Dissertations / Theses: 'Healthcare logistics'

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Houdenhoven, Mark van. "Healthcare logistics: The art of balance." [S.l.] : Rotterdam : [The Author] ; Erasmus University [Host], 2007. http://hdl.handle.net/1765/10862.

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Wiger, Malin. "Logistics Management in a Healthcare Context : Methodological development for describing and evaluating a healthcare organisation as a logistics system." Licentiate thesis, Linköpings universitet, Logistik, 2013. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-92821.

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This thesis tests whether logistics knowledge, theories and principles can be used to provide potential patient flow efficiency improvements. By emphasizing an ideal logistics system by means of its main features and then using these to evaluate two different healthcare organisations, it is assumed that knowledge regarding patient flows can be obtained and potentials for improvement highlighted. Hence, this licentiate thesis presents a developed method intended for evaluating a healthcare organisation by means of a logistics system’s main features. The purpose rests on the assumption that effective management and real flow-efficient improvements can only be accomplished by viewing logistics as an integrated system. Demographics, increased costs, strong technical and medical developments, new kinds of customer requirements, stressed staff and preventable adverse events are some of the challenges the Swedish healthcare system is currently facing. In addition, there is a constant demand on healthcare to be more cost-effective while fulfilling demands as regards waiting times, quality and availability. Experience from structural changes in other industries gives reason to be positive about the potential for long-term productivity leaps in the healthcare sector. The challenge is to simultaneously find successful application of efficient production and flexible adaptation to changing patients’ demands and requirements. Taking advantage of the logistics expertise that already exists can be a way to meet these challenges. It can be assumed that logistics knowledge applied in healthcare can lead to lower costs, shorter waiting lists, better patient service, shorter treatment times and increased capacity. Nevertheless, flow-oriented design of healthcare delivery systems is novel and positions much currently isolated research on a conceptual level or within single wards (Wiger and Aronsson, 2012). The research is part of a three-year project, "Lean and agile – logistics driven improvement in health and social care”, funded by Vinnvård, a collaboration between the Department of Management and Engineering at Linköping University, Hässleholm Healthcare Organisation and the Medical Management Center at Karolinska Institutet in Stockholm. This thesis is partly a theoretical development of logistics models. This is done in order to create an ideal logistics system’s main features and description aspects to describe a system to be able to evaluate it using these features. The two cases are used to test the adequacy of the developed method and its associated models and to identify potential for improvement towards a more flow-oriented business. Four series of interview sessions were conducted with a total of 23 respondents and 18 interviews and over 500 Excel files were collected from the business system. It is suggested that a healthcare organisation can be evaluated by the developed logistics main features. These features, listed below, together provide a possibility to complement a healthcare organisation’s ability to meet patient requirements by flow-efficiency and demonstrate logistical operational excellence. A logistics system’s purpose is to meet customer requirements by cost-effective delivery service through flow orientation by prioritising the total performance A logistics system has a flow-oriented structure A logistics system transforms orders into customer services in a flow-oriented process A logistics system can control the transformation of input (demand) to output (customer service) and thus the cost of resources A logistics system measures to capture the whole system’s logistics performance, including total logistics costs, lead times and customer service A logistics system has a strategy to meet demand A logistics system uses logistics measurements as feedback to regulate its behaviour to reduce differences between actual and desired performance The analysis of the two cases confirms the picture of an organisational design driven by medical specialties. This implies a possibility to change perspective to a more holistic view with the patient flow in focus. The fact that there are very few possibilities to control the transformation has partly to do with ownership of patient flows being less well-defined than clearly defined medical responsibilities within each specialty. It also has to do with the inability to distinguish between the uncertainty regarding unique patients on a low level of aggregation and at the higher level where there should be complete and explicit specifications of the end-product requirements and delivery requirements. The lack of demand strategies that support the total logistics performance ultimately leads to both clinics having to use a sacrificing work effort rather than working systematically to be able to meet the demand. At the case hospital, there is a lack of information aggregated from operational level about patient processes that is made available for strategic decision-making. Neither of the two cases measure on the basis of improving patient flow efficiency, especially not the total patient flow costs or the total logistics costs. The major contribution is the analysis based on the logistics system’s main features, which gives a more purposive understanding of what can be done to improve flow efficiency within a healthcare organisation to make healthcare organisations progress in their ability to be more flow-oriented. A further contribution is a more clearly defined field of healthcare logistics research and the stressed importance of the “new” research field of logistics management.

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Wang, Luyao, and Yuqiao Hu. "Third party healthcare logistics : A study of third-party logistics providers in China." Thesis, Linnéuniversitetet, Institutionen för ekonomistyrning och logistik (ELO), 2018. http://urn.kb.se/resolve?urn=urn:nbn:se:lnu:diva-74856.

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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.

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Al-Qatawneh, Lina Khalil. "A study of inventory classification in healthcare logistics using system dynamics modelling." Thesis, Sheffield Hallam University, 2006. http://shura.shu.ac.uk/19256/.

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One of the key challenges for a modern day health care provider is to dispense high quality of medical care while limiting or even reducing the health care expenditures. This research work endeavours to meet this challenge through effective management of hospitals logistics systems. The aim of this research work is to provide a structured mechanism for modelling and analysing health care logistics to be able to understand its dynamic behaviour and effectively manage its logistical activities on the basis of the model. In order to achieve the research objectives, this research uses system dynamics as the main medium of analysis, and in particular, employs an integrated system dynamics framework which has been used previously for manufacturing industry supply chain designs and tests the feasibility of the framework for analysing and modelling health care logistics. This is ascertained by developing and incorporating a decision making metrics in the system dynamics model based on item criticality, usage, and value to optimise overall logistics costs. System Dynamics methodology is employed at first to develop a model for existing inventory control decisions, and subsequently to produce two alternative approaches based on traditional (R, s, S) inventory control approach and Continuous Replenishment Inventory and Order Based Production Control CR(IOBPCS) approach. These approaches are tested for two case hospitals, namely: Children's National Medical Center (CNMC) USA, and Derbyshire Royal Infirmary (DRI) UK. The dynamic analysis for each case revealed problems in terms of multistage inventories and order batching, which could lead to demand amplification causing a detrimental effect on the inventory management throughout the supply chain. Accordingly, the simulations results produced for the two cases are benchmarked using alternative strategies in terms of lower inventory cost, and robustness to meet the unpredictable demand arising from a large number of items. Overall, this research work has enhanced the understanding of hospitals logistics systems by building qualitative and quantitative models. More specifically, this research work has illustrated the applicability of the integrated system dynamics framework in analysing and modelling hospitals logistics systems and inventory control decisions. One particular contribution of this study is introducing inventory classification based on the criticality of items for patient needs which is more suited for health care situations rather purely cost based policies prevalent in other manufacturing and service chains. Therefore, this work has rigorously tested a multi-criteria based inventory classification method that takes into account the criticality of use, cost, and usage value of items for optimising overall inventory cost while maintaining the required patient care/service level. Future studies may be conducted to further evaluate the trade-offs in between different logistics decision making (such as, inventory control, service level, purchasing, transportation and warehousing) in order to design a set of "best practice" simulation models to optimise the overall dynamic behaviour for health care supply chains.

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Fossum, Benjamin, and Johan Hedborg. "Resource management analysis at the prehospital emergency care unit in north-western Skåne." Thesis, Linköpings universitet, Kommunikations- och transportsystem, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-130004.

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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 Alarms 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.

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Hautamäki, M. (Minna). "Co-creating value-in-use for public healthcare customer through modularity of logistics services." Master's thesis, University of Oulu, 2015. http://urn.fi/URN:NBN:fi:oulu-201505211571.

