Choice of Models for the Analysis and Forecasting of Hospital Beds

There is growing concern that current health care services are not sustainable. The compartmental flow model provides the opportunity for improved decision-making about bed occupancy decisions, particularly those of a strategic nature. This modelling can be applied to complement infrastructure and workforce-planning methods. Discussion about appropriateness of the level of model complexity, the degree of fit and the ability to use compartmental flow models for generalization and forecasting has been lacking. The authors investigated model selection and assessment in relation to hospital bed compartment flow models. A compartment model for a range of scenarios was created. The training and test data related to the 1998 and 1999 calendar years, respectively. The majority of scenarios tested were based upon commonly used periods that describe periods of time. The goodness-of-fit achieved by optimisation was measured against the training and test data. Model fit improved with increasing complexity as expected. The analysis of model fit against the test data showed that increasing model complexity did result in over-fitting, and better prediction was achieved with a relatively simple model. In terms of generalisation, the seasonal models performed best. Single day census type models, which have been used by Millard and his colleagues, were also generated. The performance of these models was similar, but inferior to that of the models generated from a full year of training data. The additional data make the models better able to capture the variation across the year in activity.

The quest for customer focus

Companies have poured enormous amounts of money into customer relationship management, but in many cases the investment hasn't really paid off. That's because getting closer to customers isn't about building an information technology system. It's a learning journey-one that unfolds over four stages, requiring people and business units to coordinate in progressively more sophisticated ways. The journey begins with the creation of a companywide repository containing each interaction a customer has with the company, organized not by product, purchase, or location, but by customer. Communal coordination is what's called for at this stage, as each group contributes its information to the data pool separately from the others and then taps into it as needed. In the second stage, one-way serial coordination from centralized IT through analytical units and out to the operating units allows companies to go beyond just assembling data to drawing inferences. In stage three, companies shift their focus from past relationships to future behavior. Through symbiotic coordination, information flows back and forth between central analytic units and various organizational units like marketing, sales, and operations, as together they seek answers to questions like "How can we prevent customers from switching to a competitor?" and "Who would be most likely to buy a new product in the future"? In stage four, firms begin to move past discrete, formal initiatives and, through integral coordination, bring an increasingly sophisticated understanding oftheir customers to bear in all day-to-day operations. Skipping stages denies organizations the sure foundation they need to build a lasting customer-focused mind-set. Those that recognize this will invest their customer relationship dollars much more wisely-and will see their customer-focusing efforts pay offon the bottom line.

Knowledge logistics as an intelligent service for healthcare

OBJECTIVES

The technology of grid services is developing fast. This paper presents an approach to the implementation of an intelligent grid service that configures a hospital taking advantage of the knowledge logistics idea.

METHODS

The presented approach is based on synergistic integration of knowledge acquired from distributed sources in order to obtain new or complement insufficient knowledge. Presented approach uses ontologies and the formalism of object-oriented constraint networks for knowledge representation and applies ILOG to constraint-based problem solving.

RESULTS

The application of the approach is illustrated via a decision support system for a fictitious case study of a hospital configuration in the Binni region. The system showed the ability to produce interrelated solutions for subtasks of the hospital configuration task based on the built ontology and input parameters. Besides, such preferences as cost or time minimization are also considered by the implemented fuzzy logic module that finds a feasible solution.

CONCLUSIONS

KL would benefit from the grid, and particularly from the concept of a semantic grid. The scalable architecture of the approach enables its extension with regard to knowledge/information sources number and, thereby, with regard to factors taken into account during complex problem solving. Utilizing ontologies allows integration of the approach into existing processes and facilitates knowledge sharing with similar systems. Application of constraint networks allows rapid problem manipulation and usage of such existing efficient technologies as ILOG.

Information technology strategic planning: art or science?

It had been almost a decade since the hospitals that make up the Daughters of Charity Health System (DCHS) had engaged in a formal information technology strategic planning process. In the summer of 2002, as the health system re-formed, there was a unique opportunity to introduce a planning process that reflected the governance style of the new health system. DCHS embarked on this journey, with the CIO initiating and formally sponsoring the information technology strategic planning process in a dynamic and collaborative manner The system sought to develop a plan tailored to encompass both enterprise-wide and local requirements; to develop a governance model to engage the members of the local health ministries in plan development, both now and in the future; and to conduct the process in a manner that reflected the values of the Daughters of Charity. The DCHS CIO outlined a premise that the CIO would guide and be continuously involved in the development of this tailored process, in conjunction with an external resource. Together, there would be joint responsibility for introducing a flexible information technology strategic planning methodology; providing an education on the current state of healthcare IT, including future trends and success factors; facilitating support to tap into existing internal talent; cultivating a collaborative process to support both current requirements and future vision; and developing a well-functioning governance structure that would enable the plan to evolve and reflect user community requirements. This article highlights the planning process, including the lessons learned, the benchmarking during and in post-planning, and finally, but most importantly, the unexpected benefit that resulted from this planning process.

