University of Twente Student Theses


Tactical planning for Medisch Spectrum Twente : designing a tactical resource capacity planning concept for the outpatient clinics and operating rooms of MST

Rijntjes, R.M. (2011) Tactical planning for Medisch Spectrum Twente : designing a tactical resource capacity planning concept for the outpatient clinics and operating rooms of MST.

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Abstract:Background: Better care at less costs has become the main focus point of the health care system in the Netherlands, emphasizing the need for logistic principles that help improve both efficiency and patient care. The health care system is currently under influence of (increased) government cost cutting. In 2010, MST started a return improvement program with the main emphasis on improving efficiency of processes. In 2011, this program is accelerated to deal with additional budget cuts. Research scope: We focus our research on tactical capacity planning of outpatient clinics (OC) and operating rooms (OR) in MST. The outpatient clinic generally marks the start of the care trajectory of a patient and generates demand for the OR. Both the OC and OR require time from the specialist, their shared resource. The performance of OC and OR capacity planning, defined by access, waiting, and throughput times and production realization, is critical for hospital performance. Research problem and objective Tactical capacity planning, of patient processes and related resources of outpatient clinic and operating rooms, is hardly done in MST. Moreover, MST is also lacking the required and reliable information for tactical planning. The objective of this research is to design a tactical planning concept for the outpatient clinics and operating rooms of MST and to determine the necessary steps for implementing this concept in the organization. Method: A context analysis and literature research provide the input for the design of a tactical planning approach and recommendations for MST. The context analysis includes a description of the patient process, including related logistic indicators, an evaluation of strategic, tactical, and operational level planning and control, and the definition and description of performance indicators and assessment of current MST performance. Interviews and conversations with employees of MST provided the main input for the context analysis. The literature research consists of scientific literature on tactical capacity planning for outpatient clinics, operating rooms, and integrated planning approaches. Literature references from the bibliography of the CHOIR research unit of the University of Twente, Orchestra, are used as a starting point. Further, tactical planning in a practical setting is described, following an interview with an employee concerned with tactical planning within neighboring hospital ZGT. Also, one specific article is described in more detail as it includes tactical planning for both OC and OR. We obtained additional information on this article from a presentation and conversations with the author. Conclusions Current resource capacity planning in MST is supply-oriented. Tactical planning consist for the OR of a quarterly roster for which the exchange of OR blocks is not centrally organized and basically non existent. Apart from orthopedics, no tactical planning is made allocating capacity over patient categories. MST should benefit from increased communication and coordination on the tactical level to improve patient care and enable more efficient use of capacity. Accurate performance information is required to enable tactical planning, but while most data is available from MST systems not all information is accurately used or made available. Logistic indicators could help forecast demand and performance for the near future by using knowledge of the patient process (steps in the process and transition probabilities and times). Literature on integrated planning for OC and OR is limited. MST requires a workable method. Therefore mathematical methods from literature do not provide a solution on their own as they often provide “one optimal solution” for a certain point in time, which does not include all restricting factors and may differ extensively between periods, which complicates acceptance by specialists. In ZGT, tactical planning is already part of the organization, where tactical planning is organized in meetings in which capacity allocations are discussed and determined based on tactical management information, providing a workable method. Recommendations: Tactical planning concerns elective patient (category) planning on an intermediate term. We advise MST to organize tactical planning in tactical planning meetings in which decisions about (re)allocations of capacity will be made, based on management information of supply, demand, and past and forecasted performance. Supply and demand should be aligned by reallocating capacity among specialties and patient categories when needed, for which we assume sufficient total capacity (until proven otherwise). Scenarios should be used, in which the effects of different capacity planning decisions/adjustments on performance are evaluated, enabling timely reallocation of capacity. We advise that two meetings are held each month, between specialties on hospital level (allocating OR capacity among specialties) and within specialties on specialty level (allocating capacity among patient categories). A large part of the tactical planning concept is to know what information is required, which data to gather, how to turn this data into information, and how to use this information to your advantage. MST requires process information, patient categories, and tactical management information for tactical planning. We advise the following projects, considering information building from data already available in MST systems, to ensure the required conditions for tactical planning:  Strategic planning – strategic choices are made, and strategic goals are set. Strategic planning provides focus in the tension field between management, personnel, and patients and determines the flexibility/degrees of freedom for tactical planning.  Availability of process information – information about the patient process (probability of requiring a certain step and time between steps) is made available. This information is required for patient categorization and demand forecasting.  Patient categorization – DBC types are clustered into patient categories per specialty. Patient categories are required for capacity allocation on specialty level and enable more precise demand forecasts to be made.  Availability of tactical management information – several types of information (demand, supply, and performance information) are made available. This enables informed planning decisions to be made; capacity (re)allocation is based on this information.  Pilot tactical planning – a pilot should be started to evaluate the benefits and possible problems with tactical planning for MST. Immediate implementation into the entire organization is too extensive, therefore a small number of larger surgical specialties is included. A specific employee (or a selection of employees) should be made responsible for information gathering and specifically the availability of tactical management information. Also, a key role in tactical planning is reserved for business and medical managers. The business managers should be the driving force behind tactical planning and are concerned with project management. The medical managers represent their specialty in hospital level tactical planning meetings. Additional training may be required for all involved employees (especially those who deal with tactical management information).
Item Type:Essay (Master)
Medisch Spectrum Twente, Enschede, the Netherlands
Faculty:BMS: Behavioural, Management and Social Sciences
Subject:85 business administration, organizational science
Programme:Health Sciences MSc (66851)
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