Healthcare Systems Management: Methodologies and Applications

Performance management of hospital systems has become extremely crucial due to increasing demand for healthcare services as well as higher expectations in terms of patient satisfaction. There are mainly two different aspects of a hospital system performance, viz. clinical and operational. While the former deals with the effectiveness and appropriateness of treatment, the latter one deals with the proper functioning of the day-to-day operations in a hospital system. For various facilities in a hospital, prior appointments are required to receive the requested service (treatment or investigation). This paper deals with appointment scheduling, which is one of the aspects of improving the operational performance of a hospital system. An example of an MRI department is presented to illustrate the effect of implementing appropriate appointment scheduling rules in an appointment-based hospital system. The trade-off between waiting times of patients and the utilization of the MRI machine is considered for performance analysis.

The increased importance of the healthcare sector over the last two decades and current concern over productivity growth have stirred interest in productivity and efficiency measures in this expanding sector of the economic system. Productivity in economic position is determined as the relation between output and input. Productivity concept in manufacturing is analysed in the scope of the organization, but in the service sector like in hospital, this arena is larger and needs an external portion of the organizational position as patients. This paper deals with the measurement of efficiency and productivity growth of the hospital systems. To measure productivity and efficiency of an Indian hospital system, the Malmquist productivity index is applied, based on the data envelopment analysis (DEA). The efficiency and productivity of several departments of the given hospital are analysed and the improvement alternatives also identified.

Trauma has a huge impact on the society and the economy. Large distances between the various human settlements in Queensland are a major challenge for the delivery of desired trauma care. In addition, health care budget has been struggling due to staggering costs. An integrated trauma management system (ITMS) is expected to maximise the appropriate and judicious use of available resources and deliver best possible services within budget constraints. A limited number of researches have been conducted to identify resource constraints and effective diversions for trauma cases in remote parts of Queensland. ITMS proposed in this paper covers activities, events and persons involved in trauma management. It analyses the impact of resource constraints and diversion rules for effective trauma care. Pre-hospital data are used for developing a process map. Simulation using Queensland scenarios assumed patients arrivals following the referral from regional/remote hospitals to regional trauma centres and to major trauma centres. Time stamps are used for the development and analysis of a simulation model using probabilistic approach for time to definitive care and patient outcomes. ITMS is able to further enhance quality of strategic planning. It can be extended to real time decision-making for better healthcare and reducing delays for arriving at definitive care. It is expected to further improve clinical outcome and transform the existing healthcare system into a more efficient, cost-effective and high quality healthcare service to the people living in remote areas.

Radiology is one kind of diagnostic imaging technology for early diagnosis and prevention of disease that employs X-ray ionizing radiation for imaging of anatomical structure inside the body. The X-ray beam passing through the body gets attenuated by a varying degree depending upon the bone density, soft tissue content, muscle, water content, etc., inside the body and the transmitted X-ray beam is used to form an image of anatomical structure inside the body. At present, around 90,000 X-ray machines are in operation in India. In order to ensure safety of personnel involved in operation of different types of diagnostic radiology equipment as well as safety of the members of public, Atomic Energy Regulatory Board (AERB) exercises the powers conferred by the Atomic Energy Act, 1962 in India. The Mission of AERB is to ensure that safe use of ionizing radiation and nuclear energy in India does not cause any undue risk to the health of people and the environment. AERB issues different types of consents like registration, license for operation of diagnostic radiology facility. Before issue of consent, detailed reviews are carried out, and consent is issued for a specific period of time. Regular, special or surprise inspections are also carried out for verification of radiological safety status in diagnostic radiology facilities. Chairman, AERB, is the competent authority under the Atomic Energy (Radiation Protection) Rules, 2004 and issues time to time directives and notifications prescribing dose limits, radiation warning symbol, etc. AERB publishes several safety related documents like codes, guides, and standards for effective regulation of stakeholders like manufacturers, suppliers, service agencies, and users of diagnostic radiology equipment in the country. It is mandatory to obtain license/registration from AERB for operation of diagnostic radiology equipment. In order to strengthen and streamline the process, AERB has launched a web-based application named e-Licensing of Radiation Applications (e-LORA) for automation of regulatory process. With the increasing number of diagnostic radiology facilities in today’s scenario, effective regulatory control is a challenging task. This paper brings out different modalities of effective and efficient regulation of diagnostic radiology facilities of the country, detailing on the varied experiences acquired in the process, as well as preparedness of the regulatory body in meeting up with the challenges in future.

Tata Main Hospital (TMH), Jamshedpur is a 920-bedded hospital of Tata Steel providing free health care to employees and their families. It is a referral centre for others who pay for services. In the past 20 years, the hospital has moved from unstructured, random quality improvement projects to implementing international and national quality standards like ISO and NABH. As part of Tata Steel, the hospital introduced QIP and VE projects in 1992. In 1995, the JN Tata Excellence Model was rolled out. The hospital was certified to ISO 9001: 2008 in 2010. Subsequently, it adopted policy and daily management with formulation of ABP (Annual Business Plan) and cascaded these as departmental KPIs (key performance indicator). NABH standards were implemented in National Accreditation Board for Hospital and Healthcare Providers (NABH) (Accreditation standards for hospitals (3rd ed) 2011). The ISO and NABH standards were integrated with the daily management and healthcare protocols were developed. These were implemented in all work areas, administrative and clinical. To provide a strong base to the integrated system, document control was on LAN. Monitoring was through structured internal audits and a formal review mechanism. TMH achieved ISO certification in 2010 and recertification in 2016. NABH pre-accreditation certification was obtained in April 2016. A total of 42 quality parameters are reviewed through the integrated system and many of these have shown significant improvement over the years (morbidity, wait time, and satisfaction-related data). Through an integrated approach to quality, Tata Main Hospital helped to set up an improvement cycle with focus on patient satisfaction, quality of health care and cost. Improvement has been recorded on all three perspectives.

