Europe is confronting the challenge of presenting high quality and low-cost health care to its citizens. Prolonged medical attention for an aging population. increasing costs to pull off chronic diseases. new but dearly-won intervention possibilities. the demand for more healthcare forces. and the demand for high-quality patient intervention are of import factors in this context. Developments in ( information ) engineering allow the redesign of medical procedures. which means altering ‘traditional’ operations direction. Patient intervention requires the cooperation of healthcare suppliers from assorted medical subjects and organisations. Across these subjects. diagnostic and curative processs must be planned and prepared. assignments must be made. medical intercessions accomplished. Consequences of processs are obtained. transferred and evaluated. Patient intervention procedures are presently typically sub-divided into function-centered and organization-centered positions. and optimisation attempts halt at the doors of these organisations. Patients have to wait because resources ( e. g. . doctors. suites. or proficient equipment ) are non available. No incorporate position is available on the assorted medical processs affecting single patients.
Medical processs can non be performed because information is losing or required processs have been postponed or cancelled. An unneeded long continuance of a intervention procedure can increase the invasiveness of the intervention and hence the uncomfortableness for the patient and the costs for the health care organisation. These tendencies will speed up because health care progressively involves many different organisations in health care ironss. doing overall procedure consciousness more hard. To counter the tendency towards longer intervention processes. unnecessarily increased costs. unsatisfactory penetration into patient positions and patient uncomfortableness. a alteration is needed in the manner health care is delivered. The key in this alteration is process optimisation. where the health care procedure of a patient is treated as an incorporate whole. even if it involves many medical subjects and independent organisations. This requires a close alliance between the health care procedure. health care organisations and information about the patient.
However. current organisational constructions and information systems offer merely sub-optimal support. Emphasis needs to switch from a physician-oriented. intra-departmental position towards a patient-oriented. end-to-end wellness concatenation position. The departmental and concatenation positions must be jointly considered and optimized. Internal layout and control must be redesigned such that both the involvements of the patient and of the organisation are addressed. A broad assortment of complex strategic and operational determinations have to be made that contribute to the coincident optimisation of quality of attention. costs. and patient lead-time. Development of an equal information substructure will be an indispensable component in obtaining an end-to-end wellness concatenation position.
This information substructure will necessitate to back up electronic patient dossiers. Addressing the complexness of the developments sketched above requires an operations direction attack that is both multi-disciplinary and model-driven – two of the chief features of the Beta Research School. The Beta Healthcare plan started with the official kick-off that took topographic point at a health care symposium in October 2007. The plan addresses jobs in the health care sphere in a science-based and practice-relevant manner. In the plan. research subjects have been defined on the footing of five facets of operational procedures in health care that each require significant betterment: procedure construction. flexibleness. efficiency. effectivity. and trust. The subjects are based on the strengths of the research groups in Beta. Below. we describe research subjects per procedure facet.
Supplying procedure construction in health care: Support for concern procedures that span multiple independent organisational entities is required in order to pull off medical supply ironss. intramural distributed health care and transmural health care. Matching process direction to the service-oriented computer science paradigm is investigated to obtain webs of loosely-coupled. encapsulated collaborative health care maps. In the health care sphere. expressed procedure specifications are frequently losing or non followed in pattern. Research in procedure excavation shows how specifications can be constructed from historic logs and conformity of pattern to specifications can be analyzed. Procedure forms play a function as abstract edifice blocks for procedures. including the function of human public presentation facets in procedure executing.
Supplying flexibleness to healthcare: Automated support for flexibleness facets plays an of import function at procedure design clip and run clip. including attending for expressed exclusion direction. to cover with the many unanticipated ( or uncommon ) fortunes in medical procedures. The coming of new ( information ) engineerings changes the manner healthcare professionals execute clinical procedures ( e. g. utilizing clinical guidelines ) . This requires research into human public presentation direction in medical contexts. e. g. . altering generalist/specialist tradeoffs. and occupation quality direction in the context of technological developments. In healthcare webs. geographically thin resources ( such as dearly-won machines or extremely qualified specializers ) must be allocated such that usage features can be optimized over the health care web and logistics sub-processes ( e. g. . the conveyance of a patient ) can be flexibly interwoven in health care procedures.
Supplying resource efficiency in health care: Improvement of the use of scarce resources is required by the development and usage of maestro agendas for mono-resources ( e. g. . operating theaters ) and multi-resources. The research in this country considers flexibleness of resources. the usage of progress demand information and the coordination of be aftering jobs over the assorted phases within the infirmary procedure concatenation. The complex interplay between histrions supplying resources and histrions necessitating resources ( typically patients ) goes beyond capablenesss of traditional programming schemes.
