Classifying healthcare warehouses according to their performance. A Cluster Analysis-based approach

Purpose: The objective of this paper is to propose an approach to comparatively analyze the performance of drugs and consumable products warehouses belonging to different healthcare institutions. Design/methodology/approach: A Cluster Analysis is completed in order to classify warehouses and identify common patterns based on similar organizational characteristics. The variables taken into account are associated with inventory levels, the number of SKUs, and incoming and outgoing flows. Findings: The outcomes of the empirical analysis are confirmed by additional indicators reflecting the demand level and the associated logistics flows faced by the warehouses at issue. Also, the warehouses belonging to the same cluster show similar behaviors for all the indicators considered, meaning that the performed Cluster Analysis can be considered as coherent. Research limitations/implications: The study proposes an approach aimed at grouping healthcare warehouses based on relevant logistics aspects. Thus, it can foster the application of statistical analysis in the healthcare Supply Chain Management. The present work is associated with only one regional healthcare system. Practical implications: The approach might support healthcare agencies in comparing the performance of their warehouses more accurately. Consequently, it could facilitate comprehensive investigations of the managerial similarities and differences that could be a first step toward warehouse aggregation in homogeneous logistics units. Originality/value: This analysis puts forward an approach based on a consolidated statistical tool, to assess the logistics performances in a set of warehouses and, in turn to deepen the related understanding as well as the factors determining them

Capacity Pooling in Healthcare Systems

Healthcare systems are facing a continuously increasing demand for care while healthcare providers express a need for additional capacity. However, increased capacity in healthcare systems will not be a sufficient option in the near future, and previous research has found a need to improve healthcare capacity planning and management. Capacity planning is aggravated with the presence of variations in a system, and proactive and reactive tools for short-term flexibility in capacity management can be applied to cope with variations in both capacity and demand. One such proactive tool is a capacity pool, which is a general capacity that can be allocated to parts of the system where the temporary need for resources is unusually high. The purpose of this thesis is to develop principles and guidelines for a capacity pooling system in the healthcare sector. A theoretical framework that describes the limiting effects of aggregated variations is modern portfolio theory, first originated in the finance sector. Portfolio theory is in this thesis used to demonstrate the effects on resource utilization when capacity is organized into capacity pools. The study object is Region V\ue4stra G\uf6taland, a healthcare provider and multihospital system in Sweden. The approach of the research project has been systematic, using a mixed-methods approach with predominantly quantitative studies. An interview study, a questionnaire study and a literature review have been conducted to answer the research questions, resulting in three papers.This research project has resulted in several findings which can be useful for healthcare managers when designing and implementing capacity pools. The results include examples on how portfolio theory could be used to design capacity pools, knowledge on the use of proactive and reactive tools for short-term flexibility solutions in healthcare capacity management, and perceived barriers to a capacity pooling approach in healthcare systems. Furthermore, the findings in the three papers contribute to the existing research in several ways. For example, previous studies have requested research with a holistic approach on capacity management in healthcare systems and have highlighted the importance of researching temporary capacity changes in healthcare. The research in this thesis has through a mixed-method systematic approach focused on capacity management in a multihospital system consisting of several healthcare providers, including all types of healthcare personnel, and has provided knowledge on the use of flexibility tools for managing variations in capacity and demand

Essays on improving patient flow in hospitals

As demand for healthcare increases, hospital managers are faced with the prevalent challenge associated with patient flow and capacity management. Patient flow is the movement of patients through a healthcare facility (Hall 2013). The aim of this dissertation is to investigate how the behavior and decisions of workers and hospital managers improve these issues. Specifically, I am interested in understanding 1) hospitals' response to boarding crises, and 2) organizational approaches to improve patient flow. In Chapter 1, we examine the impact of two responses, urgent response [code yellow (CY)]: a Massachusetts mandated policy to reduce boarding crises whenever patients in the ED experience long wait times, and prevention response [pre-discharge orders (PDO)]: a health IT coordination tool to facilitate patient discharge, on patient length of stay. Using three years of inpatient level data, we find that patients with a PDO have a shorter length of stay (LOS) compared to patients without a PDO after accounting for endogeneity using an instrumental variable (IV). Conversely, using a survival analysis approach, we find there is no significant impact on LOS for patients who experience a CY during their hospital stay versus patients who do not. We also find the urgent response crowds out the prevention response. The likelihood of physicians using PDOs decreases when hospital managers call a CY. Furthermore, we find that PDO results in more discharges in a day compared to CY and that the use of PDOs often reduces the need to trigger a CY. Thus, we find that the state-mandated urgent response creates a state of chaos that deters physicians from investing in actions that could prevent future boarding crises. The study provides empirical evidence that demonstrates pressure to produce results today impedes workers’ efforts to improve future performance. In Chapter 2, we investigate the impact of external collaborative coordination in improving the efficiency of a dedicated observation unit (DOU). The DOU is a unit in the hospital designed to treat observation patients. In July 2018, the unit expanded to treat patients with higher medical complexity which increased the demand and variability in the unit. Using difference-in-difference with inverse probability weights and instrumental variables (IV) approach we examine the operational cost and the efficiency gain respectively, of this expansion. We find that the observation LOS increases in the unit after the unit expanded. However, using an IV approach, the DOU gains efficiency that results in a reduction in LOS for the observation patients cared for in the unit compared to observation patients cared for off-service in the inpatient unit. We find that our results are driven by external collaborative coordination, which enables coordination amongst the cross-functional team as well as external collaborators. In Chapter 3, we study the impact of dedicated capacity on overall hospital performance. In this essay, we study the potential benefit of pulling short-stay patients out of the inpatient unit to be cared for in the DOU thus freeing up beds for vulnerable patients. Using a difference-in-difference approach with propensity score matching, we find that boarding time decreases for vulnerable patients as a result of bed availability in the inpatient unit. However, LOS in the inpatient unit increases. Furthermore, we find no impact on 30-day readmission. We attribute the increase in LOS to the higher volume of vulnerable patients who are now able to receive care in the inpatient unit. Together, these studies extend current knowledge and provide new insights to current studies addressing the movement of patients through a healthcare facility particularly when there is supply and demand mismatch. Through this dissertation, contribution is made to literature on patient flow, capacity management and coordination. Furthermore, it offers practical implications for hospital managers by demonstrating that complex operational problems can be minimized by reducing information gap through coordination