Reallocation of beds to reduce waiting time for cardiac surgery

Waiting time for cardiac surgery is a significant problem in the current medical world. The fact that patients length of stay varies considerably makes effective hospital operation a hard job. In this paper, the patients length of stay is analyzed. Three scenarios for hospital management are presented and evaluated in two ways. First, the theoretical number of beds needed in each of these scenarios is analyzed using techniques from Markov chain theory. This analysis does not include the important variability in length of stay. Therefore, the second evaluation is based on simulation experiments to further investigate the variability. The aim of the analyses is to look at unused bed capacity in the hospital wards. By knowing the size of the unused bed capacity, it is possible to come to a more efficient reallocation of the beds. The results presented in this paper provide some insight in the relation between patients length of stay, bed availability and hospital waiting lists. Finally, some ideas are raised as discussion points for further research.

Reallocation of Beds to Reduce Waiting Time for Cardiac Surgery

Waiting time for cardiac surgery is a significant problem in the current medical world. The fact that patients' length of stay varies considerably makes effective hospital operation a hard job. In this paper, the patients' length of stay is analyzed. Three scenarios for hospital management are presented and evaluated in two ways. First, the theoretical number of beds needed in each of these scenarios is analyzed using techniques from Markov chain theory. This analysis does not include the important variability in length of stay. Therefore, the second evaluation is based on simulation experiments to further investigate the variability. The aim of the analyses is to look at unused bed capacity in the hospital wards. By knowing the size of the unused bed capacity, it is possible to come to a more efficient reallocation of the beds. The results presented in this paper provide some insight in the relation between patients' length of stay, bed availability and hospital waiting lists. Finally, some ideas are raised as discussion points for further research

Enacting Fit in Work Organization and Occupational Structure Design:The Case of Intermediary Occupations in a Dutch Hospital

We report and interpret findings from an investigation of work redesign and the introduction of a new occupational position, nurse practitioner (NP), in four different subunits in a large Dutch university hospital. Full development of the new position and its contribution to performance crucially depend on the delegation of medical tasks to NPs. The motive for introducing the new occupation and redesigning the work processes was to improve treatment quality and patient-centredness, to reduce throughput times and to assure operating efficiency. However, the degree and modality of reaching such objectives depends on the local politics of management and medical practitioners, resting on interpretations of appropriate roles and task divisions. Thus, task environmental influences affect work structure redesign as the former were perceived and enacted by local practitioners. The overall process of redesign and the way it differed between departments is best explained by combining a modified contingency theory with an interactionist and organizational politics approach