A framework for health care planning and control

Rising expenditures spur health care organizations to organize their processes more efficiently and effectively. Unfortunately, health care planning and control lags far behind manufacturing planning and control. Successful manufacturing planning and control concepts can not be directly copied, because of the unique nature of health care delivery. We analyze existing planning and control concepts or frameworks for health care operations management, and find that they do not properly address various important planning and control problems. We conclude that they only focus on hospitals, and are too narrow, focusing on a single managerial area, such as resource capacity planning, or ignoring hierarchical levels. We propose a modern framework for health care planning and control. Our framework integrates all managerial areas involved in health care delivery operations and all hierarchical levels of control, to ensure completeness and coherence of responsibilities for every managerial area. The framework can be used to structure the various planning and control functions, and their interaction. It is applicable broadly, to an individual department, an entire health care organization, and to a complete supply chain of cure and care providers. The framework can be used to identify and position various types of managerial problems, to demarcate the scope of organization interventions, and to facilitate a dialogue between clinical staff and managers. We illustrate the application of the framework with examples

The enigma that is the nucleus pulposus cell: the search goes on

The development of an effective treatment for degenerative disc disease has been hampered for many years by what seems a fundamental problem; what exactly defines a nucleus pulposus (NP) cell? The paper by Gilson and colleagues elegantly re-opens the debate concerning the lineage and identity of NP cells that are alike yet different from chondrocytes. As we pursue novel investigations and treatment strategies for degenerative disc disease, how do we isolate these unique cells and what is the role of the primordial notochordal cell that may well linger within the NP far longer and perhaps in a different phenotypic appearance than previously thought? The paper by Gilson and colleagues that is the subject of the present editorial presents compelling data concerning the heterogeneity of the cells of the NP, and their origin, development, maturation and function

Electronic Structure of Superconducting Ba6c60

We report the results of first-principles electronic-structure calculations for superconducting Ba6C60. Unlike the A3C60 superconductors, this new compound shows strong Ba-C hybridization in the valence and conduction regions, mixed covalent/ionic bonding character, partial charge transfer, and insulating zero-gap band structure.Comment: 11 pages + 4 figures (1 appended, others on request), LaTeX with REVTE

Farm household risk balancing : implications for policy from an EU perspective

Purpose - Building on the risk balancing theory and on recent discussions the appropriateness of using farm income maximization as behavioural assumption, this paper extends the risk balancing framework by accounting for business-household interactions. The purpose of this paper is to theoretically introduce the concept of farm household risk balancing, a theoretical framework in which the farm household sets a constraint on the total household-level risk and balances farm-level and off-farm-level risk. Design/methodology/approach - The paper argues that the risk behaviour of farmers is better understood by considering risk at the household level. Using an analytical framework, equations are derived linking the farm activities, off-farm activities, consumption and business and private liquidity. Findings - The framework shows that a farm household that wants to minimize the risk that total household cash flow falls below consumption needs, may exhibit a wide variety of behavioural responses to changes in the policy and economic environment. Social implications - The framework suggests multiple ways for policy makers and individual farmers to support risk management. Originality/value - Risk management is at the core of the agricultural policy and it is of paramount importance to be able to understand behavioural responses to market and policy instruments. This paper contributes to that by suggesting that the focus of current risk analysis and management studies may be too narrowly focused at the farm level

Improve OR-schedule to reduce number of required beds

After surgery most of the surgical patients have to be admitted in a ward in the hospital. Due to financial reasons and an decreasing number of available nurses in the Netherlands over the years, it is important to reduce the bed usage as much as possible. One possible way to achieve this is to create an operating room (OR) schedule that spreads the usage of beds nicely over time, and thereby minimizes the number of required beds. An OR-schedule is given by an assignment of OR-blocks to specific days in the planning horizon and has to fulfill several resource constraints. Due to the stochastic nature of the length of stay of patients, the analytic calculation of the number of required beds for a given OR-schedule is a complex task involving the convolution of discrete distributions. In this paper, two approaches to deal with this complexity are presented. First, a heuristic approach based on local search is given, which takes into account the detailed formulation of the objective. A second approach reduces the complexity by simplifying the objective function. This allows modeling and solving the resulting problem as an ILP. Both approaches are tested on data provided by Hagaziekenhuis in the Netherlands. Furthermore, several what-if scenarios are evaluated. The computational results show that the approach that uses the simplified objective function provides better solutions to the original problem. By using this approach, the number of required beds for the considered instance of HagaZiekenhuis can be reduced by almost 20%

Study of the impact of projection-based assistance systems for improving the learning curve in assembly processes

Abstract With the introduction of Industry 4.0 the use of worker assistance systems is getting more and more important. Assistance systems should support operators to increase efficiency and to reduce physical and mental stress and thus increase ergonomics of the work. In this paper, we investigate the impact of a projection-based worker assistance system conducting lab experiments simulating a ramp-up situation of a new product in assembly. The specific aim is the investigation of the impact of such systems in assembly for improving the learning curve, when products are changing. The study shows the results of a comparison between the assembly process with traditional worker instructions and the use of cognitive assistance systems to project instructions on the workplace

An analytical comparison of the patient-to-doctor policy and the doctor-to-patient policy in the outpatient clinic

Outpatient clinics traditionally organize processes such that the doctor remains in a consultation room, while patients visit for consultation, we call this the Patient-to-Doctor policy. A different approach is the Doctor-to-Patient policy, whereby the doctor travels between multiple consultation rooms, in which patients prepare for their consultation. In the latter approach, the doctor saves time by consulting fully prepared patients. We compare the two policies via a queueing theoretic and a discrete-event simulation approach. We analytically show that the Doctor-to-Patient policy is superior to the Patient-to-Doctor policy under the condition that the doctor’s travel time between rooms is lower than the patient’s preparation time. Simulation results indicate that the same applies when the average travel time is lower than the average preparation time. In addition, to calculate the required number of consultation rooms in the Doctor-to-Patient policy, we provide an expression for the fraction of consultations that are in immediate succession; or, in other words, the fraction of time the next patient is prepared and ready, immediately after a doctor finishes a consultation.We apply our methods for a range of distributions and parameters and to a case study in a medium-sized general hospital that inspired this research