In 2018, we had the joint KU-University of Bath workshop at Bath University, thanks to the support of the Newton Fund.
Please see here for a list of all participants.
“Optimisation in Health Care Operations Management”
Prof. Erwin Hans
The agenda planning / block schedules of hospital departments greatly impact the pace in downstream departments. Improper alignment results in bullwhip effects: long access time for patients and highly fluctuating staff workloads. This presentation will present and discuss several models for predicting downstream research usage given the agenda planning / block schedule of a department. Also, we present optimization approaches that make use of the aforementioned forecasting models to optimize the integral patient flows in hospitals. Several of these models and techniques have been implemented and tested in Dutch hospitals. The presentation will also include an overview of our experiences herewith.
Check here for slides: Workshop 2018 (Erwin Hans)
“Hospital readmission reduction program does not provide the right incentives: Issues and remedies”
Tolga Tezcan, London Business School
CMS in the USA implemented the Hospital Readmissions Reduction Program (HRRP) to incentivize hospitals to reduce readmissions by penalizing hospitals with excess readmissions. Using a principle-agent model, we show that the financial incentive mechanism HRRP uses does not provide the right incentives for hospitals to reduce readmissions. Specifically, we show that, even when the risk adjustment issues are ignored; i) HRRP over-penalizes hospitals with excess readmissions, ii) penalty-only provision precludes overall reductions in readmission levels, and iii) having a penalty cap curtails the effect of financial incentives and may result in hospitals exerting no-effort to reduce readmissions. We then show that a bundled-payment type reimbursement mechanism, which has the same informational burden as HRRP, would result in hospitals exerting socially optimal cost and readmission reduction efforts. Finally we show that when capacity is limited and delays to access care are inevitable, the payment schemes need to provide additional incentives to hospitals to invest sufficiently in capacity.
Joint work with Hang Ren and Kenan Arifoglu
“Capacity Pooling in Hospitals: The Hidden Consequences of Off-Service Placement”
Associate Professor, Questrom School of Business, Boston University
Allocating inpatient bed capacity across various specialty services is a common challenge for hospital managers, particularly due to large variation in day-to-day demand within a service. In order to better manage the supply-demand mismatches between bed types and patient types, many hospitals engage in capacity pooling by assigning patients from a service with limited or no available beds to an available bed in a unit designated for a difference service. This “off-service placement” is a common occurrence in many hospitals, yet its effects are not well understood, perhaps because of the endogenous selection of off-service patients. In this paper, we study the effects of off-service placement on various patient and operational outcomes. Using data from a large academic medical center with 19.6% of patients placed off service on average, we use an instrumental variables approach to account for the endogeneity issues and find that off-service placement is associated with a 25.6% increase in remaining hospital LOS. We also find that off-service placement is associated with a higher likelihood of hospital readmission, in-hospital mortality, and clinical trigger (rapid response) events. We identify longer distances to the service’s home unit as a key mechanism that drives the effect on LOS. In contrast, a mismatch in nursing specialization does not explain this effect. Our work has important implications for theory and practice. Quantifying the effects of off-service placement on patient and operational outcomes can inform future models of patient flow and enable hospitals to make better informed decisions around capacity allocation and off-service placement.
Check here for slides:Workshop 2018 Anita Tucker
Erwin W. Hans is a Full Professor Operations Management in Healthcare at the University of Twente in the Netherlands. He has an MSc (1996) and PhD (2001) degree in Applied Mathematics, specializing in Mathematical Programming and Operations Research. Since 2003, his research focuses on the area of Healthcare Operations Management and Operations Research. In 2007 he co-founded the Center of Healthcare Operations Improvement & Research (CHOIR, https://www.utwente.nl/en/choir/), the leading Netherlands’ research center for OR/OM in healthcare. He works closely with several (university) hospitals in the Netherlands, and has studied many applications like the operating theatre, ICU, and radiology departments. His particular interest is the demand-driven integral planning of healthcare services. He is one of the initiators of CHOIR spin-off Rhythm, a company that brings the outcomes of CHOIR research into practice. He is a lecturer of Healthcare OR/OM courses at all academic levels, and for healthcare professionals. In 2015 he was awarded University of Twente’s best lecturer, and was runner-up in the national final in 2016.
Tolga Tezcan is an Associate Professor of Management Science and Operations at London Business School. He teaches courses in Data Mining and Business Analytics. Prior to joining LBS, he was a faculty member at Simon School of Business in University of Rochester between 2010 and 2015, and at University of Illinois at Urbana-Champaign between 2006 and 2010.
Tolga holds a PhD in Industrial and Systems Engineering and a MS in Math from Georgia Tech, a MS in Industrial and Systems Engineering from Colorado State-Pueblo, and a BS in Industrial Engineering from Bilkent University, Turkey. Tolga’s research focuses on the robust management of service systems, such as customer service centres and healthcare systems, under uncertainty. His research has appeared in leading journals such as Management Science, Operations Research, M&SOM, and Annals of Applied Probability and he serves on the editorial boards of Management Science, Operations Research, Stochastic Systems and MMOR. He has received the Career Award from National Science Foundation (NSF) of USA in 2010.
Dr. Anita L. Tucker is an Associate Professor at Boston University Questrom School of Business. She has bachelor’s and master’s degrees in Industrial Engineering and Operations Research, and a doctorate in Business Administration. She studies care delivery processes in hospitals with the goal of improving quality of care, efficiency, and patient experience. Her papers have been published in top operations management journals, such as Management Science and M&SOM. She has won awards for her research, teaching, and service.
19.30 – Welcome drinks and registration (at the Executive Education Suite, The Edge building)
20.00 – Buffet meal and introductions from Workshop organisers
21:30 – Close
- Outline of the Workshop aims and expectations
09:15-10.00 – Participant Introductions
- 2’ introduction each
10:00-10.15 – Coffee break
10:15-11:45 – Masterclass 1 (Prof Erwin Hans)
11:45-12:30 – Group work session 1
12:30-13:30 – Lunch
13:30-15:30 – Masterclass 2 (Prof Tolga Tezcan)
15:30-16:00 – Group work session 2
16:00-17:30 – Masterclass 3 (Prof Anita Tucker)
17:30-18:00 – Group work session 3 and closing plenary discussion
18:50 – Departure from bus terminal (very near the workshop venue) to Bath for dinner
19:30-later – Dinner at Bathwick Boatman.
09:00-9:30 – Introduction to the second day
- Setting the scene for the rest of the workshop including group presentations
09:30-12:30 – Group work
- Coffee breaks to be taken as the group decides
12:30-13:30 – Lunch
13:30-14.45 – Group work
14.45-16:00 – Plenary session
- Group presentations and closing remarks
16.00 – Workshop close