An optimization model for planning community health services.

This article reports results of a project to develop methods of planning health care delivery for a community with emphasis on ambulatory services in a health maintenance organization setting. Some of the special difficulties of the problem are discussed and a linear optimization model is presented that addresses the problem of planning the ambulatory service mix for a specified population. The model accounts for population characteristics, financial data, and system dynamics (including referral patterns). An application is shown for the case of a “model cities” population in Buffalo, New York, and some implications for further research are presented.     

Collaborator or competitor: assessing the evidence supporting the role of social enterprise in health and social care

In many countries, social enterprise has been introduced into a competitive market-oriented environment as a substitute for publicly owned services, particularly in healthcare. In the United Kingdom, evidence for this move seems to derive from case studies where social enterprise operates in collaboration – as opposed to competition – with publicly owned services. Our systematic review demonstrates that there is no evidence to support the role of social enterprise as a substitute for publicly owned services. However, there is evidence to show that where social enterprise operates in a collaborative environment, enhanced outcomes can be achieved, such as connectedness, well-being and self-confidence.     

A chance-constrained multiobjective model for mental health services planning.

Mental health services planning, and particularly the planning for deinstitutionalization, is a very complex problem. This paper suggests a chance-constrained goal programming (CCGP) approach to mental health services planning. The CCGP approach is based on the sequential solution of a linear programming formulation, allowing efficient solution of large-scale planning problems using commercially available linear programming computer codes. The procedure is demonstrated with a case example and implementation of the approach is discussed.     

Morphological analysis for health care systems planning

Health care planners are continually challenged by the difficulty of ordering and understanding of the complexities of health care delivery systems. Methods are needed which can aid in extending thought processes into multi-dimensional solution space and rationalizing the thinking of various health care interests. This paper describes a useful approach to designing and evaluating health care systems utilizing a case study of a large metropolitan community.     

Computer-assisted planning for regional health care programs

In designing programs to improve regional health care, it is often necessary to synthesize hierarchies. Notwithstanding the fact that the health care milieu is highly complex, this process is frequently dealt with intuitively resulting in fragmented and redundant programs. It is proposed that formal procedures which relieve the individual of much of the complexity in developing programs and arranging their structure can contribute to improve understanding of the system and effectiveness of program design.This paper presents a rational approach to computer-assisted program design utilizing binary matrices and elementary Boolean operations.     

Disaster planning and resource allocation in health services

The increasing prevalence of natural disasters, environmental tragedies, and depraved human behavior has generated excessive costs in both human and material resources at a time when cost-efficiency and control is continually emphasized by managed care contracts, business, and government agencies. As a result, increasing pressure has been placed on hospital material managers to do more with less, while also providing the necessary resources to respond efficiently and effectively during an emergency. A successful comprehensive, risk-based emergency management program of preparedness, response, and recovery will reduce the loss of life and resources.     

A data-driven methodology for supporting resource planning of health services

In recent years, healthcare systems have been forced to better organize their services in the final attempt to maximize both care effectiveness and efficiency. In particular, emergent trends are prompting hospitals to pay more attention to the effective and efficient planning of resources and to the creation of patient-centred services, in which current activities and resources are reorganized around patients.This paper proposes a process mining based methodology to systematically support the resource planning of health services. Specifically, combining Time-Driven Activity Based Costing and process mining approaches, it automatically identifies the patient flow and analytically evaluates activities, service times, and resource consumptions for a specific class (-es) of patients (e.g., a DRG, patients with specific medical condition, etc.). Thus, it allows to reliably estimate the expected resource consumptions for the patient group under investigation. Thanks to process mining, the method overcomes the limitations of existing quantitative approaches that are often time-consuming, based on subjective observations, and too case specific. The method was applied to a real case study of lung cancer patients in an Italian hospital.     

Consumer behaviour and the purchasing of dental services: Influences on selection and evaluation of health care services

This paper examines the process of interaction between consumers and providers of dental services in terms of the key selection and evaluation criteria employed by consumers. Focusing on the United Kingdom, it examines the impact of changes in both pricing and provision on the utilisation and evaluation of dental services. Based on a questionnaire survey of dental patients, in the context of the evolving body of literature concerned with consumer behaviour in respect of services, the paper attempts to improve the current understanding of the key factors shaping consumer choice in respect of professional services. Specifically, it argues that the highly complex nature of professional services impacts on patterns of consumer behaviour, resulting in the relationship between the individual service professional and the consumer being the focus of consumer evaluation. This in turn has significant implications for the effective marketing of such professional services.     

