High tech, human touch:
|
|
- Augustine Randall
- 5 years ago
- Views:
Transcription
1 High tech, human touch: Operations Research in the Operating Room and beyond Dr.ir. Erwin W. Hans Associate prof. Operations Management and Process Optimization in Healthcare dep. Operational Methods for Production and Logistics (MB) Center for Healthcare Operations Improvement & Research
2 My background Positions ( ) MSc in Applied Mathematics, OR and math. programming ( ) PhD Resource loading by branch-and-price techniques ; tactical capacity planning in discrete manufacturing ( ) Assistant prof. Oper. Methods for Production & Logistics (2008-) Associate prof. OM & process optimization in healthcare (2011-) Director of Education Industrial Engineering & Management Research ( ) Planning and scheduling in discrete manufacturing (2004-) OR/OM in healthcare Chair Center for Healthcare Operations Improvement & Research Chair OR in healthcare working group of the Netherlands OR society e.w.hans@utwente.nl 1/10/2012 2
3 Agenda Introduction O.R. in healthcare process optimization Research of the CHOIR research center O.R. in the operating rooms and beyond 1/10/2012 3
4 What is Operations Management and Operations Research? Operations Management: Part of management involved in effectively and efficiently organizing processes Operations Research: Part of mathematics involved in modeling and optimizing real life processes 1/10/2012 4
5 Fries, Operations Research, 1976 Smith-Daniels, Decision Sciences, 1988 Delesie, EJOR, 1998 Cayirli, POM, 2003 Hall et al., Handbook HC Scheduling /10/2012 5
6 In 2002: <2% of the OR/MS community actually focuses on healthcare 1/10/2012 6
7 Importance of healthcare Affects all in society Ageing population More chronically ill, co-morbidity Increasingly advanced technology Expenditures growing rapidly 1/10/2012 7
8 Healthcare expenditure (% GDP) USA France Germany Belgium NL U.K. Turkey 1/10/2012 8
9 Germany vs. Netherlands Germany Netherlands Total expenditure %GDP Pharmaceutical expenditure / capita ($) Practicing physicians (nurses) / 1000 capita 3.5 (9.9) 3.9 (8.7) # beds per 1000 capita (acute care beds) 8.2 (5.7) 4.5 (3.0) Doctor consultations per capita # CT scanners per million capita Source: OECD.ORG, data from 2008 e.w.hans@utwente.nl 1/10/2012 9
10 Despite the importance of healthcare, why so little attention? Financial system did not reward efficiency Poor education of managers in operations management Poor information systems and business intelligence software Autonomy of hospital departments Autonomy of clinicians Conflicting goals Oath of Hippocrates 1/10/
11 In 2003, somewhere in the Netherlands You don t have a waiting list?? you must be a lousy doctor!! e.w.hans@utwente.nl 1/10/
12 Logistical improvements go hand-in-hand with quality improvements: patients that have to visit the hospital less often, have shorter waiting times, and may count on more attention from nurses and physicians. Logistical quality improvements will yield some 3 to 3.5 billion EUR: almost a quarter of the entire hospital budget In other words: improved care for less money! e.w.hans@utwente.nl 1/10/
13 Patient attitude change Due to: Media attention for waiting lists, bad practices Internet Benchmarking Market mechanisms patients shop Patients become more demanding 1/10/
14 Key issues for hospital management ICT innovation Hiring OM experts / OM education of managers Market positioning Specialization? Standardization of protocols (clinical pathways) LOS reduction (minimize bed usage) Copying logistical paradigms from industry with help of consultancy firms e.w.hans@utwente.nl 1/10/
15 Logistical paradigms 1/10/
16 What they all have in common 3 basic principles of Operations Management: Reduction of waste eliminate non-value-adding activities Reduction of variability eliminate disturbances, errors, fluctuations Reduction of complexity easiest effective solution is the best e.w.hans@utwente.nl 1/10/
17 Strengths Focus on performance measurement Analyzing performance Simple principles Organization-wide involvement Organization-wide improvement 1/10/
18 Weaknesses Selection of paradigm generally not based on effectiveness, but on enthusiastic consultant Paradigm = Philosophy / strive How to attain objective? Focus on operational level Low hanging fruit e.w.hans@utwente.nl 1/10/
19 What is missing? What performance levels can theoretically be attained? 10% improvement of a lousy performance is still a lousy performance! e.w.hans@utwente.nl 1/10/
20 Research is required To develop new concepts To test these concepts prospectively Using mathematical (simulation) models Under various scenarios, and a long horizon For different types of hospitals e.w.hans@utwente.nl 1/10/
21 With a chain perspective The entire care pathway optimized
22 Research is required (cont.) Operations Research provides: Optimization techniques Meta-heuristics Mathematical programming (LP, ILP) Evaluation models Queuing models Computer simulation models (DES, MC, SD) 1/10/
23 A modern framework for health care planning & control (Hans, Houdenhoven, Hulshof, 2010) Society Strategic Tactical Operational offline Operational online Medical planning Resource capacity planning Material planning Financial planning hierarchical decomposition managerial areas 1/10/
24 A modern framework for health care planning & control (Hans, Houdenhoven, Hulshof, 2010) Society Strategic Tactical Operational offline Operational online Medical planning Research planning, introduction of new treatment methods Care pathway planning Diagnosis and planning of an individual treatment Triage, diagnosing complications Resource capacity planning Case mix planning, layout planning, capacity dimensioning Allocation of time and resources to specialties, rostering Elective patient scheduling workforce planning Monitoring, emergency rescheduling Material planning Supply chain and warehouse design Supplier selection, tendering, forming purchasing consortia Purchasing, determining order sizes Rush ordering, inventory replenishing Financial planning Agreements with insurance companies, capital investments Budget and cost allocation DRG billing, cash flow analysis Expenditure monitoring, handling billing complications hierarchical decomposition managerial areas 1/10/
