Organizing timely treatment in multi-disciplinary care

Abstract

Healthcare providers experience an increased pressure to organize their processes more efficiently and to provide coordinated care over multiple disciplines. Organizing multi-disciplinary care is typically highly constrained, since multiple appointments per patient have to be scheduled with possible restrictions between them. Furthermore, schedules of professionals from various facilities or with different skills must be aligned. Since it is important that patients are treated on time, access time targets are set on the time between referral to the facility and the actual start of the treatment. These targets may vary per patient type: e.g., urgent patients have shorter access time targets than regular patients. In this thesis, we use operations research methods to support multi-disciplinary care settings in providing timely treatments with an excellent quality of care, against affordable costs, while taking patient and employee satisfaction into account. We consider settings in rehabilitation care and radiotherapy, but the underlying planning problems are applicable to many other multi-disciplinary care settings, such as cancer care or specialty clinics. The developed models are applied to case studies in the Sint Maartenskliniek Nijmegen, the AMC Amsterdam and a BCCA cancer clinic in Vancouver, Canada. The results of the thesis demonstrate that adequate admission policies and capacity allocation to different activities and stages in complex treatment processes can improve compliance with access time targets for multi-disciplinary care systems considerably, while using the available resource capacities and taking patient and employee satisfaction into account