Thesis (MBA (Business Management))--University of Stellenbosch, 2007. / ENGLISH ABSTRACT: Given the increase in the cost of health care, economic considerations have drawn more and more interest over the last decade. Facilities are faced with the challenge to reduce costs while maintaining productivity. The Operating Room (OR) represents a significant opportunity to reduce expenses and improve efficiency. With the development of ambulatory or day surgery, minimally invasive procedures and the decline in admissions to hospitals the management of the OR suite needs re-evaluation. The Battlefords Union Hospital has a four room OR suite that performs a mixture of both inhospital and day surgeries. The current OR suite efficiency is determined by its adherence to the annual budget. A literature study was conducted with the focus on OR efficiency and in particular Patient Outcome and OR Management. Other issues included Perioperative Information systems and OR design. A survey was conducted in the OR suite and responses obtained from OR staff were evaluated. The survey included questions on patient experiences, procedural times, case scheduling, support, communication, quality measures and OR efficiency. The goals of this project was not to do an extensive statistical analysis of OR data. A limited study of OR suite data was presented to highlight relevant OR efficiency indicators. A summary of the findings and recommendations for improvement of the Battlefords Union Hospital OR suite’s efficiency, concludes the report. / AFIKAANSE OPSOMMING: Na aanleiding van die verhoging in koste van gesondheidsorg die laaste dekade, is ekonomiese aspekte meer op die voorgrond. Inrigtings word deur uitdagings in die gesig gestaar om kostes te verminder, terwyl produktiwiteit gehandhaaf moet word. Die operasie suite bied ‘n aansienlike geleentheid om kostes te verminder en effektiwiteit te verhoog. Met die ontwikkeling van dagchirurgie, “minimal invasive” prosedures en die afname in hospitaal opnames, behoort die bestuur van operasie suites herevalueer te word. Die Battlefords Union Hospitaal het ‘n vier teater operasie suite waar ‘n verskeidenheid van dagchirurgie en in-hospitaal prosedures uitgevoer word. Die operasie suite se effektiwiteit word huidiglik slegs gemeet aan die mate van hoe dit binne die jaarlikse begroting bly. ‘n Literatuurstudie is uitgevoer met die fokus op operasie suite effektiwiteit, met die klem op pasient uitkoms en operasie suite bestuur. Ander items wat ook ondersoek is, sluit in perioperatiewe informasie stelsels en teater ontwerp. ‘n Empiriese studie, gebaseer op ‘n vraelys, is uitgevoer onder die staflede van die operasie suite by die Battlefords Union Hopitaal. Die vraelys het vrae ingesluit oor pasient ervarings, prosedure tye, geval skedulering, kommunikasie, kwaliteitsversekering en operasie suite effektiwiteit. Die doel van die projek was nie om ‘n uitgebreide statistiese analise van die operasie suite data te doen nie. 'n Beperkte studie van die beskikbare data is gedoen en relevante effektiwiteits indikators is uitgewys. Die verslag word afgeëindig deur bevindinge, gevolgtrekkings en aanbevelings oor hoe die Battlefords Union Hospitaal die operasie suite se effektiwiteit moontlik kan verhoog.