25 OR/OM in health care research at University of Twente: CHOIR Center for Healthcare Operations Improvement & Research Our website: Online bibliography: 1/10/
26 : collaborations UT Academic centers Top-clinical hospitals General hospitals Specialized clinic Rehabilitation centers DSS developer, consultancy Germany Belgium 1/10/
27 Research development : Focus on single departments Operating rooms (planning, scheduling, etc.) Radiology (CT, MRI) : Focus on care pathways within hospitals STW funded project LogiDOC 12 hospitals, 6 PhD students PhD students are at hospitals 2-3 days per week : optimization of the transmural care pathway optimization of rehabilitation processes e.w.hans@utwente.nl 1/10/
28 ORAHS 2012, July th annual meeting of the EURO working group on Operations Research Applied to Health Services Enschede, the Netherlands
29 Operations Research in the Operating Room 1/10/
30 First projects were no rocket science But had a huge impact! SURGERY DURATIONS SURGEON S ESTIMATE VS. HISTORICAL AVERAGE DURATION minutes Planning based on surgeon s estimates months Shorter than expected Longer than expected Planning based on historical averages e.w.hans@utwente.nl 1/10/
31 How many surgical teams are needed during the night? A discrete event simulation study (strategic level) e.w.hans@utwente.nl 1/10/
32 How many surgical teams are needed during the night? Erasmus Medical Center: 3 teams available during the night Use of 3 teams at the same time extremely rare Financially rewarding for staff Potentially dangerous to intervene Reduction in capacity may lead to deaths Simulation necessary Heavy involvement of staff in all major project steps Intervention: 1 hospital, 1 team on call e.w.hans@utwente.nl 1/10/
33 Elective surgery scheduling and sequencing (offline operational level) 1/10/
34 Offline operational level of OR planning Assignment of elective surgeries to blocks Surgery durations based on historical average Planning of slack time based on planned surgery duration variability Elective surgery sequencing Avoid problems with limited equipment Minimize chance of delays 1/10/
35 Example (11 ORs) 1/10/
36 Introduction OR planning: offline operational level Determination of the amount of slack per OR 1/10/
37 Historical data 1/10/
38 Exploiting the portfolio-effect Capacity gain 2.3%, increase in unused capacity: 40% e.w.hans@utwente.nl 1/10/
39 Emergency OR, or NOT? (tactical level) 1/10/
40 Research motivation The arrival of emergency surgeries is the most important source of disturbances in the OR leads to: overtime, surgery cancellations, waiting time, reduced OR utilization Options to deal with emergency surgery: Dedicated emergency ORs vs. Schedule emergency surgery in elective ORs 1/10/
41 Emergency OR, or not? Concept: emergency ORs Concept: No emergency ORs 1/10/
42 Emergency OR, or not? Concept: emergency ORs Concept: No emergency ORs Result of simulation: emergency OR has worse performance w.r.t.: emergency surgery waiting time, overtime, OR utilization 1/10/
43 Robust optimization of the OR schedule to deal with emergency surgery (offline operational level) 1/10/
44 Minimize emergency waiting time by optimizing the elective sequence OR1 OR2 OR3 Before 1/10/
45 Minimize emergency waiting time by optimizing the elective sequence OR1 OR2 OR3 OR1 OR2 OR3 Before After 1/10/
46 Solution approach Goal: spread Break-In-Moments between elective surgeries as evenly as possible Problem is NP-hard in the strong sense (proof by reduction from 3-partition) Input: an elective surgery schedule for a given week Optimization: constructive + local search heuristics e.w.hans@utwente.nl 1/10/
47 Constructive heuristic First calculate λ: a lower bound to min max BII λ = 1+ E S ( j J M j 1) E: earliest OR end time S: latest OR start time M j : number of surgeries in OR j Then iteratively schedule a surgery forward or backward closest to * OR1 Backward move OR2 Forward move e.w.hans@utwente.nl 1/10/
48 Simulation results operational problem Waiting time less than: First emergency procedure No BII opt. BII opt. Second emergency procedure No BII opt. BII opt. Third emergency procedure No BII opt. BII opt. 10 minutes 28.8% 48.6% 34.9% 44.9% 40.4% 46.2% 20 minutes 53.0% 75.8% 56.9% 73.6% 63.0% 69.8% 30 minutes 70.5% 90.9% 71.8% 87.2% 76.3% 86.7% Case mix Academic Hospital 1/10/
49 Results after simulation Emergency surgery in elective program instead of emergency ORs yields: Improved OR utilization (3.1%) Less overtime (21%) Break-in-moment optimization yields: Reduced waiting time for emergency surgery, especially for the first arrival (patients helped within 10 minutes: from 28.8% 48.6%) 1/10/
50 An exact approach to calculate the ward census based on the OR block schedule 1/10/
51 Peter Vanberkel An exact approach for relating recovering surgical patient workload to the OR block schedule Problem How does opening an extra op. room affect the wards? Occupancy rate Admission & discharge rates Frequency of treatments Surgery activities dictated by OR block schedule Assigns rooms to specialties Organizes the op. room department Typically cyclical Waiting Patients OR Wards Exit 51
52 Peter Vanberkel The OR block schedule Mon Tue Wed Thu Fri OR1 SUR (KLM) SUR (VWL) SUR (vwl/rur) HIPEC SUR (Kidney) SUR (VRP) OR2 ENT SUR (RUT) Urology (hbs) RT Urology (MND) OR3 ENT Plas Sur ENT ENT Plas Sur OR4 SUR (COR) Gyne SUR Mamma Plas Sur Gyne OR5 RT SUR (SND/WOS) RT (vwl/rur) Urology (pel/bex) Urology (P&B) OR6 Urology (P&B) SUR (VWL) Gyne SUR (ODB) SUR (Cor/rur) Goal: Directly derive ward workload metrics from the block schedule 1/10/
