Managing performance of operating units

1
Managing performance of operating units

• Research Plan
• Antti Peltokorpi, MSc, Researcher, PhD candidate
• antti.peltokorpi_at_tkk.fi
• Helsinki University of Technology
• BIT Research Centre
• Institute of Healthcare Engineering, Management
  and Architecture

2
Measuring success in operating unit

• Depending on the system environment and internal
  requirements, typical measures for operating unit
  performance are capacity utilization,
  contribution to margin, and waiting time
• High personnel productivity can be seen as a
  shared enabling factor for all those measures
• Hi is working hours of profession i at the given
  period, dj is an average of duration of operation
  for operation type j, and Nj is a number of
  operations j at the given period.
• Cost-efficiency takes into account also
  additional costs due to delayed operations and
  overtime working
• ci is a hourly cost of work of profession i
  during office hours, x is a hourly cost of
  operating room overtime, O is a number of
  overtime hours, y is a cost of delayed elective
  operations, C is a number of delayed elective
  operations, w is a cost of delayed emergency
  operations, and D is a number of delayed
  emergency operations.

3
Production planning and control in operating unit
Decisions to be made
Production planning
Resource planning
Demand management
1. What operations to provide and in which
site? 2. How to design the operating unit
process layout? 3. What operations and how many
to perform during next 12 months? 4. How to
staff operating unit for the next 12 months? 5.
How to allocate resources to specialties for the
next 1-6 months? 6. How to schedule operating
room time blocks? 7. How to manage demand
and resources during the day of operation?
Master production scheduling
Detailed capacity planning
Detailed material planning
Capacity requirement data
Capacity and material plans
Shop-floor scheduling systems
(adapted from Vollmann et al.1997)
4
Managerial challenges varied depending on the
nature of surgical process
Decreasing unit costs
High
Emergency units
Multi-specialty regional hospitals
In terms of proportion of emergencies and number
of specialties
Increasing process definition
Process variety
Specialized elective hospitals
Local one surgeon providers
Low
Volume per unit
Low
High
In terms of number of operating rooms and
operations per year
(adapted from Johnston Clark 2005)
5
Research questions

• The primary research question in that licentiate
  thesis is
• How to manage productivity and cost efficiency in
  multi-specialty operating unit?
• The sub-questions related to primary problem are
• How productivity and cost efficiency can be
  forecasted in the planning phase?
• What is the effect of non-planned factors, such
  like personnel absence and variation in emergency
  load, to productivity and cost efficiency?
• How the cost efficiency is consisted of the
  decisions in the surgical services management
  process?
• How operations and resources should be planned so
  that productivity and cost efficiency are
  maximized?

6
Research process

• Primary case study Jorvi Hospital
• Considering daily productivity and
  cost-efficiency
• How decisions in the planning phase reflect on
  the daily performance?
• Path-analyses and regression analyses about
  factors affecting on daily performance
• Secondary case studies Unfallkrankenhaus Berlin,
  Päijät-Häme Central Hospital, Department of
  Gynecology, Kaiser Permanente (?), Sutter Health
  (?)
• How the results from Jorvi case can be
  generalized to other operating units?

7
Example of data analysis

• Regression analysis How the decisions in the
  planning phases reflect on the daily performance?

Personnel absence
Standby personnel
Overutilized OR time
Allocated OR time
Planned personnel
Realized personnel
Realized costs
Planned productivity
Estimated productivity
Realized productivity
Cost efficiency
Planned staff intensity
Estimated OR utilization
Planned operations
Estimated operations
Realized operations
Cancelled cases
Estimated emergency load
Emergencies from previous days
Emergencies on the day of surgery
Delayed elective and emergency cases
Additional care costs
Load from previous days
Changes on the day of surgery
Planning and estimating
Performance