The purpose of this study is to investigate the preparedness at the prehospital emergency care unit in north-western Skåne. Measuring preparedness is important to ensure that the ability to respond on emergency calls is satisfactory. To do this for north-western Skåne historical data from 2015 was extracted from SOS Alarm’s database. It was used to calculate preparedness using workload and coverage as measurements. The workload was calculated by taking the busy periods and comparing them to the ambulances working times. The coverage was calculated by defining neighbouring stations to cover for each station and then finding the amount of hours when there was no ambulance at either station. These calculations show that two of the six stations in north-western Skåne are in need of improvement. To increase the preparedness to a good level resources will have to be added at the liable stations. These resources would be new ambulances. There is a possibility to relocate ambulances from stations within the district but that would lead to a worsened preparedness for the stations which these ambulances belonged to in the first place.

With the strong support from the government and investors, Chinese healthcare sector is developed rapidly. Also, the demand for healthcare logistics has also gradually increased. Currently, most Chinese pharmaceutical manufacturing are using traditional healthcare logistics, and due to the late start of Chinese healthcare logistics, there are many problems within the field. Therefore,there is a strong demand for professional 3PL providers involving Chinese healthcare sectors. The purpose of this thesis is to analyze the status of Chinese healthcare sectors, to indicate the predictable contribution of Chinese 3PL providers after entering. And also, to analyze how different types of Chinese 3PL providers can better adapt themselves to healthcare logistics sectors. Additionally, different opportunities and challenges faced by the Chinese 3PL providers in the field of healthcare logistics has been analyzed.