53 Peter Vanberkel Model: ward workload as a function of the OR block schedule Conceptual Model Scheme Infinite server queue Patients do not interfere Batches of patients arrive according to block schedule Ward Discharge Surgery Recovery Data For each surgical specialty Empirical Distributions of Cases/Block (batch size) Empirical Distribution of Length of Stay (LOS) Solution approach Cyclical block schedule Evaluate steady state distribution of ward census (discrete convolutions e.w.hans@utwente.nl 1/10/
54 Peter Vanberkel Model: ward workload as a function of the OR block schedule Conceptual Model Scheme Batches of patients arrive daily according to the MSS Metrics 1) Recovering Patients in the Hospital 2) Ward occupancy 3) Rates of admissions and discharges 4) Patients in recovery day n Ward Recovery Discharge Calculations: discrete convolutions of empirical distributions e.w.hans@utwente.nl 1/10/
55 Peter Vanberkel Example Result 90 th Percentile of Demand Initial MSS 1/10 days required 61 staffed beds 4/10 days required > 54 staffed beds 2/10 days required < 50 staffed beds Other days required b/w 50 & 54 Final MSS 1/10 days required 58 staffed beds 9/10 days required b/w 50 & 54 Further discussion is ongoing to change physician schedules to eliminate peak in week 2 e.w.hans@utwente.nl 1/10/
56 Instrument tray optimization 1/10/
57 Instrument trays for surgery Each surgery requires dozens of instruments, most of which are re-used after sterilization Stochastic requirements per surgery type Instruments are expensive Diversity of instruments is enormous Sterilization is expensive (± 1 per instrument) e.w.hans@utwente.nl 1/10/
58 Instrument trays for surgery Most hospitals use instrument trays There are: surgery type-specific trays base trays add-on trays Instruments remain in their tray (are sterilized together) Rarely used instruments are kept in inventory 1/10/
59 Problems with instrument trays Instrument trays evolve Many instruments are outdated Many instruments are not used during surgery Missing instruments must be collected from a storage space (takes time another tray is opened) The more types of trays the more inventory ( ) Preparing trays to order is very hard e.w.hans@utwente.nl 1/10/
60 Instrument trays: potential savings Potential savings: Unnecessary sterilizations, repairs, replacements Unnecessary inventory Location of inventory Required instruments not in tray(s) Time required for gathering instruments Time required for counting instruments Elske Florijn (MSc student from UT): In AMC, 21% of the instruments are obsolete 2.3 million sterilization costs per year Repair costs Handling costs / year sterilization cost savings when 12 out of the 550 trays types contents are optimized Problem: data collection is very hard e.w.hans@utwente.nl 1/10/
61 Elective surgery scheduling Challenges: Optimize utilization surgeons and ORs Optimize robustness (e.g. minimize overtime) Optimize other resources (ward/icu bed, X-ray) Care chain optimization, early personnel coord. etc. Easy implementation while maintaining the autonomy of the surgeons as much as possible Promising approach: Master Surgical Scheduling 1/10/
62 Preliminary study (see: EJOR 185) Question: how much can OR-utilization be increased by optimizing the elective surgery schedule? Approach: Optimization of elective scheduling by exploiting the portfolio effect 1/10/
63 Preliminary study Portfolio-effect Capacity gain 2.3%, increase in unused capacity: 40% e.w.hans@utwente.nl 1/10/
64 Master surgical scheduling a cyclic, integral planning of ORs and ICU department (tactical planning level) OR Spectrum, 2007 (co-work Van Oostrum et al.) e.w.hans@utwente.nl 1/10/
65 Motivation of research Low OR utilization, many cancellations OR-scheduling is time-consuming, and repetitive However: many elective surgery types are recurring! Weekly optimization using mathematical techniques Leads to nervous schedules May interfere with autonomy of medical specialists Hard to implement 1/10/
66 ICU bed requirements after surgery 1/10/
67 Capacity usage for shortstay ward 1/10/
68 Master surgical scheduling: idea Idea: design a cyclic schedule of surgery types that: covers all frequent elective surgery types levels the workload of the specialties levels the workload of subsequent departments (ICU, wards) is robust against uncertainty improves OR-utilization maintains autonomy of clinicians Assign patients to the slots in the schedule e.w.hans@utwente.nl 1/10/
69 MSS: problem description Goal: Maximize the OR-utilization Level capacity usage of subsequent resources (ICU) Constraints: OR-capacity constraints (probabilistic) All surgery types must be planned i.c.w. their frequency To determine: Length of the planning cycle A list of surgery types for every OR-day ( OR-day schedule ) e.w.hans@utwente.nl 1/10/
70 Mathematical program (base model) maximizes the OR utilization levels the hospital bed usage All surgeries assigned Probabilistic constraints for wards, ORs 1/10/
71 Master surgical scheduling: approach PHASE 1: Generation of OR-day schedules Goal: capacity utilization PHASE 2: Assignment of OR-day schedules ILP, solved by column generation and then rounding Constraints: All surgeries must be planned OR-capacity (probabilistic) ILP, solved using CPLEX in AIMMS modeling language Goal: bed usage leveling 1/10/
72 OR-day schedule example 15:30h Unused capacity Planned slack Planned surgery types 08:00h 1/10/
73 Master surgical scheduling: approach PHASE 1: Generation of OR-day schedules Goal: capacity utilization PHASE 2: Assignment of OR-day schedules ILP, solved by column generation and then rounding Constraints: All surgeries must be planned OR-capacity (probabilistic) ILP, solved using CPLEX in AIMMS modeling language Goal: bed usage leveling 1/10/
74 MSS test approach 1. Statistical analysis of surgery frequencies 2. Select a cycle length (1, 2, or 4 weeks) 3. Construct an MSS (2-phase approach) Tools: AIMMS modeling language with integrated CPLEX solver 4. Discrete event simulation Schedule rare elective procedures in reserved capacity Admission of emergency surgeries (add-on and online planning) Data: historical data from 3 types of hospitals; academic hospital, regional hospital, and clinic e.w.hans@utwente.nl 1/10/
