Operational Research for Emergency Planning in Healthcare: Volume 2
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Operational Research for Emergency Planning in Healthcare: Volume 2

Navonil Mustafee, Navonil Mustafee

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Operational Research for Emergency Planning in Healthcare: Volume 2

Navonil Mustafee, Navonil Mustafee

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About This Book

This book presents a selection of studies that have applied Operational Research methods to improve emergency planning in healthcare, to include both A&E and public health emergencies like epidemic and natural disasters. The studies have delved into qualitative Operational Research like Problem Structuring, Critical Systems Thinking, Soft Systems Methodology, and Qualitative System Dynamics, and also quantitative techniques such as Monte Carlo Simulation, Discrete-event Simulation, and System Dynamics. These techniques have been applied for review and assessment of emergency services, for policy formulation and for facilitating broader public engagement in emergency preparedness and response. Furthermore, this book presents rigorous reviews on the applications of Operational Research in the wider healthcare context. This volume focuses mainly on emergency planning at the strategic level, whereas volume 1 focuses on planning at the operational level.The OR Essentials series presents a unique cross-section of high quality research work fundamental to understanding contemporary issues and research across a range of Operational Research (OR) topics. It brings together some of the best research papers from the highly respected journals of the Operational Research Society, also published by Palgrave Macmillan.

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Year
2016
ISBN
9781137573285

1

Operational Research for Healthcare Emergency Planning at a Strategic Level

N. Mustafee

1.1 Context

Operational Research (OR) is the discipline that applies analytical methods to help make better and more informed decisions. Most of the quantitative techniques (‘Hard OR’) are mathematical, statistical or computational in nature; they are frequently used to arrive at optimal or near-optimal solutions to complex decision-making problems. ‘Hard’ OR is based on the assumption that systems are objective aspects of reality – they are generally independent of the observer; ‘Soft’ OR methods by contrast can best be characterized as assuming that a system is defined subjectively – it is a reflection of the observer’s worldview (Wienke and Mustafee, 2015). Thus, ‘Soft’ OR expects the presence of a range of decision-makers or stakeholders who may all have differing and even conflicting objectives. The application of qualitative OR techniques in this sphere is to guide and structure the various stakeholders’ discussions and build a shared understanding. Strategic level planning (which is the focus of Volume 2 of this book) is generally characterized by the presence and the active involvement of various actors in the decision-making process. Thus, ‘Soft’ OR can be used as a starting point for discussion regarding an appropriate resolution approach that all participants are prepared to implement.
OR is a vast field of study! A reference to the ‘Wiley Encyclopedia of Operations Research and Management Science’ (Cochran et al., 2011) provides scholarly insights into the enormity of this discipline. The encyclopaedia is marketed as an ‘unparallel undertaking’ that is devoted towards the advancement of OR and is an eight-volume authoritative reference set made up of over 6,000 pages! The field of OR is also expanding! The International Abstracts in Operational Research (IAOR, n.d.) is an indicator of the growing literature in OR. IAOR indexes abstracts from OR/MS journals as well as some specialized journals that are relevant to OR/MS research (IAOR, n.d.). It is maintained by the International Federation of Operational Research Societies (IFORS) and is quoted to be the ‘the only dedicated source for bibliographic and abstract information in operations research and management science’ (IFORS, n.d.). It consists of 68,000 abstracts from over 145 journal titles (Miser, 2000); the number of journals has now increased to approximately 180. Mustafee and Katsaliaki (n.d.) report that in 1961 the first issue of IAOR listed work on models of common processes in 35 categories, on problems in 11 arenas of application and on 31 types of related theory development. By 1975, the numbers in these categories had reached 47, 34 and 53, respectively, and by 1998 they were 66, 43 and 77. In the specific case of healthcare OR there is evidence that this continues to be a growing area of research (Brailsford et al., 2009; Mustafee et al., 2010; Katsaliaki and Mustafee, 2011).

