Multi-Criteria Decision Making for Medical Device Development

International audienceThe development of a new product is a complicated multi-stakeholder process with a significant risk of failure. This is particularly true in the medical device sector, where there are strict therapeutic, psychological, and normative constraints. This article presents a multi-criteria decision making process called “Define, Prioritize, Measure, and Aggregate” (DPMA). DPMA is designed to help engineering managers in decision making during the development process of new medical devices. The model is based on two sets of criteria linked to business and customer satisfaction. These criteria are weighted using the analytic hierarchy process (AHP) and group decision making (GDM) process. The performance of a medical device is measured according to each criterion. Furthermore, the final score of GO/NO GO alternatives are calculated with the simple additive weighting (SAW) method. A case study for the development of a new kind of femoral implant is presented to demonstrate the implementation of the DPMA process. This study shows that the application of the DPMA process during the design of a 3D printed femoral prosthesis provided engineering managers the key elements and green light to go ahead with the development of this medical device

Proactivity of Home Health Care systems facing health crisis

Aujourd'hui, l'accumulation des risques associés à des facteurs comme l'urbanisation croissante, le changement et la variabilité du climat, le terrorisme, les épidémies ou pandémies animales et humaines ainsi que la mobilité accrue des personnes et des biens de par le monde, ont accru le potentiel perturbateur voire destructeur de divers types de catastrophes. Des plans de gestion de crises sont élaborés pour gérer au mieux la catastrophe engendrée voire l’éviter. L’objectif de ce travail de recherche est de développer des outils d’aide à la décision pour supporter les différentes phases du plan de gestion de crises dédiés aux établissements de soins à domiciles, notamment les phases de préparation et de réponse. Un ensemble de scénarios à étudier prioritairement en considérant les différentes sources de crises et les processus métier impactés, quant à leur fréquence et leurs impacts humain et matériel, a été défini. Une approche originale d’analyse de vulnérabilité basée sur la théorie des graphes et des matrices a été développée. Le but est de pouvoir mesurer l’impact des différentes crises sur la structure d’hospitalisation à domiciles en termes d’acteurs et de flux échangés. En se basant sur cette phase d’évaluation, nous avons proposé : une classification des acteurs de l’HAD, des méthodes pour la conception des stratégies et des contremesures de mitigation pour chaque classe d’acteurs. La problématique d’accès aux soins dans le cadre d’un scénario d’intoxication massive a été abordée. Un modèle de programmation linéaire a été proposé pour simuler le scénario étudié et évaluer ses conséquences. Il modélise l'infection d'origine alimentaire et la réponse médicale dans le cadre d’une collaboration HAD-Hôpital, c.-à-d., un plan blanc élargi. La problématique d’accès aux domiciles des patients a été investiguée dans le cadre d’un scénario de type crue, épisode neigeux etc. L'outil proposé fournit un plan d'évacuation pour les patients critiques à évacuer et un plan de soutien à domicile pour les patients à risque faible qui seront maintenus à domicile, ceci en utilisant des regroupements basés sur l'évaluation du risque de chaque patient.Today, the accumulation of risks associated with factors such as increasing urbanization, climate change and variability, terrorism, animal and human epidemics or pandemics and enlarged mobility of people and goods have increased the disruptive and even destructive impact of various types of disasters. Crisis management plans are developed to better manage the crisis or even to avoid it. The purpose of this research is to develop decision aid tools to support the different phases of the crisis management plan for home health care (HHC) structures, mainly for preparation and response phases. A set of scenarios, considering the different sources of crises and the impacted business processes, with regard to their frequency and their human and material impacts, have been defined. An original approach of vulnerability analysis based on graph theory and matrix methods has been developed. The objective is to measure the impact of different crises on the HHC structure in terms of actors and exchanged flows. Based on this assessment phase we have proposed a classification of HHC actors. Different methods have been proposed for the design of mitigation strategies and countermeasures for each class of actors. The problem of access to care in the context of a scenario of massive intoxication is considered. A linear programming model has been proposed to simulate the studied scenario and evaluate its consequences. It models a foodborne infection and its medical response as part of a HHC-Hospital collaboration, in the framework of an extended white plan. The issue of access to patients' homes has been investigated in the context of a flood-like scenario. The proposed tool provides an evacuation plan for critical patients to evacuate and a home support plan for low-risk patients who will be kept at home, using clustering based on each patient's risk assessment

