Modelling the Home Health Care Nurse Scheduling Problem for Patients with Long-Term Conditions in the UK

In this work, using a Behavioural Operational Research (BOR) perspective, we develop a model for the Home Health Care Nurse Scheduling Problem (HHCNSP) with application to renal patients taking Peritoneal Dialysis (PD) at their own homes as treatment for their Chronic Kidney Disease (CKD) in the UK. The modelling framework presented in this paper can be extended to much wider spectra of scheduling problems concerning patients with different long-term conditions in future work

Evaluating Performance in the Tuscan Health Care System.

The Tuscan health care system strives to foster cooperation among the various organizations that provide services. Government authorities therefore believe it is important to plan and develop a transparent system capable of monitoring the economic results of the region’s 16 public health authorities and their ability to pursue and accomplish the aims of the regional health care plan. The principal aim of the Tuscan performance evaluation system is to give a general outline of the management of the region’s health care authorities. This outline is intended to be useful both for evaluating performance and for enhancing and promoting the results of the healthcare system.Performance evaluation system, benchmarking in healthcare.

Unpicking the Gordian knot: a systems approach to traumatic brain injury care in low-income and middle-income countries.

The Global Burden of Diseases, Injuries, and Risk Factors Study showed that in 2010 trauma accounted for 9% of the world's deaths - around 5 million people - while also resulting in millions of non-fatal injuries with resultant disability. Around 90% of injury-related deaths occurred in low and middle income countries (LMICs) which also saw the greatest rise in these injuries due to road traffic collisions.1 More recent Global Health Estimates from the World Health Organisation for 2015 show a similar picture.2 As a disease subtype, Traumatic Brain Injury (TBI) is one of the most devastating, with clinical, societal, and economic sequelae.3 It is also startlingly common with an estimated 50 million or more cases per year; enough for half of the world's population to suffer a TBI in their lifetime and again disproportionately affecting lower-income regions.

Capacity of English NHS hospitals to monitor quality in infection prevention and control using a new European framework: a multilevel qualitative analysis

Objective:(1) To assess the extent to which current English national regulations/policies/guidelines and local hospital practices align with indicators suggested by a European review of effective strategies for infection prevention and control (IPC); (2) to examine the capacity of local hospitals to report on the indicators and current use of data to inform IPC management and practice. Design A national and local-level analysis of the 27 indicators was conducted. At the national level, documentary review of regulations/policies/guidelines was conducted. At the local level data collection comprised: (a) review of documentary sources from 14 hospitals, to determine the capacity to report performance against these indicators; (b) qualitative interviews with 3 senior managers from 5 hospitals and direct observation of hospital wards to find out if these indicators are used to improve IPC management and practice. Setting 2 acute English National Health Service (NHS) trusts and 1 NHS foundation trust (14 hospitals). Participants 3 senior managers from 5 hospitals for qualitative interviews. Primary and secondary outcome measures As primary outcome measures, a ‘Red-Amber-Green’ (RAG) rating was developed reflecting how well the indicators were included in national documents or their availability at the local organisational level. The current use of the indicators to inform IPC management and practice was also assessed. The main secondary outcome measure is any inconsistency between national and local RAG rating results. Results National regulations/policies/guidelines largely cover the suggested European indicators. The ability of individual hospitals to report some of the indicators at ward level varies across staff groups, which may mask required improvements. A reactive use of staffing-related indicators was observed rather than the suggested prospective strategic approach for IPC management. Conclusions For effective patient safety and infection prevention in English hospitals, routine and proactive approaches need to be developed. Our approach to evaluation can be extended to other country settings

Developing a multi-methodological approach to hospital operating theatre scheduling

