Looking in the wrong place for healthcare improvements: a system dynamics study of an accident and emergency department

Accident and Emergency (A&E) units provide a route for patients requiring urgent admission to acute hospitals. Public concern over long waiting times for admissions motivated this study, whose aim is to explore the factors which contribute to such delays. The paper discusses the formulation and calibration of a system dynamics model of the interaction of demand pattern, A&E resource deployment, other hospital processes and bed numbers; and the outputs of policy analysis runs of the model which vary a number of the key parameters. Two significant findings have policy implications. One is that while some delays to patients are unavoidable, reductions can be achieved by selective augmentation of resources within, and relating to, the A&E unit. The second is that reductions in bed numbers do not increase waiting times for emergency admissions, their effect instead being to increase sharply the number of cancellations of admissions for elective surgery. This suggests that basing A&E policy solely on any single criterion will merely succeed in transferring the effects of a resource deficit to a different patient group.

A knowledge-driven management approach to environmental-conscious construction

This paper aims to introduce a knowledge-based managemental prototype entitled Eþ for environmental-conscious construction relied on an integration of current environmental management tools in construction area. The overall objective of developing the Eþ prototype is to facilitate selectively reusing the retrievable knowledge in construction engineering and management areas assembled from previous projects for the best practice in environmental-conscious construction. The methodologies adopted in previous and ongoing research related to the development of the Eþ belong to the operations research area and the information technology area, including literature review, questionnaire survey and interview, statistical analysis, system analysis and development, experimental research and simulation, and so on. The content presented in this paper includes an advanced Eþ prototype, a comprehensive review of environmental management tools integrated to the Eþ prototype, and an experimental case study of the implementation of the Eþ prototype. It is expected that the adoption and implementation of the Eþ prototype can effectively facilitate contractors to improve their environmental performance in the lifecycle of projectbased construction and to reduce adverse environmental impacts due to the deployment of various engineering and management processes at each construction stage.

Self-exclusion from health care in women at high risk for postpartum depression

Background A significant proportion of women who are vulnerable to postnatal depression refuse to engage in treatment programmes. Little is known about them, other than some general demographic characteristics. In particular, their access to health care and their own and their infants' health outcomes are uncharted. Methods We conducted a nested cohort case-control study, using data from computerized health systems, and general practitioner (GP) and maternity records, to identify the characteristics, health service contacts, and maternal and infant health outcomes for primiparous antenatal clinic attenders at high risk for postnatal depression who either refused (self-exclusion group) or else agreed (take-up group) to receive additional Health Visiting support in pregnancy and the first 2 months postpartum. Results Women excluding themselves from Health Visitor support were younger and less highly educated than women willing to take up the support. They were less likely to attend midwifery, GP and routine Health Visitor appointments, but were more likely to book in late and to attend accident and emergency department (A&E). Their infants had poorer outcome in terms of gestation, birthweight and breastfeeding. Differences between the groups still obtained when age and education were taken into account for midwifery contacts, A&E attendance and gestation;the difference in the initiation of breast feeding was attenuated, but not wholly explained, by age and education. Conclusion A subgroup of psychologically vulnerable childbearing women are at particular risk for poor access to health care and adverse infant outcome. Barriers to take-up of services need to be understood in order better to deliver care.

Connectivity measures for internet topologies on the level of autonomous systems

Classical measures of network connectivity are the number of disjoint paths between a pair of nodes and the size of a minimum cut. For standard graphs, these measures can be computed efficiently using network flow techniques. However, in the Internet on the level of autonomous systems (ASs), referred to as AS-level Internet, routing policies impose restrictions on the paths that traffic can take in the network. These restrictions can be captured by the valley-free path model, which assumes a special directed graph model in which edge types represent relationships between ASs. We consider the adaptation of the classical connectivity measures to the valley-free path model, where it is -hard to compute them. Our first main contribution consists of presenting algorithms for the computation of disjoint paths, and minimum cuts, in the valley-free path model. These algorithms are useful for ASs that want to evaluate different options for selecting upstream providers to improve the robustness of their connection to the Internet. Our second main contribution is an experimental evaluation of our algorithms on four types of directed graph models of the AS-level Internet produced by different inference algorithms. Most importantly, the evaluation shows that our algorithms are able to compute optimal solutions to instances of realistic size of the connectivity problems in the valley-free path model in reasonable time. Furthermore, our experimental results provide information about the characteristics of the directed graph models of the AS-level Internet produced by different inference algorithms. It turns out that (i) we can quantify the difference between the undirected AS-level topology and the directed graph models with respect to fundamental connectivity measures, and (ii) the different inference algorithms yield topologies that are similar with respect to connectivity and are different with respect to the types of paths that exist between pairs of ