Transferability of Industrial Management Concepts to Healthcare Networks

PRO-VE 09 – Thessaloniki 7-9 October 2009 1

PRO-VE’09 10th IFIP Working Conference on VIRTUAL ENTERPRISES Thessaloniki, GREECE, 7-9 October 2009

Transferability of Industrial Management Concepts to Healthcare

Networks

D. Antonelli (1), D. Bellomo(3), B. MacCarthy (2), A. Villa (1)

(1) Department of Production Systems and Industrial ManagementPolitecnico di Torino, Italy

(2) Operations Management Division, Nottingham University, UK.(3) Azienda Sanitaria Locale ASL-AT, Asti, Italy

20/10/2009 PRO-VE 09 – Thessaloniki 7-9 October 2009 2

Transferability of Industrial Management Concepts to Healthcare Networks

Scope discuss the transferability of performance evaluation (PE) methods adopted in industrial practice to a public network of healthcare services (Healthcare Territorial Agency - HTA). Discussiona) how to approach the problem

transferring concepts/methods outside of industrial sector

b) how to apply industrial management concepts to healthcare by modelling a HTA in terms of network of services

analogies between an industrial network (e.g. a Collaborative Supply Chain) and a HTA

The HTA (ASL-AT) of Asti is the living laboratory.

Initial results of the Research Project “HT-Net”.


The main goals of the healthcare service can be synthesized by: quality i.e., the effectiveness of the offered services; efficiency as, for instance, the reduction of the costs of drugs and staff, as well as the reduction of patient waiting times.

Focal issues: dimensioning the system, i.e., determining the type and number of resources to provide (staff, rooms, beds, etc.); understanding the workflow and detecting anomalies such as bottlenecks, waiting times, etc.; improving efficiency, i.e., using resources in a better way, by decreasing patients length of stay, reacting to problems such as staff absence, etc.; studying the system reactivity with respect to an increased workload.




Health stateof population

Funding

Resources allocation

Service offered

Patient cured

Management Efficiency

Efficiency, Equity, Accessibility

Quality, Effectivenessof service

The main goals of the healthcare service:

quality i.e., the effectiveness of the offered services;

efficiency as, for instance, the reduction of the costs of drugs and staff, the reduction of patient waiting times.


Both the main management goals of an HTA and the main problems to be solved are familiar in the frame of industrial management

BUTAn effective transferability of concepts & methods must be based on similarity of the systems structures and of the management and performance evaluation objectives

THENIt is mandatory:

a meta-model of the HTA network of servicesa scheme of the performance evaluation steps and related

KPIs



Formal scheme of the network of healthcare services (from HTA)

Patient input

112

Emergency Rescue

Medical officer Continuous care

Specialist doctor

Surgery Hospital

Analysis laboratory

End


Disease

Diagnosis

Therapy


The flows of patients along the scheme of HTA services:

hospital plays the role of the main service which collects flows of patients coming from several upstream services

day-hospital, local consulting services, considered as intermediate services of the network; family doctors (medical officers) and specialists, usually

acting as input services for patients

In order to avoid congestion at the hospital, the patients’ demands have to be filtered by upstream services, through careful diagnostics and prevention actions.

Besides these, the upstream services have to address their patients to downstream ones according to the service capacity.



Expected targets of any organization of a public healthcare chain:

Avoid congestion,

minimize queues (time and length),

minimize service costsAccording to principles of equity and accessibility of service providers

Such to assure a minimum admissible level of service to any person



Based on the HTA scheme and management objectives, find analogies with industrial networks….

Items Industrial Network (e.g. Supply Chain) Healthcare Service Network (e.g. HTA)

Agents (a) Supplier (producer): who sells products (b) Client (user): who purchases products

(a) Service provider (b) Patient

Agents’ position in the process

The industrial process is a concentrated-parameter process; both types of agents are associated to nodes of the network.

The healthcare system is a mixed-parameter process: service providers are associated to HTA centers, while patients are distributed on the territory.

Agents’ interactions

Negotiation to manage competition between the two types of agents

Cooperation to assure the most effective service.

Agents’ decisions

Each type of agent chooses the counterpart who seems to be the most convenient

The patient chooses the service provider who seems to be more credible and cooperative

Agents’ goals

Each agent wants to maximise its own profit, but can agree with other agents on the common target of maximizing the chain production.

The patient wants to reach a desired health status; the provider aims to be the most attractive, by assuring a desired service performance.



By the above Table, evident similarities between industrial and healthcare networks can be envisaged, but also a significant difference.