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The healthcare industry today is in the search for efficient solutions. However, currently services, such as logistics, supporting the hospital core processes are produced in-house. Recent findings have shown internally produced services may not always be as efficient as their external alternatives. This has led to hospitals outsourcing their non-core activities which allows the external service providers to expand their markets to the healthcare industry. In this thesis, a logistics service provider’s business opportunities will be explored in the context of public healthcare. Furthermore, this study considers modular service architecture as a facilitator for creating value. The research emphasises the role of operational-level customer i.e. nursing staff’s conception of value created by logistics as well as its value creation processes in a university hospital. By gaining an understanding of how logistics creates value-in-use to the hospital customer, business opportunities can be discovered. The purpose of this thesis is to find new business opportunities for a logistics service provider organisation aiming to increase its market share in the public healthcare sector. In order to achieve this goal, the researcher investigates current logistics issues in the university hospital’s surgical ward emphasising value creation processes in the ward and the operational-level customer point-of-view. In addition to addressing a practical need, this study contributes to existing research in co-creation of value and modularity in the context of logistics and healthcare. This is a qualitative study where the research phenomenon is approached utilising three divergent research methods that are semi-structured interviews, observations and a group discussion. Although this research emphasises the role of the medical staff consisting of nurses, interviews are carried on both strategic- and operational-levels in the healthcare customer and logistics service provider organisations. The group discussion is regarded to be a data collecting method enabling representatives from the logistics service provider and healthcare customer organisations to co-create value. The results of this study support existing research on modularity and its suitability in markets with heterogeneous needs, such as the healthcare industry where hospitals often contain a number of internal customers that may differ from each other in terms of their needs. Furthermore, current research on modularity emphasises monetary benefits, such as efficiency and cost reductions, created for the customer. However, this research suggests modular services may additionally create non-monetary value-in-use to the customer by improving well-being and trust among the medical staff. In other words, modular services are not solely a facilitator for efficiency. The results of this study may be applied by practitioners looking for new business opportunities through co-creation together with the customer. Furthermore, the results suggest organisations wanting to gain more market share in the healthcare industry ought to consider modular service design to be able to respond to heterogeneous customer needs. Due to the qualitative nature of this study as well as the narrow amount of empirical data, the results of this study cannot be generalised
Terveydenhuoltoalalla hankittavien ratkaisujen tehokkuus on keskeinen tekijä. Siitä huolimatta nykyiset sairaalan ydinprosesseja tukevat palvelut, kuten logistiikka, tuotetaan pääosin sisäisesti. Viimeisimmät tutkimukset osoittavat, että sisäisesti tuotetut palvelut eivät useinkaan ole ulkoiselta tarjoajalta hankittuja palveluja tehokkaampia. Tämä on johtanut ei-keskeisten palvelujen ulkoistamiseen ja mahdollistanut ulkopuolisten palveluntarjoajien levittäytymisen terveydenhuoltomarkkinoille. Tässä tutkielmassa erään logistisen palveluntuottajan liiketoimintamahdollisuuksia tarkastellaan julkisen terveydenhuollon kontekstissa. Lisäksi tutkimuksessa painotetaan modulaarisen palveluarkkitehtuurin roolia arvonluonnin mahdollistajana. Tutkielmassa korostetaan operationaalisen tason asiakkaan, eli hoitohenkilökunnan ymmärrystä logistiikan luomasta arvosta sen omissa arvonluontiprosesseissa. Arvonluontiprosessien tutkiminen mahdollistaa uusien liiketoimintamahdollisuuksien kartoittamisen. Tämän tutkielman tarkoituksena on löytää uusia liiketoimintamahdollisuuksia logistiselle palveluntarjoajalle, jonka tavoitteena on lisätä markkinaosuuttaan julkisen terveydenhuollon sektorilla. Tutkimustavoitteen saavuttamiseksi tutkija selvittää, millaisia logistisia haasteita tutkimuskohteena olevalla yliopistosairaalan keskusleikkausosastolla on tällä hetkellä ja miten ne vaikuttavat operationaalisen tason toimijoiden arvonluontiprosesseihin. Tutkimus pyrkii käytännön ongelman ratkaisemisen lisäksi tuomaan uutta tietoa arvon yhteisluonnin ja modulaarisuuden tieteellisiin keskusteluihin logistiikan ja terveydenhuollon kontekstissa. Tämä tutkimus on luonteeltaan kvalitatiivinen. Tutkimuskohdetta lähestytään kolmella eri tavalla puolistrukturoitujen haastattelujen, havainnointien ja ryhmäkeskustelun avulla. Vaikka tutkimuksessa painotetaan hoitohenkilökunnan näkemyksiä, haastatteluja tehtiin sekä strategisella että operationaalisella tasolla sekä palveluntarjoaja- että asiakasorganisaatioissa. Ryhmäkeskustelun avulla simuloitiin asiakkaan ja palveluntarjoajan välistä arvon yhteisluontiprosessia. Tutkimuksen tulokset tukevat olemassa olevaa modulaarisuuskirjallisuutta vahvistaen näkemystä, jonka mukaan modulaarinen palvelusuunnittelu toimii erityisen hyvin ympäristöissä, joissa ilmenee heterogeenisiä tarpeita. Esimerkiksi terveydenhuollon alalla sairaaloissa sisäisten asiakkaiden tarpeet voivat erota toisistaan. Lisäksi nykyisessä modulaarisuutta käsittelevässä kirjallisuudessa painotetaan modulaarisuuden rahallisia hyötyjä, kuten tehokkuutta ja kustannussäästöjä. Tämä tutkimus kuitenkin osoittaa, että modulaariset palvelut luovat asiakkaille myös ei-rahallisia hyötyjä parantamalla hoitohenkilökunnan työhyvinvointia ja luottamusta. Käytännön harjoittajat voivat soveltaa tämän tutkimuksen tuloksia etsiessään uusia liiketoimintamahdollisuuksia yhdessä nykyisten tai potentiaalisten asiakkaitten kanssa. Lisäksi tulokset osoittavat, että yritykset, jotka haluavat lisätä näkyvyyttään terveydenhuollon alalla, jolla asiakkaitten tarpeet ovat usein heterogeenisiä, voivat pitää modulaarisuutta yhtenä palvelusuunnitteluvaihtoehtona. Tutkimuksen kvalitatiivisen luonteen ja aineiston suppeuden vuoksi sen tulokset eivät ole yleistettävissä

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Callender, Carlos. "Barriers and best practices for material management in the healthcare sector." Diss., Rolla, Mo. : University of Missouri-Rolla, 2007. http://scholarsmine.umr.edu/thesis/pdf/Callender_09007dcc803c6cf5.pdf.

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Thesis (M.S.)--University of Missouri--Rolla, 2007.
Vita. The entire thesis text is included in file. Title from title screen of thesis/dissertation PDF file (viewed December 3, 2007) Includes bibliographical references (p. 29-31).

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Bennett, Ashlea R. "Home health care logistics planning." Diss., Georgia Institute of Technology, 2009. http://hdl.handle.net/1853/33989.

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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.

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Nilsson, Hanna, and Julia Johansson. "Samordning för barn och ungdomar med frekvent behov av sjukvård." Thesis, Tekniska Högskolan, Högskolan i Jönköping, JTH, Industriell organisation och produktion, 2014. http://urn.kb.se/resolve?urn=urn:nbn:se:hj:diva-24059.

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Purpose- The purpose of this project is to contribute to the knowledge of creating customer value through streamlining and coordination of patient flows for children and youth with frequent need of care on child and youth medical clinics. Method- One of the methods used for achieving the project's purpose is a case study on the Child and Youth Medicine Clinic at Länssjukhuset Ryhov in Jönköping. The case study has been used for collecting the empirical data that has been generated through interviews, observations and documents from the Child and Youth Health Clinic. Except the case study the authors also made studies in literature, which the collected empirical data has been anchored and related to. Together this led to the project's analysis and results. Results- When investigating the questions found in chapter one, it was determined standardized work is of great importance to create structure and implement procedures for the patient flows. A weak link in the patient flow has been identified, which is the sub-process coordination and planning. This constraint includes three types of requirements: patient requirements, requires of health professionals and legislated requirements. By paying attention to and taking into account these requirements a coordination function can be designed to streamline patient flows and increase the customer value. The authors concluded that a specific employment as a coordinator should be appointed. A coordinator provides opportunities for a personal communication between patients and health professionals. At the same time the coordinator is able to work with techniques for efficiency while taking into account the soft values in health care. Conclusions- There is a demand for coordination from health professionals and patients. A coordination function would streamline operations and contribute to increase the customer value. Taking into account the identified wastes and limitations a coordination can be possible. Research limitations- The project's data is collected during the case study that was conducted at the Child and Youth Health Clinic. Further case studies are desirable in other clinics and in other hospitals country wide. These studies will allow for a higher security when generalizing the results of the project.
Syfte- Syftet med projektet är att bidra till kunskapen om att skapa kundvärde genom effektivisering och samordning av patientflöden för barn med frekvent behov av vård på barn- och ungdomsmedicinska kliniker. Metod- För att uppnå projektets syfte har bland annat en fallstudie på Barn- och ungdomsmedicinska kliniken på Länssjukhuset Ryhov i Jönköping genomförts. Fallstudien har använts för insamling av empiri, genom intervjuer, observationer samt dokument från Barn- och ungdomsmedicinska kliniken. Utöver denna fallstudie har även en litteraturstudie bedrivits, som den insamlade empirin har förankrats och relaterats till. Detta har gemensamt lett till projektets analys och resultat. Resultat- Det har framkommit att ett standardiserat arbetssätt är en förutsättning för att skapa struktur och införa rutiner gällande samordning för patientflöden. En svag länk i patientflödet har identifierats vilken är delprocessen samordning och planering. Denna länk innefattar tre typer av begränsningar, patientrelaterade begränsningar, begränsningar kopplade till vårdpersonal samt lagstiftade begränsningar. Genom att uppmärksamma och ta hänsyn till dessa begränsningar kan en samordningsfunktion utformas för att effektivisera patientflödet och höja kundvärdet. En specifik befattning som samordnare bör tillsättas, vilket ger möjlighet till personlig kontakt mellan patienter och vårdpersonal och kan även arbeta med tekniker för effektivisering samtidigt som hänsyn tas till mjuka värden. Slutsatser- Det finns en efterfrågan om samordning för såväl vårdpersonal som patienter. En samordningsfunktion skulle effektivisera verksamheten och bidra till ett ökat kundvärde. Genom att ta hänsyn till identifierade slöserier i patientflödet och begränsningar i vårdprocessen kan samordning möjliggöras. Begränsningar- Projektets empiri är insamlad under den fallstudie som bedrevs på Länssjukhuset Ryhov. Författarna hade önskat utöka sina perspektiv genom att involvera fler intervjupersoner för att ge projektet högre reliabilitet och validitet. Eftersom majoriteten av all personal med planeringsansvar på Barn- och ungdomsmedicinska kliniken intervjuats hade författarna behövt intervjua personal utanför det avgränsade området. Det hade även varit önskvärt att göra ytterligare fallstudier på andra kliniker och möjligtvis även på andra sjukhus i landet för att med högre säkerhet kunna generalisera projektets resultat. På grund av sekretesslagar och geografiska avstånd var detta inte möjligt.

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Hallén, Wilma, and Linnéa Henriksson. "Analys av framtida materialflöde för Ögonkliniken US." Thesis, Linköpings universitet, Kommunikations- och transportsystem, 2020. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-168097.

