Liliana Neriz

Design and application of learning environments based on integrative problems

This work reports on the results obtained from the application of learning environments on the basis of one integrative problem and a series of other smaller problems that limit the contents to be investigated and learned by the students. This methodology, which is a variation to traditional problem-based learning approaches, is here illustrated in terms of its application in an engineering economics course, a subject that is taught in most engineering programs. The purpose of this methodology is to improve students’ learning, which is measured through the students’ academic performance and their learning strategies, and to characterise them as a function of these variables. The results obtained after the systematic application of this methodology are positive. The surveyed students showed significant changes in the examined variables as well as in their satisfaction and motivation level, and in their commitment to learning.

Scheduling operating rooms with consideration of all resources, post anesthesia beds and emergency surgeries

We propose two exact and a metaheuristic method for surgery room scheduling.We take into consideration constrained human and physical resources.The scheduling considers the availability of post-anesthesia recovery beds.We ensure adequate inter-surgery intervals for attending emergency surgeries. Surgery rooms are among the most expensive resources in hospitals and clinics. Their scheduling is difficult because, in addition to the surgical room itself, each surgery requires a particular combination of human resources, as well as different pieces of equipment and materials. Furthermore, after each surgery, a post-anesthesia bed is required for the patient to recover. Finally, in addition to planned surgeries, the scheduling must be made in such a way as to accommodate the emergency surgeries that may arrive during each day, which must be attended within a limited time. We address the surgery scheduling problem considering simultaneously, for the first time, the operating rooms, the post anesthesia recovery, the resources required by the surgery and the possible arrival of emergency surgeries. We propose an integer linear programming model that allows finding optimal solutions for small size instances, we transform it to use constraint programming, and develop a metaheuristic based on a genetic algorithm and a constructive heuristic, that solves larger size instances. Finally, we present numerical experiments.

A simulator to improve waiting times at a medical imaging center

Medical Imaging Centers (MIC) are critical units in every hospital or medical center because they are an important step in generating a patient¿s diagnostic. This paper shows a simulator designed to facilitate the development of simulation studies of MIC, which departs from traditional modeling because it uses a pull paradigm for the patients. A group technology approach was used to minimize the number of objects in the simulator, which includes objects that have the functionality of the equipments and processes found in these facilities, so that the analyst only needs to provide the parameters of the center. All the data is provided to the simulator through a Graphic User Interface (GUI), requiring no programming capacities. As an application of the simulator, an example is provided where the simulator is used to improve the waiting times and equipment rate of utilization at a research hospital in Chile.

A cost management model for hospital food and nutrition in a public hospital

BackgroundIn Chile, the use of costing systems in the public sector is limited. The Ministry of Health requires hospitals to manage themselves with the aim of decentralizing health care services and increasing their quality. However, self-management with a lack of accounting information is almost impossible. On the other hand, nutrition department costs have barely been studied before, and there are no studies specifically for activity based costing (ABC) systems. ABC focuses on the process and traces health care activities to gain a more accurate measurement of the object costs and the financial performance of an organization.MethodThis paper uses ABC in a nutrition unit of a public hospital of high complexity to determine costs associated with the different meals for inpatients. The paper also provides an activity based management (ABM) analysis for this unit.ResultsThe results show positive effects on the reduction of costs for the nutrition department after implementing ABC/ABM. Therefore, there are opportunities to improve the profitability of the area and the results could also be replicated to other areas in the hospital. ABC shed light on the amount of nutritionist time devoted to completing paperwork, and as a result, system changes were introduced to reduce this burden and allow them to focus on more relevant activities. Additional efficiencies were achieved through the elimination of non-value adding activities and automation of reports. ABC reduced the cost of the nutrition department and could produce similar results in other areas of the hospital.ConclusionsThis is a practical application of a financial management tool, ABC, which would be useful for hospital managers to reduce costs and improve the management of the unit. This paper takes ABC and examines its use in an area, which has had little exposure to the benefits of this tool.

Improving patient access to a public hospital complex using agent simulation

This paper uses agent based simulation to assess the effect of redesigning the points of access to a major public hospital complex in Chile, where nearly 15,000 people will pass through daily. The study is carried out by simulating pedestrian traffic in order to calculate density maps and service levels in hospital access and ramps. The simulation allows us to evaluate the flow of people and assess the layout performance, by identifying high patient flow areas and congested pedestrian traffic zones. By using this approach, it is possible to suggest changes to the original design and to improve pedestrian flow at hospital access points and ramps. The suggested changes reveal that pedestrian indicators could be improved, which in turn would improve the level of satisfaction of patients, relatives, and hospital personnel. A higher satisfaction level would help to reduce stress linked to hospital facilities and crowded spaces.

