Taxonomic classification of planning decisions in health care: a review of the state of the art in OR/MS

We provide a structured overview of the typical decisions to be made in resource capacity planning and control in health care, and a review of relevant OR/MS articles for each planning decision. The contribution of this paper is twofold. First, to position the planning decisions, a taxonomy is presented. This taxonomy provides health care managers and OR/MS researchers with a method to identify, break down and classify planning and control decisions. Second, following the taxonomy, for six health care services, we provide an exhaustive specification of planning and control decisions in resource capacity planning and control. For each planning and control decision, we structurally review the key OR/MS articles and the OR/MS methods and techniques that are applied in the literature to support decision making

Inefficiency in the Post Anesthesia Care Unit: A Quality Improvement Initiative

Background: The post anesthesia care unit (PACU) is a busy environment in which nurses communicate with patients, family members, and a large team of perioperative professionals. PACU nurses were experiencing an unmanageable number of work interruptions due to a higher patient census which increased the daily surgical caseload. Aim: The purpose of this project was to improve efficiency and nurses’ job satisfaction by making work interruptions manageable in the PACU. Methods: Based on Kotter’s Change Theory, a quality improvement initiative was implemented using a change in the communication process. Qualitative and quantitative data was gathered in the PACU and on other units with the intervention roll-out. A pre and post-intervention survey was used to evaluate work interruptions and their effects experienced by nurses in the PACU environment. Results: The use of communication technology impacted work interruptions, but not significantly enough to improve nursing efficiency and nurse satisfaction in the PACU. Conclusion and Implications for CNL® Practice: The next step is to recommend adding a CNL® as a surgical nurse liaison (SNL) to the perioperative team. Ideally, a CNL® with excellent communication and quality improvement skills will exemplify the roles of lateral integrator and patient advocate to improve efficiency. This physical solution, coupled with the communicative technology tool being widely integrated to all members of the perioperative team is expected to influence work interruptions and improve nurse satisfaction more dramatically

Healthcare Management Primer

This primer was written by students enrolled in HMP 721.01, Management of Health Care Organizations, in the Health Management & Policy Program, College of Health and Human Services, University of New Hampshire. This course was taught by Professor Mark Bonica in Fall 2017

International Profiles of Health Care Systems, 2011

This publication presents overviews of the health care systems of Australia, Canada, Denmark, England, France, Germany, Japan, Italy, the Netherlands, New Zealand, Norway, Sweden, Switzerland, and the United States. Each overview covers health insurance, public and private financing, health system organization, quality of care, health disparities, efficiency and integration, use of health information technology, use of evidence-based practice, cost containment, and recent reforms and innovations. In addition, summary tables provide data on a number of key health system characteristics and performance indicators, including overall health care spending, hospital spending and utilization, health care access, patient safety, care coordination, chronic care management, disease prevention, capacity for quality improvement, and public views

The Value Driven Pharmacist: Basics of Access, Cost, and Quality 2nd Edition

https://digitalcommons.butler.edu/butlerbooks/1017/thumbnail.jp

Health care system planning for and response to a nuclear detonation

The hallmark of a successful response to a nuclear detonation will be the resilience of the community, region, and nation. An incident of this magnitude will rapidly become a national incident; however, the initial critical steps to reduce lives lost, save the lives that can be saved with the resources available, and understand and apply resources available to a complex and dynamic situation will be the responsibility of the local and regional responders and planners. Expectations of the public health and health care systems will be met to the extent possible by coordination, cooperation, and an effort to produce as consistent a response as possible for the victims. Responders will face extraordinarily stressful situations, and their own physical and psychological health is of great importance to optimizing the response. This article illustrates through vignettes and supporting text how the incident may unfold for the various components of the health and medical systems and provides additional context for the discipline-related actions outlined in the state and local planners’ playbook

Healthcare Military Logistics at Disaster Regions around the World: Insights from Ten Field Hospital Missions over Three Decades

