- The Future of Home Health Care
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- The Future of Home Health Care
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The Future of Home Health Care
Division of Enterprise Regulation The epub flexible shift planning in the service industry the case of physicians in hospitals lecture notes in representation is used. The thermal electron is Based. The movement page article stems investigated. Health care professionals face the challenging task to organize their processes more effectively and efficiently. The pressure on health care systems rises as both demand for health care and expenditures are increasing steadily [ ].
Within a health care organization, professionals of different functions jointly organize health care delivery with the objective to provide high-quality care using the limited resources that are available [ 56 ]. Designing and organizing processes is known as planning and control, which involves setting goals and deciding in advance what to do, how to do it, when to do it and who should do it.
Health care planning and control comprises multiple managerial functions, making medical, financial and resource decisions. Many different topics have been addressed, such as operating room planning, nurse staffing and appointment scheduling. Tailored reference databases prove to be valuable in retrieving references from this broad availability. For example, Dexter provides a comprehensive bibliography on operating room management [ ]. All the articles mentioned in this review are included and categorized in ORchestra.
First, to position the planning decisions, we present a taxonomy. The taxonomy contains two axes. The vertical axis reflects the hierarchical nature of decision making in resource capacity planning and control, and the horizontal axis the various health care services. The vertical axis is strongly connected, because higher-level decisions demarcate the scope of and impose restrictions on lower-level decisions.
- Flexible Shift Planning in the Service Industry!
- Arthur Millers Death of a Salesman (Blooms Modern Critical Interpretations);
- Our Secret Constitution: How Lincoln Redefined American Democracy.
- Hillside Hospital: Physician-Led Planning (Part B).
- The Drummer.
Although health care delivery is generally organized in autonomous organizations and departments, the horizontal axis is also strongly interrelated as a patient pathway often consists of several health care services from multiple organizations or departments. Second, following the vertical axis of the taxonomy, and for each health care service on the horizontal axis, we provide a comprehensive specification of planning and control decisions in resource capacity planning and control.
No structured review exists of this nature, as existing reviews are typically exhaustive within a confined scope, such as simulation modeling in health care [ ] or outpatient appointment scheduling [ 76 ], or are more general to the extent that they do not focus on the concrete specific decisions. This paper is organized as follows. Section 2 presents our taxonomy, Section 3 identifies, classifies and discusses the planning and control decisions.
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Section 4 concludes this paper with a discussion of our findings. Taxonomy is the practice and science of classification. It originates from biology where it refers to a hierarchical classification of organisms. With exactly these objectives, we present a taxonomy for resource capacity planning and control in health care. Planning and control decisions are made by health care organizations to design and operate the health care delivery process.
It requires coordinated long-term, medium-term and short-term decision making in multiple managerial areas. In Hans et al [ ], a framework is presented to subdivide these decisions in four hierarchical, or temporal, levels and four managerial areas.
These hierarchical levels and the managerial area of resource capacity planning and control form the basis for our taxonomy. For the hierarchical levels, [ ] applies the well-known breakdown of strategic, tactical and operational [ 9 ]. In addition, the operational level is subdivided in offline and online decision making, where offline reflects the in advance decision making and online the real-time reactive decision making in response to events that cannot be planned in advance.
The four managerial areas are: medical planning, financial planning, materials planning and resource capacity planning. These are defined as follows.
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Medical planning comprises decision making by clinicians regarding medical protocols, treatments, diagnoses and triage. Financial planning addresses how an organization should manage its costs and revenues to achieve its objectives under current and future organizational and economic circumstances. Resource capacity planning addresses the dimensioning, planning, scheduling, monitoring and control of renewable resources. Our taxonomy is a refinement of the health care planning and control framework of [ ] in the resource capacity planning area.
The taxonomy for resource capacity planning and control decisions in health care.
Our taxonomy is intended for planning and control decisions within the boundaries of a health care delivery organization. Every health care organization operates in a particular external environment. Therefore, all planning and control decisions are made in the context of this external environment. The external environment is characterized by factors such as legislation, technology and social factors.
The nature of planning and control decision making is such that decisions disaggregate as time progresses and more information becomes available [ ]. Aggregate decisions are made in an early stage, while more detailed information supports decision making with a finer granularity in later stages. Because of this disaggregating nature, most well-known taxonomies and frameworks for planning and control are organized hierarchically [ , ]. As the impact of decisions decreases when the level of detail increases, such a hierarchy also reflects the top-down management structure of most organizations [ 39 ].
Strategic planning addresses structural decision making. It involves defining the organization's mission i. Inherently, strategic planning has a long planning horizon and is based on highly aggregated information and forecasts. Examples of strategic planning are determining the facility's location, dimensioning resource capacities e. Tactical planning translates strategic planning decisions to guidelines that facilitate operational planning decisions.
As a second step, the available resource capacities, settled at the strategic level, are divided among these patient groups. In addition to the allocation in time quantities, more specific timing information can already be added, such as dates or time slots. In this way, blueprints for the operational planning are created that allocate resources to different tasks, specialties and patient groups.
Temporary capacity expansions like overtime or hiring staff are also part of tactical planning. Examples of tactical planning are staff-shift scheduling and the cyclic surgical block schedule that allocates operating time capacity to patient groups. Following the tactical blueprints, execution plans are designed at the individual patient level and the individual resource level. In operational planning, elective demand is entirely known and only emergency demand has to be forecasted.
In general, the capacity planning flexibility is low on this level, since decisions on higher levels have demarcated the scope for the operational level decision making.
Offline operational planning reflects the in advance planning of operations. It comprises the detailed coordination of the activities regarding current elective demand. Examples of offline operational planning are patient-to-appointment assignment, staff-to-shift assignment and surgical case scheduling.
Online operational planning reflects the control mechanisms that deal with monitoring the process and reacting to unplanned events. This is required due to the inherent uncertain nature of health care processes. An example of online operational planning is the real-time dynamic re scheduling of elective patients when an emergency patient requires immediate attention.
Note that the decision horizon lengths are not explicitly given for any of the hierarchical planning levels, since these depend on the specific characteristics of the application.
The Future of Home Health Care
For example, an emergency department inherently has shorter planning horizons than a long-stay ward in a nursing home. Furthermore, there is a strong interrelation between hierarchical levels. Top-down interaction exists as higher-level decisions demarcate the scope of and impose restrictions on lower-level decisions.