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Managing performance of operating units Research Plan Antti Peltokorpi, MSc, Researcher, PhD candidate [email protected] Helsinki University of Technology BIT Research Centre Institute of Healthcare Engineering, Management and Architecture Measuring success in operating unit • • Depending on the system environment and internal requirements, typical measures for operating unit performance are capacity utilization, contribution to margin, and waiting time High personnel productivity can be seen as a shared enabling factor for all those m measures Output Pr oductivity P Input d j 1 j Nj n H i 1 i Hi is working hours of profession i at the given period, dj is an average of duration of operation for operation type j, and Nj is a number of operations j at the given period. • Cost-efficiency takes into account also additional costs due to delayed operations and overtime working n Cost Output c H i 1 i i xO yC wD m d j 1 j N j ci is a hourly cost of work of profession i during office hours, x is a hourly cost of operating room overtime, O is a number of overtime hours, y is a cost of delayed elective operations, C is a number of delayed elective operations, w is a cost of delayed emergency operations, and D is a number of delayed emergency operations. Production planning and control in operating unit Decisions to be made Resource planning Production planning Demand management 1. What operations to provide and in which site? Master production scheduling 2. How to design the operating unit process layout? 3. What operations and how many to perform during next 12 months? 4. How to staff operating unit for the next 12 months? 5. How to allocate resources to specialties for the next 1-6 months? Detailed material planning Detailed capacity planning Capacity requirement data Capacity and material plans 6. How to schedule operating room time blocks? 7. How to manage demand and resources during the day of operation? Shop-floor scheduling systems (adapted from Vollmann et al.1997) Managerial challenges varied depending on the nature of surgical process Decreasing unit costs High Emergency units In terms of proportion of emergencies and number of specialties Multi-specialty regional hospitals Increasing process definition Process variety Specialized elective hospitals Local one surgeon providers Low Low Volume per unit In terms of number of operating rooms and operations per year (adapted from Johnston & Clark 2005) High Research questions • The primary research question in that licentiate thesis is: ― • How to manage productivity and cost efficiency in multi-specialty operating unit? The sub-questions related to primary problem are: ― ― ― ― How productivity and cost efficiency can be forecasted in the planning phase? What is the effect of non-planned factors, such like personnel absence and variation in emergency load, to productivity and cost efficiency? How the cost efficiency is consisted of the decisions in the surgical services management process? How operations and resources should be planned so that productivity and cost efficiency are maximized? Research process • Primary case study: Jorvi Hospital ― ― ― • Considering daily productivity and cost-efficiency How decisions in the planning phase reflect on the daily performance? Path-analyses and regression analyses about factors affecting on daily performance Secondary case studies: Unfallkrankenhaus Berlin, PäijätHäme Central Hospital, Department of Gynecology, Kaiser Permanente (?), Sutter Health (?) ― How the results from Jorvi case can be generalized to other operating units? Example of data analysis • Regression analysis: How the decisions in the planning phases reflect on the daily performance? Personnel absence Allocated OR time Estimated OR utilization Planned staff intensity Overutilized OR time Standby personnel Planned personnel Realized personnel Realized costs Estimated productivity Planned productivity Realized productivity Cost efficiency Estimated operations Planned operations Realized operations Estimated emergency load Planning and estimating Emergencies from previous days Load from previous days Emergencies on the day of surgery Cancelled cases Changes on the day of surgery Delayed elective and emergency cases Performance Additional care costs