Developing service supply chains by using agent based simulation

The Master thesis present a novel approach to model a service supply chain with agent based simulation. Also, the case study of thesis is related to healthcare services and research problem includes facility location of healthcare centers in Vaasa region by considering the demand, resource units and service quality. Geographical information system is utilized for locating population, agent based simulation for patients and their illness status probability, and discrete event simulation for healthcare services modelling. Health centers are located on predefined sites based on managers’ preference, then each patient based on the distance to health centers, move to the nearest point for receiving the healthcare services. For evaluating cost and services condition, various key performance indicators have defined in the modelling such as Number of patient in queue, patients waiting time, resource utilization, and number of patients ratio yielded by different of inflow and outflow. Healthcare managers would be able to experiment different scenarios based on changing number of resource units or location of healthcare centers, and subsequently evaluate the results without necessity of implementation in real life.fi=Opinnäytetyö kokotekstinä PDF-muodossa.|en=Thesis fulltext in PDF format.|sv=Lärdomsprov tillgängligt som fulltext i PDF-format

Convenience, quality and choice: patient and service-provider perspectives for treating primary care complaints in urgent care settings

Aim: To investigate why patients chose to attend two, nurse-led, minor injury units (MIUs) to access primary healthcare services rather than attend their GP practice. Background: Since the 1980’s, healthcare organisations in the UK and elsewhere have implemented an increasingly consumer-orientated model of healthcare provision. As a result, patients with non-urgent presentations are attending Emergency Departments (EDs) and other urgent care facilities in growing numbers. Methods: A comparative case study approach was adopted and between October 2014 and May 2015 the researcher was embedded as a participant observer as part of the emergency nurse practitioner team at two, nurse-led, MIUs (site A and B). During this time, 40 patients, 17 service-providers and 1 senior manager were interviewed. Results: Patients and service-providers at both sites identified convenience and quality of care as the principle reasons patients presented for primary healthcare services at MIUs rather than their GP practice. Service-providers were aware that by providing treatment, they established a precedent and a sense of expectation for future care. Conclusion: Patients are acting rationally and predictably in response to healthcare policy promises regarding choice, expectation created by service-providers, and local demographic factors

The effectiveness of neonatal health care services in the primary health care units in the north-west of Ethiopia

Improving the quality of newborn care services and accelerating the service utilization of sick young infants is required to contribute to the reduction of neonatal mortality and improve the wellbeing of the newborns. The purpose of this study was to explore the effectiveness of neonatal healthcare services in the primary healthcare units in the north-west of Ethiopia and develop guideline for effective neonatal care. A mixed method approach with a sequential explanatory design was employed to explore factors affecting the effectiveness of the neonatal healthcare services. Interviewer-administered questionnaires were administered to 221 health workers and health extension workers in 142 health facilities; and service statistics abstracted for 767 sick young infants’ from the sick young infant registers. Data was entered in the EpiData 3.1, exported to SPSS and STATA for analysis. In the qualitative study, twenty-six participants from the health centers and health posts were interviewed through focus group discussions. Thematic analysis was undertaken to explore factors affecting neonatal healthcare services. Results: The quality of newborn care with the domains of newborn resuscitation, follow-up care after resuscitation and thermal care; immediate care and breastfeeding advice for very low birthweight babies were found to be moderate at primary hospitals and urban health centres; low at rural health centres and health posts. The availability of essential equipment is significantly associated with the quality of neonatal care provision in the health facilities (p < 0.05). More than forty percent of health facilities were not meeting the quality of case management tasks for sick young infants, and the newborn care knowledge of health providers is significantly associated with the quality of sick young infants’ management (p < 0.05). The sick young infants’ service utilisation was only 6.3 percent from the expected sick young infants’ population. Overall, the effectiveness of the neonatal healthcare services has a significant association with the health facilitates readiness [95%CI: 0.134-0.768]. Conclusion: The quality of neonatal healthcare provision is low to moderate; and the service utilization of sick young infants is very low. Thus, the rural health centers and health posts should be prioritised for the effective neonatal care.Health StudiesD. Litt. et Phil. (Health Studies

How service design can improve the patient experience

Significant changes are taking place in healthcare organisations, where the pressure is increasing to develop personalised services that meet patients' needs while integrating the necessary resources. This research joins a stream of research that suggests that healthcare can be more patient-centred, where the role of the patient is redefined from passive recipient to more active and collaborative participant. Through the feedback of patients and health providers, the service design should improve service quality. It is essential first to identify the challenges in the service that need to be improved. The present study was developed according to answers given by patients and health providers from Portuguese cardiology units. Data were collected using two questionnaires. The main findings show that patient satisfaction is very high but can be improved through efficient management and digital innovationinfo:eu-repo/semantics/acceptedVersio