75 Master surgical scheduling: results Outcomes differ per type of hospital: Percentage of surgeries in MSS Clinic Regional hospital Academic hospital 1 year 4 weeks 2 weeks 1 week Reason: different volume and case mix range e.w.hans@utwente.nl 1/10/
76 Master surgical scheduling: results Req. number of ICU-beds without MSS: between 0 and 12 p.day Req. number of ICU-beds with MSS (4 week cycle): 74.3% of the total ICU bed requirement is planned in an MSS of four weeks. e.w.hans@utwente.nl 1/10/
77 Master surgical scheduling: results Reduction OR-capacity usage (portfolio effect): Cycle length Academic hospital Regional hospital 1 week 2 weeks 4 weeks 1.1 % 2.7 % 4.2 % 2.8 % 5.7 % 6.3 % Clinic 4.9 % 7.3 % 8.6 % e.w.hans@utwente.nl 1/10/
78 Master surgical scheduling conclusions Advantages: Easy to implement Allows personnel coordination in early stage Less overtime, higher utilization (up to 8.6%) Less surgery cancellations shorter leadtimes Improved coordination between departments Disadvantage: Does not cover all surgeries 1/10/
79 Questions? 1/10/
80 1/10/
81 Questions? 1/10/
Decision support system for the operating room rescheduling problem
Health Care Manag Sci DOI 10.1007/s10729-012-9202-2 Decision support system for the operating room rescheduling problem J. Theresia van Essen Johann L. Hurink Woutske Hartholt Bernd J. van den Akker Received:
More informationOperating Room Manager Game
Operating Room Manager Game Authors: Erwin (E.W.) Hans*, Tim (T.) Nieberg * Corresponding author: Email: e.w.hans@utwente.nl, tel. +31(0)534893523 Address: University of Twente School of Business, Public
More informationHow to deal with Emergency at the Operating Room
How to deal with Emergency at the Operating Room Research Paper Business Analytics Author: Freerk Alons Supervisor: Dr. R. Bekker VU University Amsterdam Faculty of Science Master Business Mathematics
More informationSurgery Scheduling with Recovery Resources
Surgery Scheduling with Recovery Resources Maya Bam 1, Brian T. Denton 1, Mark P. Van Oyen 1, Mark Cowen, M.D. 2 1 Industrial and Operations Engineering, University of Michigan, Ann Arbor, MI 2 Quality
More informationHospital admission planning to optimize major resources utilization under uncertainty
Hospital admission planning to optimize major resources utilization under uncertainty Nico Dellaert Technische Universiteit Eindhoven, Faculteit Technologie Management, Postbus 513, 5600MB Eindhoven, The
More informationOptimization techniques for e-health applications
Optimization techniques for e-health applications Antonio Frangioni and Maria Grazia Scutellà Dipartimento di Informatica University of Pisa, Italy Knowledge Acceleration and ICT: Towards a Tuscany agenda
More informationLogic-Based Benders Decomposition for Multiagent Scheduling with Sequence-Dependent Costs
Logic-Based Benders Decomposition for Multiagent Scheduling with Sequence-Dependent Costs Aliza Heching Compassionate Care Hospice John Hooker Carnegie Mellon University ISAIM 2016 The Problem A class
More informationTransforming our Hospitals: Clinician-driven Operations Management. Alain Mouttham November 23rd, 2016
Transforming our Hospitals: Clinician-driven Operations Alain Mouttham November 23rd, 2016 Commonwealth Fund National Scorecard The extensive empirical analysis underpinning this book shows that there
More informationHow can the MST hospital reduce the variability in bed utilization at the nursing wards, while the OR capacity will be used in an efficient way?
July, 2017 3 Management summary Health care costs are rising, the Dutch population is aging, and the government and health care insurers are cutting costs. These are only a few of the current developments
More informationTHE USE OF SIMULATION TO DETERMINE MAXIMUM CAPACITY IN THE SURGICAL SUITE OPERATING ROOM. Sarah M. Ballard Michael E. Kuhl
Proceedings of the 2006 Winter Simulation Conference L. F. Perrone, F. P. Wieland, J. Liu, B. G. Lawson, D. M. Nicol, and R. M. Fujimoto, eds. THE USE OF SIMULATION TO DETERMINE MAXIMUM CAPACITY IN THE
More informationApplying Critical ED Improvement Principles Jody Crane, MD, MBA Kevin Nolan, MStat, MA
These presenters have nothing to disclose. Applying Critical ED Improvement Principles Jody Crane, MD, MBA Kevin Nolan, MStat, MA April 28, 2015 Cambridge, MA Session Objectives After this session, participants
More informationScheduling Home Hospice Care with Logic-based Benders Decomposition
Scheduling Home Hospice Care with Logic-based Benders Decomposition Aliza Heching Compassionate Care Hospice John Hooker Carnegie Mellon University EURO 2016 Poznan, Poland Home Health Care Home health
More informationLean Options for Walk-In, Open Access, and Traditional Appointment Scheduling in Outpatient Health Care Clinics
Lean Options for Walk-In, Open Access, and Traditional Appointment Scheduling in Outpatient Health Care Clinics Mayo Clinic Conference on Systems Engineering & Operations Research in Health Care Rochester,
More informationBig Data Analysis for Resource-Constrained Surgical Scheduling
Paper 1682-2014 Big Data Analysis for Resource-Constrained Surgical Scheduling Elizabeth Rowse, Cardiff University; Paul Harper, Cardiff University ABSTRACT The scheduling of surgical operations in a hospital
More informationNursing Manpower Allocation in Hospitals
Nursing Manpower Allocation in Hospitals Staff Assignment Vs. Quality of Care Issachar Gilad, Ohad Khabia Industrial Engineering and Management, Technion Andris Freivalds Hal and Inge Marcus Department
More informationImproving operational effectiveness of tactical master plans for emergency and elective patients under stochastic demand and capacitated resources
Improving operational effectiveness of tactical master plans for emergency and elective patients under stochastic demand and capacitated resources Ivo Adan 1, Jos Bekkers 2, Nico Dellaert 3, Jully Jeunet
More informationProceedings of the 2014 Winter Simulation Conference A. Tolk, S. Y. Diallo, I. O. Ryzhov, L. Yilmaz, S. Buckley, and J. A. Miller, eds.
