Health Systems最新文献

Operating room (OR) resources are limited, and for this reason there is usually a competition among surgeons to win them. However, the methods developed for allocating OR sessions are mostly based on optimisation methods which compensate the preferences of surgeons or surgical specialities in favour of the productivity of the entire OR department. This leads to conflict and dissatisfaction among surgeons. To overcome this problem, a methodology based on game theoretic solutions is presented in this paper that formulates the allocation problem as a simple game. The surgeons or specialities as players then jointly pursue the goal of achieving overall stability. Stability is defined and measured using a method called Power Index. The proposed method is then combined with the Monte-Carlo technique to deal with uncertainties. To demonstrate the capability of the suggested procedures, they are applied to a case study from the literature and a set of hypothetical scenarios.

Well-planned care arrangements with effective distribution of available resources have the potential to address inefficiencies in mental health services. We begin by exploring the complexities associated with mental health and describe how these influence service delivery. We then conduct a scoping literature review of studies employing optimisation techniques that address service delivery issues in mental healthcare. Studies are classified based on criteria such as the type of planning decision addressed, the purpose of the study and care setting. We analyse the modelling methodologies used, objectives, constraints and model solutions. We find that the application of optimisation to mental healthcare is in its early stages compared to the rest of healthcare. Commonalities between mental healthcare service provision and other services are discussed, and the future research agenda is outlined. We find that the existing application of optimisation in specific healthcare settings can be transferred to mental healthcare. Also highlighted are opportunities for addressing specific issues faced by mental healthcare services.

The objective of this article is to describe the current fracture between global trade and public health priorities, as well as examine opportunities for harmonisation. A literature review of public health, global trade, and intellectual property articles describes several issues with recommendations. Currently, there is mixed quality of research and a lack of health impact assessments to accompany the global trade agenda. Human rights concepts continue in debate as flexibilities to trade laws remain without organised surveillance or evaluation. There are specific, relevant recommendations to implement a trade agenda inclusive of public health leadership. Recent trade and intellctual property advances in public health collaborations should be supported and continued. Trade groups should produce impact assessments before decisions on policies are made, with quality to the research. Lastly, a global research and development treaty should be an open, accessed path.

Waiting time in healthcare is a significant problem that occurs across the world and often has catastrophic effects. There are various terms used for waiting time ("sojourn", "throughput" etc.) and there is no consensus on how these terms are defined. Ambiguous definitions of waiting time make it difficult to compare and measure the problems related to waiting times and delays in healthcare. We present a systematic search and review of the Operations Research and Management Science (ORMS) literature on delays in healthcare services. We search for articles from 2004 to 2019 and base our search strategy on a well-known healthcare planning and control decision taxonomy. An important step towards reducing the ambiguity in the definitions is to distinguish between access time and waiting time. We provide clear definitions and examples of access time and waiting time, and we classify our search results according to three categories: article type, healthcare service investigated and ORMS technique used to solve the delay problem. We find that half of the ORMS research on the waiting and access time problem is done on Ambulatory Care services. We provide tables for each healthcare service that highlight key definitions, the techniques that are used most often and the healthcare environment where the research is done. This research highlights the significant ORMS research that is done on access and waiting time in healthcare as well as the remaining research opportunities. Moreover, it provides a common language for the ORMS community to solve critical waiting time issues in healthcare.

We examine how physicians' perceptions of two computerized provider order entry (CPOE) capabilities, standardisation of care protocols and documentation quality, are associated with their perceptions of turnaround time, medical error, and job demand at three phases of CPOE implementation: pre-go-live, initial use, and continued use. Through a longitudinal study at a large urban hospital, we find standardisation of care protocols is positively associated with turnaround time reduction in all phases but positively associated with job demand increase only in the initial use phase. Standardisation also has a positive association with medical error reduction in the initial use phase, but later this effect becomes fully mediated through turnaround time reduction in the continued use phase. Documentation quality has a positive association with medical error reduction in the initial use phase and this association strengthens in the continued use phase. Our findings provide insights to effectively manage physicians' response to CPOE implementation.

Literature reviews over five decades have reported the paucity of examples of OR methods being routinely used to support decision-making in health and social care. This paper presents insights from an independent evaluation of a project intended to overcome some of the barriers to implementation by establishing a "community of practice" in Kent (England). The project itself was undertaken by practitioners, and had two main aims: providing training in system dynamics modelling to analysts, and making senior managers aware of the benefits of modelling. The findings largely confirmed previous studies, but also raised issues about style of training delivery and selection of problems to be modelled. Project leaders fully understood the barriers to embedding OR modelling skills, and made considerable efforts to avoid them, but nevertheless the main barrier, pressures on people's time, remained an obstacle. The paper concludes with general reflections and advice.

Malaria remains an important public health concern. Sub-Saharan African countries carry over 95% of the global burden. Unfortunately, there are also major resource constraints that have limited efforts to reduce the burden. Our study sought to estimate efficiency in the use of malaria resources and to identify potential determinants. We used primary data collected from district-level health facilities in three administrative regions in Ghana from 2014 to 2016. The Data Envelopment Analysis technique was used to estimate efficiency. The Malmquist productivity index was estimated and disaggregated to reflect the sources of productivity change. The findings show an average technical efficiency score of 0.61 with private facilities being more efficient. Productivity changes were driven by changes in technology/innovation advancements. Facility revenue mix and ownership type were important determinants of efficiency. The findings highlight the need to improve resource use in the delivery of specific services such as malaria.

Nowadays, the increase in patient demand and the decline in resources are lengthening patient waiting times in many chemotherapy oncology departments. Therefore, enhancing healthcare services is necessary to reduce patient complaints. Reducing the patient waiting times in the oncology departments represents one of the main goals of healthcare managers. Simulation models are considered an effective tool for identifying potential ways to improve patient flow in oncology departments. This paper presents a new agent-based simulation model designed to be configurable and adaptable to the needs of oncology departments which have to interact with an external pharmacy. When external pharmacies are utilised, a courier service is needed to deliver the individual therapies from the pharmacy to the oncology department. An oncology department located in southern Italy was studied through the simulation model and different scenarios were compared with the aim of selecting the department configuration capable of reducing the patient waiting times.

Decontamination centres provide sterilisation services (sort, disinfect, package, and sterilise) for reusable surgical instruments that have a vital impact on patient safety. The market trend is to increase the level of automation in the decontamination process, to increase productivity, and reduce the risk of human error and musculoskeletal injuries. The goal of this research is to study the use of automated guided vehicles (AGVs) in sterilisation departments, to improve safety and efficiency. A generic simulation model is created based on data gathering of various decontamination centres and is validated for a specific centre to analyse various aspects of applying AGVs to automate the internal transfer. Centre's potential to increase capacity through AGV application is analysed and a Design of Experiments is conducted to identify the most promising implementation scenarios. Results show reductions in treatment time and work in process, while ,maintaining the accessibility of medical instruments, and ensuring worker safety.