Inom sjukvården är det viktigt att material finns tillgängligt när operationer och ingrepp ska genomföras för att patienter ska få den vård de behöver. För att materialbrist inte ska uppstå krävs bra planering och hantering av material. Det finns ett flertal olika materialstyrningsmetoder som syftar till att undvika materialbrist och uppnå låga kostnader. I dagsläget ligger Ögonkliniken på sjukhusområdet på Universitetssjukhuset i Linköping men då lokalerna är gamla ska kliniken flytta till nya lokaler på Garnisonen, ett område utanför sjukhusområdet. I och med flytten kommer ett nytt materialflöde att uppstå för Ögonklinikens steriliserade material. Detta då Ögonkliniken innan flytten steriliserade allt sitt material själva på avdelningen och efter flytten kommer materialet istället att skickas till Sterilcentralen som ligger på sjukhusområdet för sterilisering. Syftet med studien är därför att skapa en bättre förståelse för det framtida materialflödetmellan Ögonkliniken och Sterilcentralen genom att analysera lämpligheten i olika materialstyrningsmetoder för Ögonklinikens verksamhet. Målet med studien är att kartlägga det framtida materialflödet samt att beräkna mängden material som behöver finnas i flödet för att materialbrist inte ska uppstå för Ögonkliniken. För att besvara syftet utgår studien från fyra frågeställningar: Vilka processer och aktiviteter kommer det framtida flödet att bestå av? Vilka karaktäristiska drag har Ögonklinikens sterila material? Givet de karaktäristiska drag som identifierats i fråga 2, vilken materialstyrningsmetod är mest lämplig? Vilka andra effektermedför valet av materialstyrningsmetodför det framtida flödet? För att kunna besvara frågeställningarna har information och data samlats in genom litteraturstudie, sekundärdata och intervjuer. Sekundärdata som samlats in är efterfrågedata,antal diskprocesser, antal autoklavkörningar och antal omkörda processer och körningar. Det framtida flödet kommer bestå av fyra parter; Ögonkliniken, Sterilcentralen, Stångåbuss och Inre Logistik. Intervjuer har genomförts med samtliga parter, där de har svarat på semistrukturerade intervjufrågor. Studien resulterar i en kartläggning över det framtida flödet, där processer och aktiviteter som flödet kommer bestå av illustreras. Det sterila materialet identifieras ha kort ledtid, ojämn efterfråganoch antingen fast eller varierande beställningsintervall samt beställningskvantitet. Kanban anses vara den mest lämpliga materialstyrningsmetoden att använda för Ögonkliniken. Detta för att kanban lämpar sig bäst för det sterila materialets karaktäristiska drag. De effekter som ett kanbansystem medför är att beställningspunkt och beställningskvantitet bestäms samt att kostnaderna och kapitalbindning kan hållas låga. Dock är inte de transporter som finns idag anpassade för ett kanbansystem, vilket leder till att detta kan behöva åtgärdas för att få ett fungerande kanbansystem. För att ett kanbansystem ska fungera behöver materialet transporteras direkt när behovet uppstår och i dagsläget fungerar inte de avtalade transporter på detta sätt. Då de avtalade transporterna går specifika tider istället. / It is crucial that sterile material is available when surgeries and other medical procedures need to be performed so that the patients receive the required healthcare. To ensure that shortfalls of required material do not occur good planning and efficient material management is required. There are several different material planning methods that can be used to avoid shortfall of material. As of today, Ögonkliniken is located within the hospital area at the university hospital in Linköping. However, Ögonkliniken is being relocated to new facilities located at Garnisonen, which is an area outside of the hospital area.The relocation is due to that the current facilities are old and worn down. Ögonkliniken handled their own sterile material and the sterilization process in their current facilities. When the relocation is complete the used sterile material will be transportedto Sterilcentralen, which is located within the hospital area, for sterilization. After sterilization,the material must be transported back to Ögonkliniken. Hence, a new material flow will emerge because of the relocation. The purpose of this study is to gain a better understanding of the new materialflow. This is achieved by analyzing different material planning methods and whether they are suited for Ögonkliniken.The aim of the study is to map the future material flow and to calculate the amount of materialt hat needs to be present in the flow to avoid material shortages at Ögonkliniken. To fulfill the purpose of the study four research questions have been formulated: What activities will the material flow consist of? What specific features does Ögonklinikens sterilized material have? Given the specific features that have been identified in question 2, which material planning method is best suited? What other impacts does the chosen material planning method result in for the future material flow? Toanswer the questions, information and data have been collected through literature study, secondary data and interviews. The secondary data that have been collected are statistics over number of preformed operations, number of washing processes, number of sterilization processes and number of processes that needed to be reprocessed. The future material flow will consist of four departments: Ögonklinken, Sterilcentralen, Stångåbuss and Inre Logistik. All departments have been interviewed where they have been asked semi structured questions. The sterile material has been identified with the following specific features, short lead time, irregular demand and either fixed or varying order interval and order quantity. The best suited material planning method for Ögonkliniken is the Kanban system. This is due to that the sterile material’s specific features match with the method. An implementation of a Kanban system will result in routines for when and what volume should be ordered. The system also allows for the cost of purchased material to be low. However, the way the transports are set up today does not suit a Kanban system. Therefore, the transports may have to be adapted so that the Kanban system will function well. For the Kanban system to work transportation of material must occur when the demand appears and today the transports only allow material to be picked up at specific times.

A simulation study of the emergency department at Vrinnevisjukhuset in Norrköping investigating the patient flow with respect to patient lead time. / <p>Examensarbetet är utfört vid Institutionen för teknik och naturvetenskap (ITN) vid Tekniska fakulteten, Linköpings universitet</p>

<p>Smart and connected technology solutions have emerged as a promising way to enhance EMS services, particularly in areas where access to professional services is limited. However, a significant challenge for improving their implementation is determining which technologies to use and how they will change current logistic operations to enhance service efficiencies and expand access to care. In this context, this thesis explores opportunities for the smart and connected technology solutions.</p> <p>The first study explores the use of medically trained volunteers in the community, known as Citizen Responders (CRs). These individuals can be quickly notified of an EMS request upon its arrival via a mobile alert receiver, which allows them to provide timely and potentially life-saving assistance before an ambulance arrives. However, traditional EMS logistic decision platforms are not equipped to effectively leverage the sharing of the real-time CR information enabled by connected technologies, such as their location and availability. To improve coordination between CRs and ambulances, this study proposes two decision tools that incorporate real-time CR information: one for redeploying ambulances after they complete service and another for dispatching ambulances in response to calls. The redeployment procedure uses mixed-integer linear programming (MILP) to maximize patient survival, while the dispatch procedure enhances a locally optimal dispatch procedure by integrating real-time CR information for priority-differentiated emergencies.</p> <p>In the second study, a third decision tool was developed to take advantage of the increasing availability of feature information provided by connected technologies: an AI-enabled dispatch rule recommendation model that is more usable for dispatchers than black-box decision models. This is a model based on supervised learning that outputs a “promising” metric-based dispatch rule for the human decision-maker. The model maintains the usability of rules while enhancing the system’s performance and alleviating the cognitive burden of dispatchers. A set of experiments were performed on a self-developed simulator to assess the performance of all the decision tools. The findings suggest they have the potential to significantly enhance the EMS system performance. </p>

