10:30 AM - 11:00 AM
Should the financing system determine the priorities and objectives of a healthcare system?
It is well established that the source of funding and system of financing influence the organisation and characteristics of health care, including coverage, provision and, for example, focus on preventive rather than curative approaches. However, recently there have been a number of claims that the funding and financing system should – rather than does – determine the objectives and priorities of health-care systems, with some commentators making a clear distinction in this respect between social insurance and tax-funded systems. Pursuit of this normative position could affect operational researchers as objectives and priorities are a central concern of many OR studies in health care.
This paper reviews the established relationship between financing and finding methods and the provision and coverage of health care. It then moves on to explore the implications for the provision and nature of health care of the claims that the objectives and priorities should be determined, or at least influenced, by the financing system. Implications for international comparison of healthcare systems and cross-border learning are examined. The extent to which such considerations affect analysis of health policy, systems, management and organisation and should be the concern of operational researchers will be explored.
11:00 AM - 11:30 AM
Improving Emergency Department (ED) Processes at Kashani Hospital by Lean Management and Simulation
Introduction: A great deal of time, effort, and resources are required to provide high quality care to each of the patients in the Emergency Department (ED), whereas if one looks at the actual sequence of events, there is a tremendous amount of unnecessary activities that go on, and therefore lots of delays, repeated tests, and events not occurring in the right sequence. Lean management is a process improvement technique to identify waste actions and activities to eliminate them. So, lean management reduces the time taken by the patient to go through the processes of treatment in the ED. Simulation can show the eventual effects of alternative improvements and the outcome of the action. Aim: The aim of this study was to improve the ED processes at Kashani Hospital in Isfahan, Iran by “lean management” and “simulation”. Methods: This research was applied and an analytical intervention study. Data was collected by brainstorming, observations, interview, review of work flow and documents. Data included lean team members’ viewpoints, waiting and service time in all workstations related to the ED's treatment processes along with diagnostic departments (e.g. Laboratory, Radiology, Ultrasonography, and C-T Scan) during 17 days-period. To perform Lean Technique the staff of the ED was familiarized with the concept of lean management and then formed a lean management team. In the next meetings, current process was reviewed by the lean management team. Then, wastes, values and proposed ideas were identified by the team. Data was analyzed through SPSS software and simulation technique. Results: Findings showed that after applying modifications, total wait time in the system reduced from 120.83 to 107.19 minutes. Conclusion: Lean management improves quality, reliability, and productivity of the ED processes; and it does so while making work easier for the medical staff by removing waste and improving the customer experience as well. Reviewing processes of the ED services can regularly help to identify waste procedures through practical, reasonable and easy suggestions by the ED staff. Simulation technique can evaluate expensive suggestions.
11:30 AM - 12:00 PM
Improving healthcare delivery at St-Mary’s hospital Laçor through OM and OR
After twenty years of armed conflict in northern Uganda, St-Marys Laçor Hospital has faced a sharp rise in the number of patients presenting chronic conditions, which require longer treatments and a profound modification of the health service offer. This situation is challenging the Hospital’s management team to review its practices and management tools in order to ensure the best delivery of services with it’s limited resources. Tuberculosis (TB) has been identified as a critical disease for which the hospital needs new methodologies and tools to improve the current process.
This project pursues two complementary objectives: 1) identify the main challenges related to the TB healthcare delivery process and propose improvements; 2) identify supports activities of the hospital which could also benefit from improved management methodologies and more sophisticated decision support tools.
Since this project was initiated without any prior information on the actual TB delivery process in place at the Hospital, the initial phase consisted in a comprehensive collection of information, through a literature review and questionnaires, followed by an extensive series of interviews and observations carried out on site. The data obtained was then analyzed to produce a comprehensive process mapping which, when complemented with the interviews, would allow to identify the main challenges encountered in the TB delivery process as well in the other hospital activities supporting it.
The major challenges identified were the following: patient follow-up activities, infection control risks and continuous improvement culture. Several solutions are proposed ranging from simple process adjustments, a prototype of computerized database, establishing a fast track for suspected TB patients, to a simulation tool. Finally, several challenges were identified in the hospital support activities such as: transportation planning and maintenance; nurse demand planning and scheduling. However, tackling these issues requires longer-term research efforts to develop decision tools based on operational research.