Operations Research in Healthcare industry

IntroductionOperational Research is the scientific study of operations for the purpose of making better decisions.It is a discipline that deals with application of advanced analytical methods to facilitate better decisions.It represents the study of optimal resource allocation.In simple terms, it is described as the science of betterNow a days the principles and techniques of Operational Research are being applied in every field of human research and development

HISTORYOperational Research has been existed as a science since 1930s.But as a formal discipline Operational Research originated by the efforts of military planner during World War IIThe analytical study of military problems was undertaken to provide scientific basis for decisions to improve military operations.In the decade after World War-II the techniques began to be applied more widely in problems of business, industries and societiesSince the time Operational Research has expanded into a field widely used in industries ranging from petro- chemical to airlines, finances, logistics and government.Now it has become an area of active academic and industrial researchThe techniques of Operational Research have been applied and proven in many industries under different names. For instance :- - Lean in manufacturing. - Supply Chain in logistics and - Yield Management in airlines.

OBJECTIVES OFOPERATIONAL RESEARCHDecision making and improve its quality. Identify optimum solution.Integrating the systems. Improve the objectivity of analysis.Minimize the cost and maximize the profit.Improve the productivity.Success in competition and market leadership.

Introduction of Operation Research in HospitalsAncillary services such as those provided by logistics seem simple and straight forward, yet their role is often overlooked by hospitals. Recent studies indicate that logistics-related activities impact significantly on the quality of health care as well as on hospital costs.Hospital logistics contributes to the provision of care to patients by ensuring that all required services and resources are delivered at the right time.Operations Research provides methodologies to support the logistical operations of hospitals and assist in process optimization.Operations Research (OR) provides a wide range of methodologies that can help hospitals and other health care systems to significantly improve their operations. At the same time, many of the complex problems presented by the health care sector also foster the development of new OR methodologies.

What are Operations Research Technologies?There are manyways in which management science and Operations Research can use information to study and improve business processes. Foremost amongst a range of techniques that we use are those of discrete-event simulation and systems optimization.Discrete-event simulationDiscrete-event simulation is particular suited to the representation of hospital services, because of its ability to reflect the non-steady stat behaviors that typify clinical demand. As its name suggests, discrete-event simulation treats each arrival, usually that of a patient, into a model of a hospital system as a specific individual and records the experiences of that particular individual as he or she passes through the processes within the model. In this way, the queues and associated delays that occur at times of peak demand are clearly revealed, in precise statistical terms. An accurate picture emerges of the extremes of system performance in a way that does not occur with more commonly used modeling techniques that use averaging methods. Discrete-event simulation is the best way to understand the effects of the peaks and troughs of clinical demand.Systems optimizationComputer based optimization techniques enhance the value of outputs from a discrete-event simulation model. They allow you to define a performance target and then perform an automated sequence of simulation experiments that, with each successive iteration, through a methodical adjustment of the key dependent variables, converge upon the optimal settings for the system. The newly optimized set of operating parameters may now be implemented in real life.

Applications of Operations Research in Health Care:The field of health care has traditionally provided a broad range of applications suitable for analysis using Operations Research (OR) techniques. Most of the historical applications were either motivated or were a consequence of the burdens new medical technologies pose on complex health care delivery systems. However, as medical technology progresses further, the spectrum of possible OR applications is only going to become broader and more exciting. In fact, the recent explosion of technological innovations in health care, which has been fuelled by new knowledge and information, has been matched by renewed interest among OR scholars. Some Operations Research application areas in health care are:-Personalization of therapies based on advanced medical information. -Optimization of new or existing medical technologies to meet either a specific clinical goal or a specific system goal. -Management and optimization of health care operations. -Resource allocation problems in health care.

The decision technologies, tools and theories of Operations Research and Management Sciences have long been applied to a wide range of issues and problems within health care. Broad Areas of Operations Research Application:Health Care Operations Improvement:-Scheduling and workforce planning -Inventory management -Supply chain management-Logistics planning and modeling -Equipment planning, -Planning-Facility location and layout-Workforce & workload models-Decision support systems -Performance measurement & modeling -Queuing models-Quality management Economic Analysis: -Equipment evaluation & selection models -Optimal pricing and costing models-Demand forecasting and planning models -Impact of policies on health care demand -Technology assessment. Public Policy: -Regional planning and network models -Access and availability population models -Technology diffusion models-Disease prevention -Health care coverage -Vaccine modeling -Organ allocation models -Disease screening -Resource allocation -Drug policies -Blood supply management policies Clinical Applications: -Risk assessment and analysis -Clinical diagnosis and decision making -Decision support systems -Disease modeling (individual level)-Treatment design and planning -Drug selection models-Optimal dosing models -Vaccine models-Clinical qualitiesIn the context of material and patient flows, hospital logistics and OM provide a broad range of applications suitable for analysis using OR techniquesAn area that has received considerable attention among operations researchers is workforce scheduling, and in particular, nurse roistering. The problem of constructing work timetables for nurses to cover fluctuating demand requirements is extremely difficult. The rosters must satisfy work regulations, distinguish between permanent and casual staff, assign suitably qualified nurses, distribute night and weekend shifts equitably among nurses, allow for leave and days, and accommodate a range of employee preferences.Despite the vast body of literature on production planning and inventory control, the translation of well-known practices into the hospital environment is not as widespread as might be hoped. Purchasing, distribution, and inventory management of medical supplies could greatly benefit from ORNeed of Operation research in Health care industryGlobal health challengesWe now look at some key generic challenges that arise in global health and consider how operational research and management science can contribute to each.