Clinical supply chain managers who do not apply effective employee turnover strategies could negatively affect team performance, employee morale, employee well-being, patient outcomes, productivity, profitability, and the sustainability of organizational activities. The purpose of this multiple case study was to explore strategies that supply chain managers used to decrease employee turnover in clinical logistics organizations. The targeted population consisted of 6 clinical logistics supply chain managers working in 6 community hospitals located in Maryland who had experience implementing successful strategies to decrease employee turnover. The servant leadership theory served as the study's framework. Data collection included semistructured interviews and a review of company records. Data were analyzed according to Yin's comprehensive data analysis method, including categorizing and coding words and phrases, word frequency searches to categorize patterns, and organizing the data to interpret recurring themes. Five main themes emerged from the data analysis: understanding employee turnover, proactive leadership, employee professional development, motivating employees, and effective communication. The findings from this study might contribute to social change by providing strategies that clinical logistics supply chain managers can implement to reduce employee turnover, which might sustain organizational profitability, improve the quality of life for employees, quality of service to patients, lower unemployment rates, and promote community health, wealth, and sustainability.

This thesis develops quantitative methods which incorporate transportation modeling for tactical and operational home health logistics planning problems. We define home health nurse routing and scheduling (HHNRS) problems, which are dynamic periodic routing and scheduling problems with fixed appointment times, where a set of patients must be visited by a home health nurse according to a prescribed weekly frequency for a prescribed number of consecutive weeks during a planning horizon, and each patient visit must be assigned an appointment time belonging to an allowable menu of equally-spaced times. Patient requests are revealed incrementally, and appointment time selections must be made without knowledge of future requests. First, a static problem variant is studied to understand the impact of fixed appointment times on routing and scheduling decisions, independent of other complicating factors in the HHNRS problem. The costs of offering fixed appointment times are quantified, and purely distance-based heuristics are shown to have potential limitations for appointment time problems unless proposed arc cost transformations are used. Building on this result, a new rolling horizon capacity-based heuristic is developed for HHNRS problems. The heuristic considers interactions between travel times, service times, and the fixed appointment time menu when inserting appointments for currently revealed patient requests into partial nurse schedules. The heuristic is shown to outperform a distance-based heuristic on metrics which emphasize meeting as much patient demand as possible. The home health nurse districting (HHND) problem is a tactical planning problem which influences HHNRS problem solution quality. A set of geographic zones must be partitioned into districts to be served by home health nurses, such that workload is balanced across districts and nurse travel is minimized. A set partitioning model for HHND is formulated and a column generation heuristic is developed which integrates ideas from optimization and local search. Methods for estimating district travel and workload are developed and implemented within the heuristic, which outperforms local search on test instances.