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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 materialflödet mellan 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: 1. Vilka processer och aktiviteter kommer det framtida flödet att bestå av? 2. Vilka karaktäristiska drag har Ögonklinikens sterila material? 3. Givet de karaktäristiska drag som identifierats i fråga 2, vilken materialstyrningsmetod är mest lämplig? 4. Vilka andra effekter medför valet av materialstyrningsmetod för 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 efterfrågan och 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 proceduresneed to be performed so that the patients receive the required healthcare. To ensure thatshortfalls of required material do not occur good planning and efficient material managementis required. There are several different material planning methods that can be used to avoidshortfall of material.As of today, Ögonkliniken is located within the hospital area at the university hospital inLinköping. 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 facilitiesare old and worn down. Ögonkliniken handled their own sterile material and the sterilizationprocess in their current facilities. When the relocation is complete the used sterile materialwill be transported to Sterilcentralen, which is located within the hospital area, forsterilization. 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 studyis to gain a better understanding of the new material flow. This is achieved by analyzingdifferent material planning methods and whether they are suited for Ögonkliniken. The aimof the study is to map the future material flow and to calculate the amount of material thatneeds to be present in the flow to avoid material shortages at Ögonkliniken. To fulfill thepurpose of the study four research questions have been formulated:1. What activities will the material flow consist of?2. What specific features does Ögonklinikens sterilized material have?3. Given the specific features that have been identified in question 2, which materialplanning method is best suited?4. What other impacts does the chosen material planning method result in for the futurematerial flow?To answer the questions, information and data have been collected through literature study,secondary data and interviews. The secondary data that have been collected are statistics overnumber of preformed operations, number of washing processes, number of sterilizationprocesses and number of processes that needed to be reprocessed. The future material flowwill consist of four departments: Ögonklinken, Sterilcentralen, Stångåbuss and Inre Logistik.All departments have been interviewed where they have been asked semi structuredquestions.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 suitedmaterial planning method for Ögonkliniken is the Kanban system. This is due to that thesterile material’s specific features match with the method. An implementation of a Kanbansystem will result in routines for when and what volume should be ordered. The system alsoallows for the cost of purchased material to be low. However, the way the transports are setup today does not suit a Kanban system. Therefore, the transports may have to be adapted sothat the Kanban system will function well. For the Kanban system to work transportation ofmaterial must occur when the demand appears and today the transports only allow material tobe picked up at specific times.

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Johansson, Erik, and Karlsson Oscar. "Effektivisering av måltidsprocessen inom sjukvården." Thesis, Tekniska Högskolan, Högskolan i Jönköping, JTH, Industriell organisation och produktion, 2014. http://urn.kb.se/resolve?urn=urn:nbn:se:hj:diva-24166.

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Syfte – Syftet med denna studie är att identifiera utmaningar som kan uppkomma inom måltidsprocessen på ett sjukhus, för att sedan utveckla tillvägagångssätt för hantera dessa. För att uppfylla syftet har följande frågeställningar formulerats: Vilka utmaningar finns inom måltidsprocessen på ett sjukhus? Hur kan utmaningar inom måltidsprocessen på ett sjukhus hanteras? Metod och genomförande – Ett initialt teoretiskt ramverk upprättades som har mönsteranpassats med empirin under arbetets gång. En fallstudiemetodik antogs för att undersöka måltidsprocessen och dess utmaningar på Länssjukhuset Ryhov i Jönköping. Metoder för datainsamling bestod av intervjuer, observationer, dokumentstudier och enkätundersökning. Den insamlade empirin har sedan analyserats mot det teoretiska ramverket. Resultat – Studien har identifierat följande utmaningar inom måltidsprocessen: variationer, bristande kommunikation, varornas specifika egenskaper och avsaknad av helhetsperspektiv. Utmaningar kopplat till variationer har sin utgångspunkt i att patienter är frånvarande under måltidstillfället på grund av undersökningar eller operationer. För att hantera utmaningen med både variationerna och varornas specifika egenskaper har nya tillvägagångssätt vid nedkylning av måltider föreslagits. För att hantera utmaningen med bristande kommunikation har en samordningsfunktion presenterats som förenklar styrning och planering vid sjukvårdsavdelningarna. Slutligen för att hantera utmaningen med avsaknad av helhetsperspektiv bör nya synsätt antas kopplade till Lean och processorientering vid avdelningen för hjärtsjuka. Implikationer – Studien har fastställt ett antal utmaningar inom måltids- processen. Vid effektivisering av en måltidsprocess är det dock viktigt för varje enskild verksamhet att utvärdera vilka utmaningar som är mest kritiska för deras situation. Genom att införa förbättringarna kan kostnadsbesparingar uppnås i form av reducerat svinn och effektivare resurshantering. Begränsningar – Då fallstudien endast behandlar måltidsprocessen på Länssjukhuset Ryhov är den av enskild karaktär. Det hade eventuellt varit intressant med en studie som involverar ett flertal sjukhus för att på så sätt finna ytterligare utmaningar men även verifiera studiens resultat. Tyngdpunkten av denna studie har legat på aktiviteter kring måltidsprocessen. Om studien istället hade antagit ett tydligare patientfokus skulle ett bredare perspektiv skapas med fler infallsvinklar.
Purpose – The purpose of this study is to identify the challenges that may arise in the meal process at a hospital, and then develop approaches to address these. To fulfill the purpose of the study, the following question has been formulated: What challenges may arise in the meal process at a hospital? How can the challenges in the meal process at a hospital be managed? Methodology – An initial theoretical framework was established which has been pattern matched with the empirical data as the study progressed. A case study methodology was adopted to examine the meal process and the underlying challenges at Ryhov Länssjukhus in Jönköping. Methods of data collection consisted of interviews, observations, document studies and a questionnaire survey. The collected empirical data were then analyzed through the theoretical framework. Findings – The study has identified the following challenges in the meal process: variability, lack of communication, goods-specific characteristics and the absence of a holistic perspective. Challenges linked to variations originate from when patients are absent during the mealtime due to operations or examinations. To handle the challenges with both variations and good-specific characteristics, new approaches to the cooling of meals have been proposed. To improve the communication a coordinating function has been presented which simplifies the management and planning for the healthcare departments. Finally, to handle the challenge of absence of a holistic perspective, new approaches should be adopted related to Lean and process orientation. Implications – The study has identified a number of challenges in the meal process. While working towards improving the meal process, it is important for each individual hospital to assess the challenges that are the most critical to their situation. By implementing the proposed improvements the hospital should gain cost savings through reduced wastage of food and more efficient resource management. Research limitations – This case study examines solely the meal process at Ryhov Länssjukhus and is therefore of individual character. It might also be interesting with a study involving several hospitals to thus find additional challenges and also to verify the results of this study. The emphasis of this study has been activities related to the meal process. If the study had instead adopted a clear patient focus, a broader perspective might have been created with additional viewpoints.

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Rasmus, Lundgren, and Marcus Engwall. "Möjligheter och utmaningar med lean i sjukvården för att säkerställa spårbarhet och patientsäkerhet : En fallstudie på Gävle sjukhus." Thesis, Högskolan i Gävle, Avdelningen för industriell ekonomi, industridesign och maskinteknik, 2020. http://urn.kb.se/resolve?urn=urn:nbn:se:hig:diva-33245.

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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.

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Golshan, Behrooz. "Social Media as Cure for Information Overload : An Action Research In Swedish Healthcare." Thesis, Linnéuniversitetet, Institutionen för datavetenskap, fysik och matematik, DFM, 2012. http://urn.kb.se/resolve?urn=urn:nbn:se:lnu:diva-16846.

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Information and communication technology (ICT) had a huge impact on the healthcare services and the Internet plays an important role in forming patients’ attitudes towards health related services. Although the Internet mentioned as one of the major contributors in todays’ Information Overload (IO), common notion is that healthcare sector has been remained immune of IO effects. Throughout an action research, this study showed that IO has significant impact on treatment sessions of patients suffering from chronicle mental disorders in two ways. Firstly, patients’ acquired information from the Internet bombards physician in the treatment sessions, which eventually slows down the treatment process. Secondly, protocols and administrative procedures are subject to change, which leads to frustrating relearning cycles due to the huge amount of information attaching to them. Also, physicians have a tendency to keep themselves updated about new achievements in their field, which adds to the IO problem. In an attempt to enhance the situation an application model purposed in the second half of this research, which uses social web as a platform to provide a service based on Information Logistics (IL) principles to deal with the problem of IO.

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Simon, Brenda Marc. "Strategies to Reduce Employee Turnover in Clinical Logistics." ScholarWorks, 2019. https://scholarworks.waldenu.edu/dissertations/6672.

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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.

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Aljadir, Abdullah, and Mohamad Alnemsh. "Exploration of the COVID-19 pandemic in relation to the healthcare industry Supply Chain." Thesis, Mälardalens högskola, Akademin för ekonomi, samhälle och teknik, 2020. http://urn.kb.se/resolve?urn=urn:nbn:se:mdh:diva-48242.

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Date: 09 – 06 – 2020 Level: Bachelor Thesis in Business Administration, 15 hp Institution: School of Business, Society and Engineering, Mälardalen University Authors: Abdullah Al-jadir Mohamad Alnemesh 1996-01-13 1990-01-03 Title: Exploration of the COVID-19 pandemic in relation to the healthcare industry Supply Chain. Tutor: Edward Gillmore Keywords: Viruses, Coronavirus, COVID-19, Supply Chain, Healthcare, healthcare industry, Logistics, Stockholm. Research question: To what extent does the global pandemic COVID-19 have an impact on the supply chain of the healthcare industry in Stockholm? Purpose: The purpose of the study is to discover how the healthcare industry is affected by a global pandemic through the supply chain in Stockholm. Method: The study is based on a qualitative method involving secondary and primary data in order to fulfill the research’s purpose. Interviews were conducted with several personnel in the healthcare industry. Conclusion: Concluded that Stockholm including the rest of the world is put in a critical condition due to unavailable medical tools and restrictions in the supply chain resulting in shortages.

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Oliveira, Thomás Silva. "Proposta de aplicação das ferramentas do lean healthcare à logística hospitalar." Universidade de São Paulo, 2014. http://www.teses.usp.br/teses/disponiveis/18/18156/tde-16062014-135630/.