The real goal of a patient is to find a service which could assure that a desired health status could be reached.

This target can be reached by the collaborative actions of both the patient – who must be able to explain symptoms and ready to carefully follow prescriptions – and the service provider – who must be efficient in using right competence to make diagnosis.

Cooperation, instead of the competition governing industrial interactions, and the territorial distribution of one type of agent (the potential patients) are the two milestones of healthcare systems: they call for a better specification of this sector itself.



By transferring industrial concepts about system performance evaluation, one realises that

a) To evaluate the system utilization, first get an estimate of the demand

this means to estimate how patients will ask service to the HTA

b) To evaluate the system efficiency (from the point of view of the system manager), get an estimate of the system loading conditions

this means to estimate the attractiveness of the HTA service centers,

and to evaluate the utilization of the employed resources.

c) To evaluate the patient satisfaction, one has to develop a model of the patients’ decision-making among alternative services.



How the concepts are applicated in the Research Project –PRIN “HT-Net”, in collaboration with the HTA ASL – Asti:

Scope:Offer conceptual, methodological and practical tools for applying a re-engineering procedure to an existing HTA. This problem will be approached both at the conceptual level (trough model and criteria definition) and at the implementation level (in terms of ICT tools and procedures).

Expected results:a. New KPIs for the HTA performance evaluationb. A related procedure for HTA performance evaluation and

cost assessmentc. A web site to support HTA managerd. Experience of applications in a “Living Lab” = ASL Asti




www.lep.polito.it/prinsalute


The HTA area (Asti – Italy) and

the service centers allocation:

main HC service centers

analysis laboratory

hospital




C ANAG

C

C2 ANAG

C2

D ANAG

D

F ANAG

F

C4

C

C5

C

SDO

C

Patient’s data are separated for privacy

Every data base refers to a service (>2MB)

CDS Table Analysis …..Destination

DB

>50K

Data filtering

Available data: HTA databases (2006-2008)


Preliminary results:

how patients move towards

hospital centers to Nizza

simulated with gravity models

to Asti hospital




Along which main directions

Patients move towards hospitals

Alessandria

Acqui

Terme

Alba‐

Cuneo

prov.

Cuneo

Alessandria

Prov.

Torino

Casale

Monferrato

Vercelli

Torino




How a class of patients (diabetic) move from a HC service towards the others -> ROUTINGS -> CAPACITY ANALYSIS




1

Pre-recovery (Analysis)

2

Surgical intervention

3

Post-recovery

Health conditionof the patient

Availability ofsurgical room

Empty Casehistory

Nurses Doctors Bed

Patient readyto undergo

surgery

Patientwith

desease

Patientoperated

Health conditionof the patient

under intervention

Nurses

Surgeons

SurgicalRoom

Nurses Doctors Bed

Health conditionof the convalescent

patient

Cured patient

Case historyfilled with

analysis results

Case historyfilled with

Interventionresults

Anaesthetist

•IDEF 0 of inpatients flow in a surgery division of Asti Hospital



Queueing network of inpatient flow in the

surgery division

Service Distrib. Expression

A Partial Hospitalized (days) costant 0

B Hospitalized (days) Beta 0.5+ 22 *BETA(0.239, 3.3)

C Surgical intervention Expon EXP(2.44)

D Recovery (days) Lognorm-0.5+LOGN(2.76, 1.48)

7.5 + LOGN(5.33, 10.9)

36%

61%

0.42.8

0.2

0.5

98.9

A

C D

B

Identification of the model (Stochastic distributions of process times)



Assign “Priority” attribute to patients

(90%/10%)

Beds are occupied

Beds are released

Different operation times

Different Post- Recovery times

ARENA simulation



Performance parameters of the process (results

from an experiment of 30 runs)

Parameter Description Av. Value

Halfwidth

Number patients in 153 5.31

Cycle time Days to dismission 12.5 1.34

Effective time Days in bed 4.70 0.11

Wait time partial hospitalized (A) Days before hospitalization 7.81 1.37

Wait time hospitalized (B) Days before hospitalization 7.80 1.36

WIP Patients inside the system 32.2 3.77

Number in queueA Patients in the waiting list 13.1 2.42

Number in queueB Patients in the waiting list 7.17 1.35

Beds utilization Rate in / No. beds 0.91 0.01

Surgery utilization Rate in / capacity 0.79 0.02


Conclusions:Collaborative network management applied to HC NetworksThere are analogies and differencesAutonomous decisions by the patientNeed for a methodology (SCOR-like)



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Transferability of Industrial Management Concepts to Healthcare Networks