Guillaume Lamé

Outpatient Chemotherapy Planning: a Literature Review with Insights from a Case Study

ABSTRACT With an ageing population and more efficient treatments, demand for cancer care is increasing. Therefore, hospitals need to find ways to improve their operational efficiency for cancer care. In this article, we review the contributions in the operations management and operations research (OM/OR) literature that address the planning of outpatient chemotherapy, one of the main treatments for cancer. The distinctive characteristics of outpatient chemotherapy are highlighted. In particular, the interdependence between the administration of chemotherapy drugs in the outpatient clinic and drug preparation in the pharmacy is pointed out. This makes outpatient chemotherapy planning a multiple-department challenge where coordination is essential to the global performance of the system. The modeling challenges induced by this interdependence and by the clinical dimension of chemotherapy are presented. Finally, a case study is performed to confront the literature with the reality of a hospital. Important gaps in the literature are outlined, such as the lack of studies taking an integrated, systemic perspective on this multi-department issue.

Patient-hospital communication: a platform to improve outpatient chemotherapy

We apply Discrete Event Simulation (DES) to a system of two strongly interconnected departments, an outpatient oncology clinic for chemotherapy delivery, and the pharmacy unit that prepares the chemotherapy drugs. The model is developed in close collaboration with the French hospital Henri Mondor, and is validated using real data. The objective is to identify sources of patient waiting times in the outpatient oncology clinic and to identify relevant corrective actions. We show that the coordination between the two departments is the key barrier to higher performance. Solutions are proposed based on increased information sharing and obtaining advanced information on patient status, to allow advanced drug preparation. A two-phase project for improvement is proposed. This paper contributes to the literature on multi-department simulation, which is still rare in healthcare OR compared to one-department studies.

Usage-driven problem design for radical innovation in healthcare

While the diffusion and evaluation of healthcare innovations receive a lot of attention, the early design stages are less studied and potential innovators lack methods to identify where new innovations are necessary and to propose concepts relevant to users. To change this, we propose a structured methodology, Radical Innovation Design (RID), which supports designers who want to work on the unstated needs of potential end users in order to create superior value. In this article, the first part of RID is introduced with its two subprocesses: Problem Design and Knowledge Design. In this first period, RID guides innovators to systematically explore users’ problems and evaluate which ones are most pressing in terms of innovation, taking into account existing solutions. The result is an ambition perimeter, composed of a set of value buckets, that is, important usage situations where major problems are experienced and the current solutions provide little or no relief. The methodology then moves on to Solution Design and Business Design (which are not detailed in this article) to address the value buckets identified. With its emphasis on problem exploration, RID differs from methods based on early prototyping. The RID methodology has been validated in various industrial sectors and is well-adapted for healthcare innovation. To exemplify the methodology, we present a case study in dental imagery performed by 10 students in 8 weeks. This example demonstrates how RID favours efficiency in Problem Design and allows designers to explore unaddressed and sometimes undeclared user needs.