Improving surgeon utilization in an orthopedic department using simulation modeling

Purpose: Worldwide more than two billion people lack appropriate access to surgical services due to mismatch between existing human resource and patient demands. Improving utilization of existing workforce capacity can reduce the existing gap between surgical demand and available workforce capacity. In this paper, the authors use discrete event simulation to explore the care process at an orthopedic department. Our main focus is improving utilization of surgeons while minimizing patient wait time. Methods: The authors collaborated with orthopedic department personnel to map the current operations of orthopedic care process in order to identify factors that influence poor surgeons utilization and high patient waiting time. The authors used an observational approach to collect data. The developed model was validated by comparing the simulation output with the actual patient data that were collected from the studied orthopedic care process. The authors developed a proposal scenario to show how to improve surgeon utilization. Results: The simulation results showed that if ancillary services could be performed before the start of clinic examination services, the orthopedic care process could be highly improved. That is, improved surgeon utilization and reduced patient waiting time. Simulation results demonstrate that with improved surgeon utilizations, up to 55% increase of future demand can be accommodated without patients reaching current waiting time at this clinic, thus, improving patient access to health care services. Conclusion: This study shows how simulation modeling can be used to improve health care processes. This study was limited to a single care process; however the findings can be applied to improve other orthopedic care process with similar operational characteristics. Keywords: waiting time, patient, health care processpublishedVersio

Simulation analysis of resource flexibility on healthcare processes

Purpose: This paper uses discrete event simulation to explore the best resource flexibility scenario and examine the effect of implementing resource flexibility on different stages of patient treatment process. Specifically we investigate the effect of resource flexibility on patient waiting time and throughput in an orthopedic care process. We further seek to explore on how implementation of resource flexibility on patient treatment processes affects patient access to healthcare services. We focus on two resources, namely, orthopedic surgeon and operating room. Methods: The observational approach was used to collect process data. The developed model was validated by comparing the simulation output with actual patient data collected from the studied orthopedic care process. We developed different scenarios to identify the best resource flexibility scenario and explore the effect of resource flexibility on patient waiting time, throughput, and future changes in demand. The developed scenarios focused on creating flexibility on service capacity of this care process by altering the amount of additional human resource capacity at different stages of patient care process and extending the use of operating room capacity. Results: The study found that resource flexibility can improve responsiveness to patient demand in the treatment process. Testing different scenarios showed that the introduction of resource flexibility reduces patient waiting time and improves throughput. The simulation results show that patient access to health services can be improved by implementing resource flexibility at different stages of the patient treatment process. Conclusion: This study contributes to the current health care literature by explaining how implementing resource flexibility at different stages of patient care processes can improve ability to respond to increasing patients demands. This study was limited to a single patient process; studies focusing on additional processes are recommended. Keywords: agile strategy, waiting time, throughput, patient access, responsivenesspublishedVersio

Mining tourists’ movement patterns in a city

Although tourists generate a large amount of data (known as “big data”) when they visit cities, little is known about their spatial behavior. One of the most significant issues that has recently gained attention is mobile phone usage and user behavior tracking. A spatial and temporal data visualization approach was established with the purpose of finding tourists’ footprints. This work provides a platform for combining multiple data sources into one and transforming information into knowledge. Using Python, we created a method to build visualization dashboards aiming to provide insights about tourists’ movements and concentrations in a city using information from mobile operators. This approach can be replicated to other smart cities with data available. Weather and major events, for instance, have an impact on the movements of tourists. The outputs from this work provide useful information for tourism professionals to understand tourists’ preferences and improve the visitors’ experience. Management authorities may also use these outputs to increase security based on tourists’ concentration and movements. A case study in Lisbon with 4 months data is presented, but the proposed approach can also be used in other cities based on data availability. Results from this case study demonstrate how tourists tend to gather around a set of parishes during a specific time of the day during the months under study, as well as how unusual circumstances, namely international events, impact their overall spatial behavior.This work was supported by EEA Grants Blue Growth Programme (Call #5). Project PT-INNOVATION-0069 – Fish2Fork

