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Capacity management on the ambulatory surgery ward: balancing the workload of the ambulatory surgery ward and hereby improving the quality of care of the patients and the quality of labor for the involved staff

Vrieler, Petra H. (2009) Capacity management on the ambulatory surgery ward: balancing the workload of the ambulatory surgery ward and hereby improving the quality of care of the patients and the quality of labor for the involved staff.

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Abstract:Due to the demands of the government regarding cost containment on the delivery of health care in the Netherlands, there is a trend of doing more treatments in the ambulatory surgery ward (ASW), since this is cheaper than a patient taking up a bed on a nursing ward. The demand of patients continues to grow but the ASW in ZGT Almelo in the Netherlands cannot keep up. As a result, patients have to be moved to other nursing wards during peak periods, which affect quality of care and patient friendliness. Another effect on the ASW is that there is a large variability in the number of patients per day. This effect is common in almost all ASWs in the Netherlands (J. Oude Egberink – Visschedijk, board member of the NVDK). To reduce this variability and moving of patients to other ward, this report presents a method for leveling the demand of patients for the ASW, so the capacity of the ASW can be used more effectively. This will result in a better quality of labor for the nurses and increased quality of care for the patients. Conclusion Based on interviews, data gathering, and analysis we show how the ASW is run and how it is affected by the two main suppliers of patients; the OR and the OPC. Our analysis shows that there is a lot of variability in the number of patients per day due to the influence of the OR and the OPC schedule on the ASW. To try and resolve this issue, we have developed a capacity analysis tool in MS Excel to analyze the situation based on average arrival data, and to measure what effect changing either the length of stay (LOS), the OR schedule and/or the OPC schedule has on the number of beds needed per hour. Based on data analysis and on analysis of the schedules themselves, several organizational interventions can be done, which consist of moving OR and/or OPC programs to the days that can alleviate the pressure on the busy days (Monday and Tuesday) and have the possibility to move a program to another day. Within this set all 8 feasible interventions were tried. From this, two interventions in the OR schedule and three in the OPC schedule come out as the most effective. Changing the LOS of colonoscopies also benefit in reducing the number of beds needed on all days, since there is at least one colonoscopy program per day. Combining all these moves did not lead to a more balanced schedule for the ASW within a week. However, reducing the number of interventions lead to a better projection on the expected number of beds per day than combining all favorable interventions. The variability in a week, measured in coefficient of variation, has increased from 1,8 in the original situation to 6,2. This high value is caused by a very low average and a low standard deviation, which are lower than in the original situation. Based on the projection the ASW only needs 27 beds if the OR and OPC schedule are changed based on the proposed interventions. This shows that by making relatively small changes in the OR and OPC schedule it is possible to balance the workload of the ASW during the week. However, even these small changes result in a ripple effect to other schedules, making even one move in the schedules very difficult. It is difficult to predict what recommendations will be implemented in the future. Only recommendations that can be implemented within the boundaries of the schedules are going to be tried in the near future like reducing the LOS for colonoscopies. Recommendations Based on this research the following is recommended: Optimizing planning and scheduling in the whole hospital by creating the schedules of all departments in conjunction with each other instead of using the OR schedule as a blueprint for all other departments to conform to. Improve registration and access to data in the hospital information system to make analysis and therefore management of departments based on data possible. Try to predict the future regarding patient flows to have the possibility to adapt schedules to accommodate a growth and/or decline in certain patient groups making use of all resources as efficiently and effectively as possible. 9 Further research can be performed regarding the specific subject of ambulatory surgery by expanding models regarding hospital bed capacity planning and looking at the possibilities of how sequencing surgeries and organizing ambulatory surgery with or separate from clinical surgeries affects the need for beds per hour per week.
Item Type:Essay (Master)
Faculty:BMS: Behavioural, Management and Social Sciences
Subject:85 business administration, organizational science
Programme:Industrial Engineering and Management MSc (60029)
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