Process Analysis and Monitoring in Complex Perioperative Environments: Health Operations Management
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This thesis presents studies in perioperative environments at two large university hospitals, St. Olavs Hospital in Trondheim, Norway and Massachusetts General Hospital in Boston, USA. It is submitted in partial fulfillment of the requirements for the degree of PhD at the Norwegian University of Science and Technology. The thesis consists of two parts. First is an overarching, unifying discussion. Second is a collection of five papers, three published in international peer-reviewed journals and two that had been submitted for publication when the thesis was submitted. The aim of this thesis is to contribute to the empirically grounded development of health operations management. Health operations management is in its infancy, and it was presumed useful to: •Adapt and apply operations management tools and methods to the analysis of hospital processes and evaluate their utility for improving patient care and hospital efficiency. •Evaluate the utility of operations management approaches to process monitoring and problem-solving in hospitals. The papers present evidence that hospitals would do well to adopt a paradigm of patient centered management. Moreover, hospitals and patients can benefit from systems that make critical information active and provide transparency in processes. On a more technical level, the papers support assertions that Statistical Process Control may be more useful to detect process changes and monitor hospital operations than the statistical tools traditionally used in health care. The papers also illustrate the use of an indoor positioning system for tracking patients and monitoring perioperative processes. Finally, the papers show that hospitals may need to individually tailor their approach to operations management, to successfully deal with their particular challenges. Principles, tools, and lessons learned in manufacturing operations management show promise of increasing the robustness, efficiency, quality, and safety of health care processes.