An Operating Theater Planning Decision Support System

1. Introduction

The technological advances, medical breakthroughs, better, and more efficient services have improved the human quality of life and expectancy, leading to a new paradigm for the health care service providers. Hospitals are now able to assist patients who were once unable to receive adequate treatment due to the lack of knowledge and means; this fact along with the ageing population is increasing the demand and the pressure on health care providers to maintain service levels and quality. Patients often experience serious delays due to the highly variable patient requirements or capacity constraints, which hospitals are unable to increase due to cost pressures, regulatory constraints, or shortage of appropriate personnel (Green, 2005). Generally, the gap between offer and demand leads to long waiting lists for treatment, a worldwide social problem that is recurrently observed in hospitals. The long waiting lists arise from different causes such as:

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  Public hospital preference over private;

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  Insufficient government funding;

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  Doctors’ decisions and consequent efficiency;

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  Patients’ attitudes (punctuality, cancelations and no-shows); and also

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  The uncertain nature of the health care processes (e.g., treatment durations and outcomes).

Many of the measures taken by governments and hospital organizations to tackle the waiting lists problem involve promoting overtime work in order to increase the available capacity; however, it carries a heavy financial cost in the long-run. As healthcare service providers face budget cuts due to the current economic context, the new paradigm demands them to do more and better with less. In this context, business process and continuous improvement methodologies emerge as strong frameworks in the search for a more efficient utilization of the available resources, empowering healthcare organizations to cope with the increased demand.

The operating theater is considered the hospital’s largest budget consumption segment and an important example of long waiting times for treatment in hospitals (Green, 2005). This work aims at improving decision making processes at the operating theater as a mean to increase performance within hospitals. This project is also motivated by the immediate attention that patients waiting for surgery naturally require and the importance given by governments to reduce waiting times for surgery. In addition, a relevant Portuguese public general admission hospital served as a case study; where it was noticed that the decision making processes within the operating theater were often empiric. Moreover, the existing health information system in the Portuguese public health system lacks a decision support component that could standardize the procedures. As an example, the surgery schedule planning methods observed in the case study included: (1) paper-based maps; (2) spreadsheets; and (3) online calendars; reducing the centralization to insignificant levels since these methods are personal and not transversal to a group or a specialty department. The general Portuguese public health situation related to the operating theater depicts well the problem. At the end of 2010, 161.000 patients were waiting for surgery, of which almost 15% had waited for over 12 months, and the patients operated had a median waiting time for surgery of 3.3 months (SIGIC, 2011). These statistics explain the low ranking of Portugal on a Swedish study (Bjornberg & Cebolla, 2009), that recognized Portuguese health care services as number 21 among 33 European countries, mainly due to its long waiting times for treatment. It is important to note that other countries have to face similar issues. The OECD (Organisation for Economic Co-operation and Development) reports, for instance, that Italy and Norway recently had over 25% of their surgical cases waiting more than 3 months (Siciliani & Hurs, 2004).