Proceedings of the 2014 Winter Simulation Conference A. Tolk, S. Y. Diallo, I. O. Ryzhov, L. Yilmaz, S. Buckley, and J. A. Miller, eds. EVALUATION OF OPTIMAL SCHEDULING POLICY FOR ACCOMMODATING ELECTIVE
More informationPatient mix optimisation and stochastic resource requirements: A case study in cardiothoracic surgery planning
Health Care Manag Sci (2009) 12:129 141 DOI 10.1007/s10729-008-9080-9 Patient mix optimisation and stochastic resource requirements: A case study in cardiothoracic surgery planning Ivo Adan & Jos Bekkers
More informationEliminating Common PACU Delays
Eliminating Common PACU Delays Jamie Jenkins, MBA A B S T R A C T This article discusses how one hospital identified patient flow delays in its PACU. By using lean methods focused on eliminating waste,
More informationImproving Hospital Performance Through Clinical Integration
white paper Improving Hospital Performance Through Clinical Integration Rohit Uppal, MD President of Acute Hospital Medicine, TeamHealth In the typical hospital, most clinical service lines operate as
More informationGetting the right case in the right room at the right time is the goal for every
OR throughput Are your operating rooms efficient? Getting the right case in the right room at the right time is the goal for every OR director. Often, though, defining how well the OR suite runs depends
More informationTHE INTEGRATED EMERGENCY POST
THE INTEGRATED EMERGENCY POST THE SOLUTION FOR ED OVERCROWDING? Footer text: to modify choose 'Insert' (or View for Office 2003 2/4/13 or 1 earlier) then 'Header and footer' AGENDA Introduction ZonMw Simulation
More informationA Mixed Integer Programming Approach for. Allocating Operating Room Capacity
A Mixed Integer Programming Approach for Allocating Operating Room Capacity Bo Zhang, Pavankumar Murali, Maged Dessouky*, and David Belson Daniel J. Epstein Department of Industrial and Systems Engineering
More informationTotal Joint Partnership Program Identifies Areas to Improve Care and Decrease Costs Joseph Tomaro, PhD
WHITE PAPER Accelero Health Partners, 2013 Total Joint Partnership Program Identifies Areas to Improve Care and Decrease Costs Joseph Tomaro, PhD ABSTRACT The volume of total hip and knee replacements
More informationHospital Bed Occupancy Prediction
Vrije Universiteit Amsterdam Master Thesis Business Analytics Hospital Bed Occupancy Prediction Developing and Implementing a predictive analytics decision support tool to relate Operation Room usage to
More informationHospital Patient Flow Capacity Planning Simulation Model at Vancouver Coastal Health
Hospital Patient Flow Capacity Planning Simulation Model at Vancouver Coastal Health Amanda Yuen, Hongtu Ernest Wu Decision Support, Vancouver Coastal Health Vancouver, BC, Canada Abstract In order to
More informationWebinar: Practical Approaches to Improving Patient Pre-Op Preparation
Webinar: Practical Approaches to Improving Patient Pre-Op Preparation Your Presenters Michael Hicks, MD, MBA, FACHE Chief Executive Officer EmCare Anesthesia Services Lisa Kerich, PA-C Vice President Clinical
More informationBuilding a Smarter Healthcare System The IE s Role. Kristin H. Goin Service Consultant Children s Healthcare of Atlanta
Building a Smarter Healthcare System The IE s Role Kristin H. Goin Service Consultant Children s Healthcare of Atlanta 2 1 Background 3 Industrial Engineering The objective of Industrial Engineering is
More informationEmergency-Departments Simulation in Support of Service-Engineering: Staffing, Design, and Real-Time Tracking
Emergency-Departments Simulation in Support of Service-Engineering: Staffing, Design, and Real-Time Tracking Yariv N. Marmor Advisor: Professor Mandelbaum Avishai Faculty of Industrial Engineering and
More informationOnline Scheduling of Outpatient Procedure Centers
Online Scheduling of Outpatient Procedure Centers Department of Industrial and Operations Engineering, University of Michigan September 25, 2014 Online Scheduling of Outpatient Procedure Centers 1/32 Outpatient
More informationSIMULATION FOR OPTIMAL UTILIZATION OF HUMAN RESOURCES IN SURGICAL INSTRUMENTS DISTRIBUTION IN HOSPITALS
SIMULATION FOR OPTIMAL UTILIZATION OF HUMAN RESOURCES IN SURGICAL INSTRUMENTS DISTRIBUTION IN HOSPITALS Arun Kumar School of Mechanical & Production Engineering, Nanyang Technological University, Singapore
More informationPayment innovations in healthcare and how they affect hospitals and physicians
Payment innovations in healthcare and how they affect hospitals and physicians Christian Wernz, Ph.D. Assistant Professor Dept. Industrial and Systems Engineering Virginia Tech Abridged version of the
More informationMatching Capacity and Demand:
We have nothing to disclose Matching Capacity and Demand: Using Advanced Analytics for Improvement and ecasting Denise L. White, PhD MBA Assistant Professor Director Quality & Transformation Analytics
More informationQUEUING THEORY APPLIED IN HEALTHCARE
QUEUING THEORY APPLIED IN HEALTHCARE This report surveys the contributions and applications of queuing theory applications in the field of healthcare. The report summarizes a range of queuing theory results
More informationPart 4. Change Concepts for Improving Adult Cardiac Surgery. In this section, you will learn a group. of change concepts that can be applied in
Change Concepts for Improving Adult Cardiac Surgery Part 4 In this section, you will learn a group of change concepts that can be applied in different ways throughout the system of adult cardiac surgery.
More informationThe PCT Guide to Applying the 10 High Impact Changes
The PCT Guide to Applying the 10 High Impact Changes This Guide has been produced by the NHS Modernisation Agency. For further information on the Agency or the 10 High Impact Changes please visit www.modern.nhs.uk
More informationConsultation Paper. Distributed Medical Imaging in the new Royal Adelaide Hospital Central Adelaide Local Health Network
Consultation Paper Distributed Medical Imaging in the new Royal Adelaide Hospital Central Adelaide Local Health Network Issued: April 2016 TABLE OF CONTENTS TABLE OF CONTENTS 2 1. INTRODUCTION 3 2. PURPOSE
More informationOptimizing Resource Allocation in Surgery Delivery Systems
Optimizing Resource Allocation in Surgery Delivery Systems by Maya Bam A dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy (Industrial and Operations
More informationSurgical Instrumentation: Eliminating Chaos. The Complex Process of Surgical Instrument Maintenance and Improving the Healthcare Environment
Surgical Instrumentation: Eliminating Chaos The Complex Process of Surgical Instrument Maintenance and Improving the Healthcare Environment 1 Knowledge of Surgical Instrument Procedures Individuals considering
More informationScheduling operating rooms: achievements, challenges and pitfalls
Scheduling operating rooms: achievements, challenges and pitfalls Samudra M, Van Riet C, Demeulemeester E, Cardoen B, Vansteenkiste N, Rademakers F. KBI_1608 Scheduling operating rooms: Achievements, challenges
More informationLV Prasad Eye Institute Annotated Bibliography
Annotated Bibliography Finkler SA, Knickman JR, Hendrickson G, et al. A comparison of work-sampling and time-and-motion techniques for studies in health services research.... 2 Zheng K, Haftel HM, Hirschl
More informationProceedings of the 2005 Systems and Information Engineering Design Symposium Ellen J. Bass, ed.
