- INVESTIGACION DE OPERACIONES: OR in healthcare: A European perspective

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European Journal of Operational Research xxx (2010) xxx–xxx

Contents lists available at ScienceDirect

European Journal of Operational Research journal homepage: www.elsevier.com/locate/ejor

Invited Review

OR in healthcare: A European perspective Sally Brailsford a, Jan Vissers b,c,⇑ a

School of Management, University of Southampton, Southampton SO17 1BJ, UK Institute of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands c School of Industrial Engineering, Eindhoven University of Technology, P.O. Box 513, 5600 MB Eindhoven, The Netherlands b

a r t i c l e

i n f o

Article history: Received 18 October 2009 Accepted 16 October 2010 Available online xxxx Keywords: OR in health services Applications of OR Review

a b s t r a c t The European Working Group ‘‘Operational Research Applied to Health Services’’ (ORAHS) is one of the domain specific EURO Working Groups organized by EURO – the European Association of Operational Research Societies. In this paper we report on the development of ORAHS as a platform for OR in health, and analyse the papers presented at meetings over the 35 years of its existence. We propose a two-way framework for analysis, where one dimension is the nine stages of the product life cycle: identifying consumer requirements, designing a new service to meet these requirements, forecasting demand for such a service, securing resources for it, allocating these resources, developing Programs & Plans to use these resources for delivering the service, establishing criteria for service delivery, managing the performance of the service, and finally, evaluating its performance. The other dimension is a three-level classification into broad application areas referring to processes at different levels in healthcare: Patients & Providers, Units & Hospitals, and Regional & National. We use this framework to carry out a quantitative analysis of all the papers presented during the meetings of ORAHS since its inception in 1975. We then describe developments over this period in applying OR approaches and techniques to healthcare, and present an overview of the main application areas and challenges. ! 2010 Elsevier B.V. All rights reserved.

1. Introduction The use of Operational Research in healthcare has developed considerably over the years, for a number of reasons. Healthcare has become a major industry, with many people involved either as employees in healthcare delivery organisations or as consumers of healthcare services. The UK’s National Health Service is actually the largest employer in Europe. The rising costs of healthcare due to new technologies and demographic trends (in particular, the ageing population), is a vitally important issue for healthcare policy makers. At the same time there is a paradigm shift in the service concept of healthcare. Patients are no longer prepared to accept poor quality service, either in terms of long waiting times or inconvenient appointment systems, and expect that services are well organized from a ‘‘customer’’ perspective. The service concept has shifted from optimizing the use of resources to finding a balance between service for patients and efficiency for providers. These developments have had an impact on the popularity of OR

⇑ Corresponding author at: Institute of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands. Tel.: +31 10 4089182; fax: +31 10 4089094. E-mail addresses: S.C.Brailsford@soton.ac.uk (S. Brailsford), vissers@bmg.eur.nl (J. Vissers).

in healthcare not only in terms of the number of OR applications but also of the scope of topics covered. The characteristics of health OR – which make it different from OR in industry or in commercial services – stem from the way healthcare organisations operate and from the type of healthcare system in use in a particular country. A hospital organisation, for instance, consists of units (outpatient departments, wards, operating theatres, etc.) which contribute to the processes delivered by clinical specialties. Hospital management does not always have much control over output, as core processes are often controlled by clinical specialists who in many European countries have a contract with the hospital but are not salaried. Therefore, the line of command structure in hospitals is not always straightforward. Decision making is carried out in more of a political arena in which the interests of different stakeholders need to be balanced. Standardisation of product and process is difficult due to the high variation between hospitals and also between clinicians within the same specialty. Moreover, medical professionals want to keep their autonomy in the care delivery process. Although doctors manage the clinical process, and nurses the nursing process, no one is in charge of the customer process as a whole. The healthcare system in use in a given country is another important influential factor in the healthcare industry. Healthcare systems vary between countries in terms of their incentives for reducing waiting lists or controlling the costs of care. Countries

0377-2217/$ - see front matter ! 2010 Elsevier B.V. All rights reserved. doi:10.1016/j.ejor.2010.10.026

Please cite this article in press as: Brailsford, S., Vissers, J. OR in healthcare: A European perspective. European Journal of Operational Research (2010), doi:10.1016/j.ejor.2010.10.026


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