Towards an ecosystem of Healthcare OR/OM education ... · Scientific multi-disciplinary approach,...
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Towards an ecosystem of Healthcare OR/OM education, research and impact Prof.dr.ir. Erwin W. Hans Full professor Operations Management in Healthcare Industrial Engineering & Business Systems CHOIR-Center for Healthcare Operations Improvement & Research
Transcript of Towards an ecosystem of Healthcare OR/OM education ... · Scientific multi-disciplinary approach,...
Towards an ecosystem of
Healthcare OR/OM
education, research and impactProf.dr.ir. Erwin W. Hans
Full professor Operations Management in Healthcare
Industrial Engineering & Business Systems
CHOIR-Center for Healthcare Operations Improvement & Research
My background
1997 MSc in Operations Research
2001 PhD Tactical capacity planning in discrete manufacturing
2007 Founded CHOIR research center
2012 Program Director Industrial Engineering & Management
2013 Full professor Operations Management in Healthcare
2014 Started CHOIR spin-off Rhythm
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Delesie, EJOR, 1998
Smith-Daniels, Decision Sciences, 1988
Hall et al., Handbook HC Scheduling 2006
Fries, Operations Research, 1976
Cayirli, POM, 2003
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You don’t have a waiting list??
… you must be a lousy doctor!!
In 2003, somewhere in the Netherlands…
Problems in hospitals
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• Poor ICT
• Departments are siloes
• Subjective idea of performance
• Poor training of management
• Conflicting autonomies
• Perverse financial incentives
• Dogmatic decision making
Center for Healthcare Operations
Improvement & Research
Our website:
http://www.utwente.nl/choir
Online bibliography:
http://www.utwente.nl/choir/orchestra
mission
CHOIR - Center for Healthcare Operations Improvement & Research
To help care providers to reach their goals w.r.t.
Improvement of productivity
Improvement of quality of care, labor and safety
Scientific multi-disciplinary approach,
Quantitative techniques and ICT,
Together with care providers,
Striving for maximal impact
CHOIR: research, education, valorisation
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Research (demand-driven):
- PhD students and staff
- BSc and MSc students
Education:
- BSc & MSc programs @ UT
- Courses for healthcare administrators and clinicians
- 2-year PDEng program Healthcare Logistics
Valorisation:
- Spin-off company:
University of Twente spin-off
Germany
Belgium
Question
Research
Prototype,
pilot
Implemen-tation
Evaluation
Our ecosystema successful collaboration between
practice, research, development
RESEARCH
EDUCATION
IMPACT
Germany
Belgium
Language barriers between clinicians
and industrial engineers
Engineers Clinicians
Demand Supply
Problem analysis Anamnesis
Solution Intervention
Model, quantitative Controlled prospectiveexperiment, etc. assessment
Optimization Improvement
Performance Quality of care, quality of labor, efficiency
Design approach Empirical approach
Experimentation Risk avoiding, evidence based
Optimization of
healthcare processes
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What they have in common?
3 basic principles of Operations Management:
Maximization of value
continuously eliminate waste
Reduction of variability, variations
in quality, disturbances, errors, fluctuations
Reduction of complexity
easiest effective solution is the best
Optimization of
healthcare processes
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Integral planning & control?
Encompasses the entire care pathway
(chain perspective)
Encompasses all managerial areas
Encompasses all hierarchical levels of control
Out-patientclinic
Diag-nostics
Oper. Rooms
IC WardsDis-
charge
Hierarchical planning & control framework
Strategic
Operational
offline
Tactical
Resource
capacity planning
Materials
planningMedical
planning
Financial
planning
Operational
online
managerial areas
H
iera
rchic
ald
ecom
po
sitio
n
In: Hans et al. (2011), Handbook of Health Care
Systems Scheduling, Chapter 12
Hierarchical planning & control framework
Strategic
Operational
offline
Tactical
Resource
capacity planning
Materials
planningMedical
planning
Financial
planning
Operational
online
managerial areas
H
iera
rchic
ald
ecom
po
sitio
n
In: Hans et al. (2011), Handbook of Health Care
Systems Scheduling, Chapter 12
Hierarchical planning & control framework
Strategic
Operational
offline
Tactical
Resource
capacity planning
Materials
planningMedical
planning
Financial
planning
Operational
online
managerial areas
H
iera
rchic
ald
ecom
po
sitio
n
In: Hans et al. (2011), Handbook of Health Care
Systems Scheduling, Chapter 12
Hierarchical planning & control framework
Underexposed
Strategic
Operational
offline
Tactical
Resource
capacity planning
Materials
planningMedical
planning
Financial
planning
Operational
online
managerial areas
H
iera
rchic
al d
ecom
po
sitio
n
In: Hans et al. (2011), Handbook of Health Care
Systems Scheduling, Chapter 12
Goal: Directly derive ward workload metrics from the MSS
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Additional 8th operating room
without any additional nursing
capacity
Example:
The relation between operating rooms and wardsPeter Vanberkel
Tactical planning… the missing link
Tactical decisions based on historical
development rather than calculations
Complex!