Thesis (MCur (Interdisciplinary Health Sciences. Nursing Science))--University of Stellenbosch, 2010. / ENGLISH ABSTRACT: Patient safety remains one of the biggest challenges to healthcare organizations. With the escalation in health care costs due to medical errors, many organizations are adopting a number of strategies like the keeping of electronic medical records, the use of medication bar coding, instituting protocol for common procedures and checklists. Although each of these interventions has had a positive impact, problems of preventable medical errors still persist in many health care organizations throughout the world. In order to combat this, a small but increasing number of organizations are trying out basic technology as a low cost solution for patient safety in order to adopt this culture. Approval was given to the researcher to conduct an assessment of the safety culture in a specialized obstetric and gynecology operating room setting in Abu Dhabi. The aim of the study was to explore the patient safety culture and the contributing factors influencing patient safety in the operating room, as part of the preparations for accreditation by the Joint Commission International. A quantitative descriptive survey as research design was implemented for this purpose. In May 2010 the researcher surveyed the entire population of operating room staff, i.e. 250 participants, following a pilot study consisting of 10% of the total sample. The popular hospital wide survey questionnaire of the Agency for Healthcare Research and Quality (AHRQ) was adjusted and used to assess the safety culture among the operating room staff. The survey measured four common dimensions of patient safety, namely an overall perception and grade of patient safety, and the frequency and number of events reported. Further sub-dimensions were also measured in terms of leadership support, team work, and communication. A total of 118 completed questionnaires were received, which represents a 52% response rate. All of the participants had direct interaction or contact with patients. The composite overall score for the perception of safety was 48%. Although findings of the survey indicate that the operating room has patient safety problems, the findings also show much positive strength in the operating room and the organization as a whole. The positive composite scores are reflected in the findings of 74% for hospital management support for patient safety, 70% for teamwork within the units, and 61% for teamwork across hospital units, and 60% for feedback and communication regarding medical errors. The implications of the survey findings were taken into consideration in order for the organization to comply with the requirements for the Joint Commission International’s recertification with the focus on staff education and improving safety standards. / AFRIKAANSE OPSOMMING:Pasiëntbeveiliging bly een van de grootste uitdagings vir gesondheidsorganisasies. Met die toename in onkoste vir gesondheidsorg vanweë mediese misstappe, pas baie organisasies ’n aantal strategieë toe, soos die byhou van elektroniese mediese rekords, die aanbring van strepieskodes op medisyne, die daarstelling van protokolle vir algemene prosedures en kontrolelyste. Alhoewel elkeen van hierdie intervensies ’n positiewe impak gehad het, bestaan probleme vanweë mediese misstappe nog steeds in vele gesondheidsorg organisasies dwarsoor die wêreld. Om dit te voorkom, probeer ’n klein, maar toenemende aantal organisasies om ‚n kultuur van basiese tegnologie as ’n lae-koste oplossing vir pasiëntbeveiliging te kweek. Toestemming is aan die navorser gegee om ’n assessering te doen van die veiligheidskultuur in ’n gespesialiseerde verloskundige en ginekologiese operasiesaal in Abu Dhabi. Die doel van hierdie studie is om die pasiëntveiligheidskultuur te ondersoek, asook die bydraende faktore wat pasiëntbeveiliging in die operasiesaal beïnvloed as deel van die voorbereiding vir akkreditasie deur die Gesamentlike Kommissie Internasionaal (GKI). ’n Kwantitatiewe, beskrywende opname as navorsingsontwerp is toegepas vir hierdie doel. Gedurende Mei 2010 het die navorser ’n opname van die totale populasie van die operasiesaalpersoneel gedoen, naamlik 250 deelnemers, na ’n loodsondersoek wat 10% van die totale steekproef uitgemaak het. Die bekende Agentskap vir Gesondheidsnavorsing en Kwaliteit (AGNK) se hospitaalwye opnamevraelys is aangepas en gebruik om die veiligheidskultuur in die operasiesaal te assesseer. Die opname het vier algemene dimensies van pasiëntveiligheid gemeet, naamlik ’n algemene persepsie en gradering van pasiëntveiligheid, as ook die frekwensie en die aantal ongunstige gebeure wat plaasvind. ’n Totaal van 118 voltooide vraelyste is ontvang wat ’n 52% responskoers verteenwoordig. Al die deelnemers het direkte interaksie of kontak met pasiënte. Die samegestelde algehele telling van persepsie van veiligheid is 48%. Alhoewel bevindinge van die opname aandui dat die operasiesaal pasiëntveiligheidsprobleme het, wys bevindinge ook baie positiewe aspekte in die operasiesaal en die organisasie as ’n geheel uit. Die positiewe samegestelde telling word gereflekteer in die bevindinge van 74% vir ondersteuning vanaf die hospitaalbestuur vir pasiëntbeveiliging, 70% vir spanwerk binne die eenhede, 61% vir spanwerk dwarsoor die hospitaaleenhede en 60% vir terugvoering en kommunikasie ten opsigte van mediese misstappe. Die implikasies van die opname se bevindinge is in ag geneem ten einde die organisasie in staat te stel om te voldoen aan die Gesamentlike Kommissie Internasionaal se hersertifisering met die fokus op personeelopleiding en verbetering van veiligheidstandaarde.

This research has been defined in response to the Winnipeg children's hospital (WCH) challenges such as long waiting times, delays and cancellations in surgical flow. Preliminary studies on the surgical flow revealed that definition and implementation of successful process improvement projects (PIPs) along with application of an efficient master surgical schedule (MSS) are efficient solutions to the critical problems in WCH. In the first phase of this work, a process improvement program including three major PIPs, is defined and implemented in WCH in order to improve the efficiency of the processes providing surgical service for patients. In the second phase, two new multi-objective mathematical models are presented to develop efficient MSSs for operating room department (OR) in WCH.