A promising attack is the agent-oriented paradigm. where independent package agents negotiate on behalf of their proprietors on market topographic points in a goal-oriented manner. Many procedures in health care are inherently of a non-routine nature. It is an as yet unsolved issue whether traditional public presentation direction rules can besides be efficaciously applied in these non-routine work procedures. Work is frequently organized in self-managing squads. who are confronting increased force per unit area to optimise both efficiency of their work procedures and quality of the service they provide to clients. Undertakings associating squad public presentation direction and psychological wellbeing of squad members. service quality and client satisfaction can help healthcare organisations in optimising single and team parts to organisational public presentation.
Supplying effectivity in health care: Modern occupation demands imposed on health care employees imply renewed probe of available. frequently limited. occupation resources ( such as occupation control. emotional support and ergonomic Plutos ) . Allotment of fiting occupation resources is an of import avenue for farther research in this country. An illustration would be to increase emotional support from supervisors and co-workers to battle emotional demands by ireful patients.
Supplying trust in health care: Safety direction in today’s health care is still in its babyhood. Detailed specifications of the analytic bosom of a safety direction system – i. e. prognostic hazard analysis and retrospective incident analysis – and the attach toing execution procedure are severely needed. Transaction direction is of import in complex. dynamic health care processes to vouch reliable procedure semantics. e. g. . to guarantee that all stairss in a procedure are so performed or to guarantee that the right medical information is available merely to the right people at the right clip.
Prof. doctor Ir. P. W. P. J. Grefen. doctor Ir. E. W Hans
Involved senior research workers
Prof. doctor Ir. W. M. P. new wave der Aalst. doctor Ir. I. J. B. F. Adan. prof. doctor R. J. Boucherie. doctor Ir. N. P. Dellaert. doctor J. L. Hurink. doctor N. Litvak. prof. doctor J. de Jonge. prof. doctor Ir. H. A. La Poutre . doctor Ir. H. A. Reijers. doctor Ir. A. A. M. Spil. doctor Ir. J. J. M. Trienekens.
Research high spots
Agent-based Scheduling in Healthcare: In cooperation with Catharina Hospital Eindhoven ( one of the two big regional infirmaries in Eindhoven ) . the application of package agents for programming of intensive attention units is being researched. Scheduling determinations in infirmaries are frequently taken in a decentralised manner. This means that different specialised infirmary units decide autonomously on patient admittances or runing room agendas. In this undertaking. an agent-based theoretical account is developed for the choice of an optimum mix for patient admittances. The theoretical account is based on an extended instance analysis. affecting informations analysis and interviews. The focal point is on the coordination of different surgical patient types with probabilistic intervention processes affecting multiple hospital units. Unplanned reaching of other patients ( partially ) necessitating the same infirmary resources is included in the theoretical account. Planning and Scheduling in Healthcare: In cooperation with Erasmus MC and regional infirmaries like Isala klinieken Zwolle and SKB Winterswijk. robust planning and programming of operating theaters is studied.
Using mathematical scheduling techniques. distinct event simulation. line uping analyses and meta-heuristics. jobs are studied on each hierarchal degree of control. e. g. : ( strategic degree ) the capacity dimensioning of the operating theater. ( tactical degree ) the finding of the sum of slack planned to obtain robust agendas. ( operational degree ) sequencing of elected surgeries to minimise exigency surgery waiting clip. In coaction with AMC Amsterdam. the entree clip to CT scanners has been reduced from 4 hebdomads to 3 yearss. by optimising the agenda and cut downing the procedure variableness. In cooperation with Leiden UMC. AMC. ORTEC. UMC Utrecht. MST Enschede. Isala klinieken. Deventer Ziekenhuis. SKB Winterswijk. ORBIS group. and College Bouw Zorginstellingen. research is performed to optimise the end-to-end attention tract. i. e. . to optimise the attention pathway along all involved sections or establishments by development of robust planning and scheduling techniques. and analytical and simulation theoretical accounts.
Workflow Management in Healthcare: In cooperation with ( and co-funded by ) Amsterdam Academic Medical Center. a research undertaking is being carried out to supply theories and artefacts in order to use workflow engineering in academic infirmaries. In general. there is a demand to back up the diagnostic and curative flight of health care procedures. A figure of troubles normally arise when infirmaries attempt to automatize health care procedures. because these procedures are diverse. require flexibleness. and multiple medical sections can be involved in the diagnostic and intervention procedure. A big instance survey has been carried out in order to place what sort of flexibleness demands to be provided by workflow direction systems in order to be applied in the infirmary sphere. Based on these consequences. the focal point will be on be aftering facets and on the support of ( little ) processes which can be initiated and terminated at any clip during the intervention procedure.