Finnish stakeholder engagement in the restoration of a radioactively contaminated food supply chain

An expert group was established in 2001 representing various organisations and authorities responsible for primary production, food processing, the distribution and consumption of foodstuffs, food safety and availability, catering and extension services, nature conservation, research into environmental impacts, and the media. The aim was to strengthen networking and improve the stakeholder response to accidental radioactive contamination of rural areas through participation in the FARMING network project. A hypothetical contamination of a large milk-producing area provided a suitable framework for evaluation of actions ensuring clean feeding of dairy cows during grazing. The following year the group received a compilation of rural countermeasures and waste disposal methods, described by the STRATEGY project. The robust, uncomplicated approach of the evaluation meetings was fruitful and efficient, and the multidisciplinary group was capable of taking shared views on various measures after updating their knowledge together. High priority was given to measurements of radioactivity and the provision of information and advice to a wider audience.

Impact of an Electronic Meeting System on the Group Decision-Making Process

Traditional face-to-face meetings are effective for many meeting formats; however, there are occasions when communication needs to be conducted in a more open, anonymous style. When the discussion centers on controversial and/or emotional issues, such as curriculum planning, the need for a nontraditional style may even be greater. Our nursing program decided to utilize a new campus resource called the Group Decision Center to facilitate undergraduate curriculum planning. The Group Decision Center is an electronic meeting system in which the discussion takes place in a face-to-face electronic format. The advantages of an electronic meeting system format include participant anonymity, equal and increased participation by group members, increased productivity and efficiency, automated record keeping, group synergy, and a more structured meeting. The disadvantages include the potential for inappropriate or hostile conversations, loss of acknowledgment for individual idea generation, breakdown of linear conversation, and lack of the nonverbal communication that often influences the meaning within a traditional conversation. The process of developing, planning, and participating in the electronic meeting and the automated record are discussed.

The planning cycle

Information technology planning can be described as a continuous cyclical process composed of three phases whose primary purpose is optimum allocation of scarce resources. In the assessment phase, planners assess user needs, environmental factors, business objectives, and IT infrastructure needs to develop IT projects that address needs in each of these areas. A major goal of this phase is to develop a broad IT inventory. The prioritization phase seeks to ensure optimum allocation of scarce resources by prioritizing ITprojects based on: Costs--total life cycle costs. Benefits--both quantitative and non-quantitative, including support for the organization's strategic business objectives. Risks--subjective assessments of technological and non-technological risks. Implementation requirements--time and personnel requirements to implement the system. The scheduling phase incorporates sequencing considerations, personnel availability, and budgetary constraints to produce an IT plan in which project priorities are adjusted to meet organizational realities.

Stakeholder involvement facilitates decision making for UK nuclear accident recovery

The importance of major stakeholders participating in the formulation of strategies for maintaining food safety and agricultural production following a nuclear accident has been successfully demonstrated by the UK 'Agriculture and Food Countermeasures Working Group' (AFCWG). The organisation, membership and terms of reference of the group are described. Details are given of the achievements of the AFCWG and its sub-groups, which include agreeing management options that would be included in a recovery handbook for decision-makers in the UK and tackling the disposal of large volumes of contaminated milk, potentially resulting from a nuclear accident.

Ontology-based knowledge repository support for healthgrids

Healthgrids unite a large amount of independent and distributed organisations to provide for various healthcare services. Often the involved organisations can belong to different areas of healthcare and even different countries. However to achieve efficient operation they have to act in a well coordinated manner. As a result, an efficient knowledge sharing between multiple participating parties of the healthgrid is required. The paper describes application of an earlier developed ontology-driven KSNet (Knowledge Source Network) - approach to knowledge repository support for healthgrids. This approach is based on representation of knowledge via ontologies using formalism of object-oriented constraint networks. Such representation makes it possible to define and solve various tasks from the areas of management, planning, configuration, etc., by using constraint solving engines such as, for instance, ILOG or CLP. The major discussed aspects cover the formalism of knowledge representation via ontologies and implementation of the approach as a decision support system for a case study from the area of health service logistics.

Successful strategic planning: creating clarity

Most healthcare organizations have a strategic plan of some kind. Many of these organizations also have difficulty translating their strategic plan into specific actions that result in successful performance. In the worst cases, this can jeopardize the viability of the organization. The trouble lies in a lack of clarity in what a strategic plan is and what it should do for the organization. This article will answer key questions such as: What is strategy and how does it fit with other commonly used constructs such as mission, vision, and goals? What criteria can be used to determine if something is truly strategic to the organization? What are the phases of the strategy lifecycle? How do approaches for dealing with uncertainty, such as scenario planning, fit with organizational strategic planning? How can a meaningful IT strategy be developed if the organization strategy is lacking? What principles should guide a good IT planning process?