Operating theatres and surgeons are among the most expensive resources in any hospital, so it is vital that they are used efficiently. Due to the complexity of the challenges involved in theatre scheduling we split the problem into levels and address the tactical and day-to-day scheduling problems.Cognitive mapping is used to identify the important factors to consider in theatre scheduling and their interactions. This allows development and testing of our understanding with hospital staff, ensuring that the aspects of theatre scheduling they consider important are included in the quantitative modelling.At the tactical level, our model assists hospitals in creating new theatre timetables, which take account of reducing the maximum number of beds required, surgeons’ preferences, surgeons’ availability, variations in types of theatre and their suitability for different types of surgery, limited equipment availability and varying the length of the cycle over which the timetable is repeated. The weightings given to each of these factors can be varied allowing exploration of possible timetables.At the day-to-day scheduling level we focus on the advanced booking of individual patients for surgery. Using simulation a range of algorithms for booking patients are explored, with the algorithms derived from a mixture of scheduling literature and ideas from hospital staff. The most significant result is that more efficient schedules can be achieved by delaying scheduling as close to the time of surgery as possible, however, this must be balanced with the need to give patients adequate warning to make arrangements to attend hospital for their surgery.The different stages of this project present different challenges and constraints, therefore requiring different methodologies. As a whole this thesis demonstrates that a range of methodologies can be applied to different stages of a problem to develop better solutions

User-led Innovation in the UK National Health Service

Healthcare services are delivered to patients using complex technology systems. Many innovative healthcare technologies are produced by industrial suppliers; however, healthcare staff are also active innovators of the technologies that they use in their own work. By assuming the role of user-innovators, they can create new technologies, procedures, processes and service-designs that improve and support healthcare provision. The focus of the research reported in this thesis is the phenomenon of user-led innovation of healthcare technology in the UK National Health Service (NHS). Exploratory research was carried out to develop a detailed understanding of user-led innovation within the NHS based on the perspectives of user-innovators. This thesis presents the results of the research in the form of four interpretive case studies, that contribute to an understanding of the enabling and inhibiting factors affecting user-led innovation. Each case presents an overview of the process of user-led innovation which was followed and the context in which it occurred. Several distinctive characteristics of user-led innovation are identified and a generic activity model of the user-led innovation process is described. Evaluation in user-led innovation processes is highlighted to have multiple purposes,beyond objective technology assessment. It is shown to support the on-going social-construction of user-developed technologies but also highlights the role of evaluation as a resource for exercising political influence within the innovation process. User led innovation is established as a theoretically useful and coherently defined mode of innovation, distinct from the lead user or open innovation paradigms. The major contribution of the thesis is an integrated model of healthcare technology systems that emphasises the role of protoinstitutions as critical products of user-led innovation. The thesis concludes that in order to maximise the benefit of user-led innovation in the NHS, innovation policy and practice should be broadened to recognise the role of proto-institutions as a valuable product of user-led innovation

Lean thinking in healthcare services: learning from case studies

JEL: D22, I12Healthcare organisations, especially in public sector, have been adopting Lean management practices with increasing outcomes’ evidences in several parts of the world, since the beginning of this century. However, Lean deployment in Healthcare services has been addressed in the literature in a surgical way by an array of case reports addressing the “hard” side of Lean deployment, sometimes with no result’s consistency or even follow-up analysis. This thesis seek to add to the operational side of Lean deployment in Healthcare, a complementary understanding of Lean deployment approaches, addressing both “hard” and “soft” sides, identifying the real constraints of Lean in Healthcare sector and the sustainability factors. Supported by two main literature reviews and a multi-case approach, a deep research on the eligible Portuguese cases was conducted answering the questions: (i) What are the different outcomes from Lean deployment in Healthcare?; (ii) What are the barriers to Lean implementation in Healthcare?; (iii) What enables Lean implementation in Healthcare?; (iv) What are the risks of Lean in Healthcare?; (v) How to measure Lean achievements in Healthcare services?; and (vi) How to develop a sustainable Lean culture? This contribution to the academic debate on Lean deployment in Healthcare creates clarity on what can be called Lean practices in Healthcare settings under the light of the concept’s founders; what pattern of a Lean deployment journey was followed by Healthcare organisations; and how different cultural (organisational and national) contexts can influence the pace in pursuing that pattern.As organizações de saúde, nomeadamente públicas, têm vindo a adoptar práticas de gestão Lean com crescente evidência de resultados em várias partes do mundo, desde o início deste século. Contudo, a aplicação do Lean em serviços de saúde tem tido um tratamento cirúrgico na literatura, recaindo apenas nos aspectos “hard” e sem grande consistência ou seguimento de resultados . Esta tese pretende acrescentar aos aspectos “hard” do Lean, um entendimento complementar juntando os aspectos “hard” e “soft”, identificando as restrições e factores de sustentabilidade da aplicação do Lean no sector da saúde. Tendo por base duas revisões bibliográficas primordiais e uma abordagem empírica multi-caso a partir de casos portugueses elegíveis, esta tese fornece respostas às questões: (i) Quais os diferentes resultados da aplicação do Lean na Saúde?; (ii) Quais as barreiras à aplicação do Lean na Saúde?; (iii) Quais os facilitadores da implementação do Lean na Saúde?; (iv) Quais os riscos do Lean na Saúde?; (v) Como medir a implementação do Lean na Saúde; e (vi) como desenvolver uma cultura Lean sustentável? Este contributo para o debate académico sobre a aplicação do Lean na Saúde introduz clareza sobre o que pode ou não ser chamado de práticas Lean na Saúde tendo como referência os conceitos dos fundadores; que padrão de implementação é seguido pelas organizações; e de que forma diferentes contextos culturais (nacionais e organizacionais) influenciam o ritmo desse padrão de implementação