Tools to manage the decision-making process in operating rooms

Methods We analyzed and created a model to deal with and better manage current problems in operating rooms such as inefficiency in the use of resources, low productivity, extended waiting times, and the elevated costs associated with providing surgical services. By gathering data from the surgical process, we built a dictionary of activities, identified the cost-drivers and the cost object to trace the overhead cost using the ABC methodology. In combination with the information obtained we identified indicators to measure performance associated to operating room use, using @risk software to simulate the optimum performance for continuous improvement.

Tools to Improve the Patient’s Processes at Imaging Centers

There is a worldwide concern for increased efficiency and cost effectiveness in healthcare delivery which in the USA represents about 16% of the Gross Domestic Product. The variability and complexity of the processes within healthcare systems demand the use of more sophisticated management tools, such as the recommended by a joint study by the National Academy of Engineering and the Institute of Medicine in the USA (NAE 2005), to improve the healthcare delivery system. In this chapter it is seen the integration of three management tools (Activity Based Costing, Lean Healthcare and Process Simulation) to facilitate the development of Medical Imaging Center (MIC) studies in order to improve the patient s processes, which departs from traditional modeling because it uses a pull paradigm for the patients. Activity Based Costing (ABC Costing) is used to identify improvement opportunities from the managers’ point of view, Lean Healthcare (Lean) to identify opportunities from the Customers point of view and Process Simulation (Simulation) to test the potential impact of any proposed alternative identified with ABC Costing or Lean, prior to its implementation. The center to be modeled might be as simple as having one x-ray machine, or, more complex having all kind of imaging machines (magnetic resonance, CT, x-ray, digestive radiology, ultrasound scan, angiography, mammography and others).

Emergency departments key performance indicators: A unified framework and its practice

Context An emergency department (ED) in a hospital provides 24‐hour care for the injured/severely ill patients. EDs are essential in any health care system. However, they face many challenges to provide timely treatment such as shortage of specialists, inadequate infrastructure, and unavailability of hospital beds, among others. These challenges are worldwide and undermine the effectiveness of operations and quality of services throughout the hospital. Methods This study aims to improve the performance of EDs using key performance indicators (KPIs). The KPIs will help decision makers to monitor and manage the performance of EDs systematically. Based on an in‐depth field study, expert opinions, and literature review, we propose 5 categories of KPIs regarding Capacity for, Temporality of, Quality of, Outcomes of, and Economics of emergency care. The KPIs are applicable to the basic stages of emergency care. The achievement of the KPIs in each stage will be a function of (1) how the KPIs are used, (2) resources for achieving the KPIs, and (3) management of the resources. The unified systemic framework to manage EDs is presented as an ontology that articulates the very large number of potential ways of ED performance management. Results Seventy‐five KPIs were defined for monitoring purposes. The KPIs and the proposed framework were validated and applied in 2 EDs at a public childrens hospital and a medium size clinic in Chile. Conclusions Based on the study, we propose to standardize the essential information necessary to assess the performance of EDs in Chile using KPIs for their continuous improvement.

COSTEO DE PRODUCTOS EN LA INDUSTRIA DEL MUEBLE MEDIANTE MÉTODO ABC

El trabajo presenta un modelo de determinacion de costos de muebles, disenado utilizando el enfoque de Costeo Basado en Actividades (ABC). El modelo resulta de particular interes y aplicacion en la industria del mueble, por la gran diversidad de productos, procesos y equipos involucrados en la fabricacion de muebles. El Sistema ABC utiliza un procedimiento de asignacion, donde los recursos son primero asignados a las actividades y luego estas son asignadas a los productos o objetos de costo, mediante los llamados generadores o inductores de costos. Este sistema permite la asignacion y distribucion de los diferentes costos indirectos de acuerdo a las actividades realizadas, identificando el origen del costo de la actividad, no solo para la etapa de produccion sino tambien para la distribucion y venta. Para ilustrar el uso del modelo, este se aplica a la determinacion del costo de produccion de dos sillas mecedoras del tipo deslizantes. Se concluye que los costos totales de fabricacion son subvaluados por el metodo tradicional respecto del metodo ABC, en un 19,8% para el modelo Pelequen y en un 29,3% modelo Moderno Palabras clave : Determinacion de costos de muebles; costeo basado en actividades; costos de fabricacion; generadores de costos; industria del mueble.