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While hospitals can learn from other industries, they cannot be improved or run like factories. With work that is more individualized than standardized, and limited control over volume and arrivals, even the leanest-minded hospital must recognize that healthcare systems are more dynamic than nearly any work environment.Written with the creativity n
Our nation's capacity to care is becoming increasingly stressed as an aging and increasingly unhealthy population collides with a relative reduction in the numbers of clinicians and ever-tightening financial resources. If even the mildest of future-state predictions are to be believed, we need a significant restructuring of our entire healthcare system and its total Capacity to Care, such that we can simultaneously improve care capacity, cost, quality, accessibility, and resource gratification. Optimizing Your Capacity to Care: A Systems Approach to Hospital and Population Health Management provides comprehensive guidance to a new way to optimize and manage community-wide Care Capacity via a unique, holistic approach to healthcare operations. Through clear examples and actual project results, the book demonstrates the outcomes of a systems-level way of thinking about a community's Capacity to Care that incorporates and integrates the full spectrum of available clinical and communal resources into the care of patients, including hospitals, physicians, emergency departments, surgical services, local churches, civic organizations, pharmacies, and volunteers. The book details operational models for each major department of the hospital and a fully integrated communal resource pool to demonstrate how the optimization of capacity, resource utilization, cost, and clinical outcomes can be attained. And by providing healthcare leaders with a deeper understanding of key elements missing from the most common process improvement methodologies and approaches, this book offers fresh perspectives and bold alternatives for hospitals, health systems, and entire communities.
In both rich and poor nations, public resources for health care are inadequate to meet demand. Policy makers and health care providers must determine how to provide the most effective health care to citizens using the limited resources that are available. This chapter describes current and future challenges in the delivery of health care, and outlines the role that operations research (OR) models can play in helping to solve those problems. The chapter concludes with an overview of this book – its intended audience, the areas covered, and a description of the subsequent chapters. KEY WORDS Health care delivery, Health care planning HEALTH CARE DELIVERY: PROBLEMS AND CHALLENGES 3 1.1 WORLDWIDE HEALTH: THE PAST 50 YEARS Human health has improved significantly in the last 50 years. In 1950, global life expectancy was 46 years [1]. That figure rose to 61 years by 1980 and to 67 years by 1998 [2]. Much of these gains occurred in low- and middle-income countries, and were due in large part to improved nutrition and sanitation, medical innovations, and improvements in public health infrastructure.
Although much has been achieved in care coordination and accountable care, healthcare leaders need additional, game-changing innovations to deal with constraints in clinical resources, care capacity, and cost that have not yet been fully addressed. This need for innovation is especially great in the care of the chronically ill: the most costly, highest-risk segments of our populations. Filling this void, Developing a Poly-Chronic Care Network: An Engineered, Community-Wide Approach to Disease Management reconstructs and augments traditional chronic care delivery models. The proposed solution—the Poly-Chronic Care Network© (PCCN)—is a specific iteration of the Care Circle Network© (CCN) concept that creates a sustainable community-engaging response to the complexity, cost, and outcomes of chronic diseases. By dynamically engineering all the elements of a community’s "Capacity to Care" directly into short- and long-term patient care processes, the PCCN expands care capacity and physician "reach", and improves quality and outcomes, without increasing the total cost of care. The book describes the fundamental concepts, principles, and requirements for the PCCN and explains how this care model could augment and enhance other new business models, such as Accountable Care Organizations (ACOs) and Patient-Centered Medical Homes (PCMHs). In addition to a detailed description of implementation steps and organizational structures, the text provides useful insights into technologies that can aid and enhance implementation, including home/virtual monitoring, social networking, and dynamic simulation. Importantly, the book includes both detailed examples and a flexible how-to guide for setting up a PCCN or other CCN, offering readers step-by-step guidelines and options for combining readily-available communal resources with simple technologies in the design of innovative care models for their communities. With this book in hand, readers can confidently pick and choose specific components to match their community’s needs and capabilities, "amending the blend" to account for the size, scale, scope, and population of the community and patients they wish to serve.
From the Preface: Collectively, the chapters in this book address application domains including inpatient and outpatient services, public health networks, supply chain management, and resource constrained settings in developing countries. Many of the chapters provide specific examples or case studies illustrating the applications of operations research methods across the globe, including Africa, Australia, Belgium, Canada, the United Kingdom, and the United States. Chapters 1-4 review operations research methods that are most commonly applied to health care operations management including: queuing, simulation, and mathematical programming. Chapters 5-7 address challenges related to inpatient services in hospitals such as surgery, intensive care units, and hospital wards. Chapters 8-10 cover outpatient services, the fastest growing part of many health systems, and describe operations research models for primary and specialty care services, and how to plan for patient no-shows. Chapters 12 – 16 cover topics related to the broader integration of health services in the context of public health, including optimizing the location of emergency vehicles, planning for mass vaccination events, and the coordination among different parts of a health system. Chapters 17-18 address supply chain management within hospitals, with a focus on pharmaceutical supply management, and the challenges of managing inventory for nursing units. Finally, Chapters 19-20 provide examples of important and emerging research in the realm of humanitarian logistics.
Measuring Capacity to Care Using Nursing Data presents evidence-based solutions regarding the adoption of safe staffing principles and the optimum use of operational data to enable health service delivery strategies that result in improved patient and organizational outcomes. Readers will learn how to make better use of informatics to collect, share, link and process data collected operationally for the purpose of providing real-time information to decision- makers. The book discusses topics such as dynamic health care environments, health care operational inefficiencies and costly events, how to measure nursing care demand, nursing models of care, data quality and governance, and big data. The content of the book is a valuable source for graduate students in informatics, nurses, nursing managers and several members involved in health care who are interested in learning more about the beneficial use of informatics for improving their services. Presents and discusses evidences from real-world case studies from multiple countries Provides detailed insights of health system complexity in order to improve decision- making Demonstrates the link between nursing data and its use for efficient and effective healthcare service management Discusses several limitations currently experienced and their impact on health service delivery
This book demonstrates how to successfully manage and lead healthcare institutions by employing the logic of business model innovation to gain competitive advantages. Since clerk-like routines in professional organizations tend to overlook patient and service-centered healthcare solutions, it challenges the view that competition and collaboration in the healthcare sector should not only incorporate single-end services, therapies or diagnosis related groups. Moreover, the authors focus on holistic business models, which place greater emphasis on customer needs and put customers and patients first. The holistic business models approach addresses topics such as business operations, competitiveness, strategic business objectives, opportunities and threats, critical success factors and key performance indicators.The contributions cover various aspects of service business innovation such as reconfiguring the hospital business model in healthcare delivery, essential characteristics of service business model innovation in healthcare, guided business modeling and analysis for business professionals, patient-driven service delivery models in healthcare, and continuous and co-creative business model creation. All of the contributions introduce business models and strategies, process innovations, and toolkits that can be applied at the managerial level, ensuring the book will be of interest to healthcare professionals, hospital managers and consultants, as well as scholars, whose focus is on improving value-generating and competitive business architectures in the healthcare sector.
This proceedings volume highlights the state-of-the-art knowledge related to optimization, decisions science and problem solving methods, as well as their application in industrial and territorial systems. It includes contributions tackling these themes using models and methods based on continuous and discrete optimization, network optimization, simulation and system dynamics, heuristics, metaheuristics, artificial intelligence, analytics, and also multiple-criteria decision making. The number and the increasing size of the problems arising in real life require mathematical models and solution methods adequate to their complexity. There has also been increasing research interest in Big Data and related challenges. These challenges can be recognized in many fields and systems which have a significant impact on our way of living: design, management and control of industrial production of goods and services; transportation planning and traffic management in urban and regional areas; energy production and exploitation; natural resources and environment protection; homeland security and critical infrastructure protection; development of advanced information and communication technologies. The chapters in this book examine how to deal with new and emerging practical problems arising in these different fields through the presented methodologies and their applications. The chapter topics are applicable for researchers and practitioners working in these areas, but also for the operations research community. The contributions were presented during the international conference “Optimization and Decision Science” (ODS2017), held at Hilton Sorrento Palace Conference Center, Sorrento, Italy, September 4 – 7, 2017. ODS 2017, was organized by AIRO, Italian Operations Research Society, in cooperation with DIETI (Department of Electrical Engineering and Information Technology) of University “Federico II” of Naples.
Healthcare improvements is constantly relevant and an important topic. Healthcare is frequently being called upon to be more cost-efficient and still fulfil demands regarding waiting times, quality and availability. Experience from structural changes in other contexts gives reason to be positive about the potential for logistics improvements in the healthcare sector as well. From a logistics perspective patients pass different care functions, units, organisations and health facilities. It is assumed that logistics management knowledge applied in healthcare can lead to lower costs, shorter waiting times, better patient service, shorter treatment times and increased capacity. This dissertation therefore presents an exploration of how logistics management theories can be operationalised in a healthcare context to understand care chain effectiveness. Theoretically, the operationalisation is done by systems theory creating compatibility between logistics management theories and the healthcare context. As a first step, features for a logistics system forms features for achieving care chain effectiveness. High care chain effectiveness is thus a desired condition and the care delivery system is the tool to achieve it. As the final step in the operationalisation the features for care chain effectiveness are in turn used to analyse today’s practices. Empirically, the research is based on qualitative data from a single case study with multiple units of analysis. It includes four care units at one of Sweden’s university hospitals, where the data is gathered through interviews, insight into management systems and document analysis. One of the main results is the 21 areas identified for analysing today’s practices by means of features for care chain effectiveness. Another main result is the four important concepts revealed through the operationalisation: Lead time - the episode of care from order to delivery as the amount of time for patient cases between first contact with healthcare and the last.Patient order fulfilment - fulfilment of patients’ needs, broken down into several smaller steps performed over time within different care units in one or several organisations, consisting of five sub-processes - order handling, diagnosis, treatment, follow-up, and discharge.True demand – patients’ needs that is to be met and thus sets what care to deliver, i.e. the production plan and the subordinate resource plan.System boundaries - defines which care units to include when focusing on the care delivery system’s performance as a whole and should be more important than the performance and productivity of each individual care unit. A number of direct suggestions for care chain improvement can also be found in the concluding remarks, for example that objectives linked to economic influx or penalty narrow the system and that lead time data on an aggregated level is needed to cover episodes of care. The theoretical contribution of the dissertation is to the field of logistics management through the methodological development of using these theories in a new context. The managerial contribution is to healthcare managers through providing opportunities to improve care chains primarily by means of a greater understanding of care delivery systems.