This research has been defined in response to the Winnipeg children's hospital (WCH) challenges such as long waiting times, delays and cancellations in surgical flow. Preliminary studies on the surgical flow revealed that definition and implementation of successful process improvement projects (PIPs) along with application of an efficient master surgical schedule (MSS) are efficient solutions to the critical problems in WCH. In the first phase of this work, a process improvement program including three major PIPs, is defined and implemented in WCH in order to improve the efficiency of the processes providing surgical service for patients. In the second phase, two new multi-objective mathematical models are presented to develop efficient MSSs for operating room department (OR) in WCH.

Surgical Site Infections (SSI) are a significant and potentially preventable source of illness and death for surgical patients. An unknown, but potentially significant fraction of SSI may be caused by airborne infectious particles. Improved or optimized room air distribution may reduce these infections by minimizing the transport of infectious particles into the surgical site. A sophisticated CFD analysis, previously conducted by researchers at the National Institutes of Health (NIH), found that a buoyant thermal plume produced by heat from the surgical site itself could play a significant role in protecting the site from infectious particles. This study experimentally determines the airflow patterns around a simulated patient in a mock operating room using particle image velocimetry (PIV) to find the influence of the buoyant thermal plume on the flow. In addition, independent CFD analysis was performed using a standard commercial CFD program both to help guide and interpret the experimental results and to test the performance of a more readily available tool in predicting the experimental findings. The results of the experimental results and CFD analysis were quantitatively compared to find their agreement.

abstract: Surgery is one of the most important functions in a hospital with respect to operational cost, patient flow, and resource utilization. Planning and scheduling the Operating Room (OR) is important for hospitals to improve efficiency and achieve high quality of service. At the same time, it is a complex task due to the conflicting objectives and the uncertain nature of surgeries. In this dissertation, three different methodologies are developed to address OR planning and scheduling problem. First, a simulation-based framework is constructed to analyze the factors that affect the utilization of a catheterization lab and provide decision support for improving the efficiency of operations in a hospital with different priorities of patients. Both operational costs and patient satisfaction metrics are considered. Detailed parametric analysis is performed to provide generic recommendations. Overall it is found the 75th percentile of process duration is always on the efficient frontier and is a good compromise of both objectives. Next, the general OR planning and scheduling problem is formulated with a mixed integer program. The objectives include reducing staff overtime, OR idle time and patient waiting time, as well as satisfying surgeon preferences and regulating patient flow from OR to the Post Anesthesia Care Unit (PACU). Exact solutions are obtained using real data. Heuristics and a random keys genetic algorithm (RKGA) are used in the scheduling phase and compared with the optimal solutions. Interacting effects between planning and scheduling are also investigated. Lastly, a multi-objective simulation optimization approach is developed, which relaxes the deterministic assumption in the second study by integrating an optimization module of a RKGA implementation of the Non-dominated Sorting Genetic Algorithm II (NSGA-II) to search for Pareto optimal solutions, and a simulation module to evaluate the performance of a given schedule. It is experimentally shown to be an effective technique for finding Pareto optimal solutions. / Dissertation/Thesis / Ph.D. Industrial Engineering 2010

Context. With the proportional increase in the population of elderly people, there is an increase in the need for providing quality health-care. Operating room planning is one aspect that is considered to meet the requirement of providing quality health care. Operatingroom planning concerns about the efficient management of the available resources to perform surgeries. It deals with allocation and assignment of surgeries to operating rooms in a sequential manner using resource optimization strategies to manage with the available operating rooms. Objectives. In this thesis, we investigate the behavior and applicabilityof an optimization model and measure the degree to which the model can efficiently utilize the available hospital resources. Methods. Simulations are conducted to test the impact of implemented model on turnover time. The experiment is conducted on three different scenarios using the real world data collected from Blekinge hospital. Results. The impact on the turnover time measured for the three different scenarios is evaluated using simulation experiment. The relationship between the scenarios is identified by comparing the results with a baseline scenario (real world schedule). Conclusions. Based on the analysis, we conclude that the new optimization model is capable of scheduling better than the existing scheduling system used by the hospitals. The observations show that optimization model significantly reduces the turnover time compared to the real schedule. Besides, the scenario using an additional resourceis found to have better performance compared to other scenarios. The thesis concludes by showcasing the performance and applicability of the optimization model.

