5,374 research outputs found

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

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    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

    Modelling home care organisations from an operations management perspective

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    Home Care (HC) service consists of providing care to patients in their homes. During the last decade, the HC service industry experienced significant growth in many European countries. This growth stems from several factors, such as governmental pressure to reduce healthcare costs, demographic changes related to population ageing, social changes, an increase in the number of patients that suffer from chronic illnesses, and the development of new home-based services and technologies. This study proposes a framework that will enable HC service providers to better understand HC operations and their management. The study identifies the main processes and decisions that relate to the field of HC operations management. Hence, an IDEF0 (Integrated Definition for Function Modelling) activity-based model describes the most relevant clinical, logistical and organisational processes associated with HC operations. A hierarchical framework for operations management decisions is also proposed. This analysis is derived from data that was collected by nine HC service providers, which are located in France and Italy, and focuses on the manner in which operations are run, as well as associated constraints, inputs and outputs. The most challenging research areas in the field of HC operations management are also discussed

    New ways of working in acute inpatient care: a case for change

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    This position paper focuses on the current tensions and challenges of aligning inpatient care with innovations in mental health services. It argues that a cultural shift is required within inpatient services. Obstacles to change including traditional perceptions of the role and responsibilities of the psychiatrist are discussed. The paper urges all staff working in acute care to reflect on the service that they provide, and to consider how the adoption of new ways of working might revolutionise the organisational culture. This cultural shift offers inpatient staff the opportunity to fully utilise their expertise. New ways of working may be perceived as a threat to existing roles and responsibilities or as an exciting opportunity for professional development with increased job satisfaction. Above all, the move to new ways of working, which is gathering pace throughout the UK, could offer service users1 a quality of care that meets their needs and expectations

    An Optimisation-based Framework for Complex Business Process: Healthcare Application

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    The Irish healthcare system is currently facing major pressures due to rising demand, caused by population growth, ageing and high expectations of service quality. This pressure on the Irish healthcare system creates a need for support from research institutions in dealing with decision areas such as resource allocation and performance measurement. While approaches such as modelling, simulation, multi-criteria decision analysis, performance management, and optimisation can – when applied skilfully – improve healthcare performance, they represent just one part of the solution. Accordingly, to achieve significant and sustainable performance, this research aims to develop a practical, yet effective, optimisation-based framework for managing complex processes in the healthcare domain. Through an extensive review of the literature on the aforementioned solution techniques, limitations of using each technique on its own are identified in order to define a practical integrated approach toward developing the proposed framework. During the framework validation phase, real-time strategies have to be optimised to solve Emergency Department performance issues in a major hospital. Results show a potential of significant reduction in patients average length of stay (i.e. 48% of average patient throughput time) whilst reducing the over-reliance on overstretched nursing resources, that resulted in an increase of staff utilisation between 7% and 10%. Given the high uncertainty in healthcare service demand, using the integrated framework allows decision makers to find optimal staff schedules that improve emergency department performance. The proposed optimum staff schedule reduces the average waiting time of patients by 57% and also contributes to reduce number of patients left without treatment to 8% instead of 17%. The developed framework has been implemented by the hospital partner with a high level of success

    M-health review: joining up healthcare in a wireless world

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    In recent years, there has been a huge increase in the use of information and communication technologies (ICT) to deliver health and social care. This trend is bound to continue as providers (whether public or private) strive to deliver better care to more people under conditions of severe budgetary constraint

    Modelling and (re-)planning periodic home social care services with loyalty and non-loyalty features

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    This work was partially supported by the Fundacao para a Ciencia e a Tecnologia (Portuguese Foundation for Science and Technology) through the project UID/MAT/00297/2019 (Centro de Matematica e Aplicacees).The aging population alongside little availability of informal care are two of the several factors leading to an increased need for assisted living support. In this work, we tackle a home social care service problem, motivated by two real case studies where a new loyalty scheme must be considered: within a week, patient-caregiver loyalty should be pursued but, between weeks, the caregivers must rotate among patients (non-loyalty). In addition, a common situation in this kind of service is also addressed: the need of a constant re-planning caused by the leaving of patients and the arrival of new ones. This new plan should be such that minimum disturbance is caused to the visiting hours of current patients, the caregivers’ travelling time between visits is minimized, and the workload is balanced among caregivers. A multi-objective optimization approach based on mixed-integer models is developed. Results on the two real case studies show that both institutions can efficiently re-plan their activities without much disturbance on the visits of their patients, and with a patient-caregiver loyalty scheme suiting their needs.authorsversionpublishe

    Adding value to outpatient heart failure services and the patient journey through digital transformation of services

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    Introduction Heart failure (HF) is a chronic condition affecting over 900,000 people in the UK. The management of patients with HF frequently involves regular face-to-face appointments. Digital transformation of care with telemedicine, remote monitoring and mobile applications (Apps) may help improve patient experience and relieve demand on services. The Covid-19 pandemic resulted in an acceleration in telemedicine. This thesis evaluates pre-pandemic HF services at the Royal Brompton Hospital (RBH), identifying potential areas for improving patient journeys. Methods Retrospective cohort studies including over 200 patients were used to analyse the activities and actions resulting from HF clinic appointments over 3 years. Time-and-motion studies were conducted for each of the 4 consultant-led HF clinics at RBH, where flow through hospital was analysed for 58 patients. Eight clinicians and 8 patients who had undergone telemedicine consultations were interviewed about their experiences and perceptions, with narrative data thematically analysed. Focus groups and existing educational material were used to design an educational App for HF. Results Most HF patients under long-term follow-up were followed up twice yearly. At clinic visit, worsening HF symptoms and therapy change by clinicians were uncommon (21% and 36% of appointments respectively). Patients spent a median of 103 minutes in hospital on the day of an appointment for a median 20-minute consultation. The majority of consultations ran late. Clinicians and patients found telemedicine consultations generally acceptable, but both groups identified changes in time utilisation, clinical assessment, communication, and technology. Telemedicine appointments were shorter and involved less time waiting and travelling for patients. Patients and clinicians agreed that when patients are “stable”, telemedicine is preferred. A prototype HF educational “Avatar”-based App was produced. Conclusion Digital transformation of outpatient services, including telemedicine can improve patient and clinician experience, efficiency and rationalise limited resources, thus adding value to outpatient HF care.Open Acces
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