Operations Research in Healthcare industry

Introduction
Operational 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 better
Now a days the principles and techniques of Operational Research are being
applied in every field of human research and development

HISTORY
Operational 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 II
The 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 societies
Since 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 research
The 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 RESEARCH
Decision 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 Hospitals
Ancillary 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 many ways 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 simulation
Discrete-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 optimization
Computer 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 qualities
In the context of material and patient flows, hospital logistics and OM provide a
broad range of applications suitable for analysis using OR techniques
An 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 OR
Need of Operation research in Health care industry
Global health challenges
We 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 problems
Operational 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 approach23 or 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 interventions
Choosing 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 mortality and in cervical cancer screening in low-resource
settings.


Introducing new interventions
Innovation 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-up
Small-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 Research
Hospitals 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 Research
OR 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.

Conclusion
Hospitals 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.



















Operations Research in Healthcare industry

Introduction
Operational 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 better
Now a days the principles and techniques of Operational Research are being
applied in every field of human research and development

HISTORY
Operational 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 II
The 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 societies
Since 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 research
The 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 RESEARCH
Decision 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 Hospitals
Ancillary 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 many ways 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 simulation
Discrete-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 optimization
Computer 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 qualities
In the context of material and patient flows, hospital logistics and OM provide a
broad range of applications suitable for analysis using OR techniques
An 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 OR
Need of Operation research in Health care industry
Global health challenges
We 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 problems
Operational 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 approach23 or 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 interventions
Choosing 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 mortality and in cervical cancer screening in low-resource
settings.


Introducing new interventions
Innovation 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-up
Small-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 Research
Hospitals 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 Research
OR 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.

Conclusion
Hospitals 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.









































































Operations Research in Healthcare industry

Introduction
Operational 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 better
Now a days the principles and techniques of Operational Research are being
applied in every field of human research and development

HISTORY
Operational 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 II
The 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 societies
Since 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 research
The 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 RESEARCH
Decision 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 Hospitals
Ancillary 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 many ways 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 simulation
Discrete-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 optimization
Computer 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 qualities
In the context of material and patient flows, hospital logistics and OM provide a
broad range of applications suitable for analysis using OR techniques
An 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 OR
Need of Operation research in Health care industry
Global health challenges
We 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 problems
Operational 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 approach23 or 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 interventions
Choosing 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 mortality and in cervical cancer screening in low-resource
settings.


Introducing new interventions
Innovation 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-up
Small-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 Research
Hospitals 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 Research
OR 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.

Conclusion
Hospitals 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.





































































Operations Research in Healthcare industry

Introduction
Operational 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 better
Now a days the principles and techniques of Operational Research are being
applied in every field of human research and development

HISTORY
Operational 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 II
The 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 societies
Since 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 research
The 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 RESEARCH
Decision 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 Hospitals
Ancillary 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 many ways 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 simulation
Discrete-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 optimization
Computer 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 qualities
In the context of material and patient flows, hospital logistics and OM provide a
broad range of applications suitable for analysis using OR techniques
An 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 OR
Need of Operation research in Health care industry
Global health challenges
We 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 problems
Operational 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 approach23 or 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 interventions
Choosing 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 mortality and in cervical cancer screening in low-resource
settings.


Introducing new interventions
Innovation 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-up
Small-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 Research
Hospitals 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 Research
OR 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.

Conclusion
Hospitals 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.