Proactivité des systèmes de soins à domicile face à des crises sanitaires

Today, the accumulation of risks associated with factors such as increasing urbanization, climate change and variability, terrorism, animal and human epidemics or pandemics and enlarged mobility of people and goods have increased the disruptive and even destructive impact of various types of disasters. Crisis management plans are developed to better manage the crisis or even to avoid it. The purpose of this research is to develop decision aid tools to support the different phases of the crisis management plan for home health care (HHC) structures, mainly for preparation and response phases. A set of scenarios, considering the different sources of crises and the impacted business processes, with regard to their frequency and their human and material impacts, have been defined. An original approach of vulnerability analysis based on graph theory and matrix methods has been developed. The objective is to measure the impact of different crises on the HHC structure in terms of actors and exchanged flows. Based on this assessment phase we have proposed a classification of HHC actors. Different methods have been proposed for the design of mitigation strategies and countermeasures for each class of actors. The problem of access to care in the context of a scenario of massive intoxication is considered. A linear programming model has been proposed to simulate the studied scenario and evaluate its consequences. It models a foodborne infection and its medical response as part of a HHC-Hospital collaboration, in the framework of an extended white plan. The issue of access to patients' homes has been investigated in the context of a flood-like scenario. The proposed tool provides an evacuation plan for critical patients to evacuate and a home support plan for low-risk patients who will be kept at home, using clustering based on each patient's risk assessment.Aujourd'hui, l'accumulation des risques associés à des facteurs comme l'urbanisation croissante, le changement et la variabilité du climat, le terrorisme, les épidémies ou pandémies animales et humaines ainsi que la mobilité accrue des personnes et des biens de par le monde, ont accru le potentiel perturbateur voire destructeur de divers types de catastrophes. Des plans de gestion de crises sont élaborés pour gérer au mieux la catastrophe engendrée voire l’éviter. L’objectif de ce travail de recherche est de développer des outils d’aide à la décision pour supporter les différentes phases du plan de gestion de crises dédiés aux établissements de soins à domiciles, notamment les phases de préparation et de réponse. Un ensemble de scénarios à étudier prioritairement en considérant les différentes sources de crises et les processus métier impactés, quant à leur fréquence et leurs impacts humain et matériel, a été défini. Une approche originale d’analyse de vulnérabilité basée sur la théorie des graphes et des matrices a été développée. Le but est de pouvoir mesurer l’impact des différentes crises sur la structure d’hospitalisation à domiciles en termes d’acteurs et de flux échangés. En se basant sur cette phase d’évaluation, nous avons proposé : une classification des acteurs de l’HAD, des méthodes pour la conception des stratégies et des contremesures de mitigation pour chaque classe d’acteurs. La problématique d’accès aux soins dans le cadre d’un scénario d’intoxication massive a été abordée. Un modèle de programmation linéaire a été proposé pour simuler le scénario étudié et évaluer ses conséquences. Il modélise l'infection d'origine alimentaire et la réponse médicale dans le cadre d’une collaboration HAD-Hôpital, c.-à-d., un plan blanc élargi. La problématique d’accès aux domiciles des patients a été investiguée dans le cadre d’un scénario de type crue, épisode neigeux etc. L'outil proposé fournit un plan d'évacuation pour les patients critiques à évacuer et un plan de soutien à domicile pour les patients à risque faible qui seront maintenus à domicile, ceci en utilisant des regroupements basés sur l'évaluation du risque de chaque patient

Home Health Care Vulnerability Assessment Using Graph Theory and Matrix Methods

International audienceThe accumulation of factors like climate variability, epidemics and the increasing mobility of people around the world have increased the devastator impact of disasters. Furthermore, people have become more aware and exigent especially in terms of healthcare. Hence, a lot of pressure has beenexercised on the healthcare system. Home Health Care (HHC), as a vital component of the healthcare system is facing manifolds crisis that can undermine its activities. This paper addresses the question of HHC vulnerability assessment. We use digraph presentation and matrix operations in order to synthetize indexes that infer the severity of crisis situations that a HHC facility could face, based on the predefined criteria. We introduce dynamic vulnerability assessment that takes into account cascading events over time. Vulnerability Priority Index (VPI) has been proposed to support decision-making related to the design of countermeasures and mitigation policies

