Optimization and planning of operating theatre activities: an original definition of pathways and process modeling

Abstract

BackgroundThe Operating Room (OR) is a key resource of all major hospitals, but it also accounts for up 40 % of resource costs. Improving cost effectiveness, while maintaining a quality of care, is a universal objective. These goals imply an optimization of planning and a scheduling of the activities involved. This is highly challenging due to the inherent variable and unpredictable nature of surgery.MethodsA Business Process Modeling Notation (BPMN 2.0) was used for the representation of the “OR Process” (being defined as the sequence of all of the elementary steps between “patient ready for surgery” to “patient operated upon”) as a general pathway (“path”). The path was then both further standardized as much as possible and, at the same time, keeping all of the key-elements that would allow one to address or define the other steps of planning, and the inherent and wide variability in terms of patient specificity. The path was used to schedule OR activity, room-by-room, and day-by-day, feeding the process from a “waiting list database” and using a mathematical optimization model with the objective of ending up in an optimized planning.ResultsThe OR process was defined with special attention paid to flows, timing and resource involvement. Standardization involved a dynamics operation and defined an expected operating time for each operation. The optimization model has been implemented and tested on real clinical data. The comparison of the results reported with the real data, shows that by using the optimization model, allows for the scheduling of about 30 % more patients than in actual practice, as well as to better exploit the OR efficiency, increasing the average operating room utilization rate up to 20 %.ConclusionsThe optimization of OR activity planning is essential in order to manage the hospital’s waiting list. Optimal planning is facilitated by defining the operation as a standard pathway where all variables are taken into account. By allowing a precise scheduling, it feeds the process of planning and, further up-stream, the management of a waiting list in an interactive and bi-directional dynamic process.

The application of quality improvement methodologies in surgery

“…Lean methods ("lean") originated in the Japanese automotive manufacturing sector in 1990 with the Toyota production system. 4 Lean aims to eliminate waste in a system by removing unnecessary steps in a process pathway while preserving steps that maximize value to the consumer. 3,5,6 Other lean principles include reducing the time and resources required to generate results for the consumer and improving the system's ability to respond to the changing feature article needs of the consumer.…”

“…Small, medium, and large-scale QI initiatives have been introduced in the surgical setting with the goals of reducing wait times, improving operating room (OR) efficiency, decreasing operative complications, limiting unnecessary costs, and minimizing hospitalization duration. The largest portion of surgical dollars is allocated to the OR 4 , making it a high priority for QI initiatives. The purpose of this article is to provide a succinct review of QI methodologies and their application in surgery.…”

Method Proposal to Transform Medical Guidelines to a Conceptual Process Model: A Case Study for Sepsis

“…In the field of health, as a result of the nature of the service offered, health institutions' processes are also the basis for decision making which is focused on achieving their objective of providing quality medical assistance (Barbagallo et al, 2015).…”

“…It allows one to construct business process diagrams representing graphs, or networks made of "objects" exhibited by the process activities, connected by control flows, which define the logical relationship, the dependencies, and the order of execution of the activities. The use of the BPMN standard can also define a specific workflow, for the process under investigation, and its subsequent development including computerization, with resource management, and the definition of the actors involved (Barbagallo et al, 2015).…”

“…BPMN is comprehensible by different kinds of specialists: such as computer scientists, IT staff, healthcare workers, and management personnel (Barbagallo et al, 2015).…”