In today’s fast world owing to advancement in medical technology, health care has become one of the most striking application areas for the Internet of Things (IoT). There is a huge competition in building up high-speed healthcare services. The IoT has the perspective to offer many medical applications such as remote health monitoring, elder care, and chronic diseases especially heart disease monitoring and emergency support for the needy people. The study suggests a system that will improve the performance of health care even in the rural areas. Tracking patient’s location, sensing parameters like blood pressure, glucose, breathing rate and automatic data collection, and analysis of the data will take the IoT to the next level of healthcare applications. State-of-the-art IoT healthcare system built with Decision Support System (DSS) will definitely help the patients and doctors in critical conditions. Proposed work targets Ischemic Heart Disease (IHD) with IoT application.

In a healthcare system, predominantly in hospital systems, varieties of patient with distinct medical condition visit in search of care and treatment. A typical multispecialty hospital system consists of various departments like cardiology, neurology, gynecology, ophthalmology, etc., for the treatment of various patients with various medical conditions ranging from less critical conditions like fever, infections, fracture, etc., to extremely critical conditions like ischemic heart diseases, chronic obstructive pulmonary disease, urinary tract infection, etc. Thus, a hospital system with various departments/specialties appoints various specialized physicians in each domain, and maintains large quantity and variety of physician preference pharmaceutical products in the hospital inpatient pharmacy unit for both scheduled and emergency patients. Depending on the medical condition of patients and specialty, inpatient pharmacy maintains inventory of set of medicines, such as medicines acting on the respiratory tract, cardiovascular medicines, medicines affecting blood, anesthetics, analgesics/antipyretics, anti-allergics and medicines used in anaphylaxis, antidotes, anti-infective items, plasma substitutes, dermatological medicines, diuretics, gastrointestinal medicines, vitamins and minerals, medicines acting on ear, nose and oropharynx which are dispensed to wards, operating theaters, critical care units, and other department within the hospitals. Based on the timeliness of administering the medicines, the set of medicines are classified with the characteristics that the patients requiring medicines without any delay are the most critical patient and so on. Therefore, depending on the criticality of patient condition and specialty/department, set of medicines are classified. The number of patients in a hospital unit at a particular time and their medical condition and reaction to treatment during their length-of-stay is random and changes with time, so the demand of required medicines is stochastic and highly uncertain. Thus, the classification of medicines helps in determining the demand pattern and distribution of each classes and the corresponding inventory strategy for them in order to optimize the hospital inpatient pharmacy inventory so that right quantity of medicines are available at right time considering the constraints and conditions of a typical hospital system. Thus, the characteristics, such as arrival rate, transferal and discharge rates, demand distribution, list of medicines, their administration time, etc., need to be analyzed for which relevant data are collected through observations, hospital information system records and discussion with expert medical personnel and hospital administration of a multispecialty hospital in India. The purpose of the paper is to introduce the applicability of classification of pharmaceuticals based on the patient medical condition within the environment of a hospital inpatient pharmacy for improving the performance of inventory management system in hospitals.

In recent times, it is essential, for any products or systems, to apply ergonomic principles in their human–machine interactions for enhancement of system performance with negligible or very less negative effect of human work on human health. The workers in hospitals, loading and unloading the stretchers with patients into an ambulance, may face a number of health-related problems like musculoskeletal disorders, back injuries, etc. For eliminating these types of problems, researchers and practitioners have proposed several approaches addressed by the difficulties and health disorder faced by the workers to study on ergonomic improvement of patient transfer to the ambulance and other places. We need to critically appraise these approaches. In this paper, the details of these approaches being recommended for healthcare service delivery system have been discussed and critically appraised.

The problem of both under stock and over stock of blood due to seasonal variations in blood requirements is a serious problem affecting any blood distribution system in India and other countries. There may be lack of coordination between blood banks and its supply system. In this context, supply chain management may assume a significant role and has attracted serious research attention over the past few years. A literature review reveals a considerable spurt in research in theory and practice of SCM. An integrated supply chain and distribution system as an extended enterprise is to be developed for addressing the problems related to mismatch between supply and demand of blood stocks at a particular period of time with respect to a given population of patients in a location. This paper presents a model wherein the blood stocks are redistributed from one blood bank to another with the assurance of meeting the minimum level demand at emergency situation avoiding stockout situation. Demand has been estimated and forecasted considering the seasonality and trend factor in account. In this model, the blood banks considered are clustered using k-means clustering technique based on the distances between the blood banks. The blood banks with excess of stock, considered as centroid, are to distribute the excess stock to the blood banks with scarcity. The main objective of the paper is to determine the stocking rules of blood so as to reduce the wastage of the blood units and reducing the scarcity at demand points.