1.2 The triple lens

A way to describe the sheer enormity of OR content is through the identification of broad categories of OR techniques, their domain of application (application area) and application context. As mentioned in the introductory chapter of Volume 1 of this book, this is important because readers must not only build an understanding of the analytical methods that are discussed in this book, they should in addition possess domain knowledge which is specific to their area of work or study, and further, they should carefully consider the context of application since the choice of particular OR techniques can be largely dictated by specific problems that are to be solved! It therefore follows that this triple lens of technique-application-context will help readers to better appreciate the practical application of OR, and the 26 studies that have been presented in Volumes 1 and 2 of this book have been structured keeping this in mind (an outline of Volume 2 is presented in Table 1.1). Readers are referred to Chapter 1 of Volume 1 for examples of the broad categories of technique, application and context, which is based on a separate piece of research that focuses on the development of a classification scheme for OR/MS (Mustafee and Katsaliaki, n.d.).

1.3 Structure of volume two: a triple lens approach for the study of OR for emergency planning at a strategic level

The application of OR methods in healthcare has been widely reported in literature (Jun et al., 1999; Brailsford et al., 2009; Mustafee et al., 2010, 2013; Katsaliaki and Mustafee, 2011; Rais and Viana, 2011; Mustafee and Katsaliaki, 2015). Several studies have used these methods for emergency planning in healthcare. The two volumes of this book showcase studies that have applied OR methods for achieving heightened preparedness, better planning, and faster response to A&E and public health emergencies. The book covers four broad themes that are relevant to healthcare emergency planning. These are A&E, ancillary services, outbreak of epidemic and public health emergency response. A&E is core to emergency planning and the availability of adequate resources is crucial to saving lives. The second theme is that of ancillary services like ambulance service and healthcare supply chain. They support A&E and the wider healthcare operations. Planning for epidemics (the third theme) enables public health institutions to minimize the effect of outbreaks among the population. The final theme is on public health emergency response and it acknowledges the need for multi-agency planning using a qualitative approach to problem-solving. These themes intersect through the various parts and chapters of both the volumes of this book.
The focus of Volume 1 was on OR for Emergency Planning at an Operational Level. It consisted of 13 studies which were presented in three parts, namely, OR for Locating Emergency Services (Part I; three chapters), OR for Operational Planning in Emergency Services (Part II; six chapters) and OR for Inventory Management in Emergency Services (Part III; four chapters). The chapters included the application of mainly ‘Hard’ OR techniques, for example, mathematical modeling, MCDA, Bayesian decision model and discrete-event simulation (DES).
Volume 2 of this book is mainly on the application of OR for Healthcare Emergency Planning at a Strategic Level. It also includes a few literature review papers. Like Volume 1, this book consists of 13 studies which are organized under specific parts, namely, OR for Assessment and Review of Emergency Services (Part IV; Chapters 24), OR for Policy Formulation in Emergency Services (Part V, Chapters 56), OR for Broader Engagement in Planning for Emergency Services (Part VI, Chapters 710) and Application of OR within the Wider Healthcare Context (Part VII, Chapters 1114). The chapters included in this volume are outlined in Table 1.1; for every chapter (except for Part VII) the table lists the OR technique, domain of application and context of use.

