Europe is facing the challenge of delivering high quality and affordable healthcare to its citizens. Prolonged medical care for an ageing population, increasing costs to manage chronic diseases, new but costly treatment possibilities, the need for more healthcare personnel, and the demand for high-quality patient treatment are important factors in this context. Developments in (information) technology allow the redesign of medical processes, which means changing ‘traditional’ operations management. Patient treatment requires the cooperation of healthcare providers from various medical disciplines and organizations. Across these disciplines, diagnostic and therapeutic procedures must be planned and prepared, appointments must be made, medical interventions accomplished. Results of procedures are obtained, transferred and evaluated.
Patient treatment processes are currently typically sub-divided into function-centered and organization-centered views, and optimization efforts stop at the doors of these organizations. Patients have to wait because resources (e.g., physicians, rooms, or technical equipment) are not available. No integrated view is available on the various medical procedures involving individual patients. Medical procedures cannot be performed because information is missing or required procedures have been postponed or cancelled. An unnecessary long duration of a treatment process can increase the invasiveness of the treatment and therefore the discomfort for the patient and the costs for the healthcare organization. These trends will accelerate because healthcare increasingly involves many different organizations in healthcare chains, making overall process awareness more difficult.
To counter the trend towards longer treatment processes, unnecessarily increased costs, unsatisfactory insight into patient statuses and patient discomfort, a change is needed in the way healthcare is delivered. The key in this change is process optimization, where the healthcare process of a patient is treated as an integrated whole, even if it involves many medical disciplines and autonomous organizations. This requires a close alignment between the healthcare process, healthcare organizations and information about the patient. However, current organizational structures and information systems offer only sub-optimal support. Emphasis needs to shift from a physician-oriented, intra-departmental view towards a patient-oriented, end-to-end health chain view. The departmental and chain views must be jointly considered and optimized. Internal layout and control must be redesigned such that both the interests of the patient and of the organization are addressed. A wide variety of complex strategic and operational decisions have to be made that contribute to the simultaneous optimization of quality of care, costs, and patient lead-time. Development of an adequate information infrastructure will be an essential element in obtaining an end-to-end health chain view. This information infrastructure will need to support electronic patient dossiers.
Addressing the complexity of the developments sketched above requires an operations management approach that is both multi-disciplinary and model-driven – two of the main characteristics of the Beta Research School. The Beta Healthcare program started with the official kick-off that took place at a healthcare symposium in October 2007. The program addresses problems in the healthcare domain in a science-based and practice-relevant way. In the program, research topics have been defined on the basis of five aspects of operational processes in healthcare that each require substantial improvement: process structure, flexibility, efficiency, effectiveness, and trust. The topics are based on the strengths of the research groups in Beta. Below, we describe research topics per process aspect.
Providing process structure in healthcare: Support for business processes that span multiple autonomous organizational entities is required in order to manage medical supply chains, intramural distributed healthcare and transmural healthcare. Coupling process management to the service-oriented computing paradigm is investigated to obtain networks of loosely-coupled, encapsulated collaborative healthcare functions. In the healthcare domain, explicit process specifications are often missing or not followed in practice. Research in process mining shows how specifications can be constructed from historic logs and conformance of practice to specifications can be analyzed. Process patterns play a role as abstract building blocks for processes, including the role of human performance aspects in process execution.
Providing flexibility to healthcare: Automated support for flexibility aspects plays an important role at process design time and run time, including attention for explicit exception management, to deal with the many unforeseen (or uncommon) circumstances in medical processes. The advent of new (information) technologies changes the way healthcare professionals perform clinical processes (e.g. using clinical guidelines). This requires research into human performance management in medical contexts, e.g., changing generalist/specialist trade-offs, and job quality management in the context of technological developments. In healthcare networks, geographically sparse resources (such as costly machines or highly qualified specialists) must be allocated such that usage characteristics can be optimized over the healthcare network and logistics sub-processes (e.g., the transport of a patient) can be flexibly interwoven in healthcare processes.
Providing resource efficiency in healthcare: Improvement of the utilization of scarce resources is required by the development and use of master schedules for mono-resources (e.g., operating theatres) and multi-resources. The research in this area considers flexibility of resources, the use of advance demand information and the coordination of planning problems over the various stages within the hospital process chain. The complex interplay between actors providing resources and actors requiring resources (typically patients) goes beyond capabilities of traditional scheduling strategies. A promising approach is the agent-oriented paradigm, where autonomous software agents negotiate on behalf of their owners on market places in a goal-oriented fashion. Many processes in healthcare are inherently of a non-routine nature. It is an as yet unresolved issue whether traditional performance management principles can also be effectively applied in these non-routine work processes. Work is often organized in self-managing teams, who are facing increased pressure to optimize both efficiency of their work processes and quality of the service they provide to clients. Projects linking team performance management and psychological well-being of team members, service quality and client satisfaction can assist healthcare organizations in optimizing individual and team contributions to organizational performance.
Providing effectiveness in healthcare: Modern job demands imposed on healthcare employees imply renewed investigation of available, often limited, job resources (such as job control, emotional support and ergonomic aides). Allocation of matching job resources is an important avenue for further research in this area. An example would be to increase emotional support from supervisors and colleagues to combat emotional demands by irate patients.
Providing trust in healthcare: Safety management in today’s healthcare is still in its infancy. Detailed specifications of the analytic heart of a safety management system – i.e. predictive risk analysis and retrospective incident analysis – and the accompanying implementation process are badly needed. Transaction management is important in complex, dynamic healthcare processes to guarantee dependable process semantics, e.g., to ensure that all steps in a process are indeed performed or to ensure that the right medical information is available only to the right people at the right time.
Prof.dr.ir. P.W.P.J. Grefen, dr.ir. E.W Hans
Involved senior researchers
Prof.dr.ir. W.M.P. van der Aalst, dr.ir. I.J.B.F. Adan, prof.dr. R.J. Boucherie, dr.ir. N.P. Dellaert, dr. J.L. Hurink, dr. N. Litvak, prof.dr. J. de Jonge, prof.dr.ir. H.A. La Poutré, dr.ir. H.A. Reijers, dr.ir. A.A.M. Spil, dr.ir. J.J.M. Trienekens.
National and international cooperation
The program stretches across (almost) all groups participating in the Beta research school, and therefore is in itself already a cooperative effort between many groups at Eindhoven University of Technology and University of Twente. In the context of the acquisition of funds, cooperation has been set up with University of Amsterdam, Amsterdam Academic Medical Center, ORTEC and Leiden UMC.
The healthcare program has a close link with NGB (the Dutch organization for operations research). In November 2007, an NGB healthcare symposium was organized with the support of Beta. Also, the program is linked to the CHOIR healthcare knowledge center of the University of Twente.
International cooperation is currently distributed among the Beta groups participating in the program. Because the program has been operating for a short time only, there is no international collaboration at program level yet. Clearly, this is a development to strive for.
Application of research and collaboration with industry
Application of the research in the healthcare industry is seen as a very important aspect of the program. Given the specific nature of the healthcare domain, application should preferably be performed in a collaborative setting, i.e., with active participation of healthcare organizations.
Currently, a number of active collaborations is underway, both with healthcare organizations (like hospitals) and organizations that are service or product providers to the healthcare field (such as software developers), and government (Netherlands Board for Healthcare Facilities).
The healthcare program was started in 2007 (official kick-off in October) and is therefore still in the startup phase. In the short to medium term, the program will be further established along the lines described above. The following developments are seen as important in this context: