Operations Research for Hospital Efficiency and Effectiveness

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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. **