Or Management Kjeld H. Aij Mba

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Or Management Kjeld H. Aij Mba

  1. 1. Operating RoomPlanning & Scheduling Kjeld H. Aij MBA 1
  2. 2. Paspoort Kjeld H. Aij• Geboren in 1973 in Schiedam• Studeerde Biomedische Wetenschappen, verpleegkunde en bedrijfskunde• Verkreeg in 2008 de graad van Master of Business Administration aan de Business School Nederland• Promotietraject ‘applications of LEAN in Healthcare’• Getrouwd met Michelle; één zoon Steyn• Hoofd Operatiekamers VUmc, Spreker, Ondernemer, Investeerder in zilver• 2
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  4. 4. Kjeld H. Aij MBA 4
  5. 5. Kjeld H. Aij MBA 5
  6. 6. Healtcare: a business unlike all others• Financial model does not reward efficiency• Patients are customer and product at the same time Patients cannot be refused Interventions cannot be preempted• More variability than in any other industry• Many different types of care providers Different types of hospitals, different strategies Academic hospitals do almost everything Specialized clinics are often seen as “cream skimmers”• Multiple decision makers (doctors managers) Doctors are private entrepreneurs within hospital They cheat the system to advance patients• Stakeholders often have conflicting goals 6
  7. 7. Kjeld H. Aij MBA 7
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  9. 9. Operating Room Layout 9
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  11. 11. Operating Rooms• Significant source of hospital’s income• Majority of hospital admissions undergo surgery• Cost intensive (capital and labor)• Determines “the pace” of the hospital “If the OR sneezes, the hospital has a cold”• Are a dangerous place >10% of the patients experience complications or an incident• Increased less invasive surgery (endoscopic, robotic) more “daycare” / outpatient treatments• Have a lot of variability Diversity surgical procedures, complications, every patient is different, emergencies• Capacity is determined by availability of trained staf 11
  12. 12. Surgery is a complex process where manyresources act together Kjeld H. Aij MBA 12
  13. 13. Shortage of OR staff• Cyclical shortage (4-5 years) of personnel• Causes of shortage Oscillation in training capacity due to shortsighted planning Drop-out in training school Increase of part-time percentage during occupational life Aging• Fortifying effect: occurrence of employment agencies• Effects: Closure of operating rooms Increase working pressure Increase of labor costs: employment agencies, salary raises, additional income elements 13
  14. 14. Roughly speaking, Generation Y is defined as -1977 < Birth Date > 2000 31 < Current Age > 8 Kjeld H. Aij MBA 14
  15. 15. ICT 3% 8% 0% Taal en Cultuur 3% 2% 4% Chemie 1% 1% 2% Natuur 1% 0% 2% Finance 1% 1% 1% Landbouw 0% 0% 0% Dat geld verdienen de belangrijkste reden is om te gaan werken, is bijna vanzelfsprekend: de schoorsteen moet tenslotte roken. Daarnaast vertoont generatie Y verrassende verschillen in de diverse opleidingsniveaus. BELANGRIJKSTE REDENEN OM TE GAAN WERKEN % totaal Laagopgeleid Middelhoogopgeleid Hoogopgeleid Geld verdienen 89,7% 95,3% 87,3% 90,3% Zelfontplooiing 48,9% 32,6% 52,7% 58,1% 65% van de jongeren zegt in eerste instantie Kennis opdoen 41,3% 41,9% 42,7% 35,5% op de hoogte van het salaris te letten bij het Iets betekenen voor de maatschappij 28,8% 32,6% 29,1% 22,6% kiezen van een (volgende) baan. Mensen leren kennen 28,8% 41,9% 28,2% 12,9%8 15
  16. 16. BELANGRIJKE FACTOREN BIJ KIEZEN BAAN80%70%60%50% % totaal40% mannen30%20% 53,3% van de jongeren heeft al vrouwen10% tussen de 2 en 5 werkgevers gehad.0% .. ris er en rk e. rk se n aa k ala sfe ed we im we us z S de jkh nd rtt tti g Bo n de oe eli ele pa nu va n G og iss tot jk o em w eid eli ut ièr Af h p A ar r lijk ap C e tsch og aa M M 16
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  18. 18. Goed werkgeverschap • EerlijkBinden • Beloftes nakomen en waarmaken Modern werkgeverschap • Inspelen op de multiculturele arbeidsmarkt • Talent management • Inspelen op sabbatical • Flexibele werktijden/thuiswerken • Open minded • Alumni netwerken • Bijdragen leveren aan de work/life balans • Een opdracht/uitdaging aanbieden ipv baan 18
  19. 19. vertrouwen hebben in elkaar trots zijn op wat we doenplezier hebben met collegas met wie we samenwerken 19
  20. 20. Strategic level (year, quarter)Allocation of OR capacity to surgical specialties Tactical level (month) Weekly allocation of “OR-days” to specialties Operational (offline) level (weeks) Elective & semi-urgent surgery scheduling Operational (online) level (days) Monitoring and control Emergency surgery scheduling Kjeld H. Aij MBA 20
  21. 21. Strategic OR planning• Capacity dimensioning Operating rooms, equipment Staff• Division of the “capacity pie” Contract: board – OR management – specialties 21
  22. 22. OR Blueprint 22
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  24. 24. Strategic OR planning • Emergency operating rooms or not? 24
  25. 25. Tactical OR planning• Open block planning (common in US) First come first serve operation Different specialties operate successively in OR Long changeover time, unbalanced workload, overtime Emergency operating room• Closed block planning (common in Netherlands) Each specialty / surgeon gets blocks of time (ORday morning session, afternoon session) Each specialty / surgeon schedules its patients in these blocks, at least 1 week in advance More efficient, less waiting time for patients Remaining time cannot be redistributed• Semi-open block planning: combination 25
  26. 26. Process from admission to discharge 26
  27. 27. Process within an OR session F.Boer, LUMC 27
  28. 28. OR utilization Kjeld H. Aij MBA 28
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  30. 30. Planning based on surgeon’s estimate 30
  31. 31. Stochastic Surgery durations Kjeld H. Aij MBA 31
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  33. 33. Flaw of averages 33
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  35. 35. “You are not going to get the elephant to shrink or change its size.You need to face the fact that the elephant is 8 OR tall and 11 hr wide.” Steven Shafer, MD 35
  36. 36. Rooster-methodiekenFlexibele Zelfroosterenwerktijden Matching R u i Intekenrooster l e n Voorkeurrooster Repeterend roosterVastewerktijden weinig veel zeggenschap zeggenschap 36
  37. 37. Performance of an Operating Room• Productivity, e.g. Utilization Ratio: procedure time / capacity• Changeover time• Throughput time• % Cancellations, related to: patient anesthesia preparation organization• Waiting time of emergency patients• Overtime• Effectiveness (eg. revisits of patient, complications) 37
  38. 38. Kjeld H. Aij MBA 38

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