Planning decisions in healthcare - Ahmadi
35 important questions on Planning decisions in healthcare - Ahmadi
What is only provided for outpatients?
2) Specialty care
What can be performed on outpatients and inpatients?
What are 4 strategic decisions for outpatient clinics?
- The access policy for scheduled patients
- Number of servers/resources
- Policy on acceptance of walk-in patients
- Types of schedules
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3. Strategic descisions
How can the access policy for scheduled patients be divided?
- Pre-scheduled patients, scheduled in advance of the appointment day
- Same-day (open-acces) patients, scheduled for the same day
3. Strategic descisions
What are the 5 access policy, explain
Everything is booked in advance
2. Open access
All capabilities to same-day appointments
3. Hybrid
Combination traditional and open access
4. Carve out
Reserves a certain amount of capacity for specific procedures
5. Same-day or next-day policies
Books today's patients on the day they call or the next day
3. Strategic descisions
What is a downside of the traditional access policy?
3. Strategic decisions
What are barriers for the open access?
3. Strategic decisions
Why accept walk-ins?
3. Strategic decisions
What do you do?
- Walk in rate < 20%
- WAlk in rate > 20%
admitting
>20%
admit when:
number of patients waiting + expected number of punctual
pre-scheduled patients < total capacity of the remaining slots
3. Strategic decisions
When is the best time to leave slots open for urgent patients?
3. Strategic decisions
What do seasonal walk-ins (weekly or monthly) show?
3. Strategic decisions
What are is meant with offline and online schedules?
Appointments are scheduled after all requests have arrived
Online
Patients are scheduled immediately upon arrival
Importance offline planning is growing
What are 7 tactical decisions for outpatient clinics?
2. Appointment intervals
3. Appointment scheduling window
4. Block size
5. Number of appointments per consultation schedule
6. Panel size
7. Priority of patients groups
4. Tactical decisions
Why do shorter appointment slots perform better?
4. Tactical decisions
What do you do when:
- standard deviation unpunctuality increases
- mean of patient unpunctuality increases
Reduce interval size
Mean of patient unpunctuality increases
Increase the interval length slightly
4. Tactical decisions
What does an appointment scheduling window do?
4. Tactical decisions
What happens when there is a reduction in the scheduling window?
> Decrease no-show rate
> more efficient clinic
Downside: overly restrictive reduces the number of patients seen so reduction revenue.
3. Strategic decisions
What is the best performing access policy, and what is the best realisation of this access policy
Modification ratio of same-day and pre-scheduled + overbooking mitigates the impacts of no-shows and outperforms the rest
No period or two period hybrid policy makes no difference.
4. Tactical decisions
What do the following rules do:
- baileys rule
- individual block rule
- multiple block rule
- variable block rule
2 patients in the first block, 1 patient in the other blocks leave the last block empty
individual block rule
1 patient in all blocks
multiple block rule
fixed batch of patients in all slots
Variable block rule
Variable batch size
4. Tactical decisions
What does the multiple block rule and variable block rule mitigate?
But when too large, patient waiting and system overtime increase.
4. Tactical decisions
What is an approximately optimal policy for the number of appointments per consultation session?
4. Tactical decisions
What is calling population?
Consequently, panel size can be larger than service capacity
4. Tactical decisions
What happens when the panel size is too large?
- Indirect waiting times increases > increased no shows
- Level of continuity of care decreases
4. Tactical decisions
What are [2] type of priorities of patients, explain
Patient priorities must be met at all times applied upon patient arrivals (emergency)
Soft
Patient priorities are not applied upon arrival assigning a different weight reflecting relatively importance
What are [6] operational descisions?
2. Appointment day
3. Appointment time
4. Patient acceptance/rejection
5. Patient selection waiting list
6. Patient sequence
5. Operational descisions
What are [2] approaches?
Easy to implement heuristic, no guarantee of performance
OBA Optimization-Based Approach
Specifying optimal level for an operational decision with guarantee of performance, global optimal solution
5. Operational decisions
What are [2] important factors to be considered in the allocation of patients to servers/resources?
- Continuity of care
- patient preference physician
5. Operational decisions
What are [2] types of appointment time schedule?
- Predetermined appointment slots
- No predetermined slots, patients are scheduled anytime in the consultation session
5. Operational decisions
Based on what [3] things are patients selected from the waiting list?
- Capacity allocated to each patient group
- Patient waiting time
- Patient priority level
5. Operational decisions
What is a good rule in the determination of the patient sequence?
Order patients in increasing variance
6. Environmental factors
What are:
- non-preemptive interruptions
- preemptive interruptions
Between consultations
Preeptive interruptions
During consultaiton
6. Environmental factors
What are [2] type of preemptive interruptions, explain
The treatment procedure repeats from the beginning independently of the earlier service
Preemptive resume
Service resumes from the place it was interrupted
6. Environmental factors
What are:
- Single appointments
- Combination of appointments
- Appointment series
Combination of appointments
Multiple appointments one patient scheduled in one day
Appointment series
Multiple appointments on more than one day
7. Modelling approaches
What is single-stage stochastic programming
7. Modelling approaches
What is a two stage stochastic programming
- Descision variables are appointment times
- Variables are auxiliary variables
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