Furthermore. the application of procedure excavation techniques is researched in the context of health care procedures. Transactional Procedures in Healthcare: The pertinence of advanced transactional and contractual concepts is investigated in the medical sphere. The application of these concepts should take to improved dependability of operational health care processes. both from the point of position of health care suppliers and health care consumers ( e. g. . taking to improved patient safety ) . A instance survey is being undertaken at the cardio-thoracic section of Catharina Ziekenhuis Eindhoven. As a scientific footing. the attack developed in the XTraConServe NWO undertaking is applied. In this undertaking. a service-oriented attack has been developed towards executing of transactional contracted concern services. The attack includes a Business Transaction Framework that includes a flexible library of Abstract Transaction Components ( ATCs ) . expressed Transactional Quality of Service ( TxQoS ) specification. ATC composing techniques. and an enactment architecture.
Elkhuizen. S. G. . Sambeek. J. R. C. new wave. Hans. E. W. . Krabbendam. J. J. & A ; Bakker. P. J. M. ( 2007 ) . Using the assortment decrease rule to direction of accessory services. Health attention direction reappraisal. 32 ( 1 ) . 37-45. Grefen. P. W. P. J. ( 2006 ) . Towards dynamic interorganizational concern procedure direction ( text keynote address ) . In S. M. Reddy ( Ed. ) . Proceedings 15th IEEE International Workshops on Enabling Technologies: Infrastructures for Collaborative Enterprises ( pp. 13-18 ) . Manchester. Hans. E. W. . Wullink. G. . Houdenhoven. M. new wave. & A ; Kazemier. G. ( 2008 ) . Robust surgery burden. European Journal of Operations Research 185 ( 3 ) . 1038-1050. Hutzschenreuter. A. K. . Bosman. P. A. N. . Blonk-Altena. I. . Aarle J. van. & A ; La Poutre . H. ( 2008 ) . Agent-based patient admittance scheduling in infirmaries. In: Proceedings 7th International Conference on Autonomous Agents and Multi-Agent Systems. Estoril. Portugal. 2008. Litvak. N. . Boucherie. R. J. . Rijsbergen. M. new wave. & A ; Houdenhoven. M. new wave ( 2008 ) . Pull offing the flood of intensive attention patients. European Journal of Operational Research 185 ( 3 ) . 998-1010.
National and international cooperation
The plan stretches across ( about ) all groups take parting in the Beta research school. and hence is in itself already a concerted attempt between many groups at Eindhoven University of Technology and University of Twente. In the context of the acquisition of financess. cooperation has been set up with University of Amsterdam. Amsterdam Academic Medical Center. ORTEC and Leiden UMC. The health care plan has a close nexus with NGB ( the Dutch organisation for operations research ) . In November 2007. an NGB health care symposium was organized with the support of Beta. Besides. the plan is linked to the CHOIR health care cognition centre of the University of Twente. International cooperation is presently distributed among the Beta groups take parting in the plan. Because the plan has been runing for a short clip merely. there is no international coaction at plan degree yet. Clearly. this is a development to endeavor for.
Application of research and coaction with industry
Application of the research in the health care industry is seen as a really of import facet of the plan. Give the specific nature of the health care sphere. application should sooner be performed in a collaborative scene. i. e. . with active engagement of healthcare organisations. Presently. a figure of active coactions is afoot. both with health care organisations ( like infirmaries ) and organisations that are service or merchandise suppliers to the health care field ( such as package developers ) . and authorities ( Netherlands Board for Healthcare Facilities ) .
The health care plan was started in 2007 ( official kick-off in October ) and is hence still in the startup stage. In the short to medium term. the plan will be farther established along the lines described supra. The undermentioned developments are seen as of import in this context:
Escalating the cooperation between the assorted sub-disciplines take parting in the plan. The demands arising from the multidisciplinary nature of the health care operations direction country on the one manus and the multidisciplinary character of the Beta research school on the other brand this a natural development. Escalating coaction with the practical health care sphere in the signifier of larger application-oriented undertakings. Presently. a figure of smaller undertakings are already in operation. Enterprises for larger attempts are afoot and support is being sought. Transportation and reapplication of scientific attacks. techniques and tools ( chiefly package ) from other application spheres to the health care sphere. Scheduling rules can be transferred from other spheres that besides require flexible. case-based operations direction. Business theoretical accounts and package solutions from the e-business sphere can be reinvestigated for usage in distributed. flexible health care webs. National and international acknowledgment of Beta as a multidisciplinary expertness centre for operations direction in health care.