Bakgrund: I sjukhusets unika miljö kan vikten av effektiva flöden ha avgörande betydelse för liv eller död. Förutsättningarna för logistiken i ett sjukhus är föränderlig och för att hänga med i olika förbättringstekniker måste sjukhusen utvecklas. Lösningen kan vara lean i sjukvård, men forskningen inom området är begränsad, vilket ger upphov till fortsatta studier inom ämnet.   Syfte: Studien syftar till att ge utökad kunskap om lean genom att ta reda på utmaningar för samordning av två varuförsörjningsflöden samt identifiera faktorer för effektiv varuförsörjning inom sjukvården. Metod: För att besvara syftet och forskningsfrågorna har en abduktiv ansats använts, där litteraturen inhämtats parallellt med empirisk data från en fallstudie på Gävle sjukhus. Teori från litteraturen och resultatet från fallstudien har analyserats, diskuterats och utifrån analysen har en slutsats utarbetats. Resultat: Studiens resultat är en värdeflödesanalys av processen för den interna varuförsörjningen av förbrukningsartiklar på Gävle sjukhus. Genom kartläggningen åskådliggörs slöserier som de separata flödena ger upphov till.     Begränsningar: Området för lean och logistik i sjukvård är delvis outforskat och området är i behov av utvecklad kunskap. Då sjukhusets avdelningar tycks ha olika hantering för den interna varuförsörjningen hade ett utökat antal inkluderade informanter varit gynnsamt för studien. Implikationer: Studien utökar kunskapen för ämnet genom att identifiera utmaningar med arbetskulturen samt svårigheter i att standardisera processer och eliminera slöserier. Studien identifierar därtill informationsflöde, systemstöd och värdeflödesanalys som betydelsefulla faktorer för effektiv varuförsörjning på ett sjukhus. Dessutom definieras ett uttryck för logistiken i sjukhus – sjukhuslogistik. / Background: In the unique environment of a hospital the importance of efficient logistics can be a matter of life and death. The conditions for the logistics in a hospital are constantly changing and to keep up with progress being made in different techniques of improvement hospitals must evolve. The answer could be lean healthcare but the research in this area is limited and thus more studies are required. Purpose: This study aims to broaden the knowledge about lean healthcare, through exploring the challenges involved with coordination of supply flows and also by identifying success factors of efficient supply flows. Method: To answer the purpose and the research questions the study utilizes an abductive approach where the literature has been acquired in parallel with the empirical data from a case study made on Gävle hospital. Both theoretical and empirical data has then been analyzed and through this analysis a conclusion has been formed. Findings: The study is made by a value stream mapping of the internal supply chain of consumable goods at Gävle hospital. Through the mapping numerous areas of waste can be identified, which is the result of having separate supply chains. Limitations: More research in the area of using lean and logistics in combination with healthcare are still needed. Since management of the internal supply chain varies at the different hospital departments an increased number of informants would have been favorable for the study. Implications: This paper explores the topic by identifying challenges within the work culture, difficulties with standardization of processes and eliminating waste. The study also identifies flow of information, system support and value stream mapping as success factors for an efficient internal supply chain within a hospital. Because there is a lack of vocabulary for describing the area of healthcare logistics in the Swedish Language, a definition for this is also contributed in the study.

Bakgrund: Kostnadsökningen inom hälso- och sjukvården har varit ett stort problem sedan 1980-talet och kommer att fortsätta vara ett problem i framtiden. Det har lett till en mer ansträngd ekonomisk situation som hälso- och sjukvården fått förhålla sig till. Därför är det av stor vikt att de disponibla medel som finns inom hälso- och sjukvården allokeras till de områden där de skapar som mest nytta. Syfte: Syftet med studien är att göra en hälsoekonomisk utvärdering av ett nytt arbetssätt för behandling av knäskador på ortopedkliniken på Länssjukhuset i Kalmar. Metodval: Studien är utformad som en utvärderingsstudie med en abduktiv utgångspunkt. Datainsamlingen har skett utifrån semistrukturerade intervjuer på LSK med personal som är involverad i projektet. Utöver de semistrukturerade intervjuerna har även numeriska data utgjort en del av studiens empiri. Slutsats: Efter genomförd studie kan vi konstatera att fler hälsoekonomiska utvärderingar behövs på icke-nationella nivåer för att stödja verksamheter inom hälso- och sjukvården. Det är viktigt att det aktivt arbetas med effektiviseringsarbeten inom offentliga verksamheter som främst finansieras av skattemedel. Vi kan även konstatera att det nya arbetssättet är mer lönsamt än det gamla både monetärt och icke-monetärt där förändringen bidragit med flera vinningar som exempelvis kortare ledtider, bättre samarbete och utökad kompetens. / Background: The cost increase in healthcare has been a major problem since the 1980s and will continue to be a problem in the future. This has led to a more strained economic situation for the healthcare sector. Therefore, it is of the utmost importance that the available funds in the healthcare sector are allocated to the areas where they are most beneficial.  Purpose: The purpose of this study is to make a health-economic evaluation of a new work procedure for the treatment of knee injuries at the orthopedic clinic at Kalmar’s County Hospital. Method: The study is designed as an evaluation study with an abductive outset. The data collection has been based on semi-structured interviews at LSK with the staff that was involved in the project. In addition to the semi-structured interviews, numerical data has also been part of the study for the empirical data collection. Conclusion: After completion of the study, we can state that more health-economic evaluations are needed at non-national levels to support healthcare organisations. It is important to actively work with efficiency initiatives in public organisations that are primarily funded by tax assets. We can also state that the new work procedure is more profitable than the old one, both monetary and non-monetary, where the change of work procedure has resulted in several non-monetary gains, such as shorter lead times, better cooperation and increased competence.

