A Survey of Health Care

Models that Encompass

Multiple Departments

Peter Vanberkel, PhD Candidate

University of Twente
 Outline
Part 1: Literature Overview

Part 2: ORchestra – online bibliography

 Introduction
Background:
– Although there is an abundance of models for
health care processes, few consider multiple
units or departments. – Jun et al. 1999
Our Intention:
1. What relationships were being accounted for?
(i.e. What areas of the hospital?)
2. How were they being modelled?
(i.e. What techniques?)
3. Identify examples of multi-department models.
4. What factors are holding modellers back?
 Search Method
Jun, J., Jacobson, S., and Swisher, J. (1999). Application of
Discrete-Event Simulation in Health Care Clinics: A Survey.
Journal of the Operational Research Society, 50(2):109–123.
Cited by over 70 papers
– 21.4% Tutorial or Instructional
– 10% Surveys
– 40% Applications / Case Studies of a Single Department
– 28.6% Applications / Case Studies of a Multiple Department
Other papers found via citations
In Total: Identified 78 papers which we considered to be
of “Multiple Department”
1. What relationships were being accounted
for? (i.e. What areas of the hospital?)
2. How were they being modelled?
(i.e. What techniques?)
3. Identify examples of multi-department
models.
4. What factors are holding modellers
back?
1. What relationships were being accounted
for? (i.e. What areas of the hospital?)
 Our Idealized Hospital
Diagnostics (Lab / Pharmacy / X-Ray)

Outpatient Operating Inpatient

Clinics Room Wards

Emergency
Department

Diagnostics (Lab / Pharmacy / X-Ray)

 Emergency Department (12)

OR(1) ICU(1) Ward(10)

Referrals(1) Emergency
Ambulances(1) Department

Lab/DI(5)
 Chart depicting the successive loss of
French Army soldiers during Napoleon’s
Russian Campaign (1812-13)

Charles Joseph Minard

 Surgical Care (36)
DI(2)

PACU(10)
Operating
Waiting List(11)
Room Ward(22)

ICU(9)

Emergency(0)
 Inpatient Wards(20)
Lab/DI(0)

ICU(9)
Inpatient Community
OR(8) Care(1)
Wards

Emergency Dept (9)

 Outpatient Clinics (4)
DI/Lab(2) Pharmacy(1)

Outpatient Operating Room(0)

Primary Care(0)
Clinics Emergency Dept (0)

(3)
Diagnostics (3)
DI / Lab Pharmacy

OR(1) Ward(2)
OR in Health Care Campaign
Diagnostics (Lab / Pharmacy / X-Ray)

Outpatient Operating Inpatient

Clinics Room Wards

Emergency
Department

Diagnostics (Lab / Pharmacy / X-Ray)

 2. How were they being modelled?
(i.e. What techniques?)
Systems
Dynamics(6)
Simulation(36)
Queueing
Theory(7)
Mathematical
Programming(16) Other(17)
Department by Department
 Departments is Scope

Two Dept. (38)

Three Dept. (34)
Four Dept. (5)
Five Dept. (1)
Six Dept. (1)
3. Identify examples of multi-department
models.
 Notable References
Brailsford, S. et al (2004). Emergency and on-
demand health care: modelling a large complex
system. Journal of the Operational Research
Society, 55(1):34– 42.
– Scope: Referral, Ambulances, ED, Lab/DI, ICU, Ward
– Technique: Systems Dynamics

Dexter, F. (2009). Bibliography of Operating Room

Management Articles. Retrieved October 10,2008
from http://www.franklindexter.net.
– Scope: Surgical Services
 Belien, J., et al. (2006). Visualizing the Demand for
Various Resources as a Function of the Master
Surgery Schedule: A Case Study. Journal of
Medical Systems, 30(5):343–350.
– Scope: OR, Lab/DI
– Technique: Software

Cochran, J. and Bharti, A. (2006a). A multi-stage

stochastic methodology for whole hospital bed planning
under peak loading. International Journal of Industrial
and Systems Engineering, 1(1):8–36.
– Scope: OR, ICU, Ward
– Technique: Queueing Theory & Simulation
 Fletcher, A. and Worthington, D. (2007). What is a ‘generic’
hospital model? Retrieved October 13, 2008:
http://eprints.lancs.ac.uk/7051/1/004583.pdf
4. What factors are holding modellers
back?
 Factors

1. Ambiguous Care Paths

2. Complexity & Variability
3. Hospital Culture
 Problem 1: Ambiguous Care Paths
“patient care plans for the individual
patient are rarely formally recorded, as
such, they tend to evolve with the
patient stay, and exist in a piece-meal
fashion in the minds of physicians,
nurses, and discharge planners”
(Kopach-Konrad et al., 2007).
Overcoming: Ambiguous Care Paths
Discussions with managers and care
providers
Information system protocol HL7
Medical record audits
Billing code audits
Radio frequency identifiers
Bar codes
Patient tracking systems
Clinical Pathways*
 Problem 2: Complexity & Variability
The complexity and variability that is
inherent in health care either greatly limits
the scope of models or forces modellers to
take a more macro view.
Either way, researchers loose a certain
amount of perspective and perhaps draw
conclusions on a model that does not
incorporate the entire set of circumstances
Coping with: Complexity & Variability
distinguish between those complicating
factors that have the greatest influence and
those factors which are simply attributes.
To limit the amount of variability time should
initially be spent eliminating the variability
caused by the system itself.
– good protocols or work practices
– a clear understanding of the patient care
trajectories.
Problem 3: Hospital Culture
“management does not consider the total care chain
from admission to discharge, but mainly focuses on
the performance of individual units. Not surprisingly,
this has often resulted in diminished patient access
without any significant reduction in costs” (de Bruin
et al., 2005).
People working in the health care system are very
knowledgeable about their own area but have
relatively little understanding of what goes on in the
next department. (Carter 2002)
Coping with: Hospital Culture
From an Operational Research Perspective:
Better Models
– Larger Scopes with a more sophisticated
understanding of the requirements of the
environment
– Practically Relevant
– Results which illustrate the benefits of
coordination between departments
Part 2: ORchestra Bibliography
 ORchestra Bibliography
A comprehensive overview of scientific
literature in the field of “Operations
Research in Health Care”
Can be accessed at:
http://www.choir.utwente.nl/ORchestra.
Is maintained by the Center for Health
Care Operations Improvement and
Research (CHOIR)
 ORchestra Bibliography
Categorized According to:
1. Medical Category (MeSH terms)
2. Model Category (Mathematics Subject
Classification)
3. Publication Type (MeSH terms)
4. Multiple Departments?
5. Interacting Patient Flows?
 ORchestra Bibliography
What’s Available Online?
– Detailed descriptions of the
categorization method
– Sorted pdf’s of all articles in each
category
– Free Text Searching of all Articles
(Coming soon)
 Discussion & Questions?

http://beta.ieis.tue.nl/home (Literature Review)

www.choir.utwente.nl/ORchestra/ (ORchestra)