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

Diseño de una metodología integrada entre jerarquía analítica y técnicas de consenso. Caso aplicado : protección de riesgos para tenderos

Con frecuencia en la toma de decisiones en grupo se utilizan los métodos de decisión multicriterio porque estas metodologías permiten tener en cuenta diversos criterio, alternativas v variables que intervienen en la decisión. En estos casos es importante definir cómo se van a integrar los diversos puntos de vista en, la decisión final. La agregación mediante promedio geométrico o aritmético de los resultados puede ser más sencilla sin embargo, se alcanzan mejores resultados mediante el consenso. En este documento, sé propone una metodología que integra la aplicación de la metodología AHP y el consenso para alcanzar un mejor resultado. Para probar la metodología, se aplicó al diseño de un seguro para tenderos pyme.Often in complex group decision making, multicriteria decision making methods (MCDM) are used? because these methodologies allow to consider the different, criteria, alternatives and variables that must be considered important to define how the different point of view would be integrated in the final decision. The aggregation of individual results through geometric or arithmetic easier, but generally decisions made by consensus are more complete and have more commitment from the group that must implement it. In this document a methodology that integrates the use of AHP and consensus is proposed. To prove the methodology, it was applied to the design of an insurance for mom and pop stores.Ingeniero (a) IndustrialPregrad

Criação de score urofuncional para priorização de pacientes na fila do estudo urodinâmico do Hospital de Clínicas da Universidade Federal do Paraná

Orientador: Prof. Dr. Rogério de FragaCoorientadora: Prof. Dra. Marie-Ève LamontagneTese (doutorado) - Universidade Federal do Paraná, Setor de Ciências da Saúde, Programa de Pós-Graduação em Clínica Cirúrgica. Defesa : Curitiba, 15/03/2022Inclui referênciasResumo: Esta tese trata-se do desenvolvimento de scores de prioridade para o estudo urodinâmico. O estudo iniciou com a formação de um grupo multidisciplinar, no qual participaram médicos, enfermeiros, estudantes de medicina, administradores, engenheiro e matemático computacional. para determinação dos critérios de prioridade do exame, os quais foram baseados nos guidelines médicos, esta árvore de critérios foi chamada de Classificação Urofuncional. A estratégia de gestão do projeto, foi baseada nos passos da escola de administração da Universidade de Harvard. Como método de análise foi escolhido o Fuzzy AHP, este método permite que situações que envolvem critérios subjetivos possam ser quantificadas, determinando scores para cada critério. Após a aplicação do questionário Fuzzy AHP scores de prioridades foram atribuídos a cada um dos critérios da classificação urofuncional. Verificação e validação dos scores foram realizados com os experts no estudo urodinâmico, através da simulação, com pacientes reais, os quais já haviam sido referenciados para realização do estudo. Esta ferramenta demonstrou-se efetiva sendo aprovada e referenciada pelos experts para implementação na fila do estudo urodinâmico do Complexo Hospital de Clínicas da Universidade Federal do Paraná.Abstract: This thesis is about the development of priority scores for the urodynamic study. The study started with the formation of a multidisciplinary team, in which physicians, nurses, medical students, administrators, an engineer and a computational mathematician participated. To determine the priority criteria for the exame, we were based on medical guidelines. This criteria tree was called Urofunctional Classification. The project management strategy, was based on the steps of the Harvard University business school. As an analysis method the Fuzzy AHP was chosen, this method allows situations whith involving subjective criteria to be quantified, determining scores for each criterion. After applying the Fuzzy AHP questionnaire, priority scores were assigned to each criteria of the urofunctional classification. Verification and validation of the scores were performed with experts in the urodynamic study, through simulation, with real patients, who had already been referred for the study. This tool has proven effective and was approved and referenced by experts for implementation in the urodynamic study queue at the Federal University of Paraná's Hospital de Clínicas Complex

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

Conception et application d'une méthodologie multicritère floue de sélection de logiciels de planification et d'ordonnancement avancé (APS)

