1,193 research outputs found

    Operational and strategic decision making in the perioperative setting: Meeting budgetary challenges and quality of care goals.

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    Efficient operating room (OR) management is a constant balancing act between optimal OR capacity, allocation of ORs to surgeons, assignment of staff, ordering of materials, and reliable scheduling, while according the highest priority to patient safety. We provide an overview of common concepts in OR management, specifically addressing the areas of strategic, tactical, and operational decision making (DM), and parameters to measure OR efficiency. For optimal OR productivity, a surgical suite needs to define its main stakeholders, identify and create strategies to meet their needs, and ensure staff and patient satisfaction. OR planning should be based on real-life data at every stage and should apply newly developed algorithms

    Integrated Planning in Hospitals: A Review

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    Efficient planning of scarce resources in hospitals is a challenging task for which a large variety of Operations Research and Management Science approaches have been developed since the 1950s. While efficient planning of single resources such as operating rooms, beds, or specific types of staff can already lead to enormous efficiency gains, integrated planning of several resources has been shown to hold even greater potential, and a large number of integrated planning approaches have been presented in the literature over the past decades. This paper provides the first literature review that focuses specifically on the Operations Research and Management Science literature related to integrated planning of different resources in hospitals. We collect the relevant literature and analyze it regarding different aspects such as uncertainty modeling and the use of real-life data. Several cross comparisons reveal interesting insights concerning, e.g., relations between the modeling and solution methods used and the practical implementation of the approaches developed. Moreover, we provide a high-level taxonomy for classifying different resource-focused integration approaches and point out gaps in the literature as well as promising directions for future research

    Hospital administration

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    The Administrator of a hospital, particularly of a teaching hospital, is faced with the task of organising increasingly complex and specialised, high technology institutions, under constant pressure to improve patient care and community services, training of health personnel, and to seek new knowledge, therapies and techniques. In addition, acute general hospitals are being forced to re-examine their goals and functions in the light of greater competition from other health and social services for scarce resources - and of changing environmental circumstances. These activities must be undertaken in the context of new theories of management with greater emphasis on the psycho-social aspects of organisation, decision-making processes and advances in information-processing techniques. To be equipped for this task the hospital administrator must also acquire new knowledge and skills. It was therefore frustrating to discover that no training courses for hospital administrators, medical or otherwise were available in this country and that there was a dearth of literature with specific reference to the Republic. Thus, it was as a measure of desperation that this thesis was embarked on, in order to satisfy a personal need to learn about the theory of administration and to meet the need for basic research into, and documentation of, hospital administration in South Africa. In view of the necessity to study virtually every aspect of the subject and the fact that so little research had been done on the management of South African hospitals, it was felt that hospital administration should be examined as a totality rather than selecting any single aspect of the subject. General Systems theory which views any open system as a whole, in constant interaction with its environment, provided an appropriate conceptual framework for the general study of hospital administration. The Groote Schuur Hospital Group provided a suitable model within which to l examine the application of general systems theory; for analysis of the environment, resources, organisation and products of a hospital; and upon which to base some general conclusions regarding the administration of hospitals, recommendations for change and for further research. This thesis which is presented in eight chapters with a short summary of the contents at the end of each chapter has examined one teaching hospital group as a whole system. No attempt has been made to study any aspect of hospital administration in great detail, but rather to identify areas where immediate changes can be implemented to improve the effective and efficient utilisation of resources, and those where further research is essential to find better ways of achieving these goals and meeting societal needs. In the words of Tenon - The hospital is the conscience of a civilisation whose worth, in the end will be measured not by articles of faith and lofty doctrines but by the way it nurtures life; succours distress, rights injustices and transforms misery, frailty and want into hope, dignity and sufficiency

    Planning of mental health services in Portugal under uncertain conditions

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    The demand for mental health care services is increasing significantly in the World and in Europe. For a country like Portugal, that is one of the countries with the largest prevalence of mental illnesses in Europe and with a level of supply that is not enough for the level of demand that exists nowadays, the urgency to be able to present a mental health care network able to respond to the expected increase in the demand for mental health services is higher and higher. In this thesis, a mathematical programming model - MHCU model - is presented in order to assist the decision makers to plan a mental health network that can respond to the current and future situation of the mental health care in Portugal. The model focus in the Great region of Lisbon and considers the different services provided and multiple objectives relevant in the mental health sector like the minimization of the cost or the maximization of the different equities values that are used in the model. The MHCU model is a stochastic model in order to be able to take into consideration the uncertainty associated with the mental health sector in different parameters like the demand for service and the length of stay in the network for each patient.A procura por serviços da rede de saúde mental está a aumentar significativamente no mundo e na Europa. Para um país como Portugal, que é um dos países com maior número de doentes mentais na Europa e com um nível de oferta deste tipo de serviços que não é suficiente para corresponder ao nível de procura que existe. A urgência de conseguir reformular a rede de saúde mental em Portugal de forma a que consiga responder ao expectável aumento da procura é cada vez maior. Nesta tese, é apresentado um modelo matemático - modelo MHCU - como forma de assistir os responsáveis pela gestão da saúde mental em Portugal a tomar decisões que permitam reformular a rede de saúde mental em Portugal de forma a que esta consiga responder a atual e futura realidade deste sector em Portugal Este modelo é focado na grande região de Lisboa e considera os diferentes serviços e diferentes objetivos que são relevantes para o sector da saúde mental, como minimizar o custo ou maximizar as diferentes equidades que são utilizadas no modelo. O modelo MHCU é um modelo estocástico de forma a que consiga ter em consideração a incerteza que se encontra associada ao sector da saúde mental em diferentes parâmetros como a procura pelos serviços e o tempo de permanencia nos serviços por parte de cada paciente

