Logistical Care for Optimal Design (LogiDOC), funded by Technology Foundation STW (project number 08140).
Background
Driven by public opinion, increased health expenditures, an ageing population, and long waiting lists, a flood of changes in the healthcare system has been set in motion to try to make the Dutch hospitals more efficient. Supported by more advanced ICT (e.g. the introduction of electronic patient records) and a new financial system (the introduction of diagnose related groups), the majority of the hospitals is reconsidering the organisation of the internal processes. The challenge for hospital management is to redesign the internal layout and control in such a way that both the interests of the patient and of the hospital are addressed. This implies a wide variety of complex strategic decisions that contribute to the simultaneous optimisation of quality of care, costs and patient lead-time.
Project
The nature of hospital work does not allow copying success stories from industry, where logistical optimisation has a long history. Healthcare processes and supply chains show considerable differences, such as the high degree of uncertainty, the medical autonomy of clinicians, and the fact that patients cannot be treated as products. LogiDOC aims to develop mathematical models and techniques to analyse and support the design of the optimal logistical layout of a hospital with a given case mix and desired performance levels. In three PhD subprojects, the research addresses the strategic, tactical and operational level of hospital planning and control. The output consists of decision support tools, (mathematical) models and techniques that capture the inherent complexity of healthcare processes, and aid users to analyse the relation between system configurations, optimized and robust system planning and control, and system performance.
Outcomes
The expertise gained in LogiDOC broadens the knowledge domain w.r.t. hospital resource management, and provides useful tools for capacity allocation and dimensioning problems. Such capacity problems are now generally solved using statistical / spreadsheet-based analyses of aggregate data. These models cannot capture the dynamics of the healthcare process and generally do not account for the impact on lower management levels: the aforementioned redesign of hospitals requires new approaches for tactical and operational control. Hereby, capacity allocation and dimensioning problems always pose trade-offs: e.g. resource utilisation versus waiting list length, or: costs vs. quality of care, or: planning intelligence vs. solution quality. The models and techniques developed in LogiDOC provide tools to make and evaluate such trade-offs, and to assess the impact of capacity decisions on performance indicators for quality of care (e.g. cancellation rate, waiting time), quality of labour (e.g. overtime), and productivity (e.g. costs, efficiency, utilisation).
To establish broad recognition in the healthcare application domain and application of the research results LogiDOC collaborates with the following partners from the healthcare sector in two additional subprojects. Different types of hospitals will provide relevant research cases and test data, and test prototype decision support tools. Based on LogiDOCs results, the market-leading decision support software company ORTEC aims to develop decision support instruments for operational control of patient flows across the hospital. Finally, the Netherlands Board for Healthcare Institutions (NBHF), an independent organisation tasked by the Ministry of Health, Welfare and Sport, will use the knowledge gained in LogiDOC to provide expertise and support for hospitals in managerial decisions regarding the design and management of processes in situations of capacity expansions/reductions and construction. In the future, tasks of the NBHF will be transferred to the Dutch Centre for Health Assets (DuCHA), part of TNO. LogiDOC also collaborates with ongoing healthcare-ICT research at University of Twente to build upon current ICT developments, such as Electronic Patient Records and the use of agent technology for ICT-support across departments. In regular workshops, all researchers and partners will come together to discuss research results and possible topics, and exchange ideas about implementation. Additional partners from the healthcare sector may be involved at a later stage.
Involved researchers
The involved researchers from UT are active in the recently founded UT centre of expertise CHOIR (Centre for Healthcare Operations Improvement and Research; www.choir.utwente.nl), and research institute CTIT (www.ctit.utwente.nl). Within LogiDOC, UT collaborates with a large group of partners active in healthcare delivery, consultancy, and software development.