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;

Understanding facilitators and barriers to contraception screening and referral in young women with cancer

BACKGROUND: Young women with cancer often worry about impaired fertility after treatment but can experience devastating consequences from an unplanned pregnancy during treatment. Contraception screening and referral appear to occur infrequently in cancer care. OBJECTIVES: We sought to understand oncologic providers’ current practices, perceptions of facilitators and barriers to screening for adequate contraception during cancer treatment, and to understand patient perspectives on these processes. METHODS: We interviewed 19 oncologic providers and 20 female reproductive-aged oncology patients stable on treatment or who had completed therapy within the last 24 months. We recruited participants from an urban, northeast medical center where they worked or received oncologic care. Semi-structured interview questions examined components of the Promoting Action on Research Implementation in Health Services (PARiHS) framework, and subsequent constant comparative analysis identified similar themes. FINDINGS: Providers vary significantly in their current contraception screening practices with many focusing on diagnosing pregnancy rather than prevention. Providers identified many institutional and organizational barriers, including lack of education and lack of clear provider responsibility. Providers also identified resources and supports that would assist with contraception screening and referral, including education and enhanced interdisciplinary collaboration with gynecologic providers. Patients infrequently recalled contraception conversations with oncology providers and expressed challenges determining the most appropriate provider with whom to discuss contraception. CONCLUSION: Cancer centers should address barriers to contraception screening and referral locally in future implementation of contraception screening and referral. National organizations should work to develop guidelines to inform and support this process in clinical practice.2019-10-23T00:00:00

Flexible runtime support of business processes under rolling planning horizons

This work has been motivated by the needs we discovered when analyzing real-world processes from the healthcare domain that have revealed high flexibility demands and complex temporal constraints. When trying to model these processes with existing languages, we learned that none of the latter was able to fully address these needs. This motivated us to design TConDec-R, a declarative process modeling language enabling the specification of complex temporal constraints. Enacting business processes based on declarative process models, however, introduces a high complexity due to the required optimization of objective functions, the handling of various temporal constraints, the concurrent execution of multiple process instances, the management of crossinstance constraints, and complex resource allocations. Consequently, advanced user support through optimized schedules is required when executing the instances of such models. In previous work, we suggested a method for generating an optimized enactment plan for a given set of process instances created from a TConDec-R model. However, this approach was not applicable to scenarios with uncertain demands in which the enactment of newly created process instances starts continuously over time, as in the considered healthcare scenarios. Here, the process instances to be planned within a specific timeframe cannot be considered in isolation from the ones planned for future timeframes. To be able to support such scenarios, this article significantly extends our previous work by generating optimized enactment plans under a rolling planning horizon. We evaluate the approach by applying it to a particularly challenging healthcare process scenario, i.e., the diagnostic procedures required for treating patients with ovarian carcinoma in a Woman Hospital. The application of the approach to this sophisticated scenario allows avoiding constraint violations and effectively managing shared resources, which contributes to reduce the length of patient stays in the hospital.Ministerio de Economía y Competitividad TIN2016-76956-C3-2-RMinisterio de Ciencia e Innovación PID2019-105455 GB-C3

Softer perspectives on enhancing the patient experience using IS/IT

Purpose – This paper aims to argue that the implementation of the Choose and Book system has failed due to the inability of project sponsors to appreciate the complex and far-reaching softer implications of the implementation, especially in a complex organisation such as the NHS, which has multifarious stakeholders. Design/methodology/approach – The authors use practice-oriented research to try and isolate key parameters. These parameters are compared with existing conventional thinking in a number of focused areas. Findings – Like many previous NHS initiatives, the focus of this system is in its obvious link to patients. However we find that although this project has cultural, social and organisational implications, programme managers and champions of the Connecting for Health programme emphasised the technical domains to IS/IT adoption. Research limitations/implications – This paper has been written in advance of a fully implemented Choose and Book system. Practical implications – The paper requests that more attention be paid to the softer side of IS/IT delivery, implementation, introduction and adoption. Originality/value – The paper shows that patient experience within the UK healthcare sector is still well below what is desired