Purpose – This paper aims to present an applied research effort aimed at reengineering the utilization practices of operating rooms for a public Portuguese hospital. This reengineering effort is motivated by the desire to enhance the patientorientation of the hospital. The role of information systems in facilitating such organizational change is also to be examined. Design/methodology/approach – Actual data are used to simulate outcomes of three different operational scenarios related to the utilization of operating rooms and surgical teams. As such, the critical constraint related to surgical capacity is relaxed under different utilization scenarios. Findings – Based on the findings of the study, it appears that there is no conflict between operational efficiency and patient satisfaction. Welldesigned operational changes can lead to both efficiency and patient satisfaction benefits. This, in turn, can translate into competitive strategic advantage for the hospital. Research limitations/implications – The simulation results derived from this applied research are positive. In general, they tend to point to potential operational and strategic benefits to the hospital and its patients. Although the simulation model used in this study was validated using actual data, more research is needed to test its general applicability. Such research should shed more light on the interrelationships which exist within the hospital operating system. Practical implications – The approach advocated in this research has operational and strategic relevance to healthcare policy makers and hospitals' administrators. In this context, the role of the information systems in providing information relevant to tracking and improving a hospital's performance is emphasized. Originality/value – The paper presents a practical, applied, systematic approach toward enhancing operational effectiveness in healthcare organizations. It draws on bodies of knowledge pretending to system theory, simulation and operations management in order to improve the shortterm performance of hospitals.

