaires and structured interviews, the defects and
weak links in the hospital’s appointment registration model were analyzed. A
structural equation model for existing outpatient processes was established and the
influence of different variables on patients’ satisfaction level as well as the correlation
between these variables was analyzed by means of a simulation model.
- Research on outpatient process reengineering: with the needs and satisfaction
of patients as a goal, this thesis reexamines the strategic goals and internal and
external environment of HKU-SZH on the basis of Business Process Reengineering
Theory, Queuing Theory, Six Sigma Theory and Information technology. This thesis
improves HKU-SZH’s registration process, using methods of order modification,
integration, simplification and automation and materializes the process by network
technology and outpatient information system.
- An empirical study on outpatient process: this thesis conducts a systemic and
empirical analysis in a functional integration of registration and payment, process
reengineering research through information technology (development of new
functions of appointment system) and an empirical study on queuing theory.
- Research on local adaptation of outpatient process: this thesis explores
solutions and suggestions for HKU-SZH with the objective of optimize its outpatient
process through the perspectives of hospital organizational structure, information
technology, human resources, building of outpatient culture and optimization of
waiting cost.
By means of outpatient process reengineering, this thesis aim to increase the case
hospital’s efficiency and raise its patients’ satisfaction so that the hospital may
enhance its comprehensive competence. In addition, an effective and operable
methodology will be generated, which is expected to serve as a reference for other
hospitals to improve their operation and their management.Atualmente, devido a alguma atribuição irracional dos recursos médicos e de
saúde, uma proporção considerável de modernos equipamentos médicos e pessoal
médico talentoso estão concentrados em grandes hospitais urbanos. Esta situação é
particularmente comum em hospitais 3A (hospitais 3A são os hospitais que estão
equipados com mais de 501 camas, e que podem fornecer serviços médicos e de saúde
com alto nível de especialidade para diversas regiões e com pontuações superiores a
900 de acordo com o padrão de classificação), que são frequentemente sobrelotados
com pacientes. De acordo com o processo ambulatório normal, os pacientes precisam
passar por um procedimento prolongado desde o registo, tratamento, análise
laboratorial, diagnóstico, até à distribuição de medicamentos. Muitas vezes os
pacientes têm de passar um longo tempo de espera para tratamento, para receber testes
e para pagar por cuidados médicos. O congestionamento de pacientes em
determinados processos demorados, leva a que os médicos tenham pouco tempo para
verificar e tratar os pacientes completamente. Como resultado, os médicos são muitas
vezes incapazes de fazer um diagnóstico preciso e abrangente.
Considerado a montra de um hospital, o serviço ambulatório é extremamente
importante. Se o desenho do seu processo é razoável e se a sua gestão é capaz de
maximizar os interesses dos pacientes, irá afetar diretamente o nível médico do
hospital, e até mesmo os seus benefícios sociais e reputação. Portanto, tornou-se um
importante problema para um hospital conseguir otimizar o processo do seu serviço
ambulatório.
O processo ambulatório, como um processo de negócio nuclear de um hospital, é
fundamental para melhorar a qualidade do seu serviço médico, aumentar o seu
desempenho e minimizar seus custos operacionais. Portanto, reprojetar o processo
ambulatório de um hospital pode ajudar a aumentar a sua força global dotando-o de
uma competência essencial. Além disso, o hospital será impelido a oferecer aos
pacientes serviços médicos mais convenientes com maior qualidade e menor preço.
Este trabalho apresenta um estudo de caso sobre o Hospital da Universidade de
Hong Kong-Shenzhen (HKU-SZH), que foi o primeiro a implementar um sistema de
registo de consulta externa. Esta tese apresenta uma análise do processo ambulatório
do hospital através de vários métodos e teorias, como a revisão de literatura, pesquisa
de campo, consultas a especialistas, teoria da reengenharia de processos e tecnologias
da informação, com o objetivo de identificar os objetivos e estratégias do hospital na
melhoria do seu serviço ambulatório. O estudo consiste em:
- Investigação sobre a situação atual do processo de registo ambulatório de
HKU-SZH. Através de questionários e entrevistas estruturadas, foram analisados os
defeitos e pontos fracos no modelo de registro de consultas do hospital. Um modelo
de equações estruturais para os processos ambulatórios existentes foi estabelecido, e a
influência de diferentes variáveis sobre o nível de satisfação dos pacientes, bem como
a correlação entre essas variáveis foi analisada por meio de um modelo de simulação.
- Investigação sobre a reengenharia do processo ambulatório. Tendo as
necessidades e satisfação dos pacientes como objetivo, esta tese reexamina as metas
estratégicas e o ambiente interno e externo de HKU-SZH com base na Teoria da
Reengenharia de Processos, Teoria das Filas, Teoria Six Sigmae Tecnologias da
Informação. Esta tese melhora o processo de registro de HKU-SZH, usando métodos
de modificação, integração, simplificação e automação e materializa o processo
através de tecnologias de rede e um sistema de informação para o processo
ambulatório.