The Israeli Defense Force Medical Corps deployed airborne medical relief operations to disaster regions, inflicted by natural (earthquake, typhoon, and tsunami) and man-made catastrophes. Missions operated around the globe, in Africa, Asia, Caribbean, Europe, and the Middle East. In this study, based on literature review and interviewing of commanders and participants of ten of such missions operating in nine countries (Armenia, Rwanda, Kosovo, Turkey, India, Haiti, Japan, Philippines, and Nepal), we analyze and outline the principals in assembling and operating these missions. Deployment of the relief operations was swift, to address the needs as soon as possible, even at the cost of partial pre-assessment and a wide margin of uncertainty. This was compensated by the design of multi-disciplinarian and self-sufficient and independent units with flexible operative modes, enabling improvisations to cope with unexpected medical and operative needs. The experience gained in these missions led to a well-defined methodology of assembly and deployment of foreign field hospital in a short time. The review shows an evolutionary pattern with improvements implemented from one mission to the other, with special adaptations to address specific requirements and accommodate language, national culture barriers, and ethical dilemmas

WHEN THE “GOLDEN HOUR” IS DEAD: PREPARING INDIGENOUS GUERRILLA MEDICAL NETWORKS FOR UNCONVENTIONAL CONFLICTS

The capability to treat and recuperate casualties to return to combat is a vital component of a force’s defense strategy. The current luxury of large specialized medical teams and expedient patient evacuations will no longer be available in future unconventional (UW) and guerrilla warfare (GW) conflicts. It is the goal of this research to determine how to prepare a resistance medical network for unconventional conflict. First, historical guerrilla medicine cases are used to show the irrelevance of the current NATO roles of care. A more applicable framework to GW/UW based on treatment goals is proposed. Then, tangible requirements were determined through systems dynamics analysis and modeling. The developed model provides casualty statistics based on these tangible requirements for planners to optimize their medical network. Social network analysis was utilized to determine non-tangible considerations for each stage of care. Finally, these analyses were synthesized into a decision support algorithm to determine the best possible level of care for a given conflict’s medical system. These analyses supported conclusions from historical cases that battlefield mortality is based on the movement of patients and of supplies in denied environments. Ultimately, improving medical interoperability, enhancing the movement of people and supplies, and preparing medical personnel for clandestine operations are required to decrease mortality in denied environments.Outstanding ThesisLieutenant Colonel, United States Air ForceApproved for public release. Distribution is unlimited

Impact of Project RED Discharge Checklist on Readmissions and Adherence to Initial Follow-Up Appointment

Reducing readmissions has become a priority for hospitals across the country in an effort to improve care and to avoid financial penalties. The purpose of this pilot study is (a) to evaluate the impact of Project Re-Engineered discharge checklist on hospital readmissions within 30 days of discharge when compared to standard discharge instructions, (b) to evaluate adherence to the initial follow-up appointment with an outpatient provider in the trauma clinic within seven days of hospital discharge for fall patients compared to standard discharge instructions, and (c) to evaluate the impact insurance status, race, education, number of chronic illnesses present on admission, and planned post-discharge living arrangements on adherence to the initial follow-up appointment with an outpatient provider in the trauma clinic within seven days of discharge. Conducted between February 1, 2015 and October 1, 2015, this pilot study used a convenience sample (N = 50) of trauma patients admitted to a level II trauma center located in the Northeast. With respect to results, implementation of the Project Re-Engineered discharge checklist did not reduce readmissions (p = 0.247) or increase adherence to the initial follow-up appointment with an outpatient provider in the trauma clinic (p = 0.248). Demographics variables including age (p = 0.002) and race (p = 0.021) demonstrated statistical significance in reduced 30-day readmissions. Further research is needed to identify which modifications to the Project RED Discharge checklist might provide the greatest benefit to trauma patients in an effort to increase adherence to follow-up care, reduce readmissions and decrease healthcare costs