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A logística representa uma importante e complexa função de apoio dentro do hospital, assegurando a correta e ótima movimentação dos fluxos de materiais, informações e pessoas, a fim de que os cuidados médicos (competência essencial) sejam prestados com eficácia aos pacientes. Pode-se perceber, no entanto, que embora as atividades logísticas possuam um caráter estratégico, tanto em relação ao custo que representam para as finanças hospitalares, quanto para o nível de serviço prestado e a consequente percepção do paciente, alguns hospitais não a possuem de maneira bem estruturada e desenvolvida, principalmente dentro do setor público. Dessa forma, considerando a relevância da logística hospitalar, afirma-se que a busca de melhorias na execução de suas atividades pode trazer benefícios diretos ao hospital e aos seus clientes internos (colaboradores) e externos (pacientes e familiares). É nesse contexto que se insere o lean healthcare, abordagem advinda do Sistema Toyota de Produção. Baseado em princípios e ferramentas voltados a eliminação de desperdícios, criação de valor para o cliente e melhoria contínua, a produção enxuta já tem sido aplicada com sucesso para otimizar as atividades no ambiente hospitalar. O objetivo desta pesquisa é, portanto, desenvolver uma proposta de aplicação das ferramentas do lean healthcare na gestão da logística hospitalar, em uma unidade laboratorial de um hospital público de ensino. Classificada como uma pesquisa exploratória e qualitativa, foi adotado o método do estudo de caso único e realizado em um hospital público de ensino, localizado no interior do estado de São Paulo. Cinco etapas foram definidas como roteiro de execução: mapeamento da situação atual, seminários de aprovação, projeção de uma situação futura, análise dos resultados esperados e estudo de viabilidade para aplicação. Ao final, a contraposição entre a literatura revisada e as informações do caso estudado permitiu subsidiar a construção da proposta de aplicação das ferramentas do lean healthcare na logística hospitalar. A principal contribuição deste trabalho é, portanto, prática, caracterizada como um roteiro de ações a serem adotadas ao longo do processo de implantação. Espera-se que tal proposta seja uma possível referência aos gestores dos hospitais que desejem implantar as ferramentas do lean healthcare na gestão logística dos fluxos de materiais, pacientes e informações.
Logistics is an important and complex hospital support area that allows the correct and optimal flow of material, information and people. Its activities are part of hospital strategy, because of cost that they represent and the impact on the quality of the service perceived by the patient. Despite of these relevant characteristics, some hospitals do not have a developed and well-structured logistics area, mainly on public sector. Therefore, considering the importance of hospital logistics, looking forward improvements on its activities would benefit internal customers (workers) and external (patients and parents). In this context, lean healthcare, approach emerged from Toyota, could be presented. Based on principles and tools that eliminate waste, create value to customer and continues improvement, lean production has been successfully applied to optimize hospital activities. Thus, the goal of this research is develop an application proposal of lean healthcare tools in hospital logistics, into a laboratory of a public teaching hospital. Classified like an exploratory and qualitative research, the single case method was adopted and executed into a public teaching hospital, located in São Paulo state. Five steps were defined like a sequence of execution: current state mapping, approval seminars, prediction of a future state, analysis of expected results and study of viability to do the application. In the end, the comparison between the reviewed literature and the case informations allowed the construction of an application proposal of lean healthcare tools in hospital logistics. Therefore, the main contribution of this research is practical, described like a sequence of prescribed actions to be adopted during the process of implantation. It is expected that this proposal could be a reference for hospital managers who want to apply lean healthcare tools on logistics\' management of material, patient and information flow.

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Svensson, Ivan, and Elin Berglund. "At the heart of it all : A value stream mapping of the heart emergency at Danderyds Sjukhus AB." Thesis, KTH, Industriell ekonomi och organisation (Inst.), 2015. http://urn.kb.se/resolve?urn=urn:nbn:se:kth:diva-170535.

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Dagens situation med en åldrande befolkning som leder till en större förekomst av allvarliga kroniska sjukdomar gör att sjukvården står inför nya utmaningar. Då de flesta vårdinrättningar har en mycket hög beläggning och begränsade resurser har man börjat använda sig av produktionsstrategier som traditionellt använts i mer industrinära miljöer, exempelvis Lean production. I denna studie har värdeflödet kartlagts och analyserats för besök vid hjärtakuten på Danderyds Sjukhus AB. Detta har genomförts med hjälp av fältstudieobservationer och intervjuer, för att undersöka verksamheten på en vårdinstitution som arbetar enligt Lean healthcare. Studien har genomförts för att identifiera potentiella förbättringsområden och förändringar inom dessa, som kan leda till effektivare patientflöde. Resultaten av vår fallstudie tyder på att det förekommer icke-värdeskapande inslag relaterade till Transport, Motion, Waiting, Overproduction & Over processing, Defects, Confusion och People på hjärtakuten. Den vanligaste orsaken till slöseri har upptäckts vara kopplad till arbetsrutiner och hur väl dessa rutiner följs, även om problem relaterade till kommunikation och arbetsplatskultur också har upptäckts. Vår främsta rekommendation för att effektivisera verksamheten på akuten är att skapa standardiserade rutiner som är lätta för personalen att följa. Studien och dess resultat kan ses som ett bidrag till den generella diskursen på områdena Lean healthcare, kartläggning samt analys av värdeflöden. Den kan även användas av vårdinrättningar liknande fallkliniken som är i stånd att genomföra en värdeflödesanalys.
The aging population and higher occurrence of chronic diseases today has healthcare facing a very high occupancy and limited resources. To meet rising demands, many healthcare institutions have adapted operational strategies traditionally used in more industrial settings such as Lean production. In this study, the value flow during emergency visits to the heart emergency at Danderyds hospital (Danderyds Sjukhus AB) was mapped and analysed through observations and interviews. The aim was to identify potential changes that might render a more efficient patient flow and improve the operations at a healthcare institution working in accordance with Lean healthcare. The findings from the study show that waste related to Transport, Motion, Waiting, Overproduction & Over processing, Defects, Confusion and People exists at the heart emergency. The most common source of waste is related to routines and compliance to them among the staff, all though some issues related to communication and workplace culture were also discovered. Our main suggestion is therefore to establish standardised routines that are easy to follow for the staff at the clinic, to make emergency visits and patient flow more efficient. The study and its findings can be seen as a general contribution to the discourse regarding Lean healthcare, value stream mapping and analysing. It can also be used by healthcare institutions similar to the case clinic, about to perform an analysis of the value stream.

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Beja, Fezekile Sydwell. "An assessment of opportunities for implementing lean management in the healthcare supply chain of selected clinics in the East London area." Thesis, Nelson Mandela Metropolitan University, 2013. http://hdl.handle.net/10948/d1020958.

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When the current South African government came into power two decades ago they inherited a fragmented health care system whose main focus was on the tertiary care level. The strategy of the current government was to re-focus the whole health care system and prioritize primary health care system. That included setting up district health care systems and building primary health care centres in the areas within the communities in order to make health care accessible to everybody. Due to financial difficulties the majority of the people staying in these communities solely depend on these clinics as they cannot afford to buy health care services in the private sector. The study seeks to assess the current medication supply chain to these clinics with a view of coming up with recommendations that, when implemented, will ensure that the supply of medication by the clinics is able to meet the demands of their patients. Lean management is a system that was started in the manufacturing sector and because of its success there it was later adopted by the service industry. Lean is a system that seeks to eliminate all forms of waste and improve the quality of the service rendered to the satisfaction of the customer/patient. Literature review and discussion of lean implementation is discussed extensively. The findings of the study are presented, analyzed and discussed. In these findings it is noted that the system is functioning very well but there are challenges in these clinics that need to be addressed. Recommendations of how lean management can be implemented successfully to optimize the functioning of the current system are discusse The permission received from the Department of Health to conduct this study came with contractual obligations that the researcher promised to honour. One of those requirement stated clearly that the findings of the study should not be published anywhere without the permission of the Department (see addendums A & C). It is under that premise that the researcher wants to bring this to the attention of the relevant university departments, with the hope of ensuring that this contractual obligation is honoured.

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Silfverberg, Joel, and Anders Axelsson. "Värdeflödesanalys på intern varuförsörjning för att utöka kunskap om lean i sjukvården : En fallstudie på Gävle sjukhus." Thesis, Högskolan i Gävle, Avdelningen för Industriell utveckling, IT och Samhällsbyggnad, 2018. http://urn.kb.se/resolve?urn=urn:nbn:se:hig:diva-26846.

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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.

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Leku, Faton, and Louis Perikala. "Hälsoekonomisk utvärdering av ett nytt arbetssätt för behandling av knäskador : En studie gjord på ortopedkliniken på Länssjukhuset i Kalmar." Thesis, Linnéuniversitetet, Institutionen för ekonomistyrning och logistik (ELO), 2017. http://urn.kb.se/resolve?urn=urn:nbn:se:lnu:diva-65821.

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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.

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Laczik, Tamás. "Encoding Temporal Healthcare Data for Machine Learning." Thesis, KTH, Skolan för elektroteknik och datavetenskap (EECS), 2021. http://urn.kb.se/resolve?urn=urn:nbn:se:kth:diva-299433.