- Estudo empírico sobre o processo ambulatório. Esta tese conduz uma análise
sistémica e empírica sobre a integração funcional de inscrições e pagamentos, a
pesquisa de reengenharia de processos através de tecnologias da informação
(desenvolvimento de novas funções do sistema de consultas) e um estudo empírico
sobre a teoria das filas.
- Investigação sobre a adaptação local do processo ambulatório. Esta tese explora
soluções e sugestões para o HKU-SZH para otimizar seu processo ambulatório
através das perspetivas de estrutura hospitalar organizacional, tecnologias da
informação, recursos humanos, construção da cultura do ambulatório e otimização do
custo de espera.
Por meio do processo de reengenharia do serviço de ambulatório, esta tese visa
aumentar a eficiência do processo de internamento e aumentar a satisfação dos seus
pacientes para que o hospital possa aumentar a sua capacidade global. Além disso, foi
gerada uma metodologia eficiente e operacionalizavel, a qual se espera possa servir
como referência para outros hospitais, para melhorar o seu funcionamento e a sua
gestão
Population Density-based Hospital Recommendation with Mobile LBS Big Data
The difficulty of getting medical treatment is one of major livelihood issues
in China. Since patients lack prior knowledge about the spatial distribution
and the capacity of hospitals, some hospitals have abnormally high or sporadic
population densities. This paper presents a new model for estimating the
spatiotemporal population density in each hospital based on location-based
service (LBS) big data, which would be beneficial to guiding and dispersing
outpatients. To improve the estimation accuracy, several approaches are
proposed to denoise the LBS data and classify people by detecting their various
behaviors. In addition, a long short-term memory (LSTM) based deep learning is
presented to predict the trend of population density. By using Baidu
large-scale LBS logs database, we apply the proposed model to 113 hospitals in
Beijing, P. R. China, and constructed an online hospital recommendation system
which can provide users with a hospital rank list basing the real-time
population density information and the hospitals' basic information such as
hospitals' levels and their distances. We also mine several interesting
patterns from these LBS logs by using our proposed system
Integral multidisciplinary rehabilitation treatment planning
This paper presents a methodology to plan treatments for rehabilitation outpatients. These patients require a series of treatments by therapists from various disciplines. In current practice, when treatments are planned, a lack of coordination between the different disciplines, along with a failure to plan the entire treatment plan at once, often occurs. This situation jeopardizes both the quality of care and the logistical performance. The multidisciplinary nature of the rehabilitation process complicates planning and control. An integral treatment planning methodology, based on an integer linear programming (ILP) formulation, ensures continuity of the rehabilitation process while simultaneously controlling seven performance indicators including access times, combination appointments, and therapist utilization. We apply our approach to the rehabilitation outpatient clinic of the Academic Medical Center (AMC) in Amsterdam, the Netherlands. Based on the results of this case, we are convinced that our approach can be valuable for decision-making support in resource capacity planning and control at many rehabilitation outpatient clinics. The developed model will be part of the new hospital information system of the AMC
Health care system in Armenia: Past, present and prospects
The paper describes the state and trends of health care, as well as the comprehensive reform program in Armenia. It presents previous, current situation and focuses on future development options. After demonstrating the logic of the investigation, the paper recapitulates the information about results of reform that do not appear to meet all the objectives of health care policy. The reform process has encountered resistance and there is now a serious risk that reformers may throw out the baby with the bath water. The most challenging problem that must be faced involves the drastic decrease in access even to the most essential health care services, as unlike many other transition countries, social-economic factors have prevented the implementation of medical insurance and generated a decrease in subsidized health services and visits for medical aid. Funding shortages often mean that even vulnerable groups have to pay. This has led to an increase of the length of illness and chronic pathology. Thus, the principle of equity with respect to financing and access is undermined. The paper indicates that disparity and polarization are quite high in the society. There are insufficient public funds and the highest share of informal payments prevents the poor to get adequate care. The paper describes the negative effects of widespread use of informal payments in health care and possible steps to reduce it. It analyzes topics such as, feasibility of state health insurance. The paper proposes to implement many interchangeable opportunities for learning in transitional countries and brings to attention the necessity to develop a mechanism for shared learning at the international level. These are outlined briefly at the end of the paper. The paper concludes and summarizes the range of recommendations which are most relevant to developing countries. -- Die Arbeit beschreibt die aktuelle Lage und die Perspektiven des armenischen Gesundheitssystems sowie das umfassende Reformprogramm für das armenische Gesundheitswesen. Sie zeigt die Entwicklung und die aktuelle Situation auf und konzentriert sich auf Möglichkeiten der zukünftigen Ausgestaltung. Nach einem Überblick zum Gang der Untersuchung rekapituliert die Arbeit Informationen zu den Ergebnissen der Reform, die die Ziele der Gesundheitspolitik nicht zu erreichen scheinen. Der Reformprozess stieß auf Widerstände und es besteht nun die Gefahr, dass die Reformer das Kind mit dem Bade ausschütten. Das größte Problem stellt der drastische Rückgang beim Zugang selbst