Strategic asset management for improved healthcare infrastructure planning in English NHS Trusts

The management of physical healthcare assets is vital for efficient delivery of healthcare services along with improving quality and productivity, amidst significant structural and funding re-organisation within the NHS. Capital allocations are under pressure and advanced strategic planning of healthcare infrastructure is required to maintain services. In doing so, the complexity of multiple interacting systems and mixed stakeholder expectations and competencies need to be addressed. The relationship between stakeholder public consultation and estates strategy development in theory and practice is poorly understood and further theoretical development is required to advance our knowledge in Strategic Asset Management (SAM). This thesis adopts an interpretivist paradigm, and an abductive approach with a case study design methodology. Data were collected from six case studies comprising 91 participants (focus groups and workshops); 6 unstructured interviews; 907 questionnaires; and observations resulting in over 30 hours of transcribed data, along with web-based document analyse (desk studies) within 149 NHS Trusts. The data were further analysed using thematic analyses. Findings reveal how localised conditions within individual healthcare Trusts influence the ways in which national initiatives are interpreted and incorporated; these impact existing ways of developing an estates strategy and in some cases, have implications on the usability of associated healthcare infrastructure spaces. This had clear implications on existing SAM practice, which were diverse, driven by individual project team competencies and associated project management practice. In practice, more focus was given to technical competencies (knowledge of SAM datasets and tools) and behavioural competencies were downplayed. Thus, the integrative Strategic Asset Management (iSAM) framework developed in this research, established a unique baseline to develop SAM plans from a complex interaction of care, estates and transport, providing a valuable resource for healthcare planning teams. Stakeholder consultation should be selective (representative sample) and the content of consultation should be appropriate at various SAM stages. Trusts should clearly indicate how their plans have been influenced, given the feedback from stakeholder consultation. Thus, moving it from a tick box exercise, to one that adds value in the decision making process. Empirical findings revealed that although literature promoted tools and methods to facilitate SAM, in practice, these were hardly used and most teams within English healthcare Trusts were not aware of best practice tools and solutions. Structuration theory was further used as a heuristic device to theoretically triangulate the empirical findings and contribute to a nuanced understanding of SAM within healthcare Trusts. In doing so, a middle range theory for integrative SAM (iSAM) was developed. It revealed that a dynamic system of individual action and organisational structure both constrained and enabled SAM. It was evident that the process of SAM is an open, emergent process of sense making rather than a pre-determined and closed process following prescriptive rules. This thesis has advanced knowledge in SAM and has raised the importance of front end project management within English healthcare Trusts. The new integrative and interdisciplinary iSAM framework facilitates the development of estates strategy and stakeholder consultation decision-making within healthcare Trusts