Aanpak efficiency te ondoordacht

Om de efficiency in een ziekenhuis te vergroten wordt steeds vaker gebruikgemaakt van bedrijfskundige methoden en operations management-technieken. Wat daarover wordt gerapporteerd, zijn vooral successtory’s. Terwijl het bewijs voor het effect nogal mager is

An exact approach for relating recovering surgical patient workload to the master surgical schedule

No other department influences the workload of a hospital more than the Department of Surgery and in particular, the activities in the operating room. These activities are governed by the master surgical schedule (MSS), which states which patient types receive surgery on which day. In this paper we describe an analytical approach to project the workload for downstream departments based on this MSS. Specifically the ward occupancy distributions, patient admission/discharge distributions, and the distributions for ongoing interventions/treatments is computed. Recovering after surgery requires the support of multiple departments, such as nursing, physiotherapy, rehabilitation and long term care. With our model, managers from these departments can determine their workload by aggregating tasks associated with recovering surgical patients. The model, which supported the development of a new MSS at the Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, provides the foundation for a decision support tool to relate downstream hospital departments to the operating room

Improving resource capacity planning in hospitals with business approaches.

This dissertation contributed to the knowledge on the translation of approaches from businesses and services to improve the resource capacity planning on tactical and operational level in (oncologic) hospital care. The following studies were presented: * Chapter 2 surveyed the business approaches and tools that Dutch hospitals applied to improve resource capacity planning, and analyzed the results the hospitals claimed to have achieved. * Chapter 3 explored the application of the focused factory concept in four multiple case studies, by examining the degree of focus, the organizational context, and the operational performance. * Chapter 4 dealt with the feasibility, the process and the success factors of international (comprehensive) benchmarking in specialty hospitals and specialized cancer centres. * Chapter 5 examined how a combination of benchmarking and lean management can enable considerable patient growth in a chemotherapy day unit without adding proportionally staff, while sustaining current quality and patient satisfaction levels. * Chapter 6 examined the relation between simulation and the implementation of recommendations with a literature review and a survey to the authors included in the literature review. * Chapter 7 examined the use of computer simulation to reduce the time between the CT request and the consult in which the CT report is discussed while maintaining an acceptable idle time and overtime of the CT. Effects of the intervention were evaluated using a before-and-after design. All examined business approaches may contribute to the improvement of resource capacity planning. The recommendations were mainly context specific while applied and developed seem to be generally applicable. Critical factors to implement the approaches successfully were identified

Materiales para una flora de las algas del NE de España. I. Zygnemales

Posteriormente a la publicación de mi primera contribución a la flora algológica de nuestras aguas dulces (1944), he dado preferencia a la preparación de trabajos de carácter local y ecológico, por entender que éstos podían conducir más rápidamente al planteamiento, y quizá a la resolución, de problemas de interés superior al puramente taxonómico. Pero el estudio de muchos centenares de muestras de algas, procedentes de localidades dispersas de Cataluña y de comarcas limítrofes, ha ido prosiguiendo independientemente, permitiendo reunir una cantidad considerable de datos inéditos. Eáta nota es la primera de una serie de contribuciones taxonómicas a nuestra flora algológica, que tendrán como base el material no utilizado en otros trabajos de limnología regional o local

Exploring improvements in patient logistics in Dutch hospitals with a survey

Background Research showed that promising approaches such as benchmarking, operations research, lean management and six sigma, could be adopted to improve patient logistics in healthcare. To our knowledge, little research has been conducted to obtain an overview on the use, combination and effects of approaches to improve patient logistics in hospitals. We therefore examined the approaches and tools used to improve patient logistics in Dutch hospitals, the reported effects of these approaches on performance, the applied support structure and the methods used to evaluate the effects. Methods A survey among experts on patient logistics in 94 Dutch hospitals. The survey data were analysed using cross tables. Results Forty-eight percent of all hospitals participated. Ninety-eight percent reported to have used multiple approaches, 39% of them used five or more approaches. Care pathways were the preferred approach by 43% of the hospitals, followed by business process re-engineering and lean six sigma (both 13%). Flowcharts were the most commonly used tool, they were used on a regular basis by 94% of the hospitals. Less than 10% of the hospitals used data envelopment analysis and critical path analysis on a regular basis. Most hospitals (68%) relied on external support for process analyses and education on patient logistics, only 24% had permanent internal training programs on patient logistics. Approximately 50% of the hospitals that evaluated the effects of approaches on efficiency, throughput times and financial results, reported that they had accomplished their goals. Goal accomplishment in general hospitals ranged from 63% to 67%, in academic teaching hospitals from 0% to 50%, and in teaching hospitals from 25% to 44%. More than 86% performed an evaluation, 53% performed a post-intervention measurement. Conclusions Patient logistics appeared to be a rather new subject as most hospitals had not selected a single approach, they relied on external support and they did not have permanent training programs. Hospitals used a combination of approaches and tools, about half of the hospitals reported goal accomplishment and no approach seemed to outperform the others. To make improvement efforts more successful, research should be conducted into the selection and application of approaches, their contingency factors, and goal-setting procedure

Selecting indicators for international benchmarking of radiotherapy centres

Introduction: Benchmarking can be used to improve hospital performance. It is however not easy to develop a concise and meaningful set of indicators on aspects related to operations management. We developed an indicator set for managers and evaluated its use in an international benchmark of radiotherapy centres. The indicator set assessed the efficiency, patient-centeredness and timeliness of the services delivered.\ud Methods: We identified possible indicators from literature and professionals. Stakeholders’ feedback helped to produce a shortlist of indicators. For this indicator set, data were obtained in a pilot that included four European radiotherapy centres. With these data, the indicators were evaluated on definition clarity, data availability, reliability and discriminative value.\ud Results: Literature produced a gross list of 81 indicators. Based on stakeholder feedback, 33 indicators were selected and evaluated in the benchmark. Six negatively evaluated indicators were adapted, together with eight positively evaluated indicators 14 indicators seemed feasible. Examples of indicators concerned utilisation, waiting times, patient satisfaction and risk analysis.\ud Conclusions: This study provides a pragmatic indicator development process for international benchmarks on operations management. The presented indicators showed to be feasible for use in international benchmarking of radiotherapy centres. The pilot identified attainable performance levels and provided leads for improvement

Selecting indicators for international benchmarking of radiotherapy centres

Introduction: Benchmarking can be used to improve hospital performance. It is however not easy to develop a concise and meaningful set of indicators on aspects related to operations management. We developed an indicator set for managers and evaluated its use in an international benchmark of radiotherapy centres. The indicator set assessed the efficiency, patient-centeredness and timeliness of the services delivered. Methods: We identified possible indicators from literature and professionals. Stakeholders’ feedback helped to produce a shortlist of indicators. For this indicator set, data were obtained in a pilot that included four European radiotherapy centres. With these data, the indicators were evaluated on definition clarity, data availability, reliability and discriminative value. Results: Literature produced a gross list of 81 indicators. Based on stakeholder feedback, 33 indicators were selected and evaluated in the benchmark. Six negatively evaluated indicators were adapted, together with eight positively evaluated indicators 14 indicators seemed feasible. Examples of indicators concerned utilisation, waiting times, patient satisfaction and risk analysis. Conclusions: This study provides a pragmatic indicator development process for international benchmarks on operations management. The presented indicators showed to be feasible for use in international benchmarking of radiotherapy centres. The pilot identified attainable performance levels and provided leads for improvement