Mário Amorim Lopes

Handling healthcare workforce planning with care: where do we stand?

BackgroundPlanning the health-care workforce required to meet the health needs of the population, while providing service levels that maximize the outcome and minimize the financial costs, is a complex task. The problem can be described as assessing the right number of people with the right skills in the right place at the right time, to provide the right services to the right people. The literature available on the subject is vast but sparse, with no consensus established on a definite methodology and technique, making it difficult for the analyst or policy maker to adopt the recent developments or for the academic researcher to improve such a critical field.MethodsWe revisited more than 60 years of documented research to better understand the chronological and historical evolution of the area and the methodologies that have stood the test of time. The literature review was conducted in electronic publication databases and focuses on conceptual methodologies rather than techniques.ResultsFour different and widely used approaches were found within the scope of supply and three within demand. We elaborated a map systematizing advantages, limitations and assumptions. Moreover, we provide a list of the data requirements necessary to implement each of the methodologies. We have also identified past and current trends in the field and elaborated a proposal on how to integrate the different methodologies.ConclusionMethodologies abound, but there is still no definite approach to address HHR planning. Recent literature suggests that an integrated approach is the way to solve such a complex problem, as it combines elements both from supply and demand, and more effort should be put in improving that proposal.

A grammar for standardized wiki markup

Todays wiki engines are not interoperable. The rendering engine is tied to the processing tools which are tied to the wiki editors. This is an unfortunate consequence of the lack of rigorously specified standards. This paper discusses an EBNF-based grammar for Wiki Creole 1.0, a community standard for wiki markup, and demonstrates its benefits. Wiki Creole is being specified using prose, so our grammar revealed several categories of ambiguities, showing the value of a more formal approach to wiki markup specification. The formalization of Wiki Creole using a grammar shows performance problems that todays regular-expression-based wiki parsers might face when scaling up. We present an implementation of a wiki markup parser and demonstrate our test cases for validating Wiki Creole parsers. We view the work presented in this paper as an important step towards decoupling wiki rendering engines from processing tools and from editing tools by means of a precise and complete wiki markup specification. This decoupling layer will then allow innovation on these different parts to proceed independently and as is expected at a faster pace than before.

An EBNF grammar for Wiki Creole 1.0

Todays wiki engines are not interoperable. This is an unfortunate consequence of the lack of rigorously specified standards. This technical report presents a complete and validated EBNF-based grammar for Wiki Creole, a community standard for wiki markup. Wiki Creole is also the only standard currently available. Wiki Creole is being specified using prose, leading to inconsistencies and ambiguities. Our grammar uncovered those ambiguities which we fed back into the specification process. The Wiki Creole grammar presented in this report makes the creation of Wiki Creole parsers simple using parser generators, ANTLR in our case. Using a precise specification of wiki markup lets us decouple wiki editors from wiki storage from further wiki processing tools. Based on this decoupling layer we expect innovation on these different parts to proceed independently and at a faster pace than before.

Forecasting the medical workforce: a stochastic agent-based simulation approach.

Starting in the 50s, healthcare workforce planning became a major concern for researchers and policy makers, since an imbalance of health professionals may create a serious insufficiency in the health system, and eventually lead to avoidable patient deaths. As such, methodologies and techniques have evolved significantly throughout the years, and simulation, in particular system dynamics, has been used broadly. However, tools such as stochastic agent-based simulation offer additional advantages for conducting forecasts, making it straightforward to incorporate microeconomic foundations and behavior rules into the agents. Surprisingly, we found no application of agent-based simulation to healthcare workforce planning above the hospital level. In this paper we develop a stochastic agent-based simulation model to forecast the supply of physicians and apply it to the Portuguese physician workforce. Moreover, we study the effect of variability in key input parameters using Monte Carlo simulation, concluding that small deviations in emigration or dropout rates may originate disparate forecasts. We also present different scenarios reflecting opposing policy directions and quantify their effect using the model. Finally, we perform an analysis of the impact of existing demographic projections on the demand for healthcare services. Results suggest that despite a declining population there may not be enough physicians to deliver all the care an ageing population may require. Such conclusion challenges anecdotal evidence of a surplus of physicians, supported mainly by the observation that Portugal has more physicians than the EU average.

Comparing Comparables: An Approach to Accurate Cross-country Comparisons of Health Systems for Effective Healthcare Planning and Policy Guidance

With rising healthcare costs, using health personnel and resources efficiently and effectively is critical. International cross-country and simple worker-to-population ratio comparisons are frequently used for improving the efficiency of health systems, planning of health human resources and guiding policy changes. These comparisons are made between countries typically of the same continental region. However, if used imprudently, inconsistencies arising from frail comparisons of health systems may outweigh the positive benefits brought by new policy insights. In this work, we propose a different approach to international health system comparisons. We present a methodology to group similar countries in terms of mortality, morbidity, utilisation levels, and human and physical resources, which are all factors that influence health gains. Instead of constructing an absolute rank or comparing against the average, the method finds countries that share similar ground, upon which more reliable comparisons can then be conducted, including performance analysis. We apply this methodology using data from the World Health Organization’s Health for All database, and we present some interesting empirical relationships between indicators that may provide new insights into how such information can be used to promote better healthcare planning and policy guidance.

Enabling broadband internet access offshore using tethered balloons: The BLUECOM+ experience

The growth of the Blue Economy has been boosted by a set of traditional and new activities including maritime transportation, fisheries, environmental monitoring, deep sea mining, and inspection missions. These activities are urging for a cost-effective broadband communications solution capable of supporting both above and underwater missions at remote ocean areas, since many of them rely on an ever-increasing number of Autonomous Surface Vehicles (ASV), Autonomous Underwater Vehicles (AUV) and Remote Operated Vehicles (ROV), which need to transmit large amounts of data to shore. The BLUE-COM+ project has considered the usage of helium balloons to increase the antenna height, and overtake the earth curvature and achieve Fresnel zone clearance, combined with the use of sub-GHz frequency bands to enable long range communications. In this paper we present the results obtained in three sea trials. They show that the BLUECOM+ architecture is capable of supporting human and system activities at remote ocean areas by enabling Internet access beyond 50 km from shore, live video conference calls with the quality of experience available on land, and real-time data upload to the cloud by ASVs, AUVs and ROVs using standard access technologies with bitrates above 1 Mbit/s.