Avec la mondialisation, la croissance des entreprises et les besoins de plus en plus exigeants des clients, les défis en termes de planification et d’ordonnancement des opérations en environnement manufacturier ne cessent de croitre. Face à cette situation, les entreprises manufacturières sont dans l’obligation de mettre à jour leurs politiques de planification et d’ordonnancement en adoptant des systèmes et des approches de planifications nouvelles telles que la planification et l’ordonnancement avancés (POA). Dans cet exercice, les entreprises désirant implanter des approches de POA ont généralement deux possibilités. Elles peuvent choisir de développer une solution personnalisée ou alors d’implanter des logiciels commerciaux de POA. La deuxième piste est plus courue de nos jours. L’objectif de ce travail est d’accompagner les entreprises désirant améliorer la planification et l’ordonnancement de leurs opérations par la sélection et l’implantation d’un logiciel commercial de POA. Plus précisément, le but de ce travail est d’évaluer et de sélectionner parmi les logiciels commerciaux de POA disponibles sur le marché celui qui satisfait au mieux les besoins de l’entreprise. Trois sous objectifs ont été identifiés : la cartographie des processus de planification et d’ordonnancement de l’entreprise, la capture des besoins de l’entreprise et la conception d’une nouvelle méthodologie de sélection intégrant sous incertitude à la fois les besoins de l’entreprise et les critères et sous critères de sélection. La méthodologie adoptée pour cette étude est celle dictée par la science de la conception, qui permet l’itération du processus de conception afin de perfectionner et de valider les résultats ou les livrables obtenus. Des données sont recueillies auprès d’experts et des preneurs de décisions internes à l’entreprise à l’aide d’entrevues individuelles et de groupes. Par ailleurs, en guise de contributions de cette recherche, trois méthodes ont été conçues. La première méthode permet de cartographier les processus de l’entreprise. La deuxième méthode est destinée à la capture des besoins de l’entreprise tandis que la troisième méthode intègre le déploiement de la fonction qualité (DFQ), l’analyse hiérarchique des processus (AHP) et la méthode VIKOR pour la sélection du logiciel qui satisfait au mieux les besoins de l’entreprise. Cette intégration est rendue possible en mettant en place une version modifiée du DFQ. L’incertitude sur les données provenant des enquêtes adressées aux experts et aux preneurs de décision est considérée par l’utilisation de la logique floue et des variables linguistiques. L’approche globale de l’étude est appliquée à un cas réel d’entreprise manufacturière. Les résultats montrent la pertinence des méthodes développées face au problème de selection d’un logiciel de POA

Gestão do ciclo de vida de dispositivos médicos : papel do engenheiro biomédico

Trabalho final de mestrado para obtenção do grau de mestre em Engenharia BiomédicaDe acordo com a Organização Mundial de Saúde, nos países desenvolvidos, cerca de 50% dos Dispositivos Médicos não são adequados ou utilizados de forma correta ou otimizada. O trabalho teve como objetivo criar um modelo sistemático de análise para a implementação de uma metodologia estruturada e organizada de Gestão do Ciclo de Vida de Dispositivos Médicos, tendo por base diretivas, normas nacionais e internacionais e modelos científicos. E demonstrar a importância do tema às organizações da área da saúde. A metodologia é baseada numa abordagem de decisão multicritérios, bem definida e hierarquizada, com a qual se pretende otimizar o processo de seleção/aquisição. Estes requisitos têm que ser assegurados nesta fase através de Cadernos de Encargos e Contratos de Manutenção bem elaborados (por uma equipa multidisciplinar), já que as correções posteriores dificilmente são técnico/economicamente viáveis. Com base no modelo Analytic Hierarchy Process foi desenvolvida uma ferramenta (ASA-DM) para escolha isenta. O estudo foi aplicado a quatro tomografias computorizadas em quatro Estudos de Caso, com o intuito de que a sua aplicação seja transversal a outros dispositivos. A variação das ponderações atribuídas aos critérios e subcritérios em função das necessidades presentes e futuras de cada instituição resultou em que cada um dos equipamentos se adequasse a um Estudo de Caso. Provou-se que não existem dispositivos inúteis ou de má qualidade, quer física, técnica ou operacional, mas que se pode melhorar o custo-benefício, a qualidade dos serviços e a satisfação dos utilizadores. É importante conhecer o Custo Total do Ciclo de Vida tendo em atenção o Valor Presente em detrimento apenas do custo inicial (compreendido entre 2,68% e os 16,91% dos custos totais, nestes estudos). O Engenheiro Biomédico representa um papel preponderante na formação, liderança da equipa e na introdução e desenvolvimento das metodologias adequadas, com o intuito de facilitar o processo de decisão.According to the World Health Organization, in developed countries, about 50% of the Medical Devices are not adequate, used in a correct or optimized. The objective of this work was to create a systematic analysis model for the implementation of a structured and organized methodology of Medical Device Life Cycle Management, based on guidelines, national and international standards and scientific models. And demonstrate the importance of the topic to health organizations. The methodology is based on a well-defined and hierarchical multicriteria decision-making approach with which to optimize the selection / acquisition process. These requirements have to be ensured at this stage through well-drafted Maintenance Charges and Maintenance Contracts (by a multidisciplinary team), as further corrections are hardly technically / economically feasible. Based on the Analytic Hierarchy Process model, a tool (ASA-DM) was developed for impartial choice. The study was applied to four CT scans in four case studies, with the aim of applying it to other devices. The variation of the weights attributed to the criteria and sub-criteria according to the present and future needs of each institution resulted in each one of the equipments being more suited to each Case Study. It has been proved that there are no useless devices or poor quality ones, whether physical, technical or operational, but that it can improve the cost-benefit and at the same time improve the provision, quality of services and user satisfaction. It is important to know the Total Cost of the Life Cycle considering the Present Value, in detriment of only the initial cost (between 2.68% and 16.91% of the total costs in these studies). The Biomedical Engineer plays a preponderant role in training, team leadership, in the introduction and development of appropriate methodologies, in order to facilitate the decision process.N/

A Hybrid Fuzzy Multi-criteria Decision Making Model to Evaluate the Overall Performance of Public Emergency Departments: A Case Study

[EN] Performance evaluation is relevant for supporting managerial decisions related to the improvement of public emergency departments (EDs). As different criteria from ED context and several alternatives need to be considered, selecting a suitable Multicriteria Decision-Making (MCDM) approach has become a crucial step for ED performance evaluation. Although some methodologies have been proposed to address this challenge, a more complete approach is still lacking. This paper bridges this gap by integrating three potent MCDM methods. First, the Fuzzy Analytic Hierarchy Process (FAHP) is used to determine the criteria and sub-criteria weights under uncertainty, followed by the interdependence evaluation via fuzzy Decision-Making Trial and Evaluation Laboratory(FDEMATEL). The fuzzy logic is merged with AHP and DEMATEL to illustrate vague judgments. Finally, the Technique for Order of Preference by Similarity to Ideal Solution (TOPSIS) is used for ranking EDs. This approach is validated in a real 3-ED cluster. The results revealed the critical role of Infrastructure (21.5%) in ED performance and the interactive nature of Patient safety (C+R =12.771). Furthermore, this paper evidences the weaknesses to be tackled for upgrading the performance of each ED.Ortiz-Barrios, M.; Alfaro Saiz, JJ. (2020). A Hybrid Fuzzy Multi-criteria Decision Making Model to Evaluate the Overall Performance of Public Emergency Departments: A Case Study. International Journal of Information Technology & Decision Making. 19(6):1485-1548. https://doi.org/10.1142/S0219622020500364S14851548196Lord, K., Parwani, V., Ulrich, A., Finn, E. B., Rothenberg, C., Emerson, B., … Venkatesh, A. K. (2018). Emergency department boarding and adverse hospitalization outcomes among patients admitted to a general medical service. The American Journal of Emergency Medicine, 36(7), 1246-1248. doi:10.1016/j.ajem.2018.03.043Sørup, C. M., Jacobsen, P., & Forberg, J. L. (2013). 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(2018). A Fuzzy AHP–TOPSIS-Based Group Decision-Making Approach to IT Personnel Selection. International Journal of Fuzzy Systems, 20(5), 1576-1591. doi:10.1007/s40815-018-0474-7CHEN, M.-F., TZENG, G.-H., & TANG, T.-I. (2005). FUZZY MCDM APPROACH FOR EVALUATION OF EXPATRIATE ASSIGNMENTS. International Journal of Information Technology & Decision Making, 04(02), 277-296. doi:10.1142/s0219622005001520Gul, M., Celik, E., Gumus, A. T., & Guneri, A. F. (2016). Emergency department performance evaluation by an integrated simulation and interval type-2 fuzzy MCDM-based scenario analysis. European J. of Industrial Engineering, 10(2), 196. doi:10.1504/ejie.2016.075846Jovčić, Průša, Dobrodolac, & Švadlenka. (2019). A Proposal for a Decision-Making Tool in Third-Party Logistics (3PL) Provider Selection Based on Multi-Criteria Analysis and the Fuzzy Approach. Sustainability, 11(15), 4236. doi:10.3390/su11154236Saaty, T. L., & Vargas, L. G. (2012). Models, Methods, Concepts & Applications of the Analytic Hierarchy Process. International Series in Operations Research & Management Science. doi:10.1007/978-1-4614-3597-6Vargas, L. G. (2016). Voting with Intensity of Preferences. International Journal of Information Technology & Decision Making, 15(04), 839-859. doi:10.1142/s0219622016400058Lee, K.-C., Tsai, W.-H., Yang, C.-H., & Lin, Y.-Z. (2018). An MCDM approach for selecting green aviation fleet program management strategies under multi-resource limitations. Journal of Air Transport Management, 68, 76-85. doi:10.1016/j.jairtraman.2017.06.011Labib, A., & Read, M. (2015). A hybrid model for learning from failures: The Hurricane Katrina disaster. Expert Systems with Applications, 42(21), 7869-7881. doi:10.1016/j.eswa.2015.06.020Hosseini, S., & Khaled, A. A. (2016). A hybrid ensemble and AHP approach for resilient supplier selection. Journal of Intelligent Manufacturing, 30(1), 207-228. doi:10.1007/s10845-016-1241-yZavadskas, E. 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