Proceedings of the 2005 Systems and Information Engineering Design Symposium Ellen J. Bass, ed. ANALYZING THE PATIENT LOAD ON THE HOSPITALS IN A METROPOLITAN AREA Barb Tawney Systems and Information Engineering
More informationNeurosurgery. Themes. Referral
06 04 Neurosurgery The following recommendations were produced by the British Society of Neurological Surgeons to highlight where resources could be released in NHS neurological services, while maintaining
More informationHow Allina Saved $13 Million By Optimizing Length of Stay
Success Story How Allina Saved $13 Million By Optimizing Length of Stay EXECUTIVE SUMMARY Like most large healthcare systems throughout the country, Allina Health s financial health improves dramatically
More informationProceedings of the 2012 Winter Simulation Conference C. Laroque, J. Himmelspach, R. Pasupathy, O. Rose, and A. M. Uhrmacher, eds.
Proceedings of the 2012 Winter Simulation Conference C. Laroque, J. Himmelspach, R. Pasupathy, O. Rose, and A. M. Uhrmacher, eds. HEALTH CARE LOGISTICS AND SPACE: ACCOUNTING FOR THE PHYSICAL BUILD ENVIRONMENT
More informationBoarding Impact on patients, hospitals and healthcare systems
Boarding Impact on patients, hospitals and healthcare systems Dan Beckett Consultant Acute Physician NHSFV National Clinical Lead Whole System Patient Flow Project Scottish Government May 2014 Important
More informationLEAN Transformation Storyboard 2015 to present
LEAN Transformation Storyboard 2015 to present Rapid Improvement Event Med-Surg January 2015 Access to Supply Rooms Problem: Many staff do not have access to supply areas needed to complete their work,
More informationLet s Talk Informatics
Let s Talk Informatics Discrete-Event Simulation Daryl MacNeil P.Eng., MBA Terry Boudreau P.Eng., B.Sc. 28 Sept. 2017 Bethune Ballroom, Halifax, Nova Scotia Please be advised that we are currently in a
More informationNHS Wales Delivery Framework 2011/12 1
1. Introduction NHS Wales Delivery Framework for 2011/12 NHS Wales has made significant improvements in targeted performance areas over recent years. This must continue and be associated with a greater
More informationDEVELOPING AND TESTING A COMPUTERIZED DECISION SUPPORT SYSTEM FOR NURSE-TO-PATIENT ASSIGNMENT
DEVELOPING AND TESTING A COMPUTERIZED DECISION SUPPORT SYSTEM FOR NURSE-TO-PATIENT ASSIGNMENT ALEIDA BRAAKSMA, CATHARINA VAN OOSTVEEN, HESTER VERMEULEN NURSE-TO-PATIENT ASSIGNMENT Takes place at the start
More informationWhy Focus on Perioperative Services?
1 Why Focus on Perioperative Services? 80% 60% 40% 20% 0% Perioperative Services are key to a hospital/system's success 68% % better performers revenue from perioperative services Perioperative Services
More informationCasemix Measurement in Irish Hospitals. A Brief Guide
Casemix Measurement in Irish Hospitals A Brief Guide Prepared by: Casemix Unit Department of Health and Children Contact details overleaf: Accurate as of: January 2005 This information is intended for
More informationuncovering key data points to improve OR profitability
REPRINT March 2014 Robert A. Stiefel Howard Greenfield healthcare financial management association hfma.org uncovering key data points to improve OR profitability Hospital finance leaders can increase
More information8/10/2015. Module 1. A Fundamental Understanding of Quality. Management and its Application to Health Care
Module 1 A Fundamental Understanding of Quality Management and its Application to Health Care Addressing Physician Uncertainty about Payment Reform: Skills for Success in Value-Based Delivery Systems The
More informationPetra H. Vrieler BSc. May Master s Thesis. Industrial Engineering and Management. Health Care Technology and Management. University of Twente
Petra H. Vrieler BSc May 29 Master s Thesis Industrial Engineering and Management Health Care Technology and Management University of Twente Enschede, the Netherlands Management on the Ambulatory Surgery
More informationThe Management and Control of Hospital Acquired Infection in Acute NHS Trusts in England
Report by the Comptroller and Auditor General The Management and Control of Hospital Acquired Infection in Acute NHS Trusts in England Ordered by the House of Commons to be printed 14 February 2000 LONDON:
More informationBETTER IT BETTER HOSPITAL?
SEBASTIAN KROLOP, ACCENTURE RAINER HERZOG, HIMSS BETTER IT BETTER HOSPITAL? 10/7/2014 2 Objective of this session Examine whether there is a corelation between the level of IT implementation in hospitals
More informationQueueing Theory and Ideal Hospital Occupancy
Queueing Theory and Ideal Hospital Occupancy Peter Taylor Department of Mathematics and Statistics The University of Melbourne Hospital Occupancy A statement to think about. Queuing theory developed by
More informationFuture of Patient Safety and Healthcare Quality
Future of Patient Safety and Healthcare Quality Patrick Conway, M.D., MSc CMS Chief Medical Officer Director, Center for Clinical Standards and Quality Acting Director, Center for Medicare and Medicaid
More informationThe Role of The Consultant, The Doctor and The Nurse Mr Gary Kitching Consultant in Emergency Medicine Foundation Training Programme Director
The Role of The Consultant, The Doctor and The Nurse Mr Gary Kitching Consultant in Emergency Medicine Foundation Training Programme Director Objective To provide an overview of your role as a junior doctor
More informationAn economic - quality business case for infection control & Prof. dr. Dominique Vandijck
An economic - quality business case for infection control & prevention @VandijckD Prof. dr. Dominique Vandijck What you/we all know, (hopefully) but do our healthcare executives, and politicians know this?
