A Framework for Operational Excellence in Hospital Logistics

The paradigm shift from volume-based to value-based care drives healthcare organisations towards aligning logistics and medical processes. The Institute for Healthcare Improvement (IHI) suggests health policy makers to follow the Quadruple Aim strategy as a guide for reforming the health system. The overall population health and the individual patients' experience of care are at the centre of this strategy, while simultaneously pursuing lower costs and improving staff satisfaction. Altogether, optimizing the Quadruple Aim provides a measure for value in healthcare. Value is defined as the ratio of quality of care over cost. In this dissertation, we call for action to control the costs by streamlining the internal hospital supply chain processes.Though often overlooked in the past, healthcare logistics, also referred to as healthcare Supply Chain Management (SCM), is put forward as a crucial strategic target for efficiency improvements in hospitals. Supply chain concepts are designed to reduce costs, enhance visibility and streamline processes to the benefit of value-based care. Moreover, SCM enhances integration among departments and therefore positively impacts hospital performance through the effective use of resources. Today, hospitals face multiple operational challenges, such as poor inventory control, redundant distribution channels, standardization issues, lack of data, etc. which hinder the material and information flows and cause misalignment between patient care and supporting logistics services. The literature rarely addresses how logistics contribute to value creation in healthcare by pursuing operational excellence. As a first step to efficiency improvement, hospitals must be able to measure the performance of the supply chain to identify the main source of waste and inefficiency. However, lack of performance management systems as well as lack of expertise in Operations Research and Operations Management (OR/OM) ask for a rigorous methodology that takes into account the complex nature of the health system.A data-driven approach is needed to evaluate logistics processes, monitor performance and gain actionable insights to control the increasing healthcare expenses. Therefore, this dissertation presents a healthcare logistics performance management framework. On the one hand, we focus on internal hospital supply chain practices, including storage and distribution of disposable medical supplies. Performance management, on the other hand, allows to improve system understanding, identify efficiency gains, implement continuous improvement programs and enhance decision-making capabilities by monitoring the relevant Key Performance Indicators (KPIs). The framework developed in this dissertation will serve as proof-of-concept to show how logistics contribute to healthcare by adopting SCM practices and addressing the unique challenges inherent to the hospital supply chain. OR/OM tools from industrial engineering applications (e.g. simulation, multi-criteria decision making, etc.) play a key role in bringing objectivity in decision making and promoting data-driven process improvement. Moreover, this reference framework incorporates stakeholder feedback to stimulate more informed decision making, to reduce supply chain fragmentation and to provide a common vocabulary and negotiation power. Hence, the framework is an orchestrator for supply chain integration in healthcare by enabling uniform performance measurement and increasing data transparency.From both a theoretical and practical point of view, contributions are made when developing the healthcare logistics performance management framework: (i) The Analytic Network Process (ANP) allows to prioritize KPIs, which constitute the elements of the "operational excellence" definition in healthcare. The ANP-based prototype is presented to translate strategic/tactical objectives into operational KPIs according to the studied application. (ii) ANP and Discrete-Event Simulation (DES) are combined into a hybrid tool to quantify the logistics impact for value-based healthcare. The Internal Logistics Efficiency Performance (ILEP) index is introduced as a multi-dimensional evaluation tool for adopting SCM practices and identifying potential efficiency gains. Besides the well-known trade-off between service level and cost, we show that standardization is an important factor to streamline inventory and distribution processes. (iii) Possibly conflicting stakeholder perspectives are integrated in the framework. In contrast to early-participation of the stakeholders, our approach aims to first increase understanding in order to create awareness of SCM. As a result, the framework promotes stakeholder commitment to strive towards value improvement, which is considered to be a shared goal that unites the interests of all stakeholders. (iv) From a practical point of view, the framework aims to bridge the gap between theory and practice-based SCM. The applicability of the framework is demonstrated using real-life case studies focusing on storing and distributing surgical disposables throughout the operating theatre. In addition, we present an implementation roadmap acting as a guideline for implementing various logistics strategies in different contexts using the framework as a blueprint. This dissertation concludes with a note on how the digitalization trend will impact healthcare SCM.

Jaar van publicatie:2020