| 21. |
- Holmström, Paul, et al.
(författare)
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Insights Gained From a Re-analysis of Five Improvement Cases in Healthcare Integrating System Dynamics Into Action Research
- 2022
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Ingår i: International Journal of Health Policy and Management. - 2322-5939. ; 11:11, s. 2707-2718
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Tidskriftsartikel (refereegranskat)abstract
- Background: Healthcare is complex with multi-professional staff and a variety of patient care pathways. Time pressure and minimal margins for errors, as well as tension between hierarchical power and the power of the professions, make it challenging to implement new policies or procedures. This paper explores five improvement cases in healthcare integrating system dynamics (SD) into action research (AR), aiming to identify methodological aspects of how this integration supported multi-professional groups to discover workable solutions to work-related challenges. Methods: This re-analysis was conducted by a multi-disciplinary research group using an iterative abductive approach applying qualitative analysis to structure and understand the empirical material. Frameworks for consultancy assignments/client projects were used to identify case project stages (workflow steps) and socio-analytical questions were used to bridge between the AR and SD perspectives. Results: All studied cases began with an extensive AR-inspired inventory of problems/objectives and ended with an SD- facilitated experimental phase where mutually agreed solutions were tested in silico. Time was primarily divided between facilitated group discussions during meetings and modelling work between meetings. Work principles ensured that the voice of each participant was heard, inspired engagement, interaction, and exploratory mutual learning activities. There was an overall pattern of two major divergent and convergent phases, as each group moved towards a mutually developed point of reference for their problem/objective and solution, a case-specific multi-professional knowledge repository. Conclusion: By integrating SD into AR, more favourable outcomes for the client organization may be achieved than when applying either approach in isolation. We found that SD provided a platform that facilitated experiential learning in the AR process. The identified results were calibrated to local needs and circumstances, and compared to traditional top-down implementation for change processes, improved the likelihood of sustained actualisation.
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| 22. |
- Holmström, Paul, et al.
(författare)
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Insights gained from a systematic reanalysis of a successful model-facilitated change process in health care
- 2021
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Ingår i: Systems Research and Behavioral Science. - : Wiley. - 1092-7026 .- 1099-1743. ; 38:2, s. 204-214
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Tidskriftsartikel (refereegranskat)abstract
- © 2020 The Authors. Systems Research and Behavioral Science published by International Federation for Systems Research and John Wiley & Sons Ltd Health care is a complex system with multiprofessional staff and multiple patient care pathways. Time pressure and minimal margins for error make it challenging to implement new policies or procedures, no matter how desirable. Changes in health care also requires the participation of the staff. System dynamics (SD) simulations can lead to shared systems understanding and allows for the development and testing of new scenarios in silico before implementing solutions. However, research shows that the actual implementation rate of simulations is low. This paper presents a reanalysis of a successful change project in health care combining SD principles with basic action research (AR) premises. The analysis was done by a multidisciplinary research group using qualitative methodology and identifies that a fruitful combination of AR inquiry and SD modelling potentially can improve implementation rates.
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| 23. |
- Larsson, Torbjörn, et al.
(författare)
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Convergent Lagrangian heuristics for nonlinear minimum cost network flows
- 2008
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Ingår i: European Journal of Operational Research. - : Elsevier BV. - 0377-2217 .- 1872-6860. ; 189:2, s. 324-346
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Tidskriftsartikel (refereegranskat)abstract
- We consider the separable nonlinear and strictly convex single-commodity network flow problem (SSCNFP). We develop a computational scheme for generating a primal feasible solution from any Lagrangian dual vector, this is referred to as "early primal recovery". It is motivated by the desire to obtain a primal feasible vector before convergence of a Lagrangian scheme, such a vector is not available from a Lagrangian dual vector unless it is optimal. The scheme is constructed such that if we apply it from a sequence of Lagrangian dual vectors that converge to an optimal one, then the resulting primal (feasible) vectors converge to the unique optimal primal flow vector. It is therefore also a convergent Lagrangian heuristic, akin to those primarily devised within the field of combinatorial optimization but with the contrasting and striking advantage that it is guaranteed to yield a primal optimal solution in the limit. Thereby we also gain access to a new stopping criterion for any Lagrangian dual algorithm for the problem, which is of interest in particular if the SSCNFP arises as a subproblem in a more complex model. We construct instances of convergent Lagrangian heuristics that are based on graph searches within the residual graph, and therefore are efficiently implementable, in particular we consider two shortest path based heuristics that are based on the optimality conditions of the original problem. Numerical experiments report on the relative efficiency and accuracy of the various schemes. © 2007 Elsevier B.V. All rights reserved.
