Assignment 1

1CM190 Health care operations planning

Student name, number:

P.G.H. (Pien) Levels, 1334735

Nico Dellaert

Word count: 1247

Eindhoven, November 29, 2021

Contents

1 Week 1 1
1.1 Topic 1: Problem Description . . . . . . . . . . . . . . . . . . . . . . . . . . 1

2 Week 2 3
2.1 Topic 2: Forecasting new patients . . . . . . . . . . . . . . . . . . . . . . . . 3

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2 Week 2
2.1 Topic 2: Forecasting new patients
In conducting a studies in the field of health care operations planning, the amount of
incoming patients and the demand for health care are critical components to investigate.
In order to optimize schedules of nurses and doctors or to determine the utilization of beds,
these components are necessary. Unfortunately, this is not always known in advance. As,
hospitals do not only provide care in a way of pre-arranged appointments but also provide
the so called emergency care whereby patients need unplanned care immediately. For
these reasons, a suitable forecasting technique of new patients is crucial.
One thesis that used a satisfactory forecasting technique was the thesis of Marle Muse-
laers (30). She predicted the number of realized nursing hours by using a multi linear
regression model. She could only use one year of data to build the model due to some
acceptable reasons. The model consisted of various independent variables to predict the
dependent variable, amongst others the number of patients present during the shift, the
percentage of patients with an age equal to or greater than 70, the difference between the
hospital admission date and the hospital discharge date and the number of admissions
and discharges that occurred on this ward during a shift. One should note that Marle
Muselaers does not give any explanations why she chooses these independent variables.
Moreover, it is important to observe that her model considers the holiday planning indi-
rectly as well since the predicted variable in this thesis is the number of realized nursing
hours. One member of the class also noted that she took into account the movement from
patient to other beds as well, which is important for the forecasting the amount of nursing
hours for each ward. Furthermore, Marle Muselaers uses clustering to decrease the com-
plexity of the model. She clustered some period variables that had some similar significant
effect on the number of patients. By using a clustering method, a model becomes smaller
and stronger at the same time. Finally, her clustering method resulted into four different
clusters which each another bed occupancy.
Tim Kragten (25) used in his thesis the same period variables as Marle Muselaers. He
aimed to determine whether the bed occupancy is influenced by the seasonal and trend
effects using a multi linear regression model. He added a good substantiated argument for
using this type of model namely that it tackles the problem of holidays which are different
each year. Unfortunately, in the model he did not use any clustering technique while
using the same period variables as Marle Muselaers. Therefore, his model is unnecessary
complex as some of the periods have similar effects on the number of patients. For a
stronger model, the periods should have been clustered. In his thesis, he forecasted the
maximum number of beds during the day by using the number of OR sessions and by
creating dummy variables that are related to seasonal factors, holidays, off-days, trend
in years and the day of the week. When looking more carefully to his approach, Tim
Kragten did not measure the real demand for beds. As an example, during holidays the
maximum bed occupation during a day might seem lower. This does not mean that there
is less demand for health care during the summer. However, it could mean that there is
less available resources because more doctors are on holidays during the summer. As the
aim of his thesis was reducing imbalances between demand and supply of bed capacity,
it is not good at all to measure the number of accepted patients in stead of the actual
demand. In all, this means that his data is influenced by the elective patients. Meaning
that, during a period, whereby there is a lower maximum bed occupancy, there are also
less scheduled patients. It is good to notice that the regression model of Tim is based
on 5 years of data, which increases the model’s accuracy. Furthermore, when comparing

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the thesis of Marle Muselaers and Tim Kragten, forecasting the amount of nursing hours
instead of the bed occupancy differs in the measuring of the amount of care. As the class
discussion made clear, not every patient needs the same amount of care. When a patient
enters a hospital, the bed care is often low, however, after the operation the bed care and
it is way higher. By predicting the realized amount of nursing hours this is considered as
well.
Another thesis that did not measure the real demand was that of Joost Menten (27).
He used a multi linear regression analysis to forecast the number of patients per weak. He
used a continuous variable for the year, a dummy variable for if a quartile is quartile three
and a dummy variable if a week had four or five working days as independent variables.
By using the four or five working days in a week to explain the differences between weeks,
Joost Menten did not take into account holidays as Marle Muselaers and Tim Kragten
did. Although, in his model he considered the off-days. As his model is already small, no
clustering was necessary. However, he was able to show a trend over the years because he
used four years of historical data to build his model.
Compared to Tim Kragten, Marle Muselaers and Joost Menten, Windi Winasti (6) and
Bregje van der Staak (1) used a different forecasting technique namely Winters’ forecasting
model. The reason for this was the presence of seasonal and trend pattern found in the
historical data. The model of Windi Winasti is only based on one year of data which
implies that she could not investigate the trends over the years. Just like Marle Muselaers
did, Windi Winasti aimed to forecast the required number of nursing hours. Windi Winasti
used her forecasting model to determine the long term estimation of the monthly patient
admission, which she then translated to the required nursing hours. Again the same thing
should be noted as in the thesis of Tim Kragten Joost Menten, even though it is eventually
translated to required nursing hours, estimating the monthly patient admission is not the
same as estimating the demand. The same applies for Bregje van der staak as in her
model the arrivals in the outpatient department is predicted. Although, she was meant to
forecast the patient demands. However, in Bregje van der Staak’s model a trend over the
years was visualized as she used three years of historical data to create the model.
In table 2, the overview of the ratings on several criteria is shown. Except from Marle
Muselaers all thesis aimed at forecasting real patient demand, but in stead predicted
the amount of incoming patients, which is not the same phenomenon. Furthermore, the
models of Bregje van der Staak, Windi Winasti and Joost Menten looked only at different
seasons and the high level trends over a year when forecasting the number of incoming
patients. However, as Tim Kraften reasoned, holidays differ each year. So when using the
Winters’ forecasting method or using a multi linear regression model with only high level
variables (such as quartiles and years), the holidays are not fully considered in the model.
Furthermore, there are also other factors that could be looked at when investigating the
amount of incoming patients or the utilization of beds, for example, the patient plans as
this can predict the actual demand of health care. When using the Winters’ forecasting
model, it is not even possible to take such variables into consideration.

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 Tim Marle Bregje Windi Joost
Kragten Muselaers van der Winasti Menten
(25) (30) Staak (1) (6) (27)
Years of historical data ++ 0 ++ - ++
Parameter optimization + ++ – - -
Motivation for + - + + +
parameter optimization
Appropriate model type + + - - +
Clustering method – ++ 0 0 0

Table 2: Overview of theses for topic 2