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This thesis contains a review of previous work in the fields of encoding sequential healthcare data and predicting graft- versus- host disease, a medical condition, based on patient history using machine learning. A new encoding of such data is proposed for machine learning purposes. The proposed encoding, called bag of binned weighted events, is a combination of two strategies proposed in previous work, called bag of binned events and bag of weighted events. An empirical experiment is designed to evaluate the predictive performance of the proposed encoding over various binning windows to that of the previous encodings, based on the area under the receiver operating characteristic curve (AUC) metric. The experiment is carried out on real- world healthcare data obtained from Swedish registries, using the random forest and the logistic regression algorithms. After filtering the data, solving quality issues and tuning hyperparameters of the models, final results are obtained. These results indicate that the proposed encoding strategy performs on par, or slightly better than the bag of weighted events, and outperforms the bag of binned events in most cases. However, differences in metrics show small differences. It is also observed that the proposed encoding usually performs better with longer binning windows which may be attributed to data noise. Future work is proposed in the form of repeating the experiment with different datasets and models, as well as changing the binning window length of the baseline algorithms.
Denna avhandling innehåller en recension av tidigare arbete inom områden av kodning av sekventiell sjukvårdsdata och förutsägelse av transplantat- mot- värdsjukdom, ett medicinskt tillstånd, baserat på patienthistoria med maskininlärning. En ny kodning av sådan data föreslås i maskininlärningssyfte. Den föreslagna kodningen, kallad bag of binned weighted events, är en kombination av två strategier som föreslagits i tidigare arbete, kallad bag of binned events och bag of weighted events. Ett empiriskt experiment är utformat för att utvärdera den föreslagna prestandan för den föreslagna kodningen över olika binningfönster jämfört med tidigare kodningar, baserat på AUC- måttet. Experimentet utförs på verkliga sjukvårdsdata som erhållits från svenska register, med random forest och logistic regression. Efter filtrering av data, lösning av kvalitetsproblem och justering av hyperparametrar för modellerna, erhålls slutliga resultat. Dessa resultat indikerar att den föreslagna kodningsstrategin presterar i nivå med, eller något bättre än bag of weighted events, och överträffar i de flesta fall bag of binned events. Skillnader i mått är dock små. Det observeras också att den föreslagna kodningen vanligtvis fungerar bättre med längre binningfönster som kan tillskrivas dataljud. Framtida arbete föreslås i form av att upprepa experimentet med olika datamängder och modeller, samt att ändra binningfönstrets längd för basalgoritmerna.

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Ismail, Muhammad, and Attuallah Jan. "Context-based supply of documents in a healthcare process." Thesis, Tekniska Högskolan, Högskolan i Jönköping, JTH. Forskningsmiljö Informationsteknik, 2012. http://urn.kb.se/resolve?urn=urn:nbn:se:hj:diva-18513.

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The more enhanced and reliable healthcare facilities, depend partly on accumulated organizational knowledge. Ontology and semantic web are the key factors in long-term sustainability towards the improvement of patient treatment process. Generally, researchers have the common consensus that knowledge is hard to capture due to its implicit nature, making it hard to manage. Medical professionals spend more time on getting the right information at the right moment, which is already available on intranet/internet. Evaluating the literature is controversial but interesting debates on ontology and semantic web encouraged us to propose a method and 4-Tier Architecture for retrieving context-based document according to user’s information in healthcare organization. Medical professionals are facing problems to access relevant information and documents for performing different tasks in the patient-treatment process. We have focused to provide context-based retrieval of documents for medical professionals by developing a semantic web solution. We also developed different OWL ontology models, which are mainly used for semantic tagging in web pages and generating context to retrieve the relevant web page documents. In addition, we developed a prototype to testify our findings in health care sector with the goal of retrieving relevant documents in a practical manner.
E-Health

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Kidman, Pontus, and David Carlson. "Riskklassificering – En säkrare strategi : En studie om hur riskklassificering kan bidra till en säkrare och mer kapitalanpassad materialstyrning för GE Healthcares artiklar på lager." Thesis, Umeå University, Umeå School of Business, 2010. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-36032.

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Problemformulering: Hur kan en riskklassificering av artiklar bidra till att lagret optimeras?

Syfte: Syftet med vår studie är att sänka GE Healthcares lagernivå med ännu icke förädlade artiklar samt, om det behövs, upprätta ett optimerat säkerhetslager baserat på artiklarnas riskbenägenhet. Detta för att minimera onödig kapitalbindning, öka lageromsättningshastigheten samt kunna bibehålla samma servicegrad företaget har idag. Tanken är att vi utifrån detta ska utforma en dynamisk formel, en algoritm, som ska kunna känna av förändringar i klassningar av de olika faktorer som återspeglar artiklarnas riskbenägenhet. För att utifrån detta kunna rekommendera vilka materialstyrnings- och säkerhetslagerstrategier som ska användas. För att komma fram med eventuella lösningsförslag och förbättringar tar författarna hjälp av verktyg och teorier för att lägga substans bakom våra antaganden. Studiens syfte återspeglar sig i att GE Healthcare ständigt söker nya förbättringar och innovativa lösningar för att reducera det som inte är nödvändigt under en process.

Metod: Kvantitativ ansats med ett deduktivt angreppsätt med fokus på en förklarande undersökning.

Resultat/Slutsats: I analysen kom författarna fram till att med hjälp av algoritmens riskklassificering kan uppdragsgivaren dynamiskt följa upp och säkra artiklarnas riskbenägenhet via matrisen. På ett lättöverskådligt sätt kan artiklar som bör prioriteras och som inköpare ska lägga mer tyngd på särskiljas. Säkerhetslagerstrategierna är utformade efter artiklarnas individuella egenskaper och hanteras därefter med den mest lämpade strategin för respektive segment. Följs denna matris kommer även kapitalbindningen minska då de mer volymtunga artiklarnas lagernivåer sjunker. Detta kräver dock en mer kontinuerlig uppföljning av segmentet för att säkerställa att brister och stopp ej uppstår. Majoriteten av artiklarna i matrisen klassificeras därför under det segment som tillhandahåller ett större säkerhetslager men har ett betydligt mindre volymvärde totalt.

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Jansz, Robert, Per Olofsson, and Malin Johansson. "Lean inom sjukvården." Thesis, University of Gävle, Department of Technology and Built Environment, 2008. http://urn.kb.se/resolve?urn=urn:nbn:se:hig:diva-659.

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Det är uppenbart för alla inom sjukvården i Gävle att de ligger på gränsen till vad de kan hantera. Landstingen bestämmer inte bara vad sjukvården skall producera, utan även vad det får kosta. Det går ibland inte ihop, vilket föder frustration och vanmakt hos berörda avdelningar och personal. Behovet av sjukvård kommer troligen att öka ytterligare i framtiden, och vi verkar ha kommit till vägens ände vad gäller nuvarande arbetssätt. Syfte och mål med detta examensarbete är att genomföra en förstudie till att implementera och arbeta med lean på Gävle sjukhus och ortopedavdelningen. Arbetet innefattar även att ta fram en generell arbetsmodell för att analysera och förbättra flöden inom sjukvården utifrån ett lean perspektiv. Examensarbetets olika moment har styrts utifrån gruppen framtagna modell. Nedan sammanfattas vilka moment som ingått i varje steg.

1) Samla kunskap om lean: Första steget i arbetsmodellen handlar hur inlärning av lean i form av faktainsamling, litteraturstudier, föreläsningar och utbildning sker.

2) Kartläggning av flödet: Andra steget behandlar kartläggning av det aktuella flödet från att patienten skadas i hemmet till att denna är färdigbehandlad. Vidare har intervjuer och observationer gjorts hos de olika avdelningarna inblandade i flödet parallellt med dokumentering.

3) Analys av flödet i ett lean och kvalitetsperspektiv: Tredje steget innebär att en göra en analys av flödet med hjälp av olika metoder och verktyg inom lean.

4) Förbättringsförslag: Fjärde steget innebär att med hjälp av analysen skapa förbättringsförslag på de problem organisationen identifierat i flödet.

5) Implementering/Uppföljning: I sista steget handlar om hur en organisation inför förbättringsförslagen genom att informera och utbilda berörd personal.

Några av de problem som upptäcktes under förstudien var långa väntetider till operation, överbeläggningar, dubbelarbete, bristande rutiner och kommunikation mellan avdelningarna. Efter insamlad information och sammanställning av intervjuer och problemformuleringar har gruppen kommit fram till en rad förbättringsförslag som anses relevanta vid implementering av lean.

De olika lean och kvalitetsverktygen som gruppen främst har valt att jobba med är framtagna med hänsyn till de upptäckta problemen. Gruppens förslag till förbättringar inom det akuta höftflödet tror vi kommer förkorta vårdköerna, ge en mer kostnadseffektiv vård samt högre patient kvalitet. Lean har stor potential för sjukvården. Men att införa lean innebär inte enbart att införa en ny metod eller några verktyg. Det kräver en total förändring i synen på chefskap, på styrningen av sjukvården och på medarbetarnas roll. Förändringen sträcker sig ifrån högsta politiska nivå på landstingen till första linjens chefer som coachar sina team till dagliga förbättringar. Att införa lean är inte gjort i en handvändning, men det får inte hindra sjukvården ifrån att börja.

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Ribeiro, Eliane de Oliveira Aranha. "Resíduos sólidos de saúde: diagnóstico e possibilidade de aplicação da logística reversa em uma Policlínica Odontológica." Universidade Federal do Amazonas, 2016. http://tede.ufam.edu.br/handle/tede/5533.

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Management of the waste related to environmental issues becomes increasingly essential for maintaining a healthy environment, and the waste of health services are part of this system that should be well planned and solved. The objective of this work is to make the diagnosis of management of dental waste production chain system in a dental clinic in the city of Manaus and check the possibility of application of reverse logistics. A single case study was conducted, with an exploratory, qualitative and observational approach, empirically, the management of waste production chain system. The management plan is a reality in the studied public health unit and complies with current legislation; however, the application of reverse logistics still does not occur. The relevance of the plan compliance assists in preserving the environment and health of the population, minimizing health and environmental risks, and demonstrates the importance of proper management of this waste.
O gerenciamento dos resíduos associados às questões ambientais torna-se cada vez mais imprescindível para a manutenção de um ambiente saudável, e os resíduos dos serviços de saúde fazem parte deste sistema que deve ser bem planejado e solucionado. O objetivo deste trabalho é realizar o diagnóstico do sistema de gestão da cadeia de produção de resíduos odontológicos em uma policlínica odontológica da cidade de Manaus e verificar a possibilidade da aplicação da logística reversa. Foi realizado um estudo de caso único, de abordagem exploratória, qualitativa e observacional, de maneira empírica, do sistema de gestão da cadeia de produção de resíduos. O plano de gerenciamento é uma realidade na unidade de saúde pública estudada e atende à legislação vingente; no entanto, a aplicação da logística reversa ainda não ocorre. A relevância do cumprimento do plano auxilia na preservação do meio ambiente e na saúde da população, minimiza riscos sanitários e ambientais, e demonstra a importância da gestão correta destes resíduos.

