Reallocating resources to focused factories: a case study in chemotherapy

This study investigates the expected service performance associated with a proposal to reallocate resources from a centralized chemotherapy department to a breast cancer focused factory. Using a slotted queueing model we show that a decrease in performance is expected and calculate the amount of additional resources required to offset these losses. The model relies solely on typical outpatient scheduling system data, making the methodology easy to replicate in other outpatient clinic settings. Finally, the paper highlights important factors to consider when assigning capacity to focused factories. These considerations are generally relevant to other resource allocation decisions

Reallocating resources to focused factories: a case study in chemotherapy

This study investigates the expected service performance associated with a proposal to reallocate resources from a centralized chemotherapy department to a breast cancer focused factory. Using a slotted queueing model we show that a decrease in performance is expected and calculate the amount of additional resources required to offset these losses. The model relies solely on typical outpatient scheduling system data, making the methodology easy to replicate in other outpatient clinic settings. Finally, the paper highlights important factors to consider when assigning capacity to focused factories. These considerations are generally relevant to other resource allocation decisions

The effects of entrepreneurship education

Entrepreneurship education ranks high on policy agendas in Europe and the US, but little research is available to assess its impact. To help close this gap we investigate whether entrepreneurship education a?ects intentions to be entrepreneurial uniformly or whether it leads to greater sorting of students. The latter can reduce the average intention to be entrepreneurial and yet be socially beneficial. This paper provides a model of learning in which entrepreneurship education generates signals to students. Drawing on the signals, students evaluate their aptitude for entrepreneurial tasks. The model is tested using data from a compulsory entrepreneurship course. Using ex ante and ex post survey responses from students, we find that intentions to found decline somewhat although the course has significant positive e?ects on students’ self-assessed entrepreneurial skills. The empirical analysis supports the hypothesis that students receive informative signals and learn about their entrepreneurial aptitude. We outline implications for educators and public policy

End-Stage Renal Disease Among HIV-Infected Adults in North America

Background. Human immunodeficiency virus (HIV)-infected adults, particularly those of black race, are at high-risk for end-stage renal disease (ESRD), but contributing factors are evolving. We hypothesized that improvements in HIV treatment have led to declines in risk of ESRD, particularly among HIV-infected blacks

Historiography and the excavation of nascent business venturing

Few facets of business venturing are more challenging to capture than nascent-stage venture creation. The principal reason for this is the inherent difficulty scholars face when addressing the dynamic interplay between individuals and opportunities. Post hoc perspectives of venture creation typically involve high “narrativity,” characterized by structured, linear, teleological sense-making that tends to omit unreasoned and unintended facets of entrepreneurship. While narrativity is indispensable to new venture storytelling, it is also the quintessence of post hoc reality restructuring, which often excludes and invariably mutates key aspects of entrepreneurial action. To mitigate the data narrativity problem, we formulate a historiographical procedure designed to (a) reveal the internal and external stimuli that govern venture creation and (b) elicit deeper understanding of the unreasoned logics that also guide entrepreneurial action. For practical benefit, we assess this procedure through the lens of four archetypal research contexts, each featuring start-ups as “sites” of historiographical analysis: “wastelands,” “ruins,” “construction sites,” and “goldmines.” Our methodological roadmap enables a richer depiction of nascent-stage venturing

Een planningsmethode voor reductie van de fluctuaties in de belasting van verpleegafdelingen

Zorgvuldige afstemming tussen het schema van de operatiekamers en de verpleegafdeling balanceert de belasting van de verpleegafdeling en vermindert het aantal afgezegde operaties. In samenwerking tussen het Center for Healthcare Operations Improvement & Research (CHOIR, kenniscentrum voor optimalisatie van zorgprocessen en onderzoek in Nederland van de Universiteit Twente) en het Nederlands Kanker Instituut – Antoni van Leeuwenhoek Ziekenhuis (NKI-AVL) is door middel van een operations-researchmodel het Master Surgery Schedule van het NKI-AVL herzien. Hierdoor heeft het NKI-AVL een extra operatiekamer in gebruik kunnen nemen zonder de capaciteit van de verpleegafdeling te hebben moeten vergroten. Dit project heeft gediend als prototype voor succesvolle implementatie-projecten van het ontwikkelde operations-researchmodel in verscheidene ziekenhuizen. Als gevolg van deze resultaten is in samenwerking met Information Builders, ontwikkelaar van business intelligence- en integratiesoftware, een business intelligence-platform\ud ontwikkeld dat momenteel wereldwijd wordt aangeboden

Implementing Algorithms to Reduce Ward Occupancy Fluctuation Through Advanced Planning

As with many hospitals, NKI-AVL is eager to improve patient access through intelligent capacity investments. To this end, the hospital expanded its operating capacity from five to six operating rooms (ORs) and redesigned their master surgical schedule (MSS) in an effort to improve utilization and decrease hospital-wide congestion; an MSS is a cyclical schedule specifying when surgical specialties operate. Designing an efficient MSS is a complex task, requiring commitment and concessions on the part of competing stakeholders. There are many restrictions which need to be adhered to, including limited specialized equipment and physician availability. These restrictions are, for the most part, known in advance. The relationship between the MSS and the ward, however, is not known in advance and is plagued with uncertainties. For example, it may be known which patient type will be admitted to the ward after surgery; however, the number of patients changes from week to week, and it is not known with certainty how long each patient will stay in the hospital. Inpatient wards, furthermore, are one of the most expensive hospital resources and can be a major source of hospital congestion, as many departments rely on inpatient wards to receive and treat their patients prior to discharge from the hospital (e.g., the emergency department). This congestion leads to long waiting times for patients, patients receiving the wrong level of care, and extended lengths of stay for patients. Well-designed surgical schedules which take into account inpatient ward resources lead to reduced cancellations and higher and balanced utilization. We observed that peaks in the ward occupancy are particularly dependent on the MSS, and, as a result, ward occupancies can be leveled through careful MSS design. Avoiding peaks and leveling ward occupancy across weekdays makes staff scheduling easier and limits the risk of exceeding capacity, which causes congestion and perpetuates inefficiencies throughout the hospital. Working with NKI-AVL we developed an operations research model to support the redesign of theirMSS. The redesigned MSS improved the use of existing ward resources, thereby allowing an additional operating room to be built without additional investments in ward capacity. A post implementation review of bed use statistics validated our model’s projections. The success of the project served as proof-of-concept for our model, which has since been applied in several other hospitals