The development and implementation of a strategic and tactical planning framework at Mayo Clinic Arizona

This article describes the Mayo Arizona process for developing an information technology strategic plan. The background of organizational events that gave rise to this strategic planning process is presented. A cross-functional team of key IT stakeholders was convened; the team used a facilitated process to derive a pro forma set of IT strategic objectives from the larger organization's emerging strategic plan. A broad set of leadership interviews was conducted to further identify detailed objectives that would confirm, complement, or conflict with the "strawperson." The IT strategic objectives then were refined and published by the organization. The article also describes the annual process of reviewing the IT strategic plan and translating it to a set of tactical objectives. This includes the committee structure for project prioritization, which is guided by the IT strategic plan. The outcome of the prioritization process is a five-year IT tactical plan, which is used to communicate the IT action plan for achievement of the strategic objectives. The strategic and tactical plans have resulted in stronger ownership and advocacy of IT activities by organizational leadership and a clearer view of the impact of technology on the organization's strategic plan.

Developing and implementing a patient-centered IT strategy

The Army Medical Department (AMEDD), a comprehensive worldwide integrated healthcare system with an annual budget of more than $6 billion, more than 50,000 employees, and 2.4 million beneficiaries, developed and implemented a comprehensive patient-centered enterprise-wide information management and information technology strategy to facilitate information management systems and infrastructure decisions by leaders. This article describes a patient-centered model used to organize and link healthcare activities and activity leaders to portray patient care, administrative, business, financial, supply, and strategic support information systems. Activity and IT leaders applied a refined strategic alignment model to identify specific clinical, business, and IT goals and to detail the necessary infrastructure investments using a systems view. The use of patient and process outcome measures tied to the AMEDD's Balanced Score Card' helped leaders to manage IT strategy execution. Now, two years into the effort, a sample activity strategy--outpatient care--is used to illustrate the application of these tools to the development and implementation of a patient-centered IT strategy.

Questioning workload resources

Available technology assists managers with fiscally sound predictions of staffing and secondary patient care resources.

A hierarchical fuzzy decision support system for the environmental rehabilitation of Lake Koronia, Greece

This article presents the design of a fuzzy decision support system (DSS) for the assessment of alternative strategies proposed for the restoration of Lake Koronia, Greece. Fuzzy estimates for the critical characteristics of the possible strategies, such as feasibility, environmental impact, implementation time, and costs are evaluated and supplied to the fuzzy DSS. Different weighting factors are assigned to the critical characteristics and the proposed strategies are ordered with respect to the system responses. The best strategies are selected and their expected impact on the ecosystem is evaluated with the aid of a fuzzy model of the lake. Sensitivity analysis and simulation results have shown that the proposed fuzzy DSS can serve as a valuable tool for the selection and evaluation of appropriate management actions.

A Decision Support System approach for rivers monitoring and sustainable management

This paper presents a Decision Support System (DSS) approach developed in the context of the Copernicus project entitled System for Water Monitoring and Sustainable Management based on Ground Stations and Satellite Images (WATERMAN). The main objective of WATERMAN is the monitoring and management of the Strymon River in the Southern Balkans. The specific DSS integrates the main components of WATERMAN and helps the decision maker to monitor the Strymon region; to control and forecast the quantity and quality of the river water; as well as to make objective decisions about the state of the water based on data provided by radio computers, earth stations and satellite images processed by mathematical and statistical models and Geographical Information Systems (GIS).

Decision support systems for risk mapping: viewing the risk from the hazards perspective

Setting as central theme the response of stakeholders to the challenges and offers of Risk Analysis, the paper proposes an approach meant to facilitate risk communication: mapping risk from the hazards perspective--that is, emphasizing the consequence-related factor in the standard risk representations. A working demonstration is presented to illustrate the concept, in relation to a decision support system (DSS) design that has caught, over the past few years, the interest of several authorities and forae in Switzerland and elsewhere, providing for useful exchanges between the risk community and stakeholders from major industries, infrastructure operations, finances and other areas.

Creating a GIS application for local health care planning in Saudi Arabia

The purpose of this paper is to show how Geographical Information Systems can be used to support health planners on a micro-scale. The first part of this paper discusses the issue that affect local health care planning which include monitoring of catchment area and facilities management. The second part defines GIS and its possible uses in the health care field. The relevant GIS functions have also been explained. The third part of this paper discusses the created GIS application, which is made for a local health centre in Makkah City, Saudi Arabia. In this application, three sets of GIS models have been produced. These are catchment area, patient profile and patient distribution and patient flows models. The created GIS models are produced to help local health planners in their health care decision output.

A management information system to plan and monitor the delivery of health‐care services in government hospitals in India

Governments all over the world are getting increasingly concerned about their ability to meet their social obligations in the health sector. In this paper, we discuss the design and development of a management information system (MIS) to plan and monitor the delivery of healthcare services in government hospitals in India. Our MIS design is based on an understanding of the working of several municipal, district, and state government hospitals. In order to understand the magnitude and complexity of various issues faced by the government hospitals, we analyze the working of three large tertiary care hospitals administered by the Ahmedabad Municipal Corporation. The hospital managers are very concerned about the lack of hospital infrastructure and resources to provide a satisfactory level of service. Equally concerned are the government administrators who have limited financial resources to offer healthcare services at subsidized rates. A comprehensive hospital MIS is thus necessary to plan and monitor the delivery of hospital services efficiently and effectively.