The main purpose of this thesis is to apply operations management methods to improve health care providers’ performance in two major areas of primary care:emergency care and preventive care. Operations Management (OM) and Operations Research (OR) have been applied to health care for many years to improve health care delivery efficiency. Primary care stands in the very center of the whole medical care system, whose key functions include providing an entry point, delivering core medical and preventive care, and helping patients coordinate and integrate care, all of which are critical in improving not only health outcome of patients, but also cost performance of the whole health care system.
Chapter 2 of this dissertation aims at improving emergency room department performance through process redesign. We set our study in a U.S. tertiary hospital emergency department (ED) that has an annual census of 55,000 patients, and look at how redesigning process for a specific blood test impacts the congestion of the ED. More specifically, we look at the changes in three performance metrics, after the analysis of patients’ blood sample for troponin level was moved from the hospital’s central lab to inside the ED. Use priority queuing theory, we generate hypotheses on the following performance measures: waiting time (defined as the time difference between patient intake registration and bed assignment), service time (defined as the time difference between bed assignment and disposition), and service quality (defined as patients’ 72-hour revisit rate).
We find the process redesign to be associated with statistically significant improvements in nearly all three measures of operational performance. We also find system wide spillover effects for patients who do not receive a POCT (no test patients). By examining the impact of POCT among both the population of patients receiving the test and the population that does not, this study is unique in identifying the system-wide benefits that can be attained through ED process redesign.
Given the significance of preventive care in saving lives and reducing cost, chapter 3 of this dissertation explores how to improve government funded preventive care program through program network redesign. We apply econometrics analyses on population participation function and client preference function to an empirically based simulation model. Through a simple iteration heuristics, we show that significant improvement to the key performance indicators can be achieved by taking account clients’ preference over a set of service attributes.
As a conclusion of both chapters, this thesis attempts to provide tools from operations management to improve efficiencies of primary health care deliveries. We generate managerial implications that not only can help health care providers to improve service quality, but more important, reduce cost to the whole health care system and save lives.
Lijie Song defending her Doctoral Thesis