No abstract

Rising expenditures spur healthcare organizations to organize their processes more efficiently and effectively. Unfortunately, healthcare planning and control lags behind manufacturing planning and control. We analyze existing planning and control concepts or frameworks for healthcare operations management and find that they do not address various important planning and control problems. We conclude that they only focus on hospitals and are too narrow, focusing on a single managerial area, such as resource capacity planning, or ignoring hierarchical levels. We propose a modern framework for healthcare planning and control that integrates all managerial areas in healthcare delivery operations and all hierarchical levels of control, to ensure completeness and coherence of responsibilities for every managerial area. The framework can be used to structure the various planning and control functions and their interaction. It is applicable to an individual department, an entire healthcare organization, and to a complete supply chain of cure and care providers. The framework can be used to identify and position various types of managerial problems, to demarcate the scope of organization interventions and to facilitate a dialogue between clinical staff and managers.

This paper addresses the problem of operating room (OR) scheduling at the tactical level of hospital planning and control. Hospitals repetitively construct operating room schedules, which is a time-consuming, tedious, and complex task. The stochasticity of the durations of surgical procedures complicates the construction of operating room schedules. In addition, unbalanced scheduling of the operating room department often causes demand fluctuation in other departments such as surgical wards and intensive care units. We propose cyclic operating room schedules, so-called master surgical schedules (MSSs) to deal with this problem. In an MSS, frequently performed elective surgical procedure types are planned in a cyclic manner. To deal with the uncertain duration of procedures we use planned slack. The problem of constructing MSSs is modeled as a mathematical program containing probabilistic constraints. Since the resulting mathematical program is computationally intractable we propose a column generation approach that maximizes the operation room utilization and levels the requirements for subsequent hospital beds such as wards and

No abstract

Long waiting times for emergency operations increase a patient's risk of postoperative complications and morbidity. Reserving Operating Room (OR) capacity is a common technique to maximize the responsiveness of an OR in case of arrival of an emergency patient. This study determines the best way to reserve OR time for emergency surgery. In this study two approaches of reserving capacity were compared: (1) concentrating all reserved OR capacity in dedicated emergency ORs, and (2) evenly reserving capacity in all elective ORs. By using a discrete event simulation model the real situation was modelled. Main outcome measures were: (1) waiting time, (2) staff overtime, and (3) OR utilisation were evaluated for the two approaches. Results indicated that the policy of reserving capacity for emergency surgery in all elective ORs led to an improvement in waiting times for emergency surgery from 74 (±4.4) minutes to 8 (±0.5) min. Working in overtime was reduced by 20%, and overall OR utilisation can increase by around 3%. Emergency patients are operated upon more efficiently on elective Operating Rooms instead of a dedicated Emergency OR. The results of this study led to closing of the Emergency OR in the Erasmus MC (Rotterdam, The Netherlands).