Inpatient flow management: a systematic review.

Purpose: In hospitals, several patient flows compete for access to shared resources. Failure to manage these flows result in one or more disruptions within a hospital system. To ensure continuous care delivery, solving flow problems must not be limited to one unit, but should be extended to other departments - a prerequisite for solving flow problems in the entire hospital.

Demand, capacity, and access of the outpatient clinic: A framework for analysis and improvement.

Rationale: While theoretical frameworks for optimization of the outpatient processes are abundant, practical step-by-step analyses to give leads for improvement, to forecast capacity, and to support decision making are sparse.

Aims And Objectives: This article demonstrates how to evaluate and optimize the triad of demand, (future) capacity, and access time of the outpatient clinic using a structured six-step method.

Methods: All individual logistical patient data of an orthopaedic outpatient clinic of one complete year were analysed using a 6-step method to evaluate demand, supply, and access time.

The Use of Operational Excellence Principles in a University Hospital.

The introduction of Operational Excellence in the Maastricht University Medical Center (MUMC+) has been the first of its kind and scale for a university hospital. The policy makers of the MUMC+ have combined different elements from various other business, management, and healthcare philosophies and frameworks into a unique mix. This paper summarizes the journey of developing this system and its most important aspects.

Improving the Prediction of Total Surgical Procedure Time Using Linear Regression Modeling.

For efficient utilization of operating rooms (ORs), accurate schedules of assigned block time and sequences of patient cases need to be made. The quality of these planning tools is dependent on the accurate prediction of total procedure time (TPT) per case. In this paper, we attempt to improve the accuracy of TPT predictions by using linear regression models based on estimated surgeon-controlled time (eSCT) and other variables relevant to TPT.

Introducing an integrated intermediate care unit improves ICU utilization: a prospective intervention study.

Background: Improvement of appropriate bed use and access to intensive care (ICU) beds is essential in optimizing utilization of ICU capacity. The introduction of an intermediate care unit (IMC) integrated in the ICU care may improve this utilization.

Method: In a before-after prospective intervention study in a university hospital mixed ICU, the impact of introducing a six-bed mixed IMC unit supervised and staffed by ICU physicians was investigated.

Reflecting on the efficacy of cognitive mapping for decision-making in intellectual disability care: a case study.

The central aspect of this study is a set of reflections on the efficacy of soft operational research techniques in understanding the dynamics of a complex system such as intellectual disability (ID) care providers. Organizations providing services to ID patients are complex and have many interacting stakeholders with often different and competing interests. Understanding the causes for failures in complex systems is crucial for appreciating the multiple perspectives of the key stakeholders of the system.

Towards an organisation-wide process-oriented organisation of care: a literature review.

Background: Many hospitals have taken actions to make care delivery for specific patient groups more process-oriented, but struggle with the question how to deal with process orientation at hospital level. The aim of this study is to report and discuss the experiences of hospitals with implementing process-oriented organisation designs in order to derive lessons for future transitions and research.

Methods: A literature review of English language articles on organisation-wide process-oriented redesigns, published between January 1998 and May 2009, was performed.

Does case-mix based reimbursement stimulate the development of process-oriented care delivery?

Objectives: Reimbursement based on the total care of a patient during an acute episode of illness is believed to stimulate management and clinicians to reduce quality problems like waiting times and poor coordination of care delivery. Although many studies already show that this kind of case-mix based reimbursement leads to more efficiency, it remains unclear whether care coordination improved as well. This study aims to explore whether case-mix based reimbursement stimulates development of care coordination by the use of care programmes, and a process-oriented way of working.

Implementation by simulation; strategies for ultrasound screening for hip dysplasia in the Netherlands.

Background: Implementation of medical interventions may vary with organization and available capacity. The influence of this source of variability on the cost-effectiveness can be evaluated by computer simulation following a carefully designed experimental design. We used this approach as part of a national implementation study of ultrasonographic infant screening for developmental dysplasia of the hip (DDH).

Applying the quality improvement collaborative method to process redesign: a multiple case study.

Background: Despite the widespread use of quality improvement collaboratives (QICs), evidence underlying this method is limited. A QIC is a method for testing and implementing evidence-based changes quickly across organisations. To extend the knowledge about conditions under which QICs can be used, we explored in this study the applicability of the QIC method for process redesign.

The choice of obstetric care by low-risk pregnant women in the Netherlands: implications for policy and management.

In the Netherlands, pregnant women at low risk of complications during pregnancy, have the opportunity to choose freely between giving birth at home or in a hospital maternity unit. This study analyses how various attributes of obstetric care, socio-economic characteristics and attitudes influence the decisions that these women make with regard to obstetric care. The method of discrete-choice experiment was applied in the process of data collection and analysis.

Performance measurement in mental health care: present situation and future possibilities.

