Operations Research for Hospital Efficiency and Effectiveness

该研究计划的总体目标是提高医院管理的运筹学和管理科学的最新水平。在这种情况下，效率是指对经营医院所需的各种资源的利用，例如医生、护士、专职卫生专业人员、技术人员、护理员、工作人员；有效性指的是医院系统在成本、护理质量、获得护理和健康结果方面的整体表现。效率和有效性的改进涉及多个利益相关者、多个目标、各种约束，因此需要进行许多困难的权衡。这构成了具有挑战性问题的温床，其中许多问题目前正在由医院管理人员根据经验和直觉加以解决。运筹学和工业工程构成了方法论领域，通过开发可靠的分析框架、决策支持工具和管理见解，我们可以从中受益，改善目前的医院管理实践。***在这笔赠款期间，我们将调查有关医院效率和效益的三个具体问题：(i)将医院出院流程与社区护理相结合，（ii）医院住院能力的战术管理，以及（iii）住院病房的业务管理。尽管临床环境（包括医院类型和患者的疾病状况）会对最终数学模型的细节产生影响，但我们的目的是努力开发一个通用的建模框架，使我们能够获得普遍适用的管理见解。鉴于我们计划研究的问题的时间依赖性，模拟、随机动态规划和马尔可夫决策过程构成了我们计划详细讨论的建模工具包。我们将开发近似动态规划算法或采用分解方法和元启发式框架来解决出现的大规模数学公式。***我们计划调查的具体问题包括精神病患者从急症护理设施到具有不同监管水平的住房单位的过渡（第（一）项），非服务病房分配对医院整体绩效的影响（第（二）项），以及基于实时模拟的外科病房操作优化方法的开发（第（三）项）。我们在这三个研究领域的合作伙伴分别是道格拉斯医院、蒙特利尔总医院和犹太总医院。特别是，第三个关于操作决策的研究流将利用实时定位系统（RTLS）进行，该系统现已安装在JGH的两个外科病房，感谢向申请人提供的CFI资助。**

The overarching objective of this research program is to improve the state of the art in operations research and management science for hospital management. In this context, efficiency refers to the utilization of the variety of resources that are required for running a hospital e.g., physicians, nurses, allied health professionals, technicians, orderlies, staff; and effectiveness refers to the overall performance of the hospital system in terms of the cost, quality of care, access to care and health outcomes. The improvement of efficiency and effectiveness involve multiple stakeholders, multiple objectives, a variety of constraints and hence, a number of difficult trade offs. This constitutes a hotbed of challenging problems many of which are currently being tackled by hospital administrators based on experience and intuition. Operations research and industrial engineering constitute methodology domains from which we can benefit in improving the current practice of hospital management by developing solid analytical frameworks, decision support tools and managerial insights. ***During the period of this grant, we will investigate three specific issues concerning hospital efficiency and effectiveness: (i) integration of hospital discharge processes with community-based care, (ii) tactical management of the inpatient capacity in a hospital, and (iii) operational management of inpatient wards. Although the clinical context, including the type of hospital and the patient's disease condition, would have an impact on the specifics of the resulting mathematical models, our intent is to strive for the development of a generic modeling framework that would enable us to derive generally applicable managerial insights. In light of the time-dependent nature of the problems we plan to study, simulation, stochastic dynamic programming and Markov decision processes constitute the modeling toolkit we plan to dwell on. We will develop approximate dynamic programming algorithms or adopt decomposition methods and meta-heuristic frameworks for solving the arising large-scale mathematical formulations.***The specific problems we plan to investigate include the transitioning of mentally ill patients from acute care facility to housing units with varying levels of supervision (under (i)), the impact of off-service ward assignments on the hospital's overall performance (under (ii)), and the development of real-time simulation based optimization methods for the operation of surgical wards (under (iii)). Our partners for these three streams of research are the Douglas Hospital, Montreal General Hospital and Jewish General Hospital (JGH), respectively. In particular, the third research stream on operational decisions will be carried out utilizing the real-time location system (RTLS) that is now installed at two surgical wards of JGH, thanks to a CFI grant to the applicant. **