The school as a social system: Indicators for change

In systems analysis, the school may be viewed as a functionally differentiated subsystem of the broader social system in which it is embedded. To maintain a viable relationship with that social system, the school is subject to continual changes to meet the shifting social, economic, political, and technological forces in its environment. However, the more successful the school organization is in assessing accurately changing environmental forces, and in making appropriate adjustments to those forces, the more successful will it be in resisting temporary pressures and transitory movements and in controlling its own directions.

A major research problem is to identify those organizational properties that enable the school to assess accurately new demands and to adjust appropriately to those demands. Theoretically, those properties might be expected to include: (1) operationalized statements of instrumental goals; (2) a work structure that involves interdependence in task performance; (3) participation in decision making; (4) an incentive system that utilizes performance criteria rather than expressive relationships; (5) personnel practices that encourage a cosmopolitan orientation; and (6) institutionalized provisions for change advocacy.

The specification of the relationships among these properties, or variables, and the determination of means for assessing them quantitatively, are tasks that remain to be accomplished.     

Aggregate nursing requirement planning in a public health care delivery system.

In this paper, we present an aggregate nursing requirement planning model for inpatient services to provide inputs for preparing yearly budgets in a public health care delivery system. A forecasting system using autoregressive integrated moving average time-series models forms the basis of project demands for nursing hours by medical specialities. These projections along with the institutional constraints and patient care requirements are all incorporated in a linear programming model for assessing needs for permanent staff, overtime pay and contracting temporary help—by medical service, nursing skill level and time period (month). We also expand the model to evaluate the sizing of a pool of float nurses. The model is developed within the framework of routine managerial planning process of the system under study (vis-à vis, the data base and the organizational structure). Historical data are used to estimate input parameters for the model. The staffing needs generated from the model for 1978 are compared with the actual system performance.     

A new approach to optimal selection of services in health care organizations.

A new reimbursement policy adopted by Medicare in 1983 caused financial difficulties for many hospitals and health care organizations. Several organizations responded to these difficulties by developing systems to carefully measure their costs of providing services. The purpose of such systems was to provide relevant information about the profitability of hospital services. This paper presents a new method of making hospital service selection decisions: it is based on an optimization model that avoids arbitrary cost allocations as a basis for computing the costs of offering a given service. The new method provides more reliable information about which services are profitable or unprofitable, and it provides an accurate measure of the degree to which a service is profitable or unprofitable. The new method also provides useful information about the sensitivity of the optimal decision to changes in costs and revenues. Specialized algorithms for the optimization model lead to very efficient implementation of the method, even for the largest health care organizations.     

A quantitative index of access to primary medical care for health planning

The emphasis of Public Law 93–641 on numerical goals of health care, as elaborated upon by the National Health Planning Council in its guidelines, foreshadows the emergence of quantitative indices in many areas of health resources utilization and health outcomes. In the area of access to primary medical care, the guidelines spell out in detail what is considered the reasonable waiting period for an appointment, travelling time to the source of care, and in-office waiting time for individuals seeking care. An index of access is developed on the basis of these reasonable limits of waiting for health services research and planning purposes. An example of hypothesis-testing with hypothetical data is given, along with a caveat in the interpretation of the results.     

Analysis of cost and coverage of government financed primary health care services in Tanzania.

A method for cost analysis is presented and applied to Primary Health Care Services in Tanzania. Primary care utilization figures are combined with budget and cost data to arrive at estimates of per capita and per visit cost. Data for analysis of geographical coverage, health care needs, and utilization are most readily available for the MCH sector of Primary Health Care Services, the most important health care sector in LDCs, which is used in this paper as a proxy for estimating health care needs and utilization. The importance of separating appropriately identified investment costs from recurrent costs is illustrated. Speedy implementation of health care for all requires assistance for investment costs, the recurrent costs of appropriately designed Primary Health Care Services being within the reach of developing nations themselves.     

Co-location as a catalyst for service innovation: a study of Scottish health and social care

Academic literature and policy on co-location of local public services focus on the cost benefits. Other benefits and outcomes of co-location, including service innovations benefiting users, are under-conceptualized. This paper suggests a framework for evaluating co-location as a learning environment for innovation, drawing on new case studies of five Community Health Partnerships in Scotland charged with more closely coordinating health and social care. We conclude that partnerships using co-location are benefiting from additional service innovations.     

Predicting workload requirements for scheduled health care services, with an application to radiology departments.

A model is developed for predicting workload requirements for scheduled health care services. The model is then applied to an actual planning problem for a radiology department. The probability distribution of future workload is represented by the convolution of two families of random variables such that a compound Poisson process adequately describes workload requirements. The model developed herein can be applied to a wide assortment of capacity-expansion problems that are characterized by discrete demands (e.g. number of jobs) occurring in a given period of time, where the amount of time needed to complete each job is a continuous random variable.