    Discrete Event Simulations

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    Considered by many authors as a technique for modelling stochastic, dynamic and discretely evolving systems, this technique has gained widespread acceptance among the practitioners who want to represent and improve complex systems. Since DES is a technique applied in incredibly different areas, this book reflects many different points of view about DES, thus, all authors describe how it is understood and applied within their context of work, providing an extensive understanding of what DES is. It can be said that the name of the book itself reflects the plurality that these points of view represent. The book embraces a number of topics covering theory, methods and applications to a wide range of sectors and problem areas that have been categorised into five groups. As well as the previously explained variety of points of view concerning DES, there is one additional thing to remark about this book: its richness when talking about actual data or actual data based analysis. When most academic areas are lacking application cases, roughly the half part of the chapters included in this book deal with actual problems or at least are based on actual data. Thus, the editor firmly believes that this book will be interesting for both beginners and practitioners in the area of DES

    Determining efficient scheduling approach of doctors for operating rooms: An analysis on Al-Shahid Ghazi Al-Hariri hospital in Baghdad

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    Government hospitals in Iraq have long been suffering from overcrowded patients, and shortages of doctors and nurses. Unstable environment with occurrences of random warrelated incidents has put further burden on hospitals’ limited resources particularly the surgical department. Large number of pre-scheduled elective surgeries has occasionally been interrupted by the incoming war-related incidents patients. This in turn has put tremendous pressure on the hospital management to maximize utilization of its operating rooms’ resources including surgeons and nurses, whilst simultaneously minimizing idle time. Al-Shahid Ghazi Al-Hariri hospital in Baghdad is presently experiencing these issues. Therefore, this study has been undertaken with the aims to identify efficient scheduling approach for elective surgeries for operating rooms in Al-Shahid Ghazi Al-Hariri hospital while considering interruptions from non-elective surgery (incoming patients from warrelated incidents). Specifically, this study intends to develop a Mixed Integer Linear Programming (MILP) model to maximize the utilizations of operating rooms, availability of surgeons as well as to minimize potential idle time. A meta-heuristic approach in the form of a Tabu Search is then employed to generate an acceptable solution and utilizing time more efficiently. Real data was collected from the hospital in the form of interviews, observations and secondary reports. The initial MILP computational results show that the proposed model has successfully produced optimal solutions by improving the utilization of operating rooms. Notwithstanding, the difficulty to produce results in reasonable time for larger problem instances has led to the application of a more efficient meta-heuristic approach. The Tabu Search results indicated better performance of the model with good quality solutions in fewer computation times. The finding is important as it determines the feasibility of the proposed model and its potential benefit to all relevant stakeholders

    The Contribution of Nursing to the Health of New Zealand

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    Nursing in New Zealand, has been a recognised profession for one hundred years. Throughout this time the profession has made a significant contribution to the health of communities, nationally and internationally. Despite the obvious effort and achievement, the evidence of this contribution is not well known, is documented in a few literature sources only although it is talked about widely as part of 'myth and legend'. Nurses, now as never before, are challenged to show how they 'add value' and to explain why nursing expertise is essential to safe service delivery. Finding a way to communicate this contribution has been identified as one of the most important issues facing the profession. This thesis explores the concept of contribution and presents a model, the 'Contribution Model', to show how nursing can articulate the action and achievements that show how nursing professionals have and will continue to contribute to health gain in New Zealand. Through the application of the 'Contribution Model' and framework presented in this thesis, nursing is shown to have made a contribution to health gain by using the broad range of knowledge, skills and experiences in a wide range of settings, to provide care wherever and whenever required. Case studies and scenarios from history, observation and prediction are used to show how the actions and achievements of nursing meet the expectations of individuals, the community and society: past, present and future

    A deconstruction and reconstruction of advanced nurse specialisation and education

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    The purpose of this study was to present issues and the paradoxes surrounding advanced nurse specialisation (ANS) and education, This study was conducted in two parts. Part A examined the prospective experiences of 13 registered nurses (RNs) who were advancing in an area of special is III ion: they were working in a specialist area of practice and studying in II course specific 10 their specialisation. Two rounds of interviews were completed over six-month intervals. Part B examined the data gathered from a focus group interview and follow-up feedback from 10 nurse executives as stakeholders. The intersubjective data from this group of nurses expanded on the political, economic, and social complexities surrounding the same phenomenon of interest
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