Global health challenges for operational research and management science

Identifying problemsOperational research methods are useful for the systematic identification of problems and the search for potential solutions. Structured approaches to identifying options, such as the strategic choice approach23or systematic creativity approaches.New approaches are important for global health because strategies and programmes must be designed to deal with both current and future challenges from the global spread of disease to the impact of climate change. This can sometimes take us beyond traditional forecasting methodologies to the use of scenario analysis and other futures thinking methods.

Choosing interventionsChoosing appropriate interventions is clearly a crucial step. Effectiveness, safety, cost and equity should all be considered and researchers will be familiar with standard text-book methods for assessing these. But, in reality, assessments are rarely straightforward. It is often more effective and efficient to combine interventions, or to treat more than one disease at a time. For example, the integration of treatments for different diseases into cost-saving combined packages. Finding the best combinations and delivery methods is a major research exercise in its own right. Modelling different intervention strategies before roll-out is now ubiquitous in many industries but is less common in health care.Combining this approach with the necessary field and pilot studies should speed up and focus efforts. Modelling work has been done on ways to reduce maternal mortalityand in cervical cancer screening in low-resource settings.

Introducing new interventionsInnovation is a key issue in global health. For instance telemedicine is increasingly being used in high-income countries, and beginning to be applied in middle- and low-income countries, enabled by the rapid global spread of mobile phone networks. However, many such applications in developing countries are not evaluated so there is a clear role for operational research to assess them and to improve their design and deliveryThe contribution that operational research and management science can make to design and delivery is not restricted to high technology. Oral rehydration therapy is a low-techlow-costhigh-impact innovation in which operational research was used to explore ways it could be administered at low cost using readily available ingredients by lay people, with an escalation pathway to treatment by health-care professionals when necessary.

Scaling-upSmall-scale projects generally need considerable modifications to work on a larger scale. For example, we need to understand better what happens when whole countries are treated with drugs or vaccines. Such upscaling includes a need to forecast future demand, to decide the location and size of facilities and to set staffing levels. Classic operational research techniques such as simulation modelling can be used in locating services, managing the pharmaceutical supply chain and developing the health care workforce.

Improving patient flows through Operations ResearchHospitals are complicated places. Every day they must face the problem of how best to meet complex, often rapidly changing clinical demands with the finite resources that are actually available to them. Unlike many manufacturing and service industries, few hospitals can draw upon the proven capabilities of Operations Research based technologies to guide them with capacity planning and with their daily operations.At Hospital Navigator we study the logistics of hospital services. We use management science and Operations Research techniques to enable hospitals to treat patients better, to meet performance targets and yet contain costs.

Opportunities for Operations ResearchOR has a long history of successful application of advanced analytical methods to help make better decisions in many industrial sectors Although health care OR is not a new field the number and impact of OR applications lag behind other service industries. Often, decision-makers claim that health care systems, and in particular hospitals, pose rather complex and dynamic problems compared to those faced by other service industries, thereby hindering the successful application of OR tools. However, complex processes also arise in industrial settings and many OM concepts and OR methodologies have been successfully developed to tackle them. Naturally, it is necessary to identify their applicability to meet the specific conditions encountered in hospitals.

ConclusionHospitals are under increasing pressure to reduce unnecessary costs while improving the quality of the care they provide to patients. There is much room for OR to improve resource management and thus making supply meet demand for care adequately. A fundamental requirement for the successful application of OR techniques is a basic understanding of the core hospital processes and the way in which they use resources. There are many protocol-based care pathways for patients with a given clinical profile that define the expected steps to be followed by such patients. However, these protocols are often clinically focused and ignore the interactions between processes and the use of resources.Operational Research needs to be integrated as an essential part of monitoring and evaluation efforts in Public Health.Thus concept of MORE could become a new paradigm for enhancing the practice of integrated monitoring and evaluation dimensions as one common component into program management system.