| Driven by an ageing population, public opinion, increased health expenditures, and long waiting lists, a flood of changes in the healthcare system has been set into motion. Many of these changes aim to improve efficiency and are planned by considering patient interactions within a single department or care service. This limited scope approach allows the complexity and uncertainty, which is inherent in healthcare, to be manageable by the problem solver. However, suboptimal conclusions may be drawn when only considering one or two departments; particularly if the influences of other services are ignored or if the effect of the change on the overall care chain is overlooked. In this project we aim to overcome the shortfalls caused by a departmentalized solution approach. In the healthcare modelling literature we see many papers that consider multiple departments when trying to understand and model a problem (typical examples include weekend bed occupancy being dictated by the weekday OR schedule, and Emergency Room congestion being caused by overcapacity in the inpatient wards). However, it is rare that these models include more than one additional department either upstream or downstream. For this project we wish to develop models that maintain this theme of looking beyond a single department, but would like to increase the number of departments included. To identify the relevant departments we plan to study patient care trajectories that highlight how patients flow between departments and consequently what interactions must be included in the model. Even a cursory literature search of the keywords patient flow will result in a long list of references to clinical pathway. Clinical pathways by definition are multidisciplinary and represent the flow of patient between care givers and across departments. Clearly this is the insight needed to design the models that we aspire to, thus it must not be overlooked in our research. However, the majority of this research debates the merits of clinical pathways, shares the varied success and failures of clinical pathway case studies, and, finally, describes how to develop, implement and measure clinical pathways. Although the research is comprehensive from a single patient type perspective, it often fails to consider how other patients competing for the same resources are affected. In contrast to the problem solver who considers all patient types within one department, clinical pathways researchers consider all departments but only one patient type. In this project we will use clinical pathways to help identify interdepartmental relationships and will provide insight into the effect of clinical pathways patients on remaining patient population. With comprehensive operational research models that include the many relationships that exist between departments and between patients we will be able to approach health care planning and control from a logistics and supply chain perspective. Instead of focusing on planning each individual department we plan to focus on developing techniques that in the first place optimize the care trajectory, and, secondly, reduce cost. This will lead to reduced waiting times, a higher level of service, a decrease in work-in-process, and thus improved quality of care. |
