A holistic approach to hospital material management process reengineering by means of the MRP algorithm

2012-2013The Hospital Materials Management (HMM) process deals with the coordination of all activities related to material ordering, holding, and administrating It is usually treated with a look-back approach (called AS IS process), by which materials are pushed into the hospital on the basis of demand forecasts, while high stock levels are distributed throughout the system to prevent stockouts. In this thesis, the possibility of reducing stocks while assuring a high service level to patients is analysed, proposing a new holistic approach to the supply chain management (called TO BE process). Medical information are used to issue materials orders (look-ahead approach), in a pulled ow of information from bed to hospital pharmacy warehouses. The research has been carried out in two steps. The first one deals with the HMM modelling and the technical feasibility evaluation of the proposal. Taking into account the clinical requirements, a deep analysis of hospital processes has been carried out and a streamlined process - from medical prescription to hospital pharmacy orders - has been proposed, which allows materials traceability and information sharing while simplifying the activities accomplishment by operators. The process has been modelled by using the Business Process Model Notation. A new Information System prototype has been implemented and verified in terms of “clinical” completeness and usability in hospital setting. The second step copes with the mathematical formalization of HMM inventory policies and the economic assessment of the proposal. The AS IS and TO BE processes have been mathematically formalized. In particular, the AS IS process follows the Periodic Review Par Level servicing approach while the TO BE adopts the Materials Requirements Planning (MRP) method. A discrete event simulation model of both processes has been developed in Arena Rockwell software. A cost performance indicator of HMM has been defined taking into account tangible and intangible aspects. Drug demand data and HMM costs have been collected in a medium university hospital. The design of experiment has been developed to simulate different hospital working scenarios. It has been found that: cost savings can range, in dependence on the scenario, from 2% to 7%; the higher is the drug demand variability, the greater is the convenience of the proposal; the savings are slightly influenced by variations in external stockouts and pharmacy ordering costs. Moreover, the results show that, even in the traditional way to manage hospital inventory, managers should try to reach a balance between underage and overage material costs instead of keeping full warehouses. Results from this thesis have been published in several research papers (Iannone et al., 2011-2012-2013-2014 and Guida et al, 2012 a-b). [edited by author]XII ciclo n.s

The Role of Emergence in Service Systems

It has been recognized that a service systems perspective, informed by service-dominant logic, provides a dynamic approach for studying value co-creation. According to this view, value is the increase in the viability of the system in which actors co-create value. A construct from systems theory – emergence – can be of particular interest in contributing to and detracting from systems viability. Emergence is related to the nonlinear interactions characterizing systems’ elements that can give rise to novel and unpredictable properties not contained in the elements. This paper relates emergence to service systems based on the service-dominant logic and systems theory literature. Such issues can be useful for service science scholars to identify new research avenues for service systems

Modelling Hospital Materials Management Processes

Materials management is an important issue for healthcare systems because it influences clinical and financial outcomes. Before selecting, adapting and implementing leading or optimized practices, a good understanding of processes and activities has to be developed. In real applications, the information flows and business strategies involved are different from hospital to hospital, depending on context, culture and available resources; it is therefore difficult to find a comprehensive and exhaustive description of processes, even more so a clear formalization of them. The objective of this paper is twofold. First, it proposes an integrated and detailed analysis and description model for hospital materials management data and tasks, which is able to tackle information from patient requirements to usage, from replenishment requests to supplying and handling activities. The model takes account of medical risk reduction, traceability and streamlined processes perspectives. Second, the paper translates this information into a business process model and mathematical formalization. The study provides a useful guide to the various relevant technology-related, management and business issues, laying the foundations of an efficient reengineering of the supply chain to reduce healthcare costs and improve the quality of care

A model for vendor selection and dynamic evaluation

Abstract. The present paper proposes an evaluation model able to integrate the selection phase with the monitoring and the continuous analysis of the vendor performances. The vendor evaluation process is realised through an opportune methodology which puts beside qualitative judgements (i.e. the adequacy of the organisation or the maintenance management policies) and performance data (i.e. delivery delays, number of non conformities, discrepancies in the delivered quantities, etc.) and builds the database which will support the daily decisions of the buyers. Thanks to its generality and customisability, together with the use of basic managerial tools, the system represents an appropriate trade-off between implementation costs and obtainable benefits

Emergence in marketing: an institutional and ecosystem framework

Many core marketing concepts (e.g., markets, relationships, customer experience, brand meaning, value) concern phenomena that are difficult to understand using linear and dyadic approaches, because they are emergent. That is, they arise, often unpredictably, from interactions within complex and dynamic contexts. This paper contributes to the marketing discipline through an explication of the concept of emergence as it applies to marketing theory. We accomplish this by first drawing on the existing literature on emergence in philosophy, sociology, and the theory of complex adaptive systems, and then link and extend this understanding to marketing using the theoretical framework of service-dominant (S-D) logic, particularly as enhanced by its service-ecosystems and institutionalization perspectives. Our work recognizes both emergence and institutionalization as integral or interrelated processes in the creation, maintenance, and disruption of markets and marketing phenomena. We conclude by discussing implications for marketing research and practice

Gioco e valore per il consumatore

Il mercato del gioco pubblico analizzato attraverso l’Approccio Sistemico Vitale presenta alcune criticità che non gli permettono di connaturarsi come sistema vitale e, pertanto, di generare valore. Risulta necessario il ruolo dello Stato, che deve indirizzare e controllare l’operato degli attori che a vario titolo operano in questo sistema reticolare, favorendone relazioni di risonanza

Daily nurse requirements planning based on simulation of patient flows

Nurses account for approximately 50 % of total hospital budgets and their allocation to medical units and shifts can significantly affect the quality of care provided to patients. The adoption of flexible shift schedules and the assessment of actual nursing time can enable sensible resource planning, balancing the quality of care with efficiency in resource use. Starting from the concept that nurse requirements are triggered by patient needs, which are stochastic in nature both for clinical activities and their duration, this paper proposes an innovative Nurse Requirement Planning model grounded on the concept of the clinical pathway (the “standard” sequence of diagnostic, therapeutic and care activities a patient with certain pathology should undertake over time) with its inner routing probability and patient dependence on nurses, which can be correlated to the time needed to perform nursing tasks. In merging and modelling these two aspects, the method summarizes the best features of acuity-quality and timed-task/activity techniques, well known although not usually applied for reasons of demands on clinicians’ time. Instead, in this paper, for each shift of the day, hospital management is enabled to choose the optimal number of nurses to meet actual requirements according to a desired service level and personnel saturation by means of a tool that simulates the patient flow in a medical unit based on automatic data retrieval from hospital databases. The validation and verification of the proposal were undertaken in a stroke unit