Redesigning the Barranquilla's public emergency care network to improve the patient waiting time

Tesis por compendio[ES] La oportunidad en la atención es uno de los críticos de mayor relevancia en la satisfacción de los pacientes que acuden a los servicios de Urgencias. Por tal motivo, las instituciones prestadoras de servicio y las organizaciones gubernamentales deben propender conjuntamente por una atención cada vez más oportuna a costos operacionales razonables. En el caso de la Red Pública en Servicios de Urgencias de Barrannquilla, compuesta por 8 puntos de atención y 2 hospitales, la tendencia marca un continuo crecimiento de la oportunidad en la atención con una tasa de 3,08 minutos/semestre y una probabilidad del 93,13% de atender a los pacientes después de una espera mayor a 30 minutos. Lo anterior se constituye en un síntoma inequívoco de la incapacidad de la Red para satisfacer los estándares de oportunidad establecidos por el Ministerio de Salud, hecho que podría desencadenar el desarrollo de sintomatologías de mayor complejidad, el incremento de la probabilidad de mortalidad, el requerimiento de servicios clínicos más complejos (hospitalización y cuidados intensivos) y el aumento de los costos asociados al servicio. En consecuencia, la presente tesis doctoral presenta el rediseño de la Red Pública en Servicios de Urgencias anteriormente mencionada a fin de otorgar a la población diana un servicio eficiente y altamente oportuno donde tanto las instituciones prestadoras del servicio como los organismos gubernamentales converjan efectivamente. Para ello, fue necesaria la ejecución de 4 grandes fases a través de las cuales se consolidó una propuesta orientada al desarrollo efectivo y sostenible de las operaciones de la Red. Primero, se caracterizó la Red Pública de Servicios de Urgencias en Salud considerando su comportamiento actual en términos de demanda y oportunidad de la atención. Luego, a través de una revisión sistemática de la literatura, se identificaron los enfoques metodológicos que se han implementado para la mejora de la oportunidad y otros indicadores de rendimiento asociados al servicio de Urgencias. Posteriormente, se diseñó una metodología para la creación de redes de Urgencias eficientes y sostenibles la cual luego se validó en la Red Pública sudamericana a fin de disminuir la oportunidad de atención promedio en Urgencias y garantizar la distribución equitativa de los beneficios financieros derivados de la colaboración. Finalmente, se construyó un modelo multicriterio que permitió evaluar el rendimiento de los departamentos de Urgencia e impulsó la creación de estrategias de mejora focalizadas en incrementar su respuesta ante la demanda cambiante, los críticos de satisfacción y las condiciones de operación estipuladas en la ley. Los resultados de esta aplicación evidenciaron que los pacientes que acceden a la Red tienden a esperar en promedio 201,6 min con desviación de estándar de 81,6 min antes de ser atendidos por urgencia. Por otro lado, de acuerdo con la revisión de literatura, la combinación de técnicas de investigación de operaciones, ingeniería de la calidad y analítica de datos es ampliamente recomendada para abordar este problema. En ese sentido, una metodología basada en modelos colaterales de pago, simulación de procesos y lean seis sigma fue propuesta y validada generando un rediseño de Red cuya oportunidad de atención promedio podría disminuir entre 6,71 min y 9,08 min con beneficios financieros promedio de US$29,980/nodo. En último lugar, un modelo compuesto por 8 criterios y 35 sub-criterios fue diseñado para evaluar el rendimiento general de los departamentos de Urgencias. Los resultados del modelo evidenciaron el rol crítico de la infraestructura (Peso global = 21,5i garantir la distribució equitativa dels beneficis financers derivats de la col´laboració. Finalment, es va construir un model multicriteri que va permetre avaluar el rendiment dels departaments d'Urgència i va impulsar la creació d'estratègies de millora focalitzades en incrementar la seva resposta davant la demanda canviant, els crítics de satisfacció i les condicions d'operació estipulades en la llei. Els resultats d'aquesta aplicació van evidenciar que els pacients que accedeixen a la Xarxa tendeixen a esperar de mitjana 201,6 min amb desviació d'estàndard de 81,6 min abans de ser atesos per urgència. D'altra banda, d'acord amb la revisió de literatura, la combinació de tècniques d'investigació d'operacions, enginyeria de la qualitat i analítica de dades és àmpliament recomanada per abordar aquest problema. En aquest sentit, una metodologia basada en models col´laterals de pagament, simulació de processos i llegeixin 6 sigma va ser proposada i validada generant un redisseny de Xarxa la oportunitat d'atenció mitjana podria disminuir entre 6,71 min i 9,08 min amb beneficis financers mitjana d'US$ 29,980 / node. En darrer lloc, un model compost per 8 criteris i 35 sub-criteris va ser dissenyat per avaluar el rendiment general dels departaments d'Urgències. Els resultats de el model evidenciar el paper crític de la infraestructura (Pes global = 21,5%) en el rendiment dels departaments d'Urgència i la naturalesa interactiva de la Seguretat de l'Pacient (C + R = 12,771).[EN] Waiting time is one of the most critical measures in the satisfaction of patients admitted within emergency departments. Therefore, hospitals and governmental organizations should jointly aim to provide timely attention at reasonable costs. In the case of Barranquilla's Pubic Emergency Service Network, composed by 8 Points of care (POCs) and 2 hospitals, the trend evidences a continuous growing of the waiting time with a rate of 3,08 min/semester and a 93,13% likelihood of serving patients after waiting for more than 30 minutes. This is an unmistakable symptom of the network inability for satisfying the standards established by the Ministry of Health, which may trigger the development of more complex symptoms, increase in the death rate, requirement for more complex clinical services (hospitalization and intensive care unit) and increased service costs. This doctoral dissertation then illustrates the redesign of the aforementioned Public Emergency Service Network aiming at providing the target population with an efficient and highly timely service where both hospitals and governmental institutions effectively converge. It was then necessary to implement a 4-phase methodology consolidating a proposal oriented to the effective and sustainable development of network operations. First, the Public Emergency Service Network was characterized considering its current behavior in terms of demand and waiting time. A systematic literature review was then undertaken for identifying the methodological approaches that have been implementing for improving the waiting time and other performance indicators associated with the emergency care service. Following this, a methodology for the creation of efficient and sustainable emergency care networks was designed and later validated in the Southamerican Public network for lessening the average waiting time and ensuring the equitable distribution of profits derived from the collaboration. Ultimately, a multicriteria decision-making model was created for assessing the performance of the emergency departments and propelling the design of improvement strategies focused on bettering the response against the changing demand conditions, critical to satisfaction and operational conditions. The results evidenced that the patients accessing to the network tend to wait 201,6 min on average with a standard deviation of 81,6 min before being served by the emergency care unit. On the other hand, based on the reported literature, it is highly suggested to combine Operations Research (OR) methods, quality-based techniques, and data-driven approaches for addressing this problem. In this sense, a methodology based on collateral payment models, Discrete-event simulation, and Lean Six Sigma was proposed and validated resulting in a redesigned network whose average waiting time may diminish between 6,71 min and 9,08 min with an average profit US$29,980/node. Lately, a model comprising of 8 criteria and 35 sub-criteria was designed for evaluating the overall performance of emergency departments. The model outcomes revealed the critical role of Infrastructure (Global weight = 21,5%) in ED performance and the interactive nature of Patient Safety (C + R = 12,771).Ortíz Barrios, MÁ. (2020). Redesigning the Barranquilla's public emergency care network to improve the patient waiting time [Tesis doctoral]. Universitat Politècnica de València. https://doi.org/10.4995/Thesis/10251/156215TESISCompendi

