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 multilevel integrative approach to hospital case mix and capacity planning.

Hospital case mix and capacity planning involves the decision making both on patient volumes that can be taken care of at a hospital and on resource requirements and capacity management. In this research, to advance both the hospital resource efficiency and the health care service level, a multilevel integrative approach to the planning problem is proposed on the basis of mathematical programming modeling and simulation analysis. It consists of three stages, namely the case mix planning phase, the master surgery scheduling phase and the operational performance evaluation phase. At the case mix planning phase, a hospital is assumed to choose the optimal patient mix and volume that can bring the maximum overall financial contribution under the given resource capacity. Then, in order to improve the patient service level potentially, the total expected bed shortage due to the variable length of stay of patients is minimized through reallocating the bed capacity and building balanced master surgery schedules at the master surgery scheduling phase. After that, the performance evaluation is carried out at the operational stage through simulation analysis, and a few effective operational policies are suggested and analyzed to enhance the trade-offs between resource efficiency and service level. The three stages are interacting and are combined in an iterative way to make sound decisions both on the patient case mix and on the resource allocation.Health care; Case mix and capacity planning; Master surgery schedule; Multilevel; Resource efficiency; Service level;

Integral resource capacity planning for inpatient care services based on hourly bed census predictions

The design and operations of inpatient care facilities are typically largely historically shaped. A better match with the changing environment is often possible, and even inevitable due to the pressure on hospital budgets. Effectively organizing inpatient care requires simultaneous consideration of several interrelated planning issues. Also, coordination with upstream departments like the operating theater and the emergency department is much-needed. We present a generic analytical approach to predict bed census on nursing wards by hour, as a function of the Master Surgical Schedule (MSS) and arrival patterns of emergency patients. Along these predictions, insight is gained on the impact of strategic (i.e., case mix, care unit size, care unit partitioning), tactical (i.e., allocation of operating room time, misplacement rules), and operational decisions (i.e., time of admission/discharge). The method is used in the Academic Medical Center Amsterdam as a decision support tool in a complete redesign of the inpatient care operations

Flexible nurse staffing based on hourly bed census predictions

Workload on nursing wards depends highly on patient arrivals and patient lengths of stay, which are both inherently variable. Predicting this workload and staffing nurses accordingly is essential for guaranteeing quality of care in a cost effective manner. This paper introduces a stochastic method that uses hourly census predictions to derive efficient nurse staffing policies. The generic analytic approach minimizes staffing levels while satisfying so-called nurse-to-patient ratios. In particular, we explore the potential of flexible staffing policies which allow hospitals to dynamically respond to their fluctuating patient population by employing float nurses. The method is applied to a case study of the surgical inpatient clinic of the Academic Medical Center (AMC) Amsterdam. This case study demonstrates the method's potential to study the complex interaction between staffing requirements and several interrelated planning issues such as case mix, care unit partitioning and size, and surgical block planning. Inspired by the numerical results, the AMC decided that this flexible nurse staffing methodology will be incorporated in the redesign of the inpatient care operations during the upcoming years

The New Politics of US Health Care Prices: Institutional Reconfiguration and the Emergence of All-Payer Claims Databases

Prices are a significant driver of health care cost in the United States. Existing research on the politics of health system reform has emphasized the limited nature of policy entrepreneurs’ efforts at solving the problem of rising prices through direct regulation at the state level. Yet this literature fails to account for how change agents in the states gradually reconfigured the politics of prices, forging new, transparency-based policy instruments called all-payer claims databases (APCDs), which are designed to empower consumers, purchasers, and states to make informed market and policy choices. Drawing on pragmatist institutional theory, this article shows how APCDs emerged as the dominant model for reforming health care prices. While APCD advocates faced significant institutional barriers to policy change, we show how they reconfigured existing ideas, tactical repertoires, and legal-technical infrastructures to develop a politically and technologically robust reform. Our analysis has important implications for theories of how change agents overcome structural barriers to health reform

Understanding the Workforce Needs of New Jersey's Public Health and Other Disaster Management Employers

This report explores the priority workforce needs of New Jersey's public disaster management system. An advisory group of disaster management-related employers from law enforcement and state and local public health systems and educational institutions was convened in the spring of 2006 to identify priority workforce skill needs. Researchers also conducted interviews with state officials, domestic security, public health, and disaster planning experts, as well as reviews of labor market information, state and national websites, and industry and scholarly literature

Capacity planning in Specialized Healthcare

The purpose of the thesis is to contribute to the knowledge of healthcare capacity planning for effective use of resources. Capacity planning concerns the balancing of the demand for capacity with the available capacity of the production system. Within the healthcare setting, various studies report on the difficulties of providing healthcare services according to patient demand. So, how can the balance between required and available capacity be achieved? How can we use our resources in accordance with what the patients need?The research presented in this thesis is based on five research questions which are answered by the results of five case studies made at Swedish hospital departments. The research questions concern how discrepancies between practice and capacity planning theory may affect production performance; what a tactical capacity planning framework in healthcare would comprise; on what conditions rough-cut capacity methods (RCCP) are applicable in healthcare; the importance of including the knowledge of the surgeons when estimating required capacity; and if a team-based workflow can be employed without compromising production performance. The five research questions are answered through five individual studies, all with a case study approach. The findings presented in this thesis provide knowledge regarding the structure of capacity planning processes; more specifically regarding the linkages between capacity planning processes and their effects on production performance. Furthermore, the research provides a step-by-step framework for tactical capacity planning to improve production performance by keeping a long-term perspective when planning. The tactical framework describes the structure of the capacity planning process and its included activities. Additionally, the framework gives an account of required information for the planning process and proposes possible adjustment to balance demand and supply. The output of the planning process is also described. To support the task of balancing required and available capacity two studies contribute to the interpretation of patient demand into required capacity. First, conditions under which rough-cut capacity planning methods are applicable in a healthcare setting are studied and discussed. Second, the research extends existing knowledge of the estimation of required surgery time, based on surgeons’ subjective knowledge of the patient condition and thereby decreasing the risk of exceeding the scheduled surgery time. As concerns assessing available capacity, the research studies the use of a team-based work method, which shows an increase of productivity compared with a functionally divided production system, while maintaining the same level of resources. In a capacity planning perspective, the use of teams simplifies the assessment of available capacity by reducing the number of planning points from individual workers to the number of teams

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

Suitability and managerial implications of a Master Surgical Scheduling approach

Abstract: Operating room (OR) planning and scheduling is a popular and challenging subject within the operational research applied to health services research (ORAHS). However, the impact in practice is very limited. The organization and culture of a hospital and the inherent characteristics of its processes impose specific implementation issues that affect the success of planning approaches. Current tactical OR planning approaches often fail to account for these issues.Master surgical scheduling (MSS) is a promising approach for hospitals to optimize resource utilization and patient flows. We discuss the pros and cons of MSS and compare MSS with centralized and decentralized planning approaches. Finally, we address various implementation issues of MSS and discuss its suitability for hospitals with different organizational foci and culture