Capacity Pooling in Healthcare Systems

Licentiate thesis, 2021

Healthcare systems are facing a continuously increasing demand for care while healthcare providers express a need for additional capacity. However, increased capacity in healthcare systems will not be a sufficient option in the near future, and previous research has found a need to improve healthcare capacity planning and management. Capacity planning is aggravated with the presence of variations in a system, and proactive and reactive tools for short-term flexibility in capacity management can be applied to cope with variations in both capacity and demand. One such proactive tool is a capacity pool, which is a general capacity that can be allocated to parts of the system where the temporary need for resources is unusually high.

The purpose of this thesis is to develop principles and guidelines for a capacity pooling system in the healthcare sector. A theoretical framework that describes the limiting effects of aggregated variations is modern portfolio theory, first originated in the finance sector. Portfolio theory is in this thesis used to demonstrate the effects on resource utilization when capacity is organized into capacity pools. The study object is Region Västra Götaland, a healthcare provider and multihospital system in Sweden. The approach of the research project has been systematic, using a mixed-methods approach with predominantly quantitative studies. An interview study, a questionnaire study and a literature review have been conducted to answer the research questions, resulting in three papers.

This research project has resulted in several findings which can be useful for healthcare managers when designing and implementing capacity pools. The results include examples on how portfolio theory could be used to design capacity pools, knowledge on the use of proactive and reactive tools for short-term flexibility solutions in healthcare capacity management, and perceived barriers to a capacity pooling approach in healthcare systems. Furthermore, the findings in the three papers contribute to the existing research in several ways. For example, previous studies have requested research with a holistic approach on capacity management in healthcare systems and have highlighted the importance of researching temporary capacity changes in healthcare. The research in this thesis has through a mixed-method systematic approach focused on capacity management in a multihospital system consisting of several healthcare providers, including all types of healthcare personnel, and has provided knowledge on the use of flexibility tools for managing variations in capacity and demand.