Modelling the Shift in the Balance of Care in the NHS

The concept of Shifting the Balance of Care was first introduced to NHS Scotland in 2005 through the Kerr Report. The key messages from the report were to: ensure sustainable and safe local services, which are supported by the right skills, change the emphasis of care into the community, provide preventative reactive care, and fully integrate the system to tackle the changes, use technology more effectively, and involve the public in finding solutions to change. Following the report, a framework was developed which highlighted and prioritised eight areas of improvement. These areas for improvement are the focus by which this research examines if Operational Research (OR), specifically OR models, can have a positive impact in Shifting the Balance of Care. The research utilises underlying OR methodologies and methods and provides evidence from the literature of the ability of nine selected models to facilitate the Shift in the Balance of Care. A contributing factor to the research is the barriers to implementation of OR models into the NHS. With reference to the literature, the common barriers to implementation of OR models are categorised and used to provide direction to modellers where implementation barriers are more prevalent in some models than in others. The research also provides empirical evidence of three selected models’ (the Lean Methodology, Process Mapping and Simulation, developed over two Case Studies) ability to address and influence the prioritised Improvement Areas, with the addition of a newly developed model: SoApt. The development of SoApt follows the Principles of Model Development derived as a guide to modellers who wish to develop a new model. SoApt is also empirically explored in a Case Study and provides some evidence of the models ability to aid Decision-makers, faced with limited budgets, to choose between options which will Shift the Balance of Care. OR methods and methodologies are examined to ascertain the Roles of Models for each model explored in the Case Studies. Examination of the Roles of Models against the Improvement Areas provided evidence of a models’ ability to address more than one of the priority areas and that models can be used together or sequentially. In addition, with reference to OR methods and methodologies, a theoretical Evaluation Framework is proposed which suggests the User and User Satisfaction is key to the evaluation of a model’s success; positive experiences of the User and Use of the model may help to eliminate some of the barriers to implementation