1.4 Overview of volume 2: A focus on strategic level planning

Following this introductory chapter, the book consists of 13 chapters that are organized into four parts. Part IV focuses on the OR for Assessment and Review of Emergency Services and is the subject of the next three chapters. In Chapter 2 Brailsford et al. describe their use of qualitative and quantitative System Dynamics (SD) as part of a study that looked into whole-system review of emergency and on-demand healthcare in a city in England. They used interview data and qualitative SD to develop a conceptual map of possible patient pathways through the system; a quantitative SD model (stock-flow model) was then developed to simulate patient flows and to identify system bottlenecks. Mould et al. assess the impact of systems modeling in the redesign of an emergency department (Chapter 3) through two complimentary techniques, namely, process mapping and DES. One finding from the study is that both process mapping of the patient pathway and simulation of the A&E can be valuable, though in some applications the simpler pathway mapping may alone be sufficient. Cairns, Marshall and Kee are the authors of Chapter 4 in which they report the use of Monte-Carlo simulation to assess the effectiveness (including cost-effectiveness) of a public health scheme involving volunteer cardiac first responders. The scheme being assessed aims to improve survival of sudden cardiac arrest patients by reducing the time of emergency treatment (life-saving defibrillation); this is achieved through the active involvement of volunteers who are paged to respond to possible cardiac arrest incidents alongside the emergency medical services.
TABLE 1.1 An outline of volume 2 presented through the triple lens of technique-domain-context
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Part V of the book includes two studies on OR for Policy Formulation in Emergency Services. The study by Fletcher et al. (Chapter 5) describes a generic A&E simulation model that was developed by OR analysts within the Department of Health (DH). The primary purpose of the model was to inform the national policy team of significant barriers in achieving the national targets related to A&E. The model was used by stakeholders at the national level (DH, national A&E team) to discuss patient flows and the impact of potential policies. As the A&E model was developed to be a generic model its application was also possible at the local level, and indeed it was used as a consultancy tool to aid hospital trusts to improve their A&E departments. Chapter 6 is a study by Lane, Monefeldt and Rosenhead, which was motivated by public concern over long waiting times for admissions. The authors developed a SD model to capture the interaction of demand pattern, A&E resource deployment, other hospital processes and bed numbers. The study revealed the interconnectedness of A&E service levels, bed provision and the experience of patients on waiting lists. One principal message that came out was that using A&E waiting times alone to judge the effect of bed reductions was a naïve approach.
Part VI is the Penultimate part of the book and concentrates on OR for Broader Engagement in Planning for Emergency Services and it consists of four chapters. Lane and Husemann present a study that uses qualitative SD for mapping the flows of acute patients within the NHS (Chapter 7). The UK Department of Health provided funding and broad direction for this study. The chapter mainly focuses on the activities associated with the three workshops wherein NHS staff were able to propose ideas for improving patient flows and on the basis of which a suite of maps of general acute hospitals were drawn up. The maps and ideas were then communicated back to the DoH and subsequently informed about the modernization of A&E. Chapter 8 focuses on OR for disaster response. Planning related to Disaster Operations Management (DOM) generally takes place in multi-stakeholder environments, consisting of, for example, representatives from healthcare, fire brigade, police, disaster relief terms, politicians and indeed the vulnerable group who stand to be affected. In such environments the use of Soft OR methods like Soft Systems Methodology (Checkland, 1981), Qualitative SD, Strategic Option Development Analysis, etc. can be used for developing a shared understanding within this diverse group (Wienke and Mustafee, 2015). In Chapter 8 authors Gregory and Midgley report on one such ‘Soft OR’ study on multi-agency planning for disaster-response. The chapter describes how Critical Systems Thinking and methods from SSM were used in six, one-day workshops that were attended by representatives from 19 agencies (including four health authorities and the ambulance service) who came together to plan the basis for a counselling network that could be activated during an emergency. Further to the use of ‘Soft OR’ techniques (which are qualitative in nature), mathematical modeling, fuzzy sets, statistical techniques, decision theory and queuing theory have been used in relation to DOM, for example, for predicting environmental disasters, estimating damage, evacuation planning, among others (Wienke and Mustafee, 2015). Huang, Tsai and Wen are the authors of Chapter 9. The chapter focuses on the use of network-based simulation for teaching epidemiology. It is arguable that the use of public health simulations as a pedagogical tool enables students to better understand spreading situations; further it allows the analysis of disease patterns, prediction of epidemic dynamics and allows a safe environment for testing the possible effectiveness of public health interventions, all of which contribute towards better planning of emergencies associated with epidemic outbreak. There are also examples in Operations Management literature where business-simulation games like the Blood Supply Chain Game (Katsaliaki et al., 2014) have been used to train participants in making better decisions under pressure and in complex situations where an outcome arises from the interaction of multiple factors and interventions. A systems vision of knowledge management in emergency care is presented by authors Edwards, Hall and Shaw in Chapter 10; it draws upon research conducted in two healthcare organizations that appeared to be approaching knowledge management in a fragmented way and which prevented them from having a holistic view of the whole of the care process. The chapter explores the complexity of knowledge management in emergency healthcare and draws the distinction for knowledge management between managing local and operational knowledge, and global ...

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