Analysis of the performance of the operating room department of Scheper hospital

Jansma, A.M. (2009) Analysis of the performance of the operating room department of Scheper hospital.

Abstract:Theme and motive The Operating Room (OR) department of Scheper hospital has to deal with arrivals of unplanned surgeries. These unplanned surgeries are either urgent surgeries or emergency surgeries. Urgent surgeries have to start before 8 to 48 hours after arrival, depending on the urgency level. Emergency surgeries have to start within 30 minutes of arrival. To deal with the arrival of unplanned surgeries, Scheper hospital reserves one afternoon operating session for these surgeries. This means that the hospital does not schedule elective surgeries in this session. We call this session the emergency session. The session results in a decrease in the number of disruptions in the elective program due to unplanned surgeries and less overtime for urgent surgeries. However, this comes at a price because the session is empty much of the time. To deal with this, the OR department sometimes allows elective surgeries to be performed in the emergency session in case the elective program is running late. However, this policy does not lead to the desired increase in the utilization of the session time. We investigate alternative ways to deal with unplanned surgeries to increase the utilization of available session time. Furthermore, we investigate the successfulness of additional interventions in increasing the performance of the OR department. Method To analyze the effectiveness of different possible interventions, we simulate the OR department using discrete event simulation. The input of the simulation model consists of the general characteristics of the OR department, e.g. the room opening plan (ROP) and historical surgery durations. In the period of our research, the ROP changed a number of times. In our simulations, we use the most recent ROP. Additionally, we develop a number of new ROPs as part of possible interventions. We gathered the data concerning surgery durations with the help of the IT department and this data needed little work. The main reason for this is the introduction of a standardized electronic form in which surgeons have to register, among other details, the surgery durations. The OR planner verifies this data, as a result we obtain a reliable data set. We recommend • the OR department to work without an afternoon emergency session. Instead, the OR department can deal with unplanned surgeries by reserving capacity in all sessions. We call this reserved capacity emergency slack [Section 4.2]; • the OR department to keep ORs open during the lunch break and to hire additional OR personnel to make sure the OR personnel can still have their lunch breaks ; • to incorporate planned slack when scheduling surgeries. Management of the OR department, together with the board of Scheper hospital, have to decide on the allowed overtime probability. To help make this decision, Section 6.2 presents an overview of the expected consequences of varying overtime probabilities. 3 Motivation We show that these recommendations together result in an increase in utilization of 7.8%, a decrease in elective overtime of 39.1 minutes per day, and an increase in overtime due to urgent surgeries by 12.1 minutes per day. This results in 27 minutes less overtime per day while working with 7.25 OR hours less per week and without an afternoon emergency session. Furthermore, working without a lunch break requires 0.4 full time equivalents (FTEs) OR personnel less to make sure that surgery assistants are relieved timely by colleagues. Planning slack makes it possible to set targets for the utilization of available OR time for the individual specialties. These targets keep into account characteristics of the surgeries performed by these specialties [Section 6.2]. Consequences • Working without afternoon emergency sessions results in additional online rescheduling for the OR planner due to the arrival of urgent and emergency patients. However, the OR department has some experience in working without an afternoon emergency session, which should ease the implementation. We show that working without an afternoon emergency session results in on average 10 more disturbances per year in the elective program due to the arrival of an emergency surgery. Urgent surgeries start after the completion of the elective program and therefore do not cause disturbances in the elective program. • Working without a lunch break requires 0.4 FTEs less personnel to relief OR personnel. However, not everybody can take their lunch break at the same time. We refer to Section 4.5 for a detailed description of the consequences of working without a lunch break. • Using planned slack has minor consequences for the way the Intake office schedules surgeries since the OR department already schedules surgeries based on historical surgery times, without which it is not possible to incorporate planned slack. However, before this can be done, the board of Scheper hospital, together with the management of the OR department, will have to decide on an allowed overtime probability.
Item Type:Essay (Master)
Scheper hospital
Faculty:BMS: Behavioural, Management and Social Sciences
Subject:85 business administration, organizational science
Programme:Industrial Engineering and Management MSc (60029)
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