Economic sustainability of local food producers: a mixed methods study

IntroductionThis study investigates local food producers’ economic sustainability by examining the impact of six variables: external and internal barriers, the number of economic operators, the imbalance of power, the number of distribution options, and waste.MethodsThe investigation uses mixed methods of questionnaires and interviews. The data was collected using a self-completed questionnaire, which was answered by 57 local food producers across Norway, and four semi-structured interviews with professionals in the food industry. The quantitative data was analyzed with the use of partial least squares structural equation modeling (PLS-SEM), and the qualitative data was analyzed using a thematic analysis.ResultsThe study has statistically confirmed three out of eight hypotheses. The three hypotheses show that when the number of economic operators in the supply chain increases and also imbalances in the sales channels increase. Additionally, the imbalance of power in the sales channels has a negative effect on economic sustainability, and external barriers have a negative effect on the imbalance of power in the sales channels. The interviews supported seven of the hypotheses, although four of them were not supported.DiscussionThe empirical evidence presented in this study indicates that the lack of balance within the supply chain exerts a substantial influence on the economic sustainability of local food producers. By adopting a comprehensive approach, this research demonstrates that a more holistic perspective leads to enhanced economic sustainability. Additionally, it elucidates the diverse ways in which various factors impact the economic sustainability of local food produce

Who Is Doing What in Home Care Services?

(1) Background: This paper investigates the distribution of work hours by activity, for the main staff categories in home care services in three rural Norwegian municipalities. In Norway these categories are registered nurses, assistant nurses and assistant health workers. (2) Methods: The three categories of home care staff recorded 20,964 eligible observations over 8 weeks. We identified 19 activities, which were recorded. The majority of staff used a smartphone application for the time measuring, while some staff used a manual form for reporting purposes. (3) Results: The registered nurses (RNs) spent 32% of their time on direct patient work, while driving accounted for 18%. Direct patient work and driving accounted for the majority of activities performed by assistant nurses (48% and 29%, respectively) and assistant health workers (70% and 17%, respectively). (4) Conclusions: The demand for home care services is increasing in terms of both size and complexity. Simultaneously, there is a growing shortage of skilled staff. RNs is the group with the least face-to-face time with patients. To meet the patients’ needs, it is necessary to discuss and modify existing home care service systems in order to use resources appropriately and effectively

A prospective investigation of direct and indirect home care activities in three rural Norwegian municipalities

Abstract Background Home care providers struggle to manage their day-to-day work, which is increasing in volume and complexity. In general, they are expected to achieve more with the same planning methods, resources, and capacity. To meet emerging needs and use the available resources more effectively and efficiently, evidence and strategies are needed to inform planning methods for home care services. However, limited data are available to inform this change. This paper investigated the amount of time used to carry out direct activities and six indirect activities across three rural Norwegian municipalities (M1, M2 and M3). Methods Home care staff recorded data over 8 weeks in 2016; the majority of the staff used a smartphone application and some staff used a manual form to report the durations of the activities. Results The median time spent on direct activities was 11–13 min, and this work constituted less than 50% of the total work in the three municipalities. The median driving time was 5–7 min, which accounted for 43–54% of the total indirect work. Administration, particularly reporting and documentation, displayed greater differences across the municipalities, together accounting for 38–50% of the total indirect time. M2 and M3 used substantially more time for documentation, including 20 min in M2 and M3, in contrast to only 1 min in M1. Similarly, the median reporting times were 30 min (M2) and 28 min (M3), compared with only 17 min in M1. Conclusions Home care staff spent less time on direct activities than on indirect activities, of which several activities have the potential for change. These results may help managers utilize resources effectively and plan appropriately, and they may also serve as a basis for future research to identify areas with improvement opportunities and, in turn, make more time available for direct patient care