Dynamic Analysis of Healthcare Service Delivery: Application of Lean and Agile Concepts

Hospitals are looking to industry for proven tools to manage increasingly complex operations and reduce costs simultaneously with improving quality of care. Currently, €˜lean€™ is the preferred system redesign paradigm, which focuses on removing process waste and variation. However, the high level of complexity and uncertainty inherent to healthcare make it incredibly challenging to remove variability and achieve the stable process rates necessary for lean redesign efforts to be effective. This research explores the use of an alternative redesign paradigm €“ €˜agile€™ €“ which was developed in manufacturing to optimize product delivery in volatile demand environments with highly variable customer requirements. €˜Agile€™ redesign focuses on increasing system responsiveness to customers through improved resource coordination and flexibility. System dynamics simulation and empirical case study are used to explore the impact of following an agile redesign approach in healthcare on service access, care quality, and cost; determine the comparative effectiveness of individual agile redesign strategies; and identify opportunities where lean methods can contribute to the creation of responsive, agile enterprises by analyzing hybrid lean-agile approaches. This dissertation contributes to the emerging literature on applying supply chain management concepts in healthcare, and opens a new path for designing healthcare systems that provide the right care, at the right time, to the right patient, at the lowest price

An integrated approach for lean production using simulation and data envelopment analysis

According to the extant literature, improving the leanness of a production system boosts a company’s productivity and competitiveness. However, such an endeavor usually involves managing multiple, potentially conflicting objectives. This study proposes a framework that analyzes lean production methods using simulation and data envelopment analysis (DEA) to accommodate the underlying multi-objective decision-making problem. The proposed framework can help identify the most efficient solution alternative by (i) considering the most common lean production methods for assembly line balancing, such as single minute exchange of dies (SMED) and multi-machine set-up reduction (MMSUR), (ii) creating and simulating various alternative assembly line configuration options via discrete-event simulation modeling, and (iii) formulating and applying DEA to identify the best alternative assembly system configuration for the multi-objective decision making. In this study, we demonstrate the viability and superiority of the proposed framework with an application case on an automotive spare parts production system. The results show that the suggested framework substantially improves the existing system by increasing efficiency while concurrently decreasing work-in-process (WIP).Q10006980682000012-s2.0-8511520297

The Impact of Work Environment on Successful Implementation of Lean Six Sigma in Emergency Department

Continuous improvement (CI) is an initiative to improve the performance of processes in alignment with the customer needs and organizational strategy. Lean Six Sigma (LSS) is one of the most successful CI techniques in redesigning and improving significant processes to improve quality and eliminate waste. The healthcare sector has benefited from applying LSS due to its complicated work practices that face many challenges including increased expenditures and difficulties related to individual or community access to appropriate care. In particular, Emergency Departments (ED) have an important unit within healthcare organizations due to their essential role in providing urgent medical care services to patients. The aim of this doctoral research study is to develop a theoretical model using grounded theory to investigate the factors for successful LSS implementation in ED including how ED work environment affects the reduction of patient length of stay, which is one of the biggest issues that ED face. Therefore, the main objectives of this research are to: (1) investigate trends in the research area using systematic literature review, (2) develop an Initial Conceptual Framework including identifying the relationships between the variables of LSS implementation, (3) use an expert study where a group of experts will provide additional evidence regarding LSS implementation, and (4) test the model using survey questionnaire that examines the behavior of the variables. This research will be documented as a manuscript-style dissertation including four peer-reviewed academic journal articles each summarizing the results from a phase of this research. The results of this research will provide a conceptual model to guide the implementation of LSS in ED bringing the potential benefits of this approach to a critical department in healthcare organizations. Further, this research will inform future research by investigating the work environment effects on application of LSS

Modelling based framework for the management of emergency departments.

