In comparison to the European healthcare system, the U.S. healthcare system has lower quality care, higher costs, and covers a smaller percentage of the population. Despite the high costs, the U.S. healthcare system remains dysfunctional. The purpose of this exploratory single case study was to identify the strategies that some healthcare managers in a hospital setting in the midwestern region of the United States use to improve efficiency while decreasing healthcare costs. Complex adaptive systems theory was used to frame this study that included face-to-face interviews with 6 highly experienced healthcare managers. Data were collected from audio recorded interviews and publicly available documents, and the audio recordings were transcribed and analyzed using deductive and open coding techniques to identify themes regarding strategies used by managers to find effective ways for improvement. Three strategies emerged as themes, including improving the accuracy of information and reports, implementing precise and accurate information, and improving quality. The findings of this study may directly benefit healthcare managers and compel positive social change by facilitating successful strategies to improve efficiency and reduce costs. The successful strategies identified in the study might provide a new direction to healthcare managers attempting to adopt new methods. The findings may also contribute to social change by providing solutions that may improve overall organizational performance in a hospital setting.

The increasing demand for healthcare services, coupled with the challenges of managing budgets and navigating complex regulations, has underscored the need for sustainable and efficient healthcare delivery. In response to this pressing issue, this thesis aims to optimize hospital efficiency using Artificial Intelligence (AI) techniques. The focus extends beyond improving surgical intraoperative time to encompass preoperative and postoperative periods as well. The research presents a novel Prescriptive Analytics System (PAS) designed to enhance the Surgical Success Rate (SSR) in surgeries and specifically in high volume arthroplasty. The SSR is a critical metric that reflects the successful completion of 4-surgeries during an 8-hour timeframe. By leveraging AI, the developed PAS has the potential to significantly improve the SSR from its current rate of 39% at The Ottawa Hospital to a remarkable 100%. The research is structured around five peer-reviewed journal papers, each addressing a specific aspect of the optimization of surgical efficiency. The first paper employs descriptive analytics to examine the factors influencing delays and overtime pay during surgeries. By identifying and analyzing these factors, insights are gained into the underlying causes of surgery inefficiencies. The second paper proposes three frameworks aimed at improving Operating Room (OR) throughput. These frameworks provide structured guidelines and strategies to enhance the overall efficiency of surgeries, encompassing preoperative, intraoperative, and postoperative stages. By streamlining the workflow and minimizing bottlenecks, the proposed frameworks have the potential to significantly optimize surgical operations. The third paper outlines a set of actions required to transform a selected predictive system into a prescriptive one. By integrating AI algorithms with decision support mechanisms, the system can offer actionable recommendations to surgeons during surgeries. This transformative step holds tremendous potential in enhancing surgical outcomes while reducing time. The fourth paper introduces a benchmarking and monitoring system for the selected framework that predicts SSR. Leveraging historical data, this system utilizes supervised machine learning algorithms to forecast the likelihood of successful outcomes based on various surgical team and procedural parameters. By providing real-time monitoring and predictive insights, surgeons can proactively address potential risks and improve decision-making during surgeries. Lastly, an application paper demonstrates the practical implementation of the prescriptive analytics system. The case study highlights how the system optimizes the allocation of resources and enables the scheduling of additional surgeries on days with a high predicted SSR. By leveraging the system's capabilities, hospitals can maximize their surgical capacity and improve overall patient care.

La conception d’un produit ou d’un service en Santé est un processus complexe et risqué. Il doit intégrer dans les phases précoces de conception les normes, les contraintes réglementaires, les données de surveillance et d’évaluation de la sécurité jusqu’à l’autorisation de mise sur le marché pour les dispositifs médicaux, mais également les préférences des utilisateurs experts : professionnels de santé ou non-experts : patients. Dans le marché compétitif des nouveaux produits ou services en Santé, l’enjeu pour les ingénieurs est de faire coïncider les besoins des utilisateurs à leur contexte et usages tout en intégrant toutes les parties prenantes du système de soin. Innovation médicale, technologique et organisationnelle, la télémédecine (TM) est l’utilisation des nouvelles technologies pour délivrer des actes médicaux. L’objectif de cette thèse est la mise au point d’une méthodologie centrée sur les utilisateurs et leurs usages pour concevoir, développer, intégrer et valider une application dermatologique de la TM : la télédermatologie. L’opportunité de validation de cette méthodologie pour intégrer et déployer un service innovant dans un service de dermatologie y est également discutée. / Designing product or services for healthcare system is highly complex, costly and risky. It combines constraints such as being a multi decisional and multilevel system with specific financial model linked to the state the healthcare system organization belongs to. In the highly marketing-time sensitive context of innovative products or services, there is challenge for designers to be able to match the new design to the users’ needs, answering to their context or usages while integrating all system stakeholder components. Telemedicine (TM) is the use of ITtechnologies to provide medical care or medical advice. It is considered a care delivery transformation combining medical, technological and organizational innovation. Using the example of Teledermatology a dermatological application of TM, this PhD develops a methodology based upon users contexts and usages to design integrate and provide an assessment model to decision makers. The opportunity to implement and integrate the service in French department of dermatology is discussed.