Why resilience in health care systems is more than coping with disasters: implications for health care policy

Health care systems need to be resilient to deal with disasters like the global spread of the Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV-2) on top of serving the changing needs of a multi-morbid, ageing and often dispersed population. This paper identifies, discusses and augments critical dimensions of resilience retrieved from the academic literature. It pulls together an integrated concept of resilience characterised by organisational capabilities. Our concept does not focus on the micro-level like most resilience literature in health care but addresses the system level with many stakeholders involved. Distinguishing exogenous shocks to the health care system into adverse events and planned innovations provides the basis for our conclusions and insights. It becomes apparent only when dealing with planned interventions that transformative capabilities are indispensable to cope with sudden increases in health care pressures. Due to the current focus on absorptive and adaptive resilience, organisations over-rely on management capabilities that cannot generate a lasting increase in functionality. Therefore, reducing the resilience discussion to bouncing back from adverse events could deceive organisations into cultivating a suboptimal mix of organisational capabilities lacking transformative capabilities, which pave the way for a structural change that aims at a sustainably higher functionality

Hospital management games: a taxonomy and extensive review

Hospital management games have gained importance in better planning for scarce resources in times of growing health care demand and increasing technology costs. We classify and investigate the main characteristics of these games from an Operations Research (OR) perspective. Hospital management games model the complex decision making process of internal resource, process, and financial management all influenced by the external hospital environment (e.g., purchasing markets, job markets, legal/political conditions, competition) and simulate situations of the real world. We also highlight the potential of these games for teaching OR in the classroom. Experiencing the advantages of OR may reduce the reservations policy makers have and could make them increasingly open to promoting OR applications in practice. We also disclose potential for new applications

Competition under different reimbursement systems: The concept of an internet-based hospital management game

We have developed an internet-based management game to illustrate the economic and organisational decision-making process in a hospital by using discrete event simulation. Up to six hospitals compete against each other for inpatients with different disease categories and budget depending on hospital mission, regional health policy, inpatient reimbursement system (day-, case- and global-budget based) as well as labour and radiology technology market for 12 decision periods. Players can evaluate alternative actions for capacity planning as well as patient scheduling and control problems depending on different game situations. The uniqueness of COREmain hospital game consists of the internet-based framework, the combination of resource, process and financial result management, the competition of hospitals within a region and the consideration of different inpatient reimbursement systems. The deployment of this game in teaching, policy and research might improve policy making both at a hospital, regional and national level and also induce further research in these fields

Using discrete-event simulation to select affordable intervention programs for vertical HIV transmission in developing countries

With 40 million people living with HIV/AIDS worlwide, this pandemic has had devastating impacts on the social, economic, and demographic structure of many developing countries. Over 70% of the world's HIV-infected live in Africa. Thus, implementing cost-effective prevention programs, such as short-course anti-retroviral treatment for pregnant mothers and their offspring, are critical issues for healthcare providers in these countries.We have developed the first published discrete event simulation model to support policy makers in this area. In this paper, we analyze screening programs and Nevirapine treatment (assumed to be effective up to three months after delivery). These prices might not be affordable for developing countries, but if sponsor organizations covered the educational costs, the programs could be achievable and would even save money