Bakgrund: För ett sjukhus är kvalitetssäkringsarbetet en grundläggande faktor för att göra vården säker. I detta avseende nämns patientsäkerhet som en viktig faktor och med ett ökat behov i vården med omfattande personalminskningar och negativ ekonomisk utveckling skulle en metod för att leverera högre hälsovårdskvalitet till lägre kostnader vara ovärderlig. Lösningen kan vara att tillämpa lean inom sjukvården men forskningen inom detta område är begränsad, vilket ger upphov till fortsatta studier inom ämnet. Syfte: Detta arbete syftar till är att undersöka rutiner för ett sjukhus städprocess med fokus på att öka patientsäkerhet och spårbarhet kopplat till lean. Metod: I denna studie har en abduktiv ansats antagits där empiriskt material från en fallstudie på Gävle Sjukhus inhämtats parallellt med teori från litteraturen. Det empiriska materialet bygger på intervjuer och observationer och har utifrån teori från litteraturen analyserats och diskuterats, för att efter analys mynta ut i en slutsats. Resultat: Resultatet visar framförallt att bland de intervjuade respondenterna finns stora utmaningar med att säkerställa patientsäkerheten i ett sjukhus städprocess. Brist på standardiserade arbetssätt och kunskap är en avgörande faktor som denna studie visar. Begränsningar: Det korta tidsomfånget för denna studie har begränsat antalet inkluderade respondenter samt avdelningar på sjukhuset då ett utökat antal hade kunnat vara gynnsamt för studien. Slutsats: Studien identifierar utmaningar i sjukvården för att säkerställa spårbarhet och öka patientsäkerheten med möjligheter att applicera lean som ett angreppssätt. En implementering av lean i sjukvården kan vara en förbättringsstrategi men är ett relativt outforskat område och kräver fler studier. / Background: Quality assurance for a hospital is a fundamental factor in making the healthcare safe. In this regard, patient safety is mentioned as an important factor and with an increased need for healthcare with extensive staff reductions and negative economic development, a method for delivering higher health care quality at lower costs would be invaluable. The solution may be to implement lean in healthcare, but research in this area is limited, which gives rise to further studies in the subject. Purpose: This work aims to investigate routines for a hospital cleaning process with focus on increasing patient safety and traceability linked to lean. Method: In this study, an abductive approach is chosen where empirical material from a case study at Gävle Hospital was obtained in parallel with theory from the literature. The empirical material is based on interviews and observations and has been analysed and discussed on the basis of theory from the literature, to finalize a conclusion after analysis. Results: The results show that there is a major challenge to ensuring patient safety in a hospital cleaning process among the interviewed people. Lack of standardized working methods and knowledge is a crucial factor shown by this study. Limitations: The short timeline for this study has limited the number of included respondents as well as departments in the hospital. An increased number could have been advantageous for the study. Conclusion: This study identifies healthcare challenges to ensure traceability and increase the patient safety with opportunities to apply lean as an approach. An implementation of lean in healthcare could be a strategy with opportunities but the area is unexplored and requires more research.