Longer planning horizon, more uncertainty
Broader scope (more departments involved)
Requires flexibility in agendas
Our research…
…is to design new planning and control concepts
…is to prospectively assess these concepts using
mathematical models, computer simulation
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Optimization of
healthcare processes
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Design of planning and control
There is no universal solution
Point of departure:
Performance indicators and targets at every level
of control based on the organization’s own mission,
vision, strategy
Planning is variability management
Apparent contradictory objectives:
Staff:
minimize
overtime
Patients:
minimize
waiting
Management:
maximize
utilization
Management dogma: maximize utilization
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workload
Time
Capacity
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Effect of variability in queues
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Pollaczek-Khinchine
formula
Utilization
0.9 0.99
Waiting time
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Waiting time =
10 x service time
Maximizing utilization leads to even more:
maximizing patient waiting
maximizing overtime
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Capaciteit
werklast
Tijd
workload
time
Capacity
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workload
time
Capacity
workload
time
Higher utilization with less capacity
and reduced overtime!
More flow, so also reduced waiting!
Planning is variability management!
Planning is to create and cleverly use flexibility
to deal with variability in demand and supply
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Natural variations Artificial variations
Integral optimization of processes
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• Quality of care
• Quality of labor
• Productivity
• Strategic
• Tactical
• Operational
Operating rooms
Clinic 1
…
Clinic NED
Outpatient clinic
COORDINATING ALL RESOURCES IS COMPLEX…
Case mix
OR
schedule
Acute care &
diagn. dep.
Assignment
specialty-
clinic
Pooling
clinics
(Flexible)
nurse
planning
OC roster
Integrated
emergency
post
AND VARIABILITY PLAYS A MAJOR ROLE
Operating rooms
Clinic 1
…
Clinic NED
Outpatient clinic
Leads to waiting…
Local/myopic optimization leads to bullwhip effects in the care chain
New
patients
Surgical
patients
Tactical planning of outpatient clinic
and operating rooms
Outpatient
clinic
Operating
rooms
Repeat
visits
How to flexibly react to fluctuations in demand and supply?
Optimal ???
10-5-2017 43
To assign 100 surgeries to 10 rooms, can be
done in incredibly many ways:
1566443687596944582795497548990158844975023989184
412322502508669303787610871654830540867124458580
490301116511485059296301837315500314413183795200
00000000000000000000
10
1i
m
1i !i
1i
99
!100!i
1i
1n
!n
(when evaluating 1 million solutions per second this requires more than a 1000 years!)
Science versus impact
Science requires (near) optimality, mathematical innovation
Practice requires the easiest solution that works
So, we do both!
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Critical success factors
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University
Gather research questions from practice; refuse projects where there are no
clinicians involved
Position researchers in healthcare institutions
Learn to speak the healthcare language, and teach clinicians yours
Only invest in long-term collaborative relations
Hospitals
Invest in improving logistical data, and data analysts
Bring together enthusiasts for logistics in a centralized staff department
And team them up with data analysts, project managers
Realize this is not a short term quick win, but a continuous process of
improvement, knowledge gathering
Don’t be afraid to share experiences with other hospitals
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Some take home messages
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“The solution is not the problem”
“Maximization of utilization is maximization of waiting”
“The best practice in practice is not the best possible practice”
Combine top-down and bottom-up optimization
“If you cannot measure your ideals, the measurable becomes the ideal”
It’s not about working harder, but more clever!47
Link to my inaugural lecture (in English)
Title: Is it better now, doctor?
http://www.utwente.nl/en/bms/iebis/staff/hans/oratie-english.pdf
Thank you for your attention!
Prof.dr.ir. Erwin W. Hans
Professor Operations Management in Healthcare
E-mail: [email protected]
CHOIR: http://www.utwente.nl/choir
How about the change
of the company culture?
Lets do that Thursday,
at half past four
FOKKE AND SUKKEAlways make a tight project plan
