Improving patient safety and quality of care are among the most important challenges facing hospital executives, not the least because of recent changes in hospital reimbursement. The usual tactic is to reduce medical treatment conditions, ensure proper drug dosage, and develop and enforce standards of care. While these efforts are important, the research here has considered one of the less obvious but critical operational issues as variation in patient flow. Patient flow and the reduction of waiting times is a subject of great discussion across all healthcare providers, underpins many waiting time improvement techniques. In healthcare, flow is the movement of patients, information or equipment between departments, staff groups or organisations as part of their care pathway. Ideally they would move from one ward in their care to the next without delay. Patient flow through an Emergency Department (ED) is complex with several changes in the pathway being produced by many decisions made at various points. However, variation in patient flow occurs throughout a hospital and contributes to different problems e.g. increasing in demand, a need for interactive care pathway or delivery of care solutions to measure different types of variability on patient flow and capacity management, extended waiting times, overcrowding and boarding in the emergency department (ED) bumped and late surgeries, lack of available routine and beds, overburdened nurses, and exasperated physicians. Not only does this threaten patient safety and quality of care, but it also causes enormous stress in the institution, making it increasingly difficult for hospitals to recruit and retain physicians and nurses. Healthcare delivery improvement techniques such as Lean allow providers to improve systems by reducing waste and highlighting the non-value added activities in the process. There are many possible process improvement solutions that can only be validated by implementation and understanding the whole process. Therefore, healthcare providers are turning to innovative technologies such as patient flow simulation in order to identify non-added activities, bottlenecks and to test Lean and more radical solutions before actually implementing them. The research will aim at proving that by adding simulations a radical thinking to improve the efficiency of flow of patients by reducing waiting time and get the best utilisation. Patient flow simulation allows you to immediately see the benefits of process changes with real time data and graphical visualisations. A novel approach is introduced within this research through the integration of simulation modelling techniques along with Taguchi analysis to investigate 'what if' patient variation scenarios. Such scenarios reflect the different combinations of the variability that can affect waiting time in one flow of patients and/or more than one patient at once. In addition, the research has adopted the concept of lean thinking to develop an automated Decision Operations Heuristic Analysis-Quick Response (DOHA-QR). The model acts in an iterative manner which investigate the different levels of variability by identify constraints that may affect the waiting and different performance outputs. Optimisation routines have been developed to get the best of senior medical resource scheduling to achieve best utilisation, reducing waiting time and react to the different levels of variability. Therefore, the developed method: (i) Concentrated on using customers and resources information to improve the quality of services while improving the productivity of the resources used in ED. (ii) Its principles can be extended and applied to different healthcare departments and other types of service granting organizations. (iii) Integrate with the simulation model that will have a real time picture of flow of patients' system load, condition, and behaviour i.e. different level of variability. It will act as a quick response tool that can provide a rationale to decision makers of small-business clinics to structure the right blend of medical resources, thereby maximizing profitability and patient satisfaction. (iv) Simulate different patient acute flow conditions i.e. emergency, urgent, non-urgent flow lines where senior medical resources can be best utilized, and (v) Additionally it will look at moving senior medical resources where and when needed between different patient acute flow lines.
| Identifer | oai:union.ndltd.org:bl.uk/oai:ethos.bl.uk:585446 |
| Date | January 2012 |
| Creators | Al-Nabit, Nasser |
| Publisher | De Montfort University |
| Source Sets | Ethos UK |
| Detected Language | English |
| Type | Electronic Thesis or Dissertation |
| Source | http://hdl.handle.net/2086/9546 |
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