Healthcare Logistics: the art of balance

Healthcare management is a very complex and demanding business. The pro - cesses involved – operational, tactical and strategic – are extremely divers, sophisticated, and we see medical-technological advancements following on each other’s heels at breathtaking speed. And then there is the constant great pressure exerted from many sides: ever-increasing needs and demands from patients and society, thinking about organizations, growing competition, necessity to incorporate these rapidly succeeding medical-technological advancements into the organization, strict cost containment, growing demand for healthcare, and a constant tightening of budgets. These developments force healthcare managers in the individual organizations to find a balance between said developments, the feasibilities of organization in question, and the desired healthcare outcomes in an ever-changing world. The search for individual organizational balances requires that the world of professional competencies, i.e. the clinicians, and the world of healthcare managers should speak the same language when weighing the various developments and translating the outcomes into organizational choices. For the clinicians to make the right choices they must be facilitated to appraise the effects of their choices on organizational outcomes. Likewise, the healthcare managers’ decision- making process should include the effects on the medical policies pursued by the individual clinicians in the own organization. This thesis places a focus on developing methods for allocation of hospital resources within a framework that enables clinicians and healthcare managers to balance the developments on the various levels, thus providing a basis for policymaking

An Integrated Framework for Staffing and Shift Scheduling in Hospitals

Over the years, one of the main concerns confronting hospital management is optimising the staffing and scheduling decisions. Consequences of inappropriate staffing can adversely impact on hospital performance, patient experience and staff satisfaction alike. A comprehensive review of literature (more than 1300 journal articles) is presented in a new taxonomy of three dimensions; problem contextualisation, solution approach, evaluation perspective and uncertainty. Utilising Operations Research methods, solutions can provide a positive contribution in underpinning staffing and scheduling decisions. However, there are still opportunities to integrate decision levels; incorporate practitioners view in solution architectures; consider staff behaviour impact, and offer comprehensive applied frameworks. Practitioners’ perspectives have been collated using an extensive exploratory study in Irish hospitals. A preliminary questionnaire has indicated the need of effective staffing and scheduling decisions before semi-structured interviews have taken place with twenty-five managers (fourteen Directors and eleven head nurses) across eleven major acute Irish hospitals (about 50% of healthcare service deliverers). Thematic analysis has produced five key themes; demand for care, staffing and scheduling issues, organisational aspects, management concern, and technology-enabled. In addition to other factors that can contribute to the problem such as coordination, environment complexity, understaffing, variability and lack of decision support. A multi-method approach including data analytics, modelling and simulation, machine learning, and optimisation has been employed in order to deliver adequate staffing and shift scheduling framework. A comprehensive portfolio of critical factors regarding patients, staff and hospitals are included in the decision. The framework was piloted in the Emergency Department of one of the leading and busiest university hospitals in Dublin (Tallaght Hospital). Solutions resulted from the framework (i.e. new shifts, staff workload balance, increased demands) have showed significant improvement in all key performance measures (e.g. patient waiting time, staff utilisation). Management team of the hospital endorsed the solution framework and are currently discussing enablers to implement the recommendation

Operational Research: Methods and Applications

Throughout its history, Operational Research has evolved to include a variety of methods, models and algorithms that have been applied to a diverse and wide range of contexts. This encyclopedic article consists of two main sections: methods and applications. The first aims to summarise the up-to-date knowledge and provide an overview of the state-of-the-art methods and key developments in the various subdomains of the field. The second offers a wide-ranging list of areas where Operational Research has been applied. The article is meant to be read in a nonlinear fashion. It should be used as a point of reference or first-port-of-call for a diverse pool of readers: academics, researchers, students, and practitioners. The entries within the methods and applications sections are presented in alphabetical order. The authors dedicate this paper to the 2023 Turkey/Syria earthquake victims. We sincerely hope that advances in OR will play a role towards minimising the pain and suffering caused by this and future catastrophes

Operational Research: Methods and Applications

Throughout its history, Operational Research has evolved to include a variety of methods, models and algorithms that have been applied to a diverse and wide range of contexts. This encyclopedic article consists of two main sections: methods and applications. The first aims to summarise the up-to-date knowledge and provide an overview of the state-of-the-art methods and key developments in the various subdomains of the field. The second offers a wide-ranging list of areas where Operational Research has been applied. The article is meant to be read in a nonlinear fashion. It should be used as a point of reference or first-port-of-call for a diverse pool of readers: academics, researchers, students, and practitioners. The entries within the methods and applications sections are presented in alphabetical order

Markovian-based clustering of internet addiction trajectories

A hidden Markov clustering procedure is applied to a sample of n=185 longitudinal Internet Addiction Test trajectories collected in Switzerland. The best solution has 4 groups. This solution is related to the level of emotional wellbeing of the subjects, but no relation is observed with age, gender and BMI

A discussion on hidden Markov models for life course data

This is an introduction on discrete-time Hidden Markov models (HMM) for longitudinal data analysis in population and life course studies. In the Markovian perspective, life trajectories are considered as the result of a stochastic process in which the probability of occurrence of a particular state or event depends on the sequence of states observed so far. Markovian models are used to analyze the transition process between successive states. Starting from the traditional formulation of a first-order discrete-time Markov chain where each state is liked to the next one, we present the hidden Markov models where the current response is driven by a latent variable that follows a Markov process. The paper presents also a simple way of handling categorical covariates to capture the effect of external factors on the transition probabilities and existing software are briefly overviewed. Empirical illustrations using data on self reported health demonstrate the relevance of the different extensions for life course analysis

Using dynamic microsimulation to understand professional trajectories of the active Swiss population

Within the social and economic sciences and of particular interest to demographers are life course events. Looking at life sequences we can better understand which states, or life events, precede or are precursors to vulnerability. A tool that has been used for policy evaluation and recently has been gaining ground in life course sequence simulation is dynamic microsimulation. Within this context dynamic microsimulation consists in generating entire life courses from the observation of portions of the trajectories of individuals of different ages. In this work, we aim to use dynamic microsimulation in order to analyse individual professional trajectories with a focus on vulnerability. The primary goal of this analysis is to deepen upon current literature by providing insight from a longitudinal perspective on the signs of work instability and the process of precarity. The secondary goal of this work which is to show how, by using microsimulation, data collected for one purpose can be analysed under a different scope and used in a meaningful way. The data to be used in this analysis are longitudinal and were collected by NCCR-LIVES IP207 under the supervision of Prof. Christian Maggiori and Dr. Gregoire Bollmann. Individuals aged 25 to 55 residing in the German-speaking and French-speaking regions of Switzerland were followed annually for four years. These individuals were questioned regarding, amongst their personal, professional and overall situations and well-being. At the end of the fourth wave, there were 1131 individuals who had participated in all waves. The sample remained representative of the Swiss population with women and the unemployed slightly over represented. Using the information collected from these surveys, we use simulation to construct various longitudinal data modules where each data module represents a specific life domain. We postulate the relationship between these modules and layout a framework of estimation. Within certain data modules a set of equations are created to model the process therein. For every dynamic (time-variant) data module, such as the labour-market module, the transition probabilities between states (ex. labour market status) are estimated using a Markov model and then the possible outcomes are simulated. The benefit of using dynamic microsimulation is that longitudinal sample observations instead of stylised profiles are used to model population dynamics. This is one of the main reasons large-scale dynamic microsimulation models are employed by many developed nations. There has been limited use, however, of such approaches with Swiss data. This work contributes to the analysis of professional trajectories of the active Swiss population by utilising dynamic microsimulation methods

Models of consumer shopping behaviour in urban areas

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