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Developments in the field of healthcarelogistics and SCM: A patient flow focus
Linköping University, Department of Management and Engineering, Logistics Management. Linköping University, The Institute of Technology.
Linköping University, Department of Management and Engineering, Logistics Management. Linköping University, The Institute of Technology.
Linköping University, Department of Management and Engineering, Logistics Management. Linköping University, The Institute of Technology.
2012 (English)Manuscript (preprint) (Other academic)
Abstract [en]

Purpose

During the last years, attention for healthcare logistics and SCM has begun. This is a novel topic, with a lack of literature reviews on research related to this field. Therefore, the aim of this paper is to provide guidance in how to develop healthcare logistics and SCM research related to patient flows.

Design/methodology/approach

This paper adopted an exploratory literature review, focusing on patient flow issues, through a scanning of logistics and SCM journals. The identified articles references as well as the papers that had referred to the papers were also included in the review.

Findings

The field of healthcare logistics and SCM is still in its infancy, with few papers published. The papers with a supply chain or network as unit of analysis are mostly conceptual and the case studies mainly descriptive studies on a single healthcare unit. Some major challenges for future research is how to manage a complex service context, how to create flexibility in healthcare provision and coordinate multiple healthcare actors.

Research limitations/implications

The findings should be considered as conceptual, and provides a basis for further empirical and theoretical based research.

Practical implications

The results provide a basis for healthcare organizations and their managers, to build upon in their continuing efforts to develop more efficient patient flows.

Original/value

This literature review responds to the absence of an overview on research in healthcare logistics and SCM. It contributes to both logistics and SCM literature by identifying some important challenges and gaps for future research.

Place, publisher, year, edition, pages
2012.
Keyword [en]
Healthcare, Logistics, Supply Chain Management, Patient flow, Literature review
National Category
Transport Systems and Logistics
Identifiers
URN: urn:nbn:se:liu:diva-111587OAI: oai:DiVA.org:liu-111587DiVA: diva2:758334
Available from: 2014-10-27 Created: 2014-10-27 Last updated: 2014-10-27Bibliographically approved
In thesis
1. Managing Variable Patient Flows at Hospitals
Open this publication in new window or tab >>Managing Variable Patient Flows at Hospitals
2014 (English)Licentiate thesis, comprehensive summary (Other academic)
Abstract [en]

Healthcare is a large industry faced with major challenges, such as decreasing inpatient bed numbers and increases in the share of elderly people, which require improved efficiency and effectiveness. The organisation of hospitals normally comprises highly specialised clinical departments, through which patient flows are managed. Since patient flows often involve several clinical departments, this requires much coordination both in space and time. With every individual patient having different diseases, severity levels and responses to therapy, the variability in patient flows has an impact on the inflow, internal flow and outflow at clinical departments and hospitals. Historically, healthcare resources have not been adapted to these variations. The purpose of this licentiate thesis is therefore to explore how variable patient flows are managed in hospitals. This comprises how variable patient flows affect hospitals as well as how variable patient flows are handled. It also includes the organisational configuration, and the influence it has on the actions used to handle variable patient flows in hospitals.

Both the hierarchical levels, roles and teams that make decisions and manage the flow of patients as well as the actions used to handle variable patient flows at hospitals are included in the research. Hence, an approach where the hospital is regarded as a system is used, an approach often described as a system perspective. Three research methods have been used in this licentiate thesis. The first research method used was simulation modelling, to study how changes in an acute patient flow affected an emergency department and inpatient ward at a small hospital. A case study at a university hospital was performed to study both the actions used to handle variable patient flows as well as the influence of the organisational configuration. Several literature reviews, both structured and unstructured, has also been made to compare and evaluate the results from the empirical data.

There are several effects of variable patient flows. The case study indicates that increased patient flow variability leads to increases in bed utilization variability and thereby problems with bed shortages. Mismatches between patient inflow and outflow, in terms of number of patients, also lead to bed shortages. Literature reviews also show that bed shortages in inpatient wards are a major cause of overcrowding in emergency departments. The results from the simulation model point toward emergency departments being more adapted to variable patient inflow than inpatient wards. To handle these issues there is a need for flexibility when providing healthcare services, something suggested in the literature.

50 actions used at the university hospital to handle variable acute patient flows were identified in the research. A majority of these are used to handle the effects of the variation, not the variation itself. Nor is it effects of individual variations, such as patient inflow, that are handled but the combined effect of the variations in several variables. For example, much time and effort are spent handling bed shortages. One third of the actions are used at a hospital level, with the aim to have positive effects for the hospital as a whole. Two thirds are used and developed at a departmental level, with the aim to improve the situation at the clinical department by using the action. By having most of the actions used at individual clinical departments, without considering the impact on whole hospital, there is an obvious risk of sub-optimization.

One explanation for many actions being used at a departmental level could be that there is lack of strategic direction and decision-making ability at top management level due to the use of unanimous decision-making in the hospital management group. This hinders the control and coordination of the actions used at different clinical departments, rendering them more similar to separate organisations. Departmental collaboration is also impeded as well as organisational learning at the hospital, both bottom-up and sideways in the hierarchies, encumbering the development and sharing of successful actions for handling variable patient flows.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2014. 64 + 6 Appendices; Appendices 6-9 removed. p.
Series
Linköping Studies in Science and Technology. Thesis, ISSN 0280-7971 ; 1682
National Category
Transport Systems and Logistics
Identifiers
urn:nbn:se:liu:diva-111635 (URN)10.3384/lic.diva-111635 (DOI)978-91-7519-208-6 (ISBN)
Presentation
2014-10-31, ACAS, A-huset, Campus Valla, Linköpings universitet, Linköping, 10:15 (English)
Opponent
Supervisors
Available from: 2014-10-27 Created: 2014-10-27 Last updated: 2014-11-21Bibliographically approved

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Olsson, OlleWiger, MalinAronsson, Håkan

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