Planificación de la logística en redes de salud: análisis y resolución

Healthcare networks bring together a wide range of public and private entities (hospitals, specific service units, healthcare professionals, …) at local or regional level that seek for management effectiveness, decisional efficacy and coordination. This thesis analyzes the problem statement: "How can those organizations integrate their internal logistic network?" Theories, concepts and integration guidelines from supply chain management theory have been applied to investigate this problem. On healthcare networks already in place, the application of centralized planning procedures is the more appropriate management strategy to rationalize and pilot the change processes. Hence, a general tactical level model is stated as a mixed integer linear programming (MILP) model supporting decisions on the global view of network layout and the coordinating policy among facilities in such networks. Apart from the adoption of optimization tools to provide a framework for costefficient operations, we have identified that information sharing and service level agreements are the key aspects in the effective accomplishment of logistics integration. We have conducted a case study at the Andalusian Regional Network of Clinical Laboratories (ANCL), a large healthcare network with geographically dispersed hospitals, clinics, and testing laboratories, that initiated an organizational strategy to enhance accessibility to services, quality of care and cost savings. Different solution strategies have been addressed in the MILP model that arises, in order to embed this model into a graphical, interactive and responsive Decision Support System (DSS) tool to support ANCL planners’ analysis of What-If scenarios. Drawing on the ANCL case study, it appears that the integration of the Information Tecnologies (IT) Systems at the different facilities and locations within the network and the centralization of the logistic planning procedure can be of invaluable help for aligning operational models and organizational behavior around demand, capacity and network configuration. This suggests that although such integration projects are difficult, costly and complex, they seem worth undertaking.Las Redes de Salud se basan en el trabajo en común de una variedad de entidades públicas y privadas (hospitales, unidades de servicios específicos, profesionales sanitarios,...) a nivel local o regional, en busca de una gestión efectiva, con toma de decisiones y coordinación eficientes. Esta tesis analiza la siguiente pregunta de investigación: "¿Cómo pueden las organizaciones integrar su red logística interna" Las teorías, conceptos y directrices de integración de la Cadena de Suministro se han aplicado para investigar este problema. En redes de salud ya funcionando, la aplicación de procedimientos de planificación centralizada se identifica como la estrategia de gestión más adecuada para racionalizar y pilotar los procesos de cambio. Por ello, planteamos abordar el objeto de la tesis mediante un modelo de programación lineal entera mixta (MILP) de nivel táctico, del que emanarán las decisiones sobre la visión global del diseño de la red y la política de coordinación entre los miembros de la red. Además de la adopción de herramientas de optimización para proporcionar un marco para operaciones eficientes en costes, hemos identificado como aspectos clave en la consecución efectiva de la integración logística en este tipo de redes el intercambio de información y el cumplimiento de acuerdos de nivel de servicio. Como caso práctico, hemos realizado esta integración en la Red Andaluza Regional de Laboratorios Clínicos (ANCL), una red sanitaria extensa con hospitales, clínicas y laboratorios clínicos dispersos geográficamente, que inició una estrategia de cambio organizacional para mejorar la accesibilidad al servicio de pruebas clínicas, la calidad del servicio y propiciar ahorro de costes. Sobre el MILP que resulta al abordar este caso de estudio, hemos aplicado diferentes estrategias de solución. Puesto que este modelo de optimización ha de usarse como el corazón de un Sistema de Soporte a la Decisión (DSS) a disposición de los planificadores ANCL para realizar análisis de escenarios, la agilidad en la generación de soluciones es un requisito primordial. Basándonos en nuestra experiencia con la ANCL, parece que tanto la integración de los sistemas de Tecnologías de Información de los diferentes miembros en la red como la centralización del procedimiento de planificación logística (a través del cual se fijan las directrices de coordinación anual) son de inestimable ayuda para la alineación del modelo operativo y el comportamiento organizacional en torno a demanda, capacidad y configuración de red. Esto sugiere que aunque tales proyectos de integración sean difíciles, costosos y complejos, el esfuerzo parece valer la pena

A Decision-Making Tool for a Regional Network of Clinical Laboratories

For healthcare systems that operate in large, geographically dispersed areas, the quality of the services provided requires the effective management of a complex transportation problem. We present a decision support system to help healthcare managers improve the delivery of biological samples collected from patients in hospitals and outpatient clinics to laboratories that perform tests on them. We develop an optimization model for supporting strategic decisions on the transport of samples and the assignment of work in a large healthcare network with geographically dispersed hospitals, clinics, and testing laboratories. We embed our model in a Web-based tool to provide planners with interactive functions, enabling them to explore solutions and interactively access data to facilitate the analysis of what-if scenarios. The tool proved invaluable in helping the Andalusian Healthcare System obtain significant improvements in efficiency, quality of service, and outsourcing costsJunta de Andalucía TEP-606

