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Managing Variable Patient Flows at Hospitals
Linköping University, Department of Management and Engineering, Logistics Management. Linköping University, The Institute of Technology.
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: urn:nbn:se:liu:diva-111635DOI: 10.3384/lic.diva-111635ISBN: 978-91-7519-208-6 (print)OAI: oai:DiVA.org:liu-111635DiVA: diva2:758380
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
List of papers
1. Understanding the impact of variation on healthcare systems
Open this publication in new window or tab >>Understanding the impact of variation on healthcare systems
2012 (English)Conference paper, Oral presentation only (Other academic)
Abstract [en]

The variation associated with demand and supply of services strongly contributes to operating difficulties in healthcare. Understanding variability helps healthcare providers to more accurately model and address opportunities for improvement. This study uses discrete event simulation to investigate what consequences that alteration in patient inflow, available resources, treatment times and duration of activities at an emergency department and inpatient department has on bed occupancy and length of stay. It is concluded that the variables are intimately related and that the departments are sensitive to changes due to a considerable variation in patient inflow and treatment times.

Keyword
Healthcare, Simulation, Variation
National Category
Transport Systems and Logistics
Identifiers
urn:nbn:se:liu:diva-111586 (URN)
Conference
The 4th Production and Operations Management World Conference, July 2-4, Amsterdam, the Netherlands
Available from: 2014-10-27 Created: 2014-10-27 Last updated: 2014-10-27
2. Developments in the field of healthcarelogistics and SCM: A patient flow focus
Open this publication in new window or tab >>Developments in the field of healthcarelogistics and SCM: A patient flow focus
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.

Keyword
Healthcare, Logistics, Supply Chain Management, Patient flow, Literature review
National Category
Transport Systems and Logistics
Identifiers
urn:nbn:se:liu:diva-111587 (URN)
Available from: 2014-10-27 Created: 2014-10-27 Last updated: 2014-10-27Bibliographically approved
3. Managing a variable acute patient flow: categorising the strategies
Open this publication in new window or tab >>Managing a variable acute patient flow: categorising the strategies
2015 (English)In: Supply chain management, ISSN 1359-8546, E-ISSN 1758-6852, Vol. 20, no 2, 113-127 p.Article in journal (Refereed) Published
Abstract [en]

This study aims filling some of that gap by applying the concepts of lean and agile in a study in a health care setting, something that has been sparsely explored, even though there are examples (e.g. Aronsson et al., 2011; Rahimnia and Moghadasian, 2010). Although lean has been applied successfully in the private sector, limited research has evaluated whether the lean approach transfers successfully to the public sector and what impact the approach has on for example costs, productivity and quality of service (Radnor et al., 2006). With a lean approach the focus is on continually eliminating waste and thereby reducing the resources used to produce a given set of goods, with the ambition being to achieve a streamlined flow of production (Womack et al., 1990).

Place, publisher, year, edition, pages
Emerald Group Publishing Limited, 2015
National Category
Transport Systems and Logistics
Identifiers
urn:nbn:se:liu:diva-111588 (URN)10.1108/SCM-06-2014-0203 (DOI)000352720600001 ()
Note

On the day of the defence date the status of this article was Manuscript.

Available from: 2014-10-27 Created: 2014-10-27 Last updated: 2017-12-05
4. Managing a variable acute patient flow: planning and decision-making
Open this publication in new window or tab >>Managing a variable acute patient flow: planning and decision-making
2012 (English)Manuscript (preprint) (Other academic)
Abstract [en]

This paper focuses on the management of variability in the acute patient flow, which is another factor that complicates the organisational structure of a hospital. There is a high degree of variability in healthcare (Ronen and Pliskin, 2006), in particular when it comes to acute patients where the patient inflow fluctuates concerning time, health issues and response to treatment. Healthcare resources are also often used inappropriately and not adapted to the variations that exist (Walley et al., 2006). Variation is hence created by internal behaviours in healthcare systems such as discontinuous scheduling, variable capacity to discharge and by splitting demand into subgroups (Allder et al., 2011).

National Category
Transport Systems and Logistics
Identifiers
urn:nbn:se:liu:diva-111589 (URN)
Available from: 2014-10-27 Created: 2014-10-27 Last updated: 2014-10-27Bibliographically approved

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