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Jiao, Weiwei. "Predictive Analysis for Trauma Patient Readmission Database." The Ohio State University, 2017. http://rave.ohiolink.edu/etdc/view?acc_num=osu1492718909631318.

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Ballester, Nicholas A. "Engineering Inpatient Discharges: Disposition Prediction and Day-of-Discharge Planning." Wright State University / OhioLINK, 2017. http://rave.ohiolink.edu/etdc/view?acc_num=wright1509728298874385.

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Fernandez, Sanchez Javier. "Knowledge Discovery and Data Mining Using Demographic and Clinical Data to Diagnose Heart Disease." Thesis, KTH, Skolan för kemi, bioteknologi och hälsa (CBH), 2018. http://urn.kb.se/resolve?urn=urn:nbn:se:kth:diva-233978.

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Cardiovascular disease (CVD) is the leading cause of morbidity, mortality, premature death and reduced quality of life for the citizens of the EU. It has been reported that CVD represents a major economic load on health care sys- tems in terms of hospitalizations, rehabilitation services, physician visits and medication. Data Mining techniques with clinical data has become an interesting tool to prevent, diagnose or treat CVD. In this thesis, Knowledge Dis- covery and Data Mining (KDD) was employed to analyse clinical and demographic data, which could be used to diagnose coronary artery disease (CAD). The exploratory data analysis (EDA) showed that female patients at an el- derly age with a higher level of cholesterol, maximum achieved heart rate and ST-depression are more prone to be diagnosed with heart disease. Furthermore, patients with atypical angina are more likely to be at an elderly age with a slightly higher level of cholesterol and maximum achieved heart rate than asymptotic chest pain patients. More- over, patients with exercise induced angina contained lower values of maximum achieved heart rate than those who do not experience it. We could verify that patients who experience exercise induced angina and asymptomatic chest pain are more likely to be diagnosed with heart disease. On the other hand, Logistic Regression, K-Nearest Neighbors, Support Vector Machines, Decision Tree, Bagging and Boosting methods were evaluated by adopting a stratified 10 fold cross-validation approach. The learning models provided an average of 78-83% F-score and a mean AUC of 85-88%. Among all the models, the highest score is given by Radial Basis Function Kernel Support Vector Machines (RBF-SVM), achieving 82.5% ± 4.7% of F-score and an AUC of 87.6% ± 5.8%. Our research con- firmed that data mining techniques can support physicians in their interpretations of heart disease diagnosis in addition to clinical and demographic characteristics of patients.

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Sasseville, Maxime. "Description des facteurs prédictifs de résultats d’une intervention de prévention et de gestion des maladies chroniques en contexte de soins première ligne." Mémoire, Université de Sherbrooke, 2014. http://hdl.handle.net/11143/6018.

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Résumé : Objectif : Identifier les facteurs associés avec le succès d’une intervention multidisciplinaire de prise en charge et de prévention des maladies chroniques dans un contexte de soins de santé de première ligne. Devis : Étude corrélationnelle prédictive d’analyse secondaire des données du projet PR1MaC, un essai randomisé contrôlé analysant les effets d’une intervention intégrant un programme de prise en charge et de prévention Contexte : Huit cliniques de soins de première ligne de la région Saguenay-Lac-Saint-Jean. Participants : un échantillon de 160 patients (52,5% d’hommes) référés par des professionnels de première ligne. L’analyse a porté sur le groupe intervention seulement. Mesure de résultats primaire : Mesure d’amélioration significative dans les huit domaines du «Health Education Impact Questionnaire». Résultat : L’analyse de régression multivariée a démontré qu’être plus jeune, être célibataire et avoir un salaire plus bas a mené à plus d’amélioration au niveau du domaine « Bien-être émotionnel »; avoir de bonnes habitudes alimentaires et cibler moins de facteurs de risque durant l’intervention a mené à plus d’amélioration au niveau du domaine « Approches et attitudes constructives »; être plus jeune, avoir plus de temps de contact avec les professionnels et avoir une concertation des professionnels a mené à plus d’amélioration dans le domaine « Approches et attitudes constructives »; avoir plus de temps de contact avec les professionnels a aussi eu une influence sur l’amélioration du domaine « Engagement positif et actif dans la vie » et avoir un plus grand nombre de professionnels intervenant chez une même personne a démontré plus d’amélioration dans le domaine « Acquisition des techniques et habiletés ». Aucun facteur prédictif n’a pu être identifié pour les domaines « Comportements de santé », « Intégration sociale et soutien » et « Auto-surveillance et discernement ». Seulement les résultats statistiquement significatifs sont présentés (valeur p ≥ 0,05). La petite taille de l'échantillon ainsi que la possibilité d'une perte de signification des résultats après certains ajustements statistiques suggèrent que ces observations devraient faire l'objet d'une validation plus approfondie dans d'autres études. Conclusion : La tentative d’identification des facteurs prédictifs de résultats de cette recherche contribue à la compréhension des mécanismes complexes de l’efficacité et offre des pistes quant à l’optimisation des programmes de prévention et de gestion des maladies chroniques. // Abstract : Context : Research on the factors associated with the successes of chronic disease prevention and management (CDPM) interventions is scarce. Objectives : To identify the factors associated with the successes of an interprofessional CDPM intervention among adult patients in primary healthcare (PHC) settings. Design : Secondary analysis of data from the PR1MaC project; a pragmatic randomized controlled trial looking at the effects of an intervention involving the integration of CDPM services in PHC. Settings : Eight PHC practices in the Saguenay - Lac - Saint - Jean region of Quebec, Canada. Participants : A sample of 160 patients (84 males) referred by PHC providers constituted the sample (mean age 52.66 ± 11.5 years); 98.5% presented two or more chronic conditions analysis focused on the intervention arm sample only. Main and secondary outcome measures : Dichotomic substantive improvement in the eight domains of the Health Education Impact questionnaire (hei Q) measured at baseline and three months later. Results : Multivariate logistic regression analysis showed that being younger, being single and having a lower family income led to a better improvement in the emotional wellbeing domain; having healthy eating habits and less objectives during the intervention led to improvement in the constructive attitudes and approaches domain; being younger, a longer intervention and a consensus of professionals led to improvement in the health services navigation domain; a longer intervention led to improvement in the positive and active engagement in life domain and having more professionals involved led to improvement in the Skills and techniques acquisition domain. No predictive factors were identified for the Health - directed behaviour, Social interaction and support and S elf - monitoring and insight domains. Only significant results are presented here (p - value ≥ 0.05). The small sample and the lost of significance after statistical adjustments suggest that observations should be validated by other studies. Conclusion: In an attempt to make causal inferences in regards to improvement, this research contributes to the understanding of the complex mechanisms of efficiency and provides information about the optimisation of CDPM program delivery.

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Wang, Jensing, and 王正行. "The Study And Model Design for Outsourcing of Healthcare Logistics in District Hospitals System." Thesis, 2002. http://ndltd.ncl.edu.tw/handle/96582022192285361243.

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碩士
國立中山大學
高階經營碩士班
90
Abstract This is a pilot study for CEOs or managers working in the Hospital system.. We expect to provide a total solution of Healthcare logistics through investigation, visiting, focus group and benchmarking. Our main goal is to figure out how it works via introducing one order one delivery technology to hospitals and to prove that logistics could largely reduce the costs of hospital maintenance. We intend to study the existing Healthcare logistics models and find out the key factors of existing successful logistics cases. Besides, through visiting and experience sharing, we try to construct a suitable outsourcing Healthcare logistics model for all of the district hospitals in Taiwan. Based on integrated services of professional logistics providers, Healthcare logistics services will become more and more important to all hospitals. We try to figure out a suitable model for decision makers and demonstrate to them how to evaluate the cost-effectiveness concurrently

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(5930012), Zhongjie Ma. "Dynamic Coordination in Manufacturing and Healthcare Systems." Thesis, 2019.

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As the manufacturing and healthcare systems becomes more complex, efficiently managing these systems requires cooperation and coordination between different parties. This dissertation examines the coordination issues in a supply chain problem and diagnostic decision making in the healthcare system. Below, we provide a brief description of the problem and results achieved.

With supply chain becoming increasingly extended, the uncertainty in the upstream production process can greatly affect the material flow that aims toward meeting the uncertain demand at the downstream. In Chapter 2, we analyze a two-location system in which the upstream production facility experiences random capacities and the downstream store faces random demands. Instead of decomposing the profit function widely used to treat multi-echelon systems, our approach builds on the notions of stochastic functions, in particular, the stochastic linearity in midpoint and the directional concavity in midpoint, which establishes the concavity and submodularity of the profit functions. In general, it is optimal to follow a two-level state-dependent threshold policy such that an order is issued at a location if and only if the inventory position of that location is below the corresponding threshold. When the salvage values of the ending inventories are linear, the profit function becomes decomposable in the inventory positions at different locations and the optimal threshold policy reduces to the echelon base-stock policy. The effect of production and demand uncertainty on inventory levels depends critically on whether the production capacity is limited or ample in relation to the demand. Only when the capacity is about the demand, the upstream facility holds positive inventory; otherwise, all units produced are immediately shipped to the downstream. We further extend our analysis to situations with general stochastic production functions and with multiple locations.