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| 24. |
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| 26. |
- Lindberg, Jesper, 1983, et al.
(författare)
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A national perspective about the current work situation at modern radiotherapy departments
- 2020
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Ingår i: Clinical and Translational Radiation Oncology. - : Elsevier BV. - 2405-6308. ; 24, s. 127-134
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Tidskriftsartikel (refereegranskat)abstract
- Background: The radiotherapy (RT) community faces great challenges to meet the growing cancer incidence, especially regarding workload and recruitment of personnel. Workflow-related issues affect involved professions differently since they have specific expertise and various roles in the workflow. To obtain an objective understanding of the current working situation and identify workflow bottle necks in RT, we conducted a national survey on this topic in 2018. Materials and Methods: All 17 (photon-based) RT departments in Sweden were invited to participate in the study, which targeted both managers and employees in RT. Descriptive statistics were calculated for each profession and for small, medium and large departments (2/3–4/≥5 linacs). Results: Altogether, 364 filled-in questionnaires were returned (32/332 managers/employees; 94% response rate). Managers reported a general need for more staff (all professions). Small departments reported no problems with waiting times (0/3); whereas 2/3 of medium and large departments did (medium: 5/8, large: 2/3). All professions had a positive attitude towards working in RT (mean = 86%, 0/100%=negative/positive attitude). Organizational issues were ranked highest among reoccurring events that were most frustrating/had most negative effect on the work environment. The most severe workflow-related problems were reported to originate at contouring. Conclusion: Future efforts to improve the modern RT workflow need to focus on how to make positive mechanisms at small departments useful in larger settings. Our data also reveal that strong leadership and improved routines at contouring are warranted by all RT professions to reduce frustration related to organizational issues and to increase work effectivity.
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| 27. |
- Lindberg, Jesper, 1983, et al.
(författare)
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An analytical approach to aggregate patient inflows to a simulation model over the radiotherapy process.
- 2021
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Ingår i: BMC health services research. - : Springer Science and Business Media LLC. - 1472-6963. ; 21
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Tidskriftsartikel (refereegranskat)abstract
- In meeting input data requirements for a system dynamics (SD) model simulating theradiotherapy (RT) process, the number of patient care pathways (RT workflows) needs to be kept low to simplify the model without affecting the overall performance. A large RT department can have more than 100 workflows, which results in a complex model structure if each is to be handled separately. Here we investigated effects on model performance by reducing the number of workflows for a model of the preparatory steps of the RT process.We created a SD model sub-structure capturing the preparatory RT process. Real data for patients treated in 2015-2016 at a modern RT department in Sweden were used. RT workflow similarity was quantified by averaged pairwise utilization rate differences (%) and the size of corresponding correlation coefficients (r). Grouping of RT workflows was determined using two accepted strategies (80/20 Pareto rule; merging all data into one group) and a customized algorithm with r≥0.75:0.05:0.95 as criteria for group inclusion by two strategies (A1 and A2). Number of waiting patients for each grouping strategy were compared to the reference of all workflows handled separately.There were 128 RT workflows for 3209 patients during the studied period. The 80/20 Pareto rule resulted in 14/8/21 groups for curative/palliative/disregarding treatment intent. Correspondingly, A1 and A2 resulted in 7-40/≤4-36/7-82 groups depending on r cutoff. Results for the Pareto rule and A2 at r≥85 were comparable to the reference.The performance of a simulation model over the RT process will depend on the grouping strategy of patient input data. Either the Pareto rule or the grouping of patients by resource use can be expected to better reflect overall departmental effects to various changes than when merging all data into one group. Our proposed approach to identify groups based on similarity in resource use can potentially be used in any setting with variable incoming flows of objects which go through a multi-step process comparable to RT where the aim is to reduce the complexity of associated model structures without compromising with overall performance.
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