zu den notwendigsten Gesundheitsleistungen dar. Im Gegensatz zu vielen anderen Transformationsländern haben sozioökonomische Faktoren die Implementierung eines Krankenversicherungssystems verhindert und einen Rückgang subventionierter Gesundheitsleistungen sowie von Arztbesuchen verursacht. Finanzierungsmängel haben zur Folge, dass selbst Personen in prekärsten Lagen für Gesundheitsleistungen selbst aufkommen müssen. Dies führte zu einer Verlängerung der durchschnittlichen Krankheitsdauer und zu einer Erhöhung bei chronischen Krankheiten. Somit wird das Gerechtigkeitsprinzip in Bezug auf die Finanzierung und den Zugang unterminiert. Die Arbeit zeigt auf, dass Ungleichheit und Polarisierung in der armenischen Gesellschaft sehr groß sind. Öffentliche Finanzmittel sind unzureichend und der sehr hohe Anteil informeller Zahlungen hindert die Armen daran, adäquaten Zugang zu Gesundheitsleistungen zu erhalten. Die Arbeit beschreibt die negativen Effekte der verbreiteten informellen Bezahlung von Gesundheitsleistungen und zeigt mögliche Schritte zu deren Reduzierung. Es werden Themen wie die Machbarkeit einer staatlichen Krankenversicherung analysiert. Es wird vorgeschlagen, eine Reihe von Austauschmöglichkeiten für das Lernen in Transformationsländern zu implementieren. Die Arbeit lenkt die Aufmerksamkeit auf die Notwendigkeit, einen shared learning Mechanismus auf internationaler Ebene zu entwickeln. Dieser wird am Ende der Arbeit kurz dargestellt. Schließlich fasst die Arbeit die Bandbreite der Empfehlungen, die auch für Entwicklungsländer am wichtigsten sind, zusammen.
A decision support system for surgery sequencing at UZ Leuven's day-care department.
In this paper, we test the applicability of a decision support system (DSS) that is developed to optimize the sequence of surgeries in the day-care center of the UZ Leuven Campus Gasthuisberg (Belgium). We introduce a multi-objective function in which children and prioritized patients are scheduled as early as possible on the day of surgery, recovery overtime is minimized and recovery workload is leveled throughout the day. This combinatorial optimization problem is solved by applying a pre-processed mixed integer linear programming model. We report on a 10-day case study to illustrate the performance of the DSS. In particular, we compare the schedules provided by the hospital with those that are suggested by the DSS. The results indicate that the DSS leads to both an increased probability of obtaining feasible schedules and an improved quality of the schedules in terms of the objective function value. We further highlight some of the major advantages of the application, such as its visualization and algorithmic performance, but also report on the difficulties that were encountered during the study and the shortcomings that currently delay its implementation in practice, as this information may contribute to the success rate of future software applications in hospitals.Decision support system; Optimization; Visualization; Health care application;
Effectiveness of User Centered Design for Optimizing an Electronic Documentation Form
Problem. The electronic form used by lactation consultants to document assessment findings, interventions, plans and recommendations, did not meet user’s requirements. Purpose: The purpose of this project was to evaluate the effect of optimization through a User Centered Design (UCD) process on information quality, use and user satisfaction. Goals. The goals were to provide information technology (IT) support for the organization’s Baby Friendly initiative and to support collaborative, consistent messaging for breastfeeding families which could, in turn, support exclusive breast milk feeding. Exclusive breast milk feeding is a population health initiative that could positively impact the triple aim of better care, lower costs and better health. Objectives. Information quality, use and user satisfaction affect user adoption and acceptance of IT solutions. The objective of this project was to test the effectiveness of UCD on optimization by measuring the increase in information quality, use and user satisfaction after implementation of an optimized electronic lactation assessment. Plan. Stakeholders were identified and the electronic form was optimized through UCD. A pre-test/post-test quasi-experimental design was chosen to measure the effect of optimization. Instruments included a modified version of the System and Use Assessment Survey (AHRQ, n.d.), a chart audit tool and an electronic data warehouse use query. IRB approval was obtained from COMIRB and Regis University. The pre and post data collection periods were each six weeks in length, allowing for a two week chart audit period and four week survey. The intervention was implemented after the close of the pre-test period. Clinical users were educated following the organization’s usual methods for EHR changes. Five months after the intervention, the study timeline was repeated for the post-test period. After the post-test period, a use query was run to collect data for both pre-test and post-test periods. Data were collected, coded, and entered into electronic spreadsheets for storage and analysis. Outcomes and Results. Although the sample as a whole showed no statistically significant increases in any parameter of information quality, use, or user satisfaction, when survey participants were divided by role, nurses and providers, there was a statistically significant increase in the post-test nursing group for two measures of information quality and one measure of information use. A Mann Whitney U test found a significantly higher perception of completeness of the lactation assessment, U = 200, z = -2.11, p = .035, r = .29 and reported frequency of accessing the lactation assessment from the EHR, U= 233, z = -2.01, p = .044, r = 0.26. A Fishers exact test found a statistically significant increase in the presence of lactation assessments in the post-test chart audit [1, N = 39] = 11.8, p =.001, φ= .39). The outcomes may be explained by differences in how each role uses the EHR. Additional education for providers may be necessary to overcome these differences
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