In the twenty-first century, the healthcare industry faces ever-changing economic, social, political and technology challenges. Costs are rising, funding is diminishing, human and fiscal resources are becoming scarcer, customer-expectations are rising, the complexity of disease is increasing and technology is becoming more complex. These trends have a massive impact on every aspect of hospital operations and the Emergency Department is no exception. Overcrowding in the Emergency Department (ED) in hospitals has become a growing problem in many developed countries around the world. ED overcrowding has a direct effect on patient-care, including compromised patient-safety, increased length-of-stay, increased mortality and morbidity-rates and increased costs. Healthcare policy-makers and hospital and ED administrators are being forced to search for ways to improve the capacity of EDs by better utilisation of existing resources and creating more efficient systems to overcome this problem.Throughout the past few decades, there has been an increasing trend of using numerous systems-analysis tools and techniques which have come from manufacturing and other service industries to address the various issues in healthcare and EDs. Among those tools Discrete-Event Simulation (DES) is a powerful tool to improve the efficiency and capacity in dynamic and complex systems. Use of these tools to address the overcrowding problem in EDs has been patchy; specific aspects of issues have been studied but no attempt has been made to deploy DES or any other systems-analysis tool in a strategic and holistic manner.The aim of this research is to develop a modelling-based framework to manage the overcrowding problem in EDs. The research identified the causes of overcrowding in EDs and developed a decisions-framework with the long-term, medium-term and short-tem decisions in EDs that related to the overcrowding problem. Finally, it identified the best possible systems-analysis tools to support those decisions to overcome the overcrowding problem in EDs. This research could help the healthcare policy-makers, managers, systems-engineers as well as the researchers and consultants who are interesting in the Emergency Department operational management

Book of abstracts of the ICIEOM-CIO-IIIE International Conference 2015

BOOK OF ABSTRACTS OF THE ICIEOM-CIO-IIIE INTERNATIONAL CONFERENCE 2015: ENGINEERING SYSTEMS AND NETWORKS: The way ahead for industrial engineering and operations managemen

An Integrated Retail Supply Chain Risk Management Framework: A System Thinking Approach

It is often taken for granted that the right products will be available to buy in retail outlets seven days a week, 52 weeks a year. Consumer perception is that of a simple service requirement, but the reality is a complex, time sensitive system - the retail supply chain (RSC). Due to short product life-cycles with uncertain supply and demand behaviour, the RSC faces many challenges and is very vulnerable to disruptions. In addition, external risk events such as BREXIT, extreme weather, the financial crisis, and terror attacks mean there is a need for effective RSC risk management (RSCRM) processes within organisations. Literature shows that although there is an increasing amount of research in RSCRM, it is highly theoretical with limited empirical evidence or applied methodologies. With an active enthusiasm coming from industry practitioners for RSCRM methodologies and support solutions, the RSCRM research community have acknowledged that the main issue for future research is not tools and techniques, but collaborative RSC system wide implementation. The implementation of a cross-organisational initiative such as RSCRM is a very complex task that requires real-world frameworks for real-world practitioners. Therefore, this research study attempts to explore the business requirements for developing a three-stage integrated RSCRM framework that will encourage extended RSC collaboration. While focusing on the practitioner requirements of RSCRM projects and inspired by the laws of Thermodynamics and the philosophy of System Thinking, in stage one a conceptual reference model, The �6 Coefficient, was developed building on the formative work of supply chain excellence and business process management. The �6 Coefficient reference model has been intricately designed to bridge the theoretical gap between practitioner and researcher with the aim of ensuring practitioner confidence in partaking in a complex business process project. Stage two focused on a need for a standardised vocabulary, and through the SCOR11 reference guide, acts as a calibration point for the integrated framework, ensuring easy transfer and application within supply chain industries. In their design, stages one and two are perfect complements to the final stage of the integrated framework, a risk assessment toolbox based on a Hybrid Simulation Study capable of monitoring the disruptive behaviour of a multi-echelon RSC from both a macro and micro level using the techniques of System Dynamics (SD) and Discrete Event Simulation (DES) modelling respectively. Empirically validated through an embedded mixed methods case study, results of the integrated framework application are very encouraging. The first phase, the secondary exploratory study, gained valuable empirical evidence of the barriers to successfully implementing a complex business project and also validated using simulation as an effective risk assessment tool. Results showed certain high-risk order policy decisions could potentially reduce total costs (TC) by over 55% and reduce delivery times by 3 days. The use of the �6 Coefficient as the communication/consultation phase of the primary RSCRM case study was hugely influential on the success of the overall hybrid simulation study development and application, with significant increase in both practitioner and researcher confidence in running an RSCRM project. This was evident in the results of the hybrid model’s macro and micro assessment of the RSC. SD results effectively monitored the behaviour of the RSC under important disruptive risks, showing delayed effects to promotions and knowledge loss resulted in a bullwhip effect pattern upstream with the FMCG manufacturer’s TC increasing by as much as €50m. The DES analysis, focusing on the NDC function of the RSC also showed results of TC sensitivity to order behaviour from retailers, although an optimisation based risk treatment has reduced TC by 30%. Future research includes a global empirical validation of the �6 Coefficient and enhancement of the application of thermodynamic laws in business process management. The industry calibration capabilities of the integrated framework application of the integrated framework will also be extensively tested