More informationUSING SIMULATION MODELS FOR SURGICAL CARE PROCESS REENGINEERING IN HOSPITALS
USING SIMULATION MODELS FOR SURGICAL CARE PROCESS REENGINEERING IN HOSPITALS Arun Kumar, Div. of Systems & Engineering Management, Nanyang Technological University Nanyang Avenue 50, Singapore 639798 Email:
More informationJunior Doctors Committee. Rota design made easy
Junior Doctors Committee Rota design made easy How to design a rota Introduction With the implementation of the European Working Time Directive just around the corner, and some trusts still trying to tackle
More informationHOW 5S ORGANIZING BOOSTS MONEY, TIME, AND PATIENT OUTCOMES
HOW 5S ORGANIZING BOOSTS MONEY, TIME, AND PATIENT OUTCOMES WHAT IS 5S? THE CORE OF LEAN PHILOSOPHY Lean concepts have revolutionized the industrial world. Originating in Japan, and popularized by Toyota,
More informationJames Fenush Jr. MS, RN Director of Nursing, Clinical Support Services Rita Barry BSN, RN Nurse Manager of Scheduling and Staff Deployment
James Fenush Jr. MS, RN Director of Nursing, Clinical Support Services Rita Barry BSN, RN Nurse Manager of Scheduling and Staff Deployment 551-bed Academic/Quaternary Care Medical Center in central Pennsylvania
More informationOnline library of Quality, Service Improvement and Redesign tools. Process templates. collaboration trust respect innovation courage compassion
Online library of Quality, Service Improvement and Redesign tools Process templates collaboration trust respect innovation courage compassion Process templates What is it? Process templates provide a visual
More informationPhysician Agreements
Physician Agreements This talk includes many similar slides Paging through produces animation View with Adobe Reader for mobile: ipad, iphone, Android Slides were tested using Adobe Acrobat You can select
More informationQuality and Safe Respiratory Care: Does it Work in a Productivity Model?
Quality and Safe Respiratory Care: Does it Work in a Productivity Model? Timothy R. Myers MBA, RRT-NPS, FAARC Associate Executive Director, Brands Management American Association for Respiratory Care Adjunct
More informationLV Prasad Eye Institute Final Presentation
LV Prasad Eye Institute Final Presentation Ali Kamil, Dmitriy Lyan, Nicole Yap, MIT Student MIT Sloan School of Management Global Health Lab May 8, 2013 1 Courtesy of Ali S. Kamil, Dmitriy E. Lyan, Nicole
More informationAppointment Scheduling Optimization for Specialist Outpatient Services
Proceedings of the 2 nd European Conference on Industrial Engineering and Operations Management (IEOM) Paris, France, July 26-27, 2018 Appointment Scheduling Optimization for Specialist Outpatient Services
More informationFrom Big Data to Big Knowledge Optimizing Medication Management
From Big Data to Big Knowledge Optimizing Medication Management Session 157, March 7, 2018 Dave Webster, RPh MSBA, Associate Director of Pharmacy Operations, URMC Strong Maria Schutt, EdD, Director Education
More informationINCENTIVE OFDRG S? MARTTI VIRTANEN NORDIC CASEMIX CONFERENCE
INCENTIVE OFDRG S? MARTTI VIRTANEN NORDIC CASEMIX CONFERENCE 3.6.2010 DIAGNOSIS RELATED GROUPS Grouping of patients/episodes of care based on diagnoses, interventions, age, sex, mode of discharge (and
More informationCHEMOTHERAPY SCHEDULING AND NURSE ASSIGNMENT
CHEMOTHERAPY SCHEDULING AND NURSE ASSIGNMENT A Dissertation Presented By Bohui Liang to The Department of Mechanical and Industrial Engineering in partial fulfillment of the requirements for the degree
More informationDriving Out Clinical Variation to Drive Up Your Bottom Line
In Cooperation With: Executive White Paper Series, October 2017 Driving Out Clinical Variation to Drive Up Your Bottom Line Hospitals have always worked to be efficient. Now more than ever, it is increasingly
More informationLinking Supply Chain, Patient Safety and Clinical Outcomes
Premier s Vision for High Performing Healthcare Organizations: Linking Supply Chain, Patient Safety and Clinical Outcomes Joe M. Pleasant Sr. VP and CIO Premier Inc. Global GS1 Conference Hong Kong October
More informationIntegrating nurse and surgery scheduling
Integrating nurse and surgery scheduling Jeroen Beliën Erik Demeulemeester Katholieke Universiteit Leuven Naamsestraat 69, 3000 Leuven, Belgium jeroen.belien@econ.kuleuven.be erik.demeulemeester@econ.kuleuven.be
More informationAPPLICATION OF SIMULATION MODELING FOR STREAMLINING OPERATIONS IN HOSPITAL EMERGENCY DEPARTMENTS
APPLICATION OF SIMULATION MODELING FOR STREAMLINING OPERATIONS IN HOSPITAL EMERGENCY DEPARTMENTS Igor Georgievskiy Alcorn State University Department of Advanced Technologies phone: 601-877-6482, fax:
More informationNEW INNOVATIONS TO IMPROVE PATIENT FLOW IN THE ED AND HOSPITAL OCTOBER 12, Mike Williams, MPH/HSA The Abaris Group
NEW INNOVATIONS TO IMPROVE PATIENT FLOW IN THE ED AND HOSPITAL OCTOBER 12, 2010 Mike Williams, MPH/HSA The Abaris Group Outline Page 2 1. Top Innovations ED and Hospital 2. Top Barriers 3. Steps to Eliminate
More informationMINISTRY OF HEALTH AND LONG-TERM CARE. Summary of Transfer Payments for the Operation of Public Hospitals. Type of Funding
MINISTRY OF HEALTH AND LONG-TERM CARE 3.09 Institutional Health Program Transfer Payments to Public Hospitals The Public Hospitals Act provides the legislative authority to regulate and fund the operations
More informationRedesign of Front Door
Redesign of Front Door Transforming Acute and Urgent Care Strategic Background and Context Our Change and Improvement Programme What have we achieved and how? What did we learn? Ian Aitken, General Manager
More informationMoving from passive to active provider payment systems: DRG-based financing
International Conference Markets in European Health Systems: Opportunities, Challenges, and Limitations, Kranjska Gora/ Slovenia Moving from passive to active provider payment systems: DRG-based financing
More informationDecreasing Environmental Services Response Times
Decreasing Environmental Services Response Times Murray J. Côté, Ph.D., Associate Professor, Department of Health Policy & Management, Texas A&M Health Science Center; Zach Robison, M.B.A., Administrative
More informationOptimizing the planning of the one day treatment facility of the VUmc
Research Paper Business Analytics Optimizing the planning of the one day treatment facility of the VUmc Author: Babiche de Jong Supervisors: Marjolein Jungman René Bekker Vrije Universiteit Amsterdam Faculty
More informationThe Pain or the Gain?