ECCO Essential Requirements for Quality Cancer Care : Colorectal Cancer. A critical review

Background: ECCO essential requirements for quality cancer care (ERQCC) are checklists and explanations of organisation and actions that are necessary to give high-quality care to patients who have a specific tumour type. They are written by European experts representing all disciplines involved in cancer care. ERQCC papers give oncology teams, patients, policymakers and managers an overview of the elements needed in any healthcare system to provide high quality of care throughout the patient journey. References are made to clinical guidelines and other resources where appropriate, and the focus is on care in Europe. Colorectal cancer: essential requirements for quality care Colorectal cancer (CRC) is the second most common cause of cancer death in Europe and has wide variation in outcomes among countries. Increasing numbers of older people are contracting the disease, and treatments for advanced stages are becoming more complex. A growing number of survivors also require specialist support. High-quality care can only be a carried out in specialised CRC units or centres which have both a core multidisciplinary team and an extended team of allied professionals, and which are subject to quality and audit procedures. Such units or centres are far from universal in all European countries. It is essential that, to meet European aspirations for comprehensive cancer control, healthcare organisations implement the essential requirements in this paper, paying particular attention to multidisciplinarity and patient-centred pathways from diagnosis, to treatment, to survivorship. Conclusion: Taken together, the information presented in this paper provides a comprehensive description of the essential requirements for establishing a high-quality CRC service. The ECCO expert group is aware that it is not possible to propose a 'one size fits all' system for all countries, but urges that access to multidisciplinary units or centres must be guaranteed for all those with CRC. (C) 2016 The Authors. Published by Elsevier Ireland Ltd.Peer reviewe

ECCO essential requirements for quality cancer care : Oesophageal and gastric cancer

Background: ECCO essential requirements for quality cancer care (ERQCC) are checklists and explanations of organisation and actions that are necessary to give high-quality care to patients who have a specific type of cancer. They are written by European experts representing all disciplines involved in cancer care. ERQCC papers give oncology teams, patients, policymakers and managers an overview of the elements needed in any healthcare system to provide high quality of care throughout the patient journey. References are made to clinical guidelines and other resources where appropriate, and the focus is on care in Europe. Oesophageal and gastric: essential requirements for quality care: Oesophageal and gastric (OG) cancers are a challenging tumour group with a poor prognosis and wide variation in outcomes among European countries. Increasing numbers of older people are contracting the diseases, and treatments and care pathways are becoming more complex in both curative and palliative settings. High-quality care can only be a carried out in specialised OG cancer units or centres which have both a core multidisciplinary team and an extended team of allied professionals, and which are subject to quality and audit procedures. Such units or centres are far from universal in all European countries. It is essential that, to meet European aspirations for comprehensive cancer control, healthcare organisations implement the essential requirements in this paper, paying particular attention to multidisciplinarity and patient-centred pathways from diagnosis, to treatment, to survivorship. Conclusion: Taken together, the information presented in this paper provides a comprehensive description of the essential requirements for establishing a high-quality OG cancer service. The ERQCC expert group is aware that it is not possible to propose a one size fits all' system for all countries, but urges that access to multidisciplinary units or centres must be guaranteed for all those with OG cancer.Peer reviewe

Pediatric Critical Care in Resource-Limited Settings-Overview and Lessons Learned.

Pediatric critical care is an important component of reducing morbidity and mortality globally. Currently, pediatric critical care in low middle-income countries (LMICs) remains in its infancy in most hospitals. The majority of hospitals lack designated intensive care units, healthcare staff trained to care for critically ill children, adequate numbers of staff, and rapid access to necessary medications, supplies and equipment. In addition, most LMICs lack pediatric critical care training programs for healthcare providers or certification procedures to accredit healthcare providers working in their pediatric intensive care units (PICU) and high dependency areas. PICU can improve the quality of pediatric care in general and, if properly organized, can effectively treat the severe complications of high burden diseases, such as diarrhea, severe malaria, and respiratory distress using low-cost interventions. Setting up a PICU in a LMIC setting requires planning, specific resources, and most importantly investment in the nursing and permanent medical staff. A thoughtful approach to developing pediatric critical care services in LMICs starts with fundamental building blocks: training healthcare professionals in skills and knowledge, selecting resource appropriate effective equipment, and having supportive leadership to provide an enabling environment for appropriate care. If these fundamentals can be built on in a sustainable manner, an appropriate critical care service will be established with the potential to significantly decrease pediatric morbidity and mortality in the context of public health goals as we reach toward the sustainable development goals

