Quality-Driven Efficiency in Healthcare

Integrally shaping inpatient care services



The research presented in this talk intends to support the design and operations of inpatient care services. Effectively designing inpatient care services requires simultaneous consideration of several interrelated planning issues, such as case mix, care unit partitioning and size, and staffing decisions. The inpatient care facility is a downstream department of which the workload is mainly determined by the patient outflow of the operating theater and the emergency department. Therefore, coordination with surgical and emergency care services is essential. Workload on nursing wards depends highly on patient arrivals and patient lengths of stay, which are both inherently variable. Predicting this workload, and staffing nurses accordingly, is essential for guaranteeing quality of care in a cost effective manner.

First, we present a model to predict bed census on nursing wards by hour as a function of the operating room schedule and a cyclic arrival pattern of emergency patients. The model enables the evaluation of alternative interventions with respect to both the design and the operations of inpatient care units. The effectiveness of the model is demonstrated by applying it to a case study of four surgical nursing

wards of the AMC.

Next, we introduce a method which takes the hourly census predictions as starting point to derive efficient nurse staffing policies. It particularly explores the potential of flexible staffing policies which allows hospitals to dynamically respond to their fluctuating patient population. The flexible policies involve the employment of so-called float nurses for whom it is only at the start of a working shift decided in which specific care units they will work. During the upcoming years the presented method will be applied in the Academic Medical Center (AMC) Amsterdam in supporting the intended complete redesign of the inpatient care facility.


N. Kortbeek, A. Braaksma, H.F. Smeenk, P.J.M. Bakker, and R.J. Boucherie (2012) Integral resource capacity planning for inpatient care services based on hourly bed census predictions. Memorandum 1990, Department of Applied Mathematics, University of Twente, http://eprints.eemcs.utwente.nl/22287/

N. Kortbeek, A. Braaksma, C.A.J. Burger, R.J. Boucherie, and P.J.M. Bakker (2012) Flexible nurse staffing based on hourly bed census predictions. Memorandum 1996, Department of Applied Mathematics, University of Twente, http://eprints.eemcs.utwente.nl/22408/


Aleida Braaksma obtained her MSc in Applied Mathematics from the University of Twente in 2010. She graduated on the MSc-thesis ‘Integral multidisciplinary rehabilitation treatment planning’, for which she conducted the research in the Academic Medical Center (AMC) Amsterdam. For her MSc-thesis she received several awards, among which the Menzis/UT thesis award 2010. Since her graduation she has been working as a consultant for process optimization in healthcare in the AMC. Next to this position, she is a PhD student within CHOIR since 2011.