Applying Mathematical Models to Surgical Patient Planning

On a daily basis surgeons, nurses, and managers face cancellation of surgery, peak demands on wards, and overtime in operating rooms. Moreover, the lack of an integral planning approach for operating rooms, wards, and intensive care units causes low resource utilization and makes patient flows unpredictable. An ageing population and advances in medicine are putting the available healthcare budget under great pressure. Under these circumstances, hospitals are seeking innovative ways of providing optimal quality at the lowest costs. This thesis provides hospitals with instruments for optimizing surgical patient planning. We describe a cyclic and integrated operating room planning approach, called master surgical scheduling, and models for efficient planning of emergency operations. Application of these instruments enables the simultaneous optimization of the utilization of operating rooms, ward and intensive care units. Moreover, iteratively executing a master schedule of surgical case types provides steady and thus more predictable patient flows in hospitals. The approach is generic and so can be implemented taking account of specific characteristics of individual hospitals. Prerequisites for successful implementation of logistical models in hospitals comprise sufficient room for last-minute changes as well as keeping the ultimate responsibility for individual patient scheduling with medical specialists. Both are satisfied in the master surgical scheduling approach which has already been successfully implemented in hospitals

Levelled bed occupancy and controlled waiting lists using Master surgical schedules

Scheduling surgical patients is one of the complex organizational tasks hospitals face daily. Master surgical scheduling is one way to optimize utilization of scarce resources and to create a more predictable outflow from the operating room towards subsequent hospital departments. The paper addresses two aims. First, we investigate the effect of the length of the planning horizon and other planning parameters in a master surgical scheduling approach on patients ́ waiting time, schedule stability and hospital efficiency. Second, the master surgical scheduling approach is compared with a standard operating room planning approach on levelled bed occupancy. The assignment of patients to a master surgical schedule is carefully described. Using real case data from a regional hospital i

A method for clustering surgical cases to allow master surgical scheduling

Master surgical scheduling can improve manageability and efficiency of operating room departments. This approach cyclically executes a master surgical schedule of surgery types. These surgery types need to be constructed with low variability to be efficient. Each surgery type is scheduled based upon its frequency per cycle. Surgery types that cannot be scheduled repetitively are put together in so-called dummy surgeries. Narrow defined surgery types, with low variability, lead to a large volume of such dummy surgeries that reduce the benefits of a master surgical scheduling approach. In this paper we propose a method, based on Ward's hierarchical cluster method, to obtain surgery types that minimizes the weighted sum of the dummy surgery volume and the variability in resource demand of surgery types. The resulting surgery types (clusters) are thus based on logical features and can be used in master surgical scheduling. The approach is successfully tested on a case study in a regional hospital

Productivity and quality of Dutch hospitals during system reform

This study addresses the productivity of Dutch hospitals since the start of the health systems reform in 2005. We consider DEA based measures, which include efficiency and quality for the complete set of Dutch hospitals and present cross-sectional and longitudinal analysis. In particular, we consider how hospital efficiency has developed. As the reform created an environment of regulated competition, we pay special attention to relative efficiency. Our results suggest that the differences in efficiency among hospitals have become larger. In the years 2009–2010, the number of hospitals identified as (close to) efficient by DEA analysis decreased

Physician Incentive Management in University Hospitals: Inducing Efficient Behavior Through the Allocation of Research Facilities

The imperative to improve healthcare efficiency is now stronger than ever. Rapidly increasing healthcare demand and the prospect of healthcare cost exploding require that measures be taken to make healthcare organizations become more efficiency-aware. Alignment of organizational interests is therefore important. One of the main hurdles to overcome is the provision of the right incentives to healthcare workers, in particular physicians. In this research we investigate the incentive system for physicians in university hospitals. We present an inquiry held in a large university hospital in the Netherlands and show that non-financial incentives receive significantly more support among physicians than financial incentives. Over 95 percent of the physicians indicated they derive more work stimulus from research possibilities or scientific status than from wage. Over 80 percent of the physicians also indicated they prefer to be able to do more research. We therefore identified a broad class of non-financial incentives aimed at physicians in university hospitals: research facilities. The main tradeoff in using research facilities within an incentive system is between efficient resource utilization and inducement effects. This thesis constructs a principal-multi-agent model where agents engage in both care and research and which includes heterogeneity and private information. We study how research facilities incentives can be used to improve hospital performance if the current wage system is left intact. We show that research facilities are optimally used as incentives for both care and research activities, and that the hospital offers different contracts depending on physician ability and valuation. Moreover, if physicians need to reveal their valuations for research facilities, the hospital finds it optimal to allow physicians to make a rent. We discuss some implications of extending the theoretical results to practice

Managerial implications and suitability of a master surgical scheduling approach

Master surgical scheduling can improve manageability and efficiency of operating room departments. This approach cyclically executes a master surgical schedule of surgery types. These surgery types need to be constructed with low variability to be efficient. Each surgery type is scheduled based upon its frequency per cycle. Surgery types that cannot be scheduled repetitively are put together in so-called dummy surgeries. Narrow defined surgery types, with low variability, lead to a large volume of such dummy surgeries that reduce the benefits of a master surgical scheduling approach. In this paper we propose a method, based on Ward's hierarchical cluster method, to obtain surgery types that minimizes the weighted sum of the dummy surgery volume and the variability in resource demand of surgery types. The resulting surgery types (clusters) are thus based on logical features and can be used in master surgical scheduling. The approach is successfully tested on a case study in a regional hospital