This paper describes performance measurement and its indicators for mental health care services. Performance measurement can serve several goals such as accountability, quality improvement and performance management. For all three purposes structure, process and outcome indicators should be measured.

Changes in hospital costs after introducing an intermediate care unit: a comparative observational study.

Introduction: The high cost of critical care resources has resulted in strategies to reduce the costs of ruling out low-risk patients by developing intermediate care units (IMCs). The aim of this study was to compare changes in total hospital costs for intensive care patients before and after the introduction of an IMC at the University Hospital Maastricht.

Methods: The design was a comparative longitudinal study.

The work setting of diabetes nursing specialists in the Netherlands: a questionnaire survey.

Aim: The aim of this study is to explore whether the work organisation of diabetes specialist nurses (DSNs) differs significantly from nurses working in hospital and nursing home and if so, does this difference result in positive or negative consequences regarding work and health.

Background: In traditional health care settings, nurses exhibit a high level of environmental uncertainty and low decision-making authority, which has a negative effect on psychological reactions towards work. In professional nursing, specialisation, e.

Evaluating hospital design from an operations management perspective.

This paper describes an evaluation method for the assessment of hospital building design from the viewpoint of operations management to assure that the building design supports the efficient and effective operating of care processes now and in the future. The different steps of the method are illustrated by a case study. In the case study an experimental design is applied to assess the effect of used logistical concepts, patient mix and technologies.

Generic versus specific competencies of entry-level public health graduates: employers' perceptions in Poland, the UK, and the Netherlands.

Constant changes in society and the public health domain force public health professionals into new roles and the development of new competencies. Public health professionals will need to be trained to respond to this challenge. The aim of this comparative study among Poland, the UK and the Netherlands is to identify competence needs for Master of Public Health graduates entering the labour market from a European perspective.

A comparative study of organisational characteristics, work characteristics and nurses' psychological work reactions in a hospital and nursing home setting.

Objectives: The aim of the current study was twofold. First, we explored whether there were any differences concerning organisational characteristics, work characteristics and psychological work reactions in two types of health care setting, hospitals and nursing homes. Second, it was investigated and validated whether relationships between organisational characteristics, work characteristics and psychological work reactions found in research on hospital nursing are also present in nursing homes.

Enterprise resource planning for hospitals.

Integrated hospitals need a central planning and control system to plan patients' processes and the required capacity. Given the changes in healthcare one can ask the question what type of information systems can best support these healthcare delivery organizations. We focus in this review on the potential of enterprise resource planning (ERP) systems for healthcare delivery organizations.

Predicting capacities required in cardiology units for heart failure patients via simulation.

The management of a department of cardiology has to plan the capacity of both elective and non-elective patients. Heart failure (HF) patients are admitted to the hospital in a non-elective way. The precision with which the capacity needed for non-elective patients can be predicted determines the degree of flexibility in planning the admission of elective patients.

The importance of quality, access and price to health care consumers in Bulgaria: a self-explicated approach.

One approach to the problem of low patient satisfaction in Bulgaria is to identify attributes of health care services that the consumers value most and to focus on their improvement. Based on data from a household survey, this paper examines the importance that health care consumers attach to quality, access and price. The survey was conducted in 2000 among the population of the region of Varna (the third largest city in Bulgaria).

Costs of quality management systems in long-term care organizations: an exploration.

The article describes a method for measuring and reporting the costs of quality management in 11 long-term care organizations (nursing homes, home health care organizations, and homes for the elderly) and a national survey in 489 organizations providing long-term care. Site visits and a questionnaire were used to measure the existence of quality management (QM) activities and investigate the costs per QM activity in more detail. Health care organizations differentiate between regular activities and QM activities.

The diversity of work: differences, similarities and relationships concerning characteristics of the organisation, the work and psychological work reactions in intensive care and non-intensive care nursing.

The aim of this study was to examine differences in organisational characteristics, work characteristics and psychological work reactions, and to investigate relationships between these variables in intensive care units (ICUs) and non-ICUs. Questionnaires were distributed to intensive care (n = 184) and non-intensive care nurses (n = 927) working in 15 general hospitals in the Netherlands. MANOVA showed that ICU nurses reported significantly higher uncertainty, higher complexity, and higher decision authority than non-ICU nurses.

Application of computer simulation analysis to assess the effects of relocating a hospital phlebotomy department.

Background: This study describes a systematic approach to assess the effects of relocating a hospital department.

Methods: Using the phlebotomy service as an example, computer simulation was applied to predict changes in performance indicators, such as patient turn-around time (TAT), when planning a procedural and/or architectural redesign.

Results: Average patient TAT fell from 12 to 8 min, enabling the department to cope with any increase in numbers of patients.

Simulation studies and the alignment of interests.

Chemotherapy patients are treated with cytostatic drugs. Cytostatic drugs can be produced if ordered or they can be produced to keep in stock. The time that cytostatic drugs can be kept in stock before being spoiled is limited.