Availability of Analgesic and Anti-Inflammatory Medicines in Primary Health Care

Objective: To describe and analyze the availability and factors related to the presence of analgesics and non-steroidal anti-inflammatory drugs in the Brazilian public primary healthcare system. Material and Methods: This was a cross-sectional study that evaluated 17,903 health units that participated in the National Program for Primary Care Access and Quality Improvement (2013-2014). The dependent variable was defined as the presence of metamizole, ibuprofen, and acetaminophen in a sufficient amount. The independent variables included the type of primary health care unit, the presence of a medication disposal area, the number of physicians, nurses, and dental practitioners; and the number of primary care units with family and oral health teams. For statistical analysis, unadjusted and adjusted Odds Ratio (OR) (95% CI) were presented. Results: The three medicines were available in 62.4% of the units. Regarding Health Clinics, the Basic Health Units (OR= 1.31, CI95% 1.18-1.44), Polyclinic (OR= 2.00, 95% CI, 1.15 -3.48), and others (OR= 1.37; 95% CI 1.14-1.63) had higher chances of availability of all three drugs. The presence of a disposal area (OR = 1.64, 95% CI 1.51-1.77) and the number of physicians (OR= 1.04, 95% CI 1.00-1.08), nurses (OR= 1.08, 95% CI 1.03- 1.13), and dental practitioners (OR= 1.09, 95% CI 1.04-1.14) increased the availability odds of the analyzed drugs in the service. Conclusion: The structure of the healthcare units and the higher number of professionals were positively associated with the availability of these drugs

The Impact of the Clinical Nurse Leader/Navigator on Clinical Outcomes and Patient Satisfaction

In an era of value based purchasing and healthcare reform, hospitals face the challenge of delivering high quality care in an environment of diminishing resources. This performance improvement project describes the use of master’s prepared nurses on medical surgical units to improve quality and patient satisfaction. The setting was five medical surgical units in a 200+ bed hospital in the southeastern United States. Declining resources necessitated an increase in the nurse to patient ratios on the units (from 5:1 to 6:1). The project involved the modification of the model of care through the change in nurse/patient ratios and the addition of master’s prepared nurses to coordinate and supplement the care of the staff RNs for complex patients. While inconclusive, the literature review confirmed the impact of master’s prepared nurses on quality metrics and did not conclusively confirm that delivering high quality, safe care was not possible with nurse/patient ratios of 1:6. The goal of the project was to determine if the presence of the master’s prepared nurse could mitigate the changes in ratios and produce high quality and satisfaction outcomes. Measures of success were drawn from archived standardized quality measures in the realms of service (HCAHPS questions), patient safety (CABSI, HAPU) and quality outcomes (core measures and 30 day readmissions). The project design was a retrospective, one-group pre-post design looking at two six-month intervals—before and after project implementation. Results demonstrated sustained or improved quality in six of ten measures. Highest positive impact was in readmissions and nurse sensitive indicators. The most negative results were in patient satisfaction. Modifying the model of care is an iterative process requiring continued evaluation and changes to improve outcomes. Results of this project supported the further evaluation of staffing and expansion of the number of master’s prepared nurses on medical surgical units

Smart context-aware QoS-based admission control for biomedical wireless sensor networks

Wireless sensor networks are being used as the enabling technology that helps to support the development of new applications and services targeting the domain of healthcare, in particular, regarding data collection for continuous health monitoring of patients or to help physicians in their diagnosis and further treatment assessment. Therefore, due to the critical nature of both medical data and medical applications, such networks have to satisfy demanding quality of service requirements. Despite the efforts made in the last few years to develop quality of service mechanisms targeting wireless sensor networks and its wide range of applications, the network deployment scenario can severely restrict the network's ability to provide the required performance. Furthermore, the impact of such environments on the network performance is hard to predict and manage due to its random nature. In this way, network planning and management, in complex environments like general or step-down hospital units, is a problem still looking for a solution. In such context, this paper presents a smart context-aware quality of service based admission control method to help engineers, network administrators, and healthcare professionals managing and supervising the admission of new patients to biomedical wireless sensor networks. The proposed method was tested in a small sized hospital. In view of the results achieved during the experiments, the proposed admission control method demonstrated its ability, not only to control the admission of new patients to the biomedical wireless sensor network, but also to find the best location to admit the new patients within the network. By placing the new sensor nodes on the most favourable locations, this method is able to select the network topology in view of mitigating the quality of service provided by the network.Work supported by the Portuguese Foundation for Science and Technology, FCT, PhD Grant SFRH/BD/61278/2009. Miranda was supported by Portuguese funds through the CIDMA - Center for Research and Development in Mathematics and Applications, and the Portuguese Foundation for Science and Technology.info:eu-repo/semantics/publishedVersio