In Chapter 3, we examine the two-stage supply chain problem (described in Chapter 2) under the decentralized control. We consider two scenarios. In the first scenario, the retail store does not have any supply information including the inventory level at the manufacturing facility. We show that the upstream and downstream can be dynamically coordinated with proper transfer payment defined on local inventories and their own value function in the dynamic recursion. In the second scenario, the demand distribution is unknown to the manufacturing facility as well as the retail store does not know the supply information. We characterize the optimal transfer contracts under which coordination can be achieved, and propose an iterative algorithm to compute the optimal transfer contracts in the decentralized setting. The total profit of the decentralized system under our algorithm is guaranteed to converge to the centralized optimal channel profit for any demand and supply distribution functions.

In Chapter 4, we provide a case study for the framework developed in [1]. The authors study the evaluation and integration of new medical research considering the operational impacts. As a case study, we first describe their two-station queueing control model using the MDP framework. We then present the structural properties of the MDP model. Since multiple classes of patients are considered in the MDP model, it becomes challenging to solve when the the number of patient classes increases. We describe an efficient heuristic algorithm developed by [1] to overcome the curse of dimensionality. We also test the numerical performance of their heuristic algorithm, and find that the largest optimality gap is less than 1.50% among all the experiments.

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Xie, Y., Liz Breen, T. Cherrett, D. Zheng, and C. J. Allen. "An exploratory study of reverse exchange systems used for medical devices in the UK National Health Service (NHS)." 2015. http://hdl.handle.net/10454/7489.

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yes
Purpose This study aims to provide insights into the scale and use of Information Communication Technology (ICT) in managing medical devices in the NHS, with a focus on Reverse Exchange (RE) systems, as part of the broader Reverse Logistics (RL) systems, within which medical devices are returned and exchanged. Design/Methodology/Approach Two case studies were conducted with NHS Hospital Trusts, while another was built upon secondary resources. Primary findings were triangulated with information collected from the NHS Trusts’ reports, direct observation and a preliminary round of consultations with 12 healthcare professionals working in other NHS Trusts or Integrated Equipment Community Services. Findings The findings suggest that the sophistication of ICT implementation increases with the risks and value associated with medical devices. Operational attributes are derived from ICT implementations which can positively impact on RE performance. The forces that drive the adoption of ICT in the NHS include pressure from government, business partners and patients, competitive pressure, perceived benefits, organisation size, top management support and the availability of sufficient resources. Obstacles are mainly centred around the lack of sufficient resource. Research limitations/implications Although the Trusts that participated in this research are representative of different regions, the generalisation of the study results may be limited by the size of the sample organisations, so the results can only provide insights into the research problem. As this work is exploratory in nature, there is insufficient data on which to form definitive recommendations. Practical implications NHS Trusts may use the 6 operational attributes identified and verified by the case studies to benchmark their ICT implementation for device management. The actual and potential benefits of ICT implementation could inform technology development and encourage the uptake of ICT in healthcare. Governmental bodies can utilise this information to develop directives to actively drive ICT adoption in device management and the associated RE system. A well-considered training programme is needed to improve staff ICT skills in order to fully realise the potential of ICT systems which support the effective RE of medical devices. Originality/value The results suggest that ICT supported reverse exchange of medical devices backs up the supply chain reduces capital costs and medical risks and, facilitates the redeployment of funds to frontline medical treatment.

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Breen, Liz, Y. Xie, and T. Cherrett. "Where are you? A preliminary examination of the track and trace mechanisms in place to facilitate effective closed-loop medical equipment retrieval in the National Health Service (NHS) (UK)." 2016. http://hdl.handle.net/10454/8664.

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yes
The National Health Service (UK) is wholly accountable and heavily scrutinised for its strategy, activity, performance and spending (Appleby, 2016; NHS Confederation, 2016; Parliament UK, 2010), and much research has been undertaken as to its effectiveness at managing its operations and its competency in doing so (Gov.Uk, 2016; National Audit Office, 1999)). The impact of not performing adequately combined with threats such as funding cuts (King’s Fund, 2016), government intervention and private sector competition; has led to uncertainty and disillusion with the sustainability of the service (Hunter, 2016). Based on current economic concerns, this paper chooses to focus on the area of Medical Equipment Loans Services where products are released to patients to aid therapeutic rehabilitation and physical mobility. The aim of this study is to examine the process of product retrieval in a multi-case study analysis and consider how value-added technologies can be used to improve retrieval success rates.

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Shiu, Shin-yi, and 許欣怡. "A Study of the Impact of Healthcare Materials Supply Chain Collaboration Model on Inventory and Order Cycle – the Case of C Hospital and Z Logistics Company." Thesis, 2010. http://ndltd.ncl.edu.tw/handle/33161814002264364536.

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碩士
東吳大學
企業管理學系
98
As the national healthcare insurance policy restricts the growth of medical expenses, healthcare institutions must control their costs very cautiously. Parma products and medical devices are the second largest cost category for most healthcare institutions. It is not effective for upstream and downstream members in the healthcare supply chain to work independently, rather through the coordinated efforts of supply chain members, better performance may be achieved. Within the context of healthcare supply chain, healthcare institutions are downstream customers while logistics firms act as the bridges between healthcare institutions and the upstream suppliers. Currently, the healthcare institutions place orders very frequently, which have caused very high shipping frequencies for logistics firms. This in turn results the increase of delivery costs, order processing costs and warehousing costs for logistics firms. Therefore, it is questionable whether it is beneficiary for hospitals to order frequently. Hence, it is worthy to investigate innovative supply chain solutions which can provide effective integration of the ordering and shipping operations between healthcare institutions and logistics firms. A regional level Hospital, C and the largest pharmaceutical logistics company Z are selected as the cases for this study. We collected the ordering operational data from C regarding to Z and shipping operational data from Z regarding to C so as to conduct detail analysis of the cost/benefit effects when ordering patterns were changed. Based on the order policy change simulation of these baseline data, this research found when top 20% items sorted by yearly item order dates were selected and changed their ordering policy from irregular daily ordering to (10%+10%) alternate bi-weekly ordering, it would provide the best quantitative results on total logistics costs savings. This research further analyzed the collaborative opportunities between two parties, what collaborative models should be adopted, and the key success factors needed under the simulated optimal ordering policy. The research results are summarized below: 1. Hospital C Large variation in Hospital C's original ordering patterns has caused additional labor costs and excessive inventory. This research simulated various new ordering patterns. The optimal ordering pattern was able to save Hospital C's inspection cost, labor cost and inventory holding cost, with a total saving of $186,174 (Taiwan Dollars). Additionally, purchasing time and handling time for receiving were decreased by 1,113 minutes. 2. Company Z With the large variations of the ordering patterns of Hospital C, Company Z could not utilize efficiently its shipping trucks and had led to the increase of the operating cost. Through simulation analysis of the optimal ordering policy, we found that the order picking and order processing costs will increase; however, inventory levels can be decreased to $141,367, distribution costs can also be decreased to $45,700 and the total logistics cost can be decreased to $150,216. 3. Results of comprehensive analysis Apart from inventory policy and ordering problems, inventory data from both Hospital C and Company Z could not be matched. By further analysis, this research found that Hospital C had experienced the late delivery or multiple-day deliveries of an order. Sometimes, there was a shortage of the product supply but Z did not inform C earlier, and their information systems can not mediate changes of the inventory information. Thus, information gaps between two organizations were caused. Therefore, this research suggests Hospital C and Company Z not only collaborate in ordering and shipping policies, but also integrate their information flows. To achieve the maximum supply chain effectiveness, we found that developing a cross docking based supply chain operations can reduce the inventory level to the minimum level for emergency needs. 4. Results of supply chain collaboration analysis This research also studied what requirements would be needed if Hospital C and Company Z decided to collaborate on implementing the optimal ordering and shipping policies. Combining findings from literatures and observations during the study period, this research has found that for Hospital C and Company Z to collaborate successfully, they should follow at least the following six requirements: (1) if top management do not give full support, probability of success of collaboration is very low; (2) Hospital C and Company Z should establish joint project team to plan and execute the collaboration program. In this way, project team can learn from each other, regularly assess project performance, and make corrections to any problem quickly; (3) Both parties should provide good interface to connect their information systems to provide inventory status visibility to discover as soon as possible the product delay situations due to pharmaceutical suppliers or customs clearance. In this way, Hospital C can access real time and accurate inventory status information and prepare in advance any emergency situations; (4) Hospital C and Company Z should establish an interactive environment for employees involved in the new collaborative program to provide good training to them to ensure they can smoothly adapt to the new working model; (5) Hospital C should record the product usage of user units to gain better demand information and make accurate ordering policy; (6) In the long run, Hospital C and Company Z should move toward a pull-based cross docking supply chain to reduce inventory, labors, and space resources.

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Bailey, G., T. Cherrett, B. Waterson, Liz Breen, and R. Long. "Boxed up and locked up, safe and tight! Making the case for unattended electronic locker bank logistics for an innovative solution to NHS hospital supplies (UK)." 2015. http://hdl.handle.net/10454/9435.

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Yes
The lack of separation between urgent and non-urgent medical goods encourages sub-optimal vehicle fleet operations owing to the time critical nature of urgent items. An unattended electronic locker bank, to which individual urgent items can be delivered thereby separating urgent and non-urgent supply, was proposed for the Great Ormond Street Hospital in London, UK. This concept was quantified using ‘basic’ and ‘intuitive’ hill climbing optimisation models; and qualitatively using staff interviews and expert reviews. Results indicated that a locker bank with a fixed height (1.7 m) and depth (0.8 m) required a length of 4 m (basic model) and 3.63 m (intuitive model), to accommodate 100% of urgent consignments for a typical week. Staff interviews indicated the wider benefits such as staff personal deliveries.