The Pain or the Gain? Comprehensive Care Joint Replacement (CJR) Model DRG 469 (Major joint replacement with major complications) DRG 470 (Major joint without major complications or comorbidities) Actual
More informationNURSING WORKLOAD AND WORKFORCE PLANNING PAEDIATRIC QUESTIONNAIRE
NURSING WORKLOAD AND WORKFORCE PLANNING PAEDIATRIC QUESTIONNAIRE INSTRUCTIONS FOR COMPLETION IN EXCEL Please complete this questionnaire electronically. Questions should be answered by either entering
More informationCOMPARING TWO OPERATING-ROOM-ALLOCATION POLICIES FOR ELECTIVE AND EMERGENCY SURGERIES
Proceedings of the 2010 Winter Simulation Conference B. Johansson, S. Jain, J. Montoya-Torres, J. Hugan, and E. Yücesan, eds. COMPARING TWO OPERATING-ROOM-ALLOCATION POLICIES FOR ELECTIVE AND EMERGENCY
More informationIdentifying step-down bed needs to improve ICU capacity and costs
www.simul8healthcare.com/case-studies Identifying step-down bed needs to improve ICU capacity and costs London Health Sciences Centre and Ivey Business School utilized SIMUL8 simulation software to evaluate
More informationOperational Assessments: Utilizing Productivity Standards
Operational Assessments: Utilizing Productivity Standards Mary Klimp CEO Queen of Peace Hospital 952.758.8101 mklimp@qofp.org Ross Manson Principal Eide Bailly 701.239.8634 rmanson@eidebailly.com Agenda
More informationScheduling & Physician/Staff Utilization
Scheduling & Physician/Staff Utilization Presented By Economedix Your Partner In Building High Performance Practices Today s Course Practice Management Seminar Series First of Four Patient Flow & Marketing
More informationIntelligence. Intelligence. Workload forecasting with Cerner Clairvia. Workload forecasting with Cerner Clairvia
Intelligence Intelligence Workload forecasting with Cerner Clairvia Workload forecasting with Cerner Clairvia Better patient outcomes occur when you have the right care giver, in the right place, at the
More informationWhat s Wrong with Healthcare?
What s Wrong with Healthcare? Dan Murrey, MD, MPP Chief Executive Officer Agenda What s wrong with healthcare in the US? What would make it better? How can you help? What s wrong with US healthcare? What
More informationUpdated 10/04/ Franklin Dexter
Anesthesiologist and Nurse Anesthetist Afternoon Staffing This talk includes many similar slides Paging through produces animation View with Adobe Reader for mobile: ipad, iphone, Android Slides were tested
More informationExternal retrospective Validation of BIG criteria. An example of PDSA for Neurotrauma patients.
External retrospective Validation of BIG criteria. An example of PDSA for Neurotrauma patients. Ahmed M. Raslan, MD Assistant Professor in Neurological Surgery Neuroscience quality medical director Oregon
More informationImproving Hospital Performance. creating synergy between. payment models
Improving Hospital Performance creating synergy between quality, efficiency and payment models Niek Klazinga, Zagreb Januari 28 2013 Average OECD health expenditure Growth rates in real terms, 2000 to
More informationRedesigning Post-Acute Care: Value Based Payment Models
Redesigning Post-Acute Care: Value Based Payment Models Liz Almeida-Sanborn, MS, PT President Preferred Therapy Solutions This session will address: Discussion of the emergence of voluntary and mandatory
More informationAn analysis of the average waiting time during the patient discharge process at Kashani Hospital in Esfahan, Iran: a case study
An analysis of the average waiting time during the patient discharge process at Kashani Hospital in Esfahan, Iran: a case study Sima Ajami and Saeedeh Ketabi Abstract Strategies for improving the patient
More informationUsing Monte Carlo Simulation to Assess Hospital Operating Room Scheduling
Washington University in St. Louis School of Engineering and Applied Science Electrical and Systems Engineering Department ESE499 Using Monte Carlo Simulation to Assess Hospital Operating Room Scheduling
More informationUniversity of Michigan Health System Program and Operations Analysis. Analysis of Pre-Operation Process for UMHS Surgical Oncology Patients
University of Michigan Health System Program and Operations Analysis Analysis of Pre-Operation Process for UMHS Surgical Oncology Patients Final Report Draft To: Roxanne Cross, Nurse Practitioner, UMHS
More informationExpedition: Improving Safety and Reliability for Surgical Procedures
These presenters have nothing to disclose Expedition: Improving Safety and Reliability for Surgical Procedures Session 5 William Berry, MD, MPA, MPH, FACS Kathy Duncan, RN January 23, 2014 Expedition Coordinator
More informationThe Partner of Choice for Leading Health Systems. Learning Objectives. 45+ Health System Partners 750K+ Surgical Procedures $1.
http://www.advocatehealth.com/images/logo_advocatehealthcare.gif Co-Management: Successfully Improving Care Along the Surgical Continuum Gerald Biala, SCA Senior Vice President of Perioperative Services
More information