PrHoDom : Protection de l'Hospitalisation à Domicile

International audienceAujourd'hui, l'accumulation des risques associés à des facteurs comme l'urbanisation croissante, le changement et la variabilité du climat, le terrorisme, les épidémies ou pandémies animales et humaines ainsi que la mobilité accrue des personnes et des biens de par le monde, a accru le potentiel perturbateur voire destructeur de divers types de catastrophes. Différents scénarios de sinistres naturels ou humains ont été étudiés et ont donné lieu à la proposition d'organisations, de dimensionnements de ressources matérielles et humaines, et de pratiques dans le cadre des plans blancs des structures d'hospitalisation à domicile. Les problématiques sous-jacentes sont plus particulièrement : l'accès aux domiciles des patients pour les sinistres naturels, l'accès aux soins pour les sinistres humains, l'accès à l'information pour la cybercriminalité

A Mitigation Tool to Protect a Home Health Care Structure Facing a Hydrological Disaster

International audienceThis paper deals with the problem to face hydrological disasters such as a flood, in a home health care structure. InFrance, these hospitals deliver mainly home health care by employing liberal nurses and liberal physicians (patients’ referring physicians), but they employ also salaried nurses and salaried physicians to control the quality of cares and to ensure the care continuity, respectively. The cares and the physicians' consultations are organized through home tour schedules. In the event of a flood, home tours can be compromised depending on home accessibility. A patient home can be easily or hardly accessible and the home care tour can be or not prolonged depending on the time required to reach each patient home. In the case where the patient home is invaded by the water, the patient must be evacuated to a regular hospital or to a field hospital which has been set up temporarily to receive the evacuated patients. In this paper, a decision-making tool is proposed to face the hydrological disaster i.e. to decide: which patients must be evacuated, which resources must be used to keep patients at home, and how many beds are required to host the evacuated patients. With such a tool, home health care structures can initiate the required collaborations in order to be ready to respond to such emergency crisis and plan patient evacuations during the flood

Les plans de gestion de crises dans les pays francophones

International audienceLa gestion des catastrophes, appelée plus communément gestion des situations d'urgences ou encore gestion de crises, est la discipline qui s'intéresse à l'évaluation des menaces et de leurs risques relatifs ainsi qu'aux stratégies mises en oeuvre afin d'en limiter l'occurrence ou les conséquences en cas de survenue. Dans ce papier, nous allons étudier le cadre réglementaire et les mesures prises par les gouvernements pour gérer des situations exceptionnelles de crises dans quatre pays et une province canadienne (France, Belgique, Luxembourg, Maroc et Québec). Une étude comparative sur les structures des plans de gestion d'urgences dans ces pays/province a été menée, et nous a permis de mettre en exergue le rôle de la coordination entre les différentes parties prenantes afin de bien gérer la situation de crise. Abstract: Disaster management, more commonly called emergency management or crisis management is the discipline that focuses on assessing threats, their relative risks, and the measurements implemented in order to mitigate the consequences. In this paper we study the regulatory framework and measures taken by governments to manage exceptional situations of crises in five countries (France, Belgium, Luxembourg, Morocco and Quebec). A comparative study on the structure of emergency management plans in these countries was conducted, and we have highlighted the role of coordination between the different stakeholders to manage the crisis

An Emergency Management Plan to Face a Foodborne Criminal Attack

International audienceFood poisoning is frequent in mass catering. Infections could occur with the raw materials used, the process of food preparation, the means of transport and preservation employed, etc. In this paper, we study the scenario of a malicious food poisoning involving patients of a home health care structure. Home health care patients are mainly disabled and/or elderly people. Being non-autonomous, they order meals to caterers. A criminal employee of a caterer could infect the foods which poison part of the home health care patients and some valid people. To face such threat, the home health care structure has planned to collaborate with conventional hospitals to better care people during the acute and recovery phases of the infection, in the framework of an emergency management plan. A linear program is proposed to simulate the studied scenario and assess its consequences. It models the foodborne infection and the medical response

Simulation in degraded mode of sterilization services

International audienceHealth care services are usually subject to numerous types of risks and hazards. Besides, the risks occurrences andtheir management are slightly taken into account in the current simulation models dealing with health care systemwithin health institutions, even if some risks, and mainly those related to the services performance, can lead to anew structure and organization of the production system. In this work, we focus on the hospital sterilization service.We develop an integrated approach that consists in taking a classic simulation model and enrich it with some risksto get into a simulation in degraded mode of the sterilization service within hospitals, in order to evaluate theperformance of the system in both situations. We will discover to which extent it would be possible to implementthis approach using Arena software