Design and Assessment of an Urban Circular Combined Truck–Drone Delivery System Using Continuum Approximation Models and Integer Programming

Copyright: © 2022 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https:// creativecommons.org/licenses/by/ 4.0/).The analysis of tandem truck–drone delivery systems has recently attracted the attention of the research community, mainly focused on extending classical operational research problems such as the multiple traveling salesperson or the vehicle-routing problem. In this paper, we explore the design of an urban massive combined delivery system using a continuum approximation (CA) method for a circular city characterized by a certain density of customers. Starting from a set of parameters defining the main characteristics of trucks and drones, a sectorization of the delivery area is first determined. Then, for a given truck capacity, the optimal number of trucks is obtained considering different scenarios using three integer programming models. We propose several performance indicators to compare the tandem approach with the alternative solely truck delivery system

Project Management at University: Towards an Evaluation Process around Cooperative Learning

The enrollment in current Master's degree programs usually pursues gaining the expertise required in real-life workplaces. The experience we present here concerns the learning process of "Project Management Methodology (PMM)", around a cooperative/collaborative mechanism aimed at affording students measurable learning goals and providing the teacher with the ability of focusing on the weaknesses detected. We have designed a mixed summative/formative evaluation, which assures curriculum engage while enriches the comprehension of PMM key concepts. In this experience we converted the students into active actors in the evaluation process itself and we endowed ourselves as teachers with a flexible process in which along with qualifications (score), other attitudinal feedback arises. Despite the high level of self-affirmation on their discussion within the interactive assessment sessions, they ultimately have exhibited a great ability to review and correct the wrong reasoning when that was the case

Determinación de un plan operativo semanal para la Red Andaluza de Laboratorios Clínicos

Presentamos un modelo para coordinar el funcionamiento en una Red Regional de Laboratorios Clínicos, cuya resolución permite la reasignación de recursos, la redistribución de cargas y la reorganización de los flujos de muestras clínicas en dicha. Para ello, se determina un plan de producción y transporte: primero en un nivel táctico (anual) y luego a un nivel operativo (semanal). Se plantea como un problema de flujo multicommodity que conduce a una formulación entera mixta. Se presenta experimentación aplicada a la reordenación de las derivaciones de muestras entre los 32 nodos principales de la Red Andaluza de Laboratorios Clínicos.Andalucía. Junt

Comparison of heuristics for rescheduling in permutation flowshops

NUMERO ESPECIAL / SPECIAL ISSUE XIII Congreso de Ingeniería de Organización 3nd International Conference on Industrial Engineering and Industrial ManagementRescheduling is one of the main consequences of the variability in the shop floor, as a number of unforeseeable disruptions make impossible to follow the original schedule. In this paper we study a flowshop rescheduling problem where a set of jobs arrives to the system and it is scheduled together with jobs already present. The objective is to minimise the makespan of the new jobs and constrained with the fact that the maximum tardiness of the old jobs must be equal to zero. The problem is NP-hard, so we compare heuristic methods in order to select the best option.. La resecuenciación es una de las principales consecuencias de la variabilidad en los talleres, ya que las interrupciones no hacen posible el seguimiento de la secuencia inicial. Este trabajo aborda un problema de resecuenciación en flujo regular donde un conjunto de trabajos llega al sistema, y son secuenciados junto con un conjunto de trabajos que ya está planificado. El objetivo es minimizar el makespan de los nuevos trabajos, restringido a que la máxima tardanza de los trabajos antiguos debe ser cero. El problema es NP, por lo que se comparan diferentes métodos heurísticos para su resolución, y se selecciona la mejor opciónMinisterio de Ciencia e Innovación DPI2007-61345Junta de Andalucía P08-TEP-363

A Tandem Drone-ground Vehicle for Accessing Isolated Locations for First Aid Emergency Response in Case of Disaster

The collapse of infrastructures is very often a complicating factor for the early emergency actuations after a disaster. A proper plan to better cover the needs of the affected people within the disaster area while maintaining life-saving relief operations is mandatory hence. In this paper, we use a drone for flying over a set of difficult-to-access locations for imaging issues to get information to build a risk assessment as the earliest stage of the emergency operations. While the drone provides the flexibility required to visit subsequently a sort of isolated locations, it needs a commando vehicle in ground for (i) monitoring the deployment of operations and (ii) being a recharging station where the drone gets fresh batteries. This work proposes a decision-making process to plan the mission, which is composed by the ground vehicle stopping points and the sequence of locations visited for each drone route. We propose a Genetic Algorithm (GA) which has proven to be helpful in finding good solutions in short computing times. We provide experimental analysis on the factors effecting the performance of the output solutions, around an illustrative test instance. Results show the applicability of these techniques for providing proper solutions to the studied problem

