Planning and Control of Healthcare Services

Licentiate thesis, 2011

The focus of this study is on the planning of the production of healthcare services for the group of patients in need of surgical treatments. The aim of the thesis is to contribute to the understanding of how planning and control of healthcare services impacts patient waiting time. The theory that is used in the research is drawn from the manufacturing industry, both regarding the design of the production planning system and the conditions of the environment in which the planning system is operating. The thesis consists of a collection of three papers, each paper reporting the results of one study. All three studies provides results that contributes to the understanding of how planning and control impacts patient waiting time. The first study is concerned with the actual planning processes made at a surgery department. The study uses the structure and content of the general hierarchical planning and control system often used in the manufacturing setting. By comparing this general system to the design of healthcare planning systems, areas are identified in which the planning system of a surgery department could benefit from using a more comprehensive design. The results of the study reveal four main areas in which the general planning and control system could contribute to the planning system of the surgery department. These areas are the planning perspective of the planning process, the balance of planning focus between upper and lower planning levels, the integration between planning levels, and the use of planning tools that supports the awareness of the patient demand for healthcare services. The second study treats the quality of data that is used in the scheduling of surgeries. Two methods of estimating the surgery time is compared and assessed. The result shows that an estimating system based on historical data provides more accurate surgery time estimates than an estimating system based on the surgeon’s experience. However, the results indicate that the surgeons are able to identify surgeries that are likely to require considerable longer surgery time than the same procedure with the same surgeon would normally take. The third study concerns both the planning process and how the conditions of the planning environment affect the performance of the planning processes. The study concerns the control of the execution phase when organizing resources according to the cellular manufacturing principle at the emergency department. The results show a decrease in patient throughput time when following this principle, implemented by organizing the personnel resources in teams. The time a patient is waiting for the first medical evaluation by the doctor was also decreased.