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Costa, João Alves Pires da. "Implementação de armazéns avançados em ambiente hospitalar : estudo de caso." Master's thesis, 2013. http://hdl.handle.net/1822/26445.

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Dissertação de mestrado em Engenharia Industrial
Atualmente, em Portugal, verifica-se um aumento dos custos na indústria da saúde, devido ao envelhecimento da população, ao aumento da procura de cuidados de saúde e ao investimento em novas tecnologias. Surge então a necessidade de reduzir custos, apresentando-se a gestão eficaz e eficiente dos sistemas logísticos associados ao abastecimento com enorme potencial para atingir poupanças nas organizações prestadoras de cuidados de saúde, sem comprometer a qualidade do serviço que, neste tipo de indústria, é um fator crítico. Neste projeto de investigação estudou-se a implementação do conceito de Armazéns Avançados, baseado no sistema de reposição por níveis, no sistema de duplo lote e no modelo de consignação, nos serviços clínicos do Hospital de Braga. Neste conceito, o processo de abastecimento logístico é suportado por sistemas informáticos, permitindo uma reposição proativa com base no registo de consumos nos serviços do hospital. O estudo de caso foi desenvolvido em dois serviços clínicos do hospital, com o objetivo de estudar o impacto do funcionamento dos três sistemas de abastecimento em paralelo. Através desta implementação, conseguiu-se obter melhorias na gestão de stocks nos armazéns dos serviços, diminuindo custos associados à imobilização de capital em produtos armazenados por períodos mais ou menos longos em armazéns centrais e aumentando o nível de serviço e o controlo dos materiais dos serviços clínicos. Para além disso, foi possível também libertar os profissionais de saúde para desempenharem a sua atividade de prestação de cuidados de saúde ao utente, deixando de ter responsabilidades na gestão de stocks. A conclusão principal deste trabalho centra-se na possibilidade do funcionamento de vários modelos de abastecimento em paralelo, de acordo com os tipos de materiais com que as organizações de saúde lidam, para que estas consigam prestar cuidados de saúde de qualidade, a um custo reduzido e economicamente sustentáveis.
Actually, in Portugal, there is an increase of costs in the healthcare industry due to the aging of population, the increased demand of health care and investment in new technologies. Thus, there is a need to reduce costs, by presenting the effective and efficient management of logistics supply systems with enormous potential to achieve savings in health care organizations without compromising the quality of the provided service, which is a critical factor, in this type of industry. In this research project it has been studied the implementation of the Advanced Warehouses concept, in the Hospital de Braga patients care units, based in the par level system, the two bin system and the consignment model. In this concept the logistic supply process is supported by information systems, allowing a proactive replacement of products, based on hospital services consumption records. The case study was developed in two hospital patient care units, in order to study the impact of the operation of the three replenishment systems in parallel. Through this concept implementation significant improvements have been achieved within inventory management in the patient care unit warehouses, by reducing immobilization of capital associated costs, within the products stored for more or less long periods of time at the central warehouses, and by increasing the service level and control of the patient care units stored materials. Furthermore, it was also possible to free health care professionals to perform their activity, providing health care to the patient while leaving responsibility for the stock management. The main conclusion of this work illustrates the possibility of operating multiple replenishment models in parallel, according to the types of materials that healthcare organizations deal with, so that they are able to provide quality health care services at a reduced cost and economically sustainable.

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Figueiredo, Helder Capitão. "Otimização da gestão de stocks de dispositivos médicocirúrgicos." Master's thesis, 2015. http://hdl.handle.net/1822/37868.

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Dissertação de mestrado integrado em Engenharia e Gestão Industrial
Esta dissertação foi desenvolvida no âmbito do projeto de conclusão do Mestrado Integrado em Engenharia e Gestão Industrial, com o tema “Otimização da Gestão de Stocks de Dispositivos Médicocirúrgicos”, feito, a par do estágio curricular, no Hospital de Braga. O objetivo primário era aproveitar os dados providenciados pelas recentes melhorias na logística do hospital, nomeadamente a implementação de um sistema de armazéns avançados, para tornar a gestão de stocks mais eficaz. O sistema de armazéns avançados implementado permite a obtenção de dados relativamente aos procedimentos cirúrgicos efetuados no Bloco Operatório Central (BOC), nomeadamente os materiais gastos, o número de procedimentos efetuados e a sua disposição no tempo. Com estes dados à disposição foi pedido que se fizesse uma mudança gradual da gestão de stocks, de alguns dispositivos médico-cirúrgicos a escolher, de push para pull, com base no agendamento e na previsão da produção cirúrgica. Feita a análise dos dados disponibilizados, bem como de toda a logística de abastecimento do Hospital de Braga, foi sugerido um modelo de compra e gestão de stocks que, reduzindo a incerteza relativamente à procura, permite baixar as existências dos materiais sem que isso afete o nível de serviço.
The present dissertation, entitled “Optimization of the Inventory Management of Surgical Materials”, was developed under the scope of the completion of the Integrated Master in Industrial Management and Engineering and was made, alongside the curricular internship, at Hospital de Braga. The primary objective was to avail the data provided by recent improvements in the hospital logistics, mainly the implementation of a system of advanced warehouses, and to enhance the efficiency of the inventory management. The advanced warehouse system allows the collection of data regarding surgical procedures performed in the operating room, namely material expenses, the number of procedures undertaken, and its temporal arrangement. Having all these data, it was requested to perform a gradual change in the inventory management of some materials, from a push to a pull-based management, depending on the scheduling and surgical production forecast. After performing the data analysis, as well as the analysis of the hospital’s supply chain, it was suggested a purchase and stock management model that, achieving to reduce the demand uncertainty, allows the reduction of the materials stock without affecting the service level provided.

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Faisal, Muhammad, Andy J. Scally, R. Howes, K. Beatson, D. Richardson, and Mohammed A. Mohammed. "A comparison of logistic regression models with alternative machine learning methods to predict the risk of in-hospital mortality in emergency medical admissions via external validation." 2018. http://hdl.handle.net/10454/16623.

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Yes
We compare the performance of logistic regression with several alternative machine learning methods to estimate the risk of death for patients following an emergency admission to hospital based on the patients’ first blood test results and physiological measurements using an external validation approach. We trained and tested each model using data from one hospital (n=24696) and compared the performance of these models in data from another hospital (n=13477). We used two performance measures – the calibration slope and area under the curve (AUC). The logistic model performed reasonably well – calibration slope 0.90, AUC 0.847 compared to the other machine learning methods. Given the complexity of choosing tuning parameters of these methods, the performance of logistic regression with transformations for in-hospital mortality prediction was competitive with the best performing alternative machine learning methods with no evidence of overfitting.
Health Foundation; National Institute for Health Research (NIHR) Yorkshire and Humberside Patient Safety Translational Research Centre (NIHR YHPSTRC)

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Alves, Andreia Alexandra Mendes Ribeiro Pereira. "Procedimentos de aprovisionamento em cuidados de saúde primários: um estudo de caso." Master's thesis, 2012. http://hdl.handle.net/10071/6538.

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Uma boa gestão de stocks nas organizações prestadoras de cuidados de saúde é fundamental, pois os erros que ocorrem nesta área refletem-se no desempenho dos profissionais de saúde e, consequentemente, na própria saúde dos utentes. As unidades funcionais, por prestarem um serviço direto ao utente, devem ter esta preocupação em especial. A atribuição de autonomia de gestão às unidades funcionais, após a reforma dos cuidados de saúde primários, permite o desenvolvimento de estratégias de controlo de stocks. No entanto, os responsáveis pelo aprovisionamento nestas unidades, usualmente profissionais de saúde, não dispõem dos recursos necessários para a implementação das mesmas. Com o presente estudo pretende-se caraterizar os processos e procedimentos envolvidos no abastecimento de uma Unidade de Saúde Familiar, de forma a identificar oportunidades de melhoria e apresentar uma proposta de satisfação das necessidades encontradas. Para atingir este objetivo optou-se pelo método de estudo de caso. A análise da informação recolhida revelou problemas no âmbito do controlo das existências e dos consumos de material, assim como no seu fornecimento, o que origina, no primeiro caso, incerteza quanto às quantidades armazenadas e necessidades existentes, e no segundo caso, rotura ou acumulação de material desnecessário. A aplicação do modelo proposto pode trazer vantagens para a USF em estudo e, no longo prazo, para a própria cadeia de abastecimento. Este modelo pretende ser uma ferramenta que facilite o registo dos movimentos do material de consumo clínico, promova a realização de encomendas baseadas nas necessidades imediatas da USF, e fomente a redução do volume das encomendas, assim como a rotatividade dos stocks.
A good stock management in healthcare organizations is crucial because the mistakes that occur in these types of services influence the performance of health professionals and hence the health of the patients. Functional units should have this particular concern since they provide a direct service do patients. Granting management autonomy to functional units, after the reform of primary health care, offers a window of opportunity for the development of strategies concerning inventory management. However, people responsible for supplies in these organizations are usually health professionals, who lack the resources needed for the implementation of these procedures. The present study aims to characterize the processes and procedures involved in the supply of a Family Health Unit, in order to identify opportunities for improvement and submit a proposal for meeting the needs found. To achieve this goal was adopted the case study method. Data analysis revealed problems regarding the control of inventories and material consumption, as well as in their supply, causing, in the first case, uncertainty about the quantities stored and needs and, in the second case, rupture or accumulation of unnecessary material. The application of the proposal could provide benefits for the health unit studied and, in the long term, for the supply chain itself. This model aims to be a tool to facilitate the registration of clinical material movements, to promote the placement of orders based on the immediate needs of the unit, and to reduce of the volume of orders, as well as the turnover of stocks.

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Dissertations / Theses on the topic 'Healthcare logistics'

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