Planificación quirúrgica: revisión de la literatura

La realización de intervenciones quirúrgicas en los hospitales es una actividad crucial tanto desde un punto de vista social como económico. Por un lado, mejora la calidad de vida del paciente, mientras que por otro se estima que genera alrededor del 70% de los ingresos, y representa en torno al 40% de los costes de un hospital. El quirófano -Operating Room (OR)- es una sala acondicionada para realizar intervenciones quirúrgicas, que puede consumir entre el 10-15% del presupuesto de un hospital, siendo la instalación más cara, y constituyendo un cuello de botella para la mayoría de hospitales (Jebali et al. ,2006). Por tanto, la correcta gestión de los ORs es un factor importante en la gestión de los hospitales, puesto que son un recurso limitado por su propia capacidad y por los recursos materiales y humanos necesarios para su correcto funcionamiento. El objetivo de este trabajo es caracterizar los problemas de decisión involucrados en la planificación quirúrgica. Para ello, se ha conducido una revisión sistemática para analizar y evaluar los trabajos publicados en el ámbito de la planificación quirúrgica

Environmental gradients and the evolution of successional habitat specialization: A test case with 14 Neotropical forest sites

https://www.scopus.com/inward/record.url?eid=2-s2.0-84939570316&partnerID=40&md5=fcadae8e6c274e8b7efca96099304a7cSuccessional gradients are ubiquitous in nature, yet few studies have systematically examined the evolutionary origins of taxa that specialize at different successional stages. Here we quantify successional habitat specialization in Neotropical forest trees and evaluate its evolutionary lability along a precipitation gradient. Theoretically, successional habitat specialization should be more evolutionarily conserved in wet forests than in dry forests due to more extreme microenvironmental differentiation between early and late-successional stages in wet forest. We applied a robust multinomial classification model to samples of primary and secondary forest trees from 14 Neotropical lowland forest sites spanning a precipitation gradient from 788 to 4000 mm annual rainfall, identifying species that are old-growth specialists and secondary forest specialists in each site. We constructed phylogenies for the classified taxa at each site and for the entire set of classified taxa and tested whether successional habitat specialization is phylogenetically conserved. We further investigated differences in the functional traits of species specializing in secondary vs. old-growth forest along the precipitation gradient, expecting different trait associations with secondary forest specialists in wet vs. dry forests since water availability is more limiting in dry forests and light availability more limiting in wet forests. Successional habitat specialization is non-randomly distributed in the angiosperm phylogeny, with a tendency towards phylogenetic conservatism overall and a trend towards stronger conservatism in wet forests than in dry forests. However, the specialists come from all the major branches of the angiosperm phylogeny, and very few functional traits showed any consistent relationships with successional habitat specialization in either wet or dry forests. Synthesis. The niche conservatism evident in the habitat specialization of Neotropical trees suggests a role for radiation into different successional habitats in the evolution of species-rich genera, though the diversity of functional traits that lead to success in different successional habitats complicates analyses at the community scale. Examining the distribution of particular lineages with respect to successional gradients may provide more insight into the role of successional habitat specialization in the evolution of species-rich taxa

Structure, Process, and Mortality Associated with Acute Coronary Syndrome Management in Guatemala’s National Healthcare System: The ACS-GT Registry

Background: Acute coronary syndromes (ACS) include ST-segment elevation myocardial infarction (STEMI), non-ST-segment elevation myocardial infarction (NSTEMI), and unstable angina (UA). The leading cause of mortality in Guatemala is acute myocardial infarction (AMI) and there is no established national policy nor current standard of care. Objective: Describe the factors that influence ACS outcome, evaluating the national healthcare system’s quality of care based on the Donabedian health model. Methods: The ACS-Gt study is an observational, multicentre, and prospective national registry. A total of 109 ACS adult patients admitted at six hospitals from Guatemala’s National Healthcare System were included. These represent six out of the country’s eight geographic regions. Data enrolment took place from February 2020 to January 2021. Data was assessed using chi-square test, Student’s t-test, or Mann-Whitney U test, whichever applied. A p-value < 0.05 was considered statistically significant. Results: One hundred and nine patients met inclusion criteria (80.7% STEMI, 19.3% NSTEMI/UA). The population was predominantly male, (68%) hypertensive (49.5%), and diabetic (45.9%). Fifty-nine percent of STEMI patients received fibrinolysis (alteplase 65.4%) and none for primary Percutaneous Coronary Intervention (pPCI). Reperfusion success rate was 65%, and none were taken to PCI afterwards in the recommended time period (2–24 hours). Prognostic delays in STEMI were significantly prolonged in comparison with European guidelines goals. Optimal in-hospital medical therapy was 8.3%, and in-hospital mortality was 20.4%. Conclusions: There is poor access to ACS pharmacological treatment, low reperfusion rate, and no primary, urgent, or rescue PCI available. No patient fulfilled the recommended time period between successful fibrinolysis and PCI. Resources are limited and inefficiently used