Submitted by Fabíola Silva (fabiola.silva@famerp.br) on 2018-01-09T11:43:21Z No. of bitstreams: 1 marceloalessandrorigotti_tese.pdf: 1594173 bytes, checksum: ab2cf8bf6df41438b2a1e87f2d06b4ff (MD5) / Made available in DSpace on 2018-01-09T11:43:21Z (GMT). No. of bitstreams: 1 marceloalessandrorigotti_tese.pdf: 1594173 bytes, checksum: ab2cf8bf6df41438b2a1e87f2d06b4ff (MD5) Previous issue date: 2017-01-27 / Introduction: Contamination of hospital surfaces plays an important role in the spread of infection related to health care. There is still no consensus as to how environmental surfaces should be cleaned and / or disinfected, and the most appropriate methods for assessing the cleaning / disinfection process. There are different systems for monitoring the efficiency of the process of cleaning hospital surfaces: among them, visual inspection, fluorescent marker, adenosine triphosphate by bioluminescence and microbiological cultures. Objectives: 1. To compare the efficiency of three surface friction techniques to reduce organic matter; 2. Evaluate the efficiency of concurrent cleaning / disinfection of operating room surfaces; 3. Evaluate the efficiency before / after cleaning / disinfection of operating room surfaces after review and implementation of an L / D protocol with an emphasis on educational and procedural interventions. Material and Methods: 1. Quantitative, descriptive and exploratory study carried out before and after the cleaning / disinfection process of the bedside tables of the patient unit. Three unidirectional, bi-directional and centrifugal friction techniques were performed individually on each table. For each patient unit and friction technique, a single table and cloth moistened with 70% alcohol (w / v) was used. Organic matter was detected by the presence of adenosine triphosphate by bioluminescence using the 3M ™ Clean-Trace ™ ATP Systems system. 2. A prospective, correlational study developed in the interior of São Paulo, in July 2014. Non - probabilistic sample consisted of the surfaces: surgical table, anesthesia machine, accessory table and counter, being evaluated by visual inspection, microbiological culture and adenosine triphosphate by bioluminescence, at the frequency of one operating room per day. 3. Similar to study 2, but between the months of July and August of 2014. Together, the coordinating nurse of the surgical unit carried out educational intervention and standardization of procedures. Results: 1. For each technique, 13 samples were collected before / after the cleaning / disinfection process, totaling 78 crops. There was no statistical difference between techniques for the removal of organic matter. This study demonstrated that the three surface friction techniques are effective (p <0.05). 2. Twelve samples per surface were collected in 12 days, before and after cleaning / disinfection, totaling 96 samples. The cleaning / disinfection significantly reduced the quantification of adenosine triphosphate and microbial counting of the anesthesia and counter apparatus (p <0.05). The overall rate of cleaned surfaces by visual inspection, microbiological culture and adenosine triphosphate was, before cleaning and disinfection, 37.5%, 10.4% and 12.5%, respectively, and 39.6%, 31, 2% and 70.8% after. 3. Number of samples similar to study 2. Cleaning / disinfection significantly decreased all monitoring parameters for all surfaces. The overall rate of cleaned surfaces by visual inspection, ATP and culture was respectively 47.0%, 37.5% and 22.0% before cleaning and disinfection, and 81.2%, 89.6% and 70.1% after. Conclusions: 1. Further studies considering other indicators and surfaces are needed. 2. The protocol for cleaning / disinfecting operating room surfaces needs to be re-evaluated in order to provide safety to the surgical patient. 3. The elaboration and implementation of the protocol of cleaning / disinfection of the operating room proved to be efficient, since it presented smaller and significant results after the cleaning / disinfection, considering the methods of measurement of the process of cleaning the environmental surfaces. / Introdução: A contaminação das superfícies hospitalares desempenha importante papel na disseminação da infecção relacionada à assistência à saúde. Ainda não há consenso a respeito de como as superfícies ambientais devem ser limpas e/ou desinfetadas, bem como, quais os métodos mais apropriados para avaliar o processo de limpeza/desinfecção. Há diferentes sistemas para monitoramento da eficiência do processo de limpeza de superfícies hospitalares: entre eles, a inspeção visual, marcador fluorescente, adenosina trifosfato por bioluminescência e culturas microbiológicas. Objetivos: 1. Comparar a eficiência de três técnicas de fricção de superfície para redução de matéria orgânica; 2. Avaliar a eficiência da limpeza/desinfecção concorrente de superfícies em sala operatórias; 3. Avaliar a eficiência antes/depois da limpeza/desinfecção de superfícies de sala operatória após revisão e implementação de um protocolo de L/D com ênfase em intervenções educativa e procedimental. Material e Métodos: 1. Estudo quantitativo, descritivo e exploratório, realizado antes e após o processo de limpeza/desinfecção das mesas de cabeceiras da unidade de pacientes. Três técnicas de fricção em sentido unidirecional, bidirecional e centrífuga, foram realizadas individualmente em cada mesa. Para cada unidade de paciente e técnica de fricção, uma única mesa e pano umedecido com álcool a 70% (p/v) foi empregado. A matéria orgânica foi detectada pela presença de adenosina trifosfato por bioluminescência utilizando-se o sistema 3M™ Clean-Trace™ ATP Systems. 2. Estudo correlacional, prospectivo, desenvolvido no interior paulista, no mês de julho de 2014. Amostra não probabilística foi constituída pelas superfícies: mesa cirúrgica, aparelho de anestesia, mesa acessória e balcão sendo avaliadas por inspeção visual, cultura microbiológica e adenosina trifosfato por bioluminescência, na frequência de uma sala operatória por dia. 3. Semelhante ao estudo 2, porém entre os meses de julho a agosto de 2014. Conjuntamente foi realizado, pela enfermeira coordenadora do bloco cirúrgico, intervenção educativa e padronização de procedimentos. Resultados: 1. Para cada técnica, 13 amostras foram coletadas antes/após o processo de limpeza/desinfecção, totalizando 78 colheitas. Não se constatou diferença estatística entre as técnicas na remoção de matéria orgânica. Este estudo demonstrou que as três técnicas de fricção de superfície são eficazes (p<0,05). 2. Foram coletadas em 12 dias, antes e após a limpeza/desinfecção, 12 amostras por superfície, totalizando 96 amostras. A limpeza/desinfecção diminuiu de forma significativa apenas a quantificação de adenosina trifosfato e contagem microbianas do aparelho de anestesia e balcão (p<0,05). A taxa global de superfícies limpas por inspeção visual, cultura microbiológica e adenosina trifosfato foi, respectivamente, antes da limpeza e desinfecção, de 37,5%, 10,4% e 12,5% e, de 39,6%, 31,2% e 70,8% após. 3. Número de amostras semelhante ao estudo 2. A limpeza/desinfecção diminuiu, de forma significativa, todos os parâmetros de monitorização para todas as superfícies. A taxa global de superfícies limpas por inspeção visual, ATP e cultura foi, respectivamente, de 47,0%, 37,5% e 22,0% antes da limpeza e desinfecção, e de 81,2%, 89,6% e 70,1% após. Conclusões: 1. Estudos adicionais considerando outros indicadores e superfícies são necessários. 2. O protocolo de limpeza/desinfecção de superfícies de sala operatórias necessita ser reavaliado a fim de propiciar segurança ao paciente cirúrgico. 3. A elaboração e implementação do protocolo de limpeza/desinfecção da sala operatória se mostrou eficiente, pois apresentou resultados menores e significantes após a limpeza/desinfecção, considerando aos métodos de mensuração do processo de limpeza das superfícies ambientais.

Thesis (M.H.A.)--University of Michigan, 1974.