Melhoria de Processos em unidades de cuidados de saúde: Desenvolvimento de modelos com aplicacão a uma unidade de Medicina Nuclear Atomedical
Instituto Superior Técnico, Tese de Mestrado, (2010)Abstract
Private health care units are facing strong and challenging pressures to become more efficient and deliver high quality services in such a competitive, complex and technological health care market. In this context, decision support tools aim at helping decision makers to pursue improvements in their units that can result in minimizing costs and maximizing profits and service quality. In this study, a decision support tool was developed in the context of the larger private nuclear medicine unit in Portugal, Atomedical, with the objective of aiding the organization to deal with complex issues at the operational level, such as resource utilization and scheduling. A discrete event simulation model was developed for the unit under study since it could comprise the stochastic events inherent to the services provided and allow for analysis of efficiency and quality measures. Model development included several steps, namely the conceptualization of the patients pathway for the exams provided in the clinic (including the resources utilized at each step), the choice of which exams to model separately, the computer implementation through the SIMUL8 simulation software, the calibration of the model, using historical data and information from the staff, and the validation of the model implemented, comparing some outputs with current data available in the clinic. After model’s validation, two different scenarios were tested: the first scenario comprised the rise of 10\% in demand and an extra check-in point at the reception, and the second one an alternative appointment schedule. The analyses of results showed that the demand considered for some exams, such as myocardial perfusion study, is not in consonance with the appointment scheduling, resulting in waiting times for the exam too large. An extra check-in point does not seem to be sufficient to really improve waiting time at the reception with the current resources. The alternative appointment schedule proved to reduce the waiting time for the exam myocardial perfusion study and enhance resources utilization, but also deteriorate some quality indicators, such as waiting times in the unit.