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- Olsson, Olle, 1986-
(författare)
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Managing variation in hospital patient flows
- 2021
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Performing healthcare services is a complex practice. With the continuous developments in the medical field, healthcare organisations and professionals have become increasingly specialised, and healthcare services increasingly fragmented. When focusing on how to treat and cure diseases, the organisational and managerial aspects of care delivery can be overlooked. This increases the risk of sub-optimisation, when focusing on single activities, patient flows or healthcare units without considering the impact on the organisation as a whole. With every individual patient also having different combinations of diseases, severity levels and responses to medical interventions, much variation is introduced into patient flows. To address these challenges, the purpose of this thesis is: To explore the impact and management of variation in patient flows within hospitals. This thesis reports the results from three different studies, performed at three different hospitals. The first study analyses the impact of changes in patient inflow, available resources, treatment times and duration of activities on bed occupancy and length of stay. It does so by developing a simulation model of an emergency department (ED) and inpatient ward. The results show that the impact of variation in acute patient flows is smaller for the ED than the inpatient ward, which indicates that EDs might be more adaptable than inpatient wards in handling variation in acute patient flows. Bed occupancy on inpatient wards also seems to be strongly influenced by variation in patient flows. The second study is based on a single case study of the management of variation in acute patient flows at a university hospital. In accordance with the results of the first study, this second study shows that many actions are used to handle high bed occupancy, while few are used to handle ED overcrowding. More actions are also used to improve the situation in clinical departments than in the hospital as a whole, increasing the risk of sub-optimisation. The study highlights the need for top management to support department chiefs in managing variation in patient flows, e.g. by establishing a hospital-wide strategy for handling variation in acute patient flows. In the third study, the combined results from a case study and a quantitative before/after study are used to analyse whether the implementation of standardised cancer care pathways leads to crowding out effects, in terms of longer waiting times for other elective patient groups. The study shows that care pathway implementation is likely to lead to crowding out effects, if these effects are not addressed in the implementation process. Hence, a strategy to handle variation in one patient flow influences the options for handling variation in other patient flows and at the healthcare units as a whole. Crowding out effects were evaluated as most likely for patients from the patient group that is overtaken by the care pathway patients, and least likely for patients from the patient group with the lowest priority, due to a redistribution of waiting times between different patient groups. All in all, the research reported in this thesis demonstrates the need to take a systems perspective when managing variation in patient flows in order to avoid sub-optimisation, which otherwise often follows when focusing on just one part of a system.
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| 2. |
- Haag, Linnea, 1992-
(författare)
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Dynamic capabilities for managing logistics challenges of retailers
- 2021
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The increase in globalisation of trade, digitalisation and new technical advances in marketing, IT, and logistics have created new opportunities for retailers to expand and reshape their businesses. These changes have resulted in more complex logistics, and retailers are now facing several critical logistics challenges. To manage these challenges, retailers need to have dynamic capabilities (DCs) that enable them to continuously modify their logistics in order to create and maintain wellfunctioning logistics systems that are both cost-effective and service oriented. In addition, retailers need to have specific antecedents in place that enable them to develop and use such DCs. Despite the importance of DCs in retail, there is a limited understanding of these DCs and their antecedents, and how they enable retailers to adapt their logistics to manage logistics challenges. Hence, the purpose of this dissertation is to: Using a DC lens, explain how retailers can manage logistics challenges. This dissertation is based on two studies and includes six appended papers, which together cover the two logistics challenges of geographical expansion of retailers and transition to omni-channel retailing. The methodologies applied include a combination of literature studies and multiple case studies of large-sized Swedish retailers, in order to identify, describe, and explain DCs and their antecedents in a retail setting. A DC lens was used to study DCs and their antecedents from an intraorganisational and an interorganisational perspective, in which intraorganisational DCs were first studied in the geographical expansion of retailers, followed by interorganisational DCs (IDCs) in the transition to omni-channel retailing. The findings present accessing, integration, and utilisation as three important DCs to manage the geographical expansion of retailers. In addition, the findings present three receive-oriented IDCs: accessing, integration, and utilisation, as well as two transferoriented IDCs: identify knowledge-transfer opportunities and transfer of knowledge, which together are important for the transition to omni-channel retailing. In terms of antecedents, four antecedents of intraorganisational DCs: centralised logistics control, centralised logistics structure, standardisation of logistics operations, and learning orientation, were found to support the geographical expansion of retailers. In the transition to omni-channel retailing, two antecedents of IDCs: supply chain orientation and learning orientation, were found. This research provides in-depth insight into how retailers can manage two important logistics challenges in retail: the geographical expansion of retailers and the transition to omni-channel retailing. In addition, this research provides a refinement of DCs and their antecedents to increase our understanding of how such DCs and their antecedents enable retailers to manage different logistics challenges. Previous research has not identified, described, or explained how DCs enable retailers to systematically adapt their logistics to new conditions and issues related to different challenges. By studying DCs from both an intraorganisational and an interorganisational perspective, this research identifies a distinction between receive-oriented and transfer-oriented DCs, which are essential for accessing, integration, and utilisation of external resources, as well as for identifying and transferring internal resources, in order to facilitate new logistics solutions to manage different logistics challenges. For logistics practitioners, this research demonstrates the importance of retailers working systematically to manage different logistics challenges and provides several concrete examples of how retailers can take on such challenges, as well as summarising valuable learning and experiences from retail practitioners. In addition, the research reveals the importance of a shared logistics vision, a proactive role taken by the logistics function of retailers, and collaboration between retailers and LSPs, in order to better manage logistics challenges in retail.
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| 3. |
- Sandberg, Erik, 1978-, et al.
(författare)
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Interactive research framework in logistics and supply chain management : Bridging the academic research and practitioner gap
- 2022
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Ingår i: Technological forecasting & social change. - : Elsevier Inc.. - 0040-1625 .- 1873-5509. ; 178
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Tidskriftsartikel (refereegranskat)abstract
- Logistics and supply chain management (SCM) practice has grown in scope and complexity in recent years. A challenge for research in logistics and SCM is to create value for both academics and practitioners. The purpose of this paper is to introduce interactive research (IR) into the domain of logistics and SCM research and to describe the lessons learned from the implementation of this research approach. Compared to traditional empirical research methods, IR takes place in a context where inferences are co-produced in collaboration with practitioners. Taking an academic–practitioner lens, we draw on the IR framework to develop a deeper understanding of academic and practitioner exchanges in the increasingly complex and multidimensional domain of logistics and supply chain research. In addition to introducing the IR approach, based on four collaborative research projects, we outline and provide potential solutions to challenges arising from IR. Introducing IR to logistics and SCM research could enrich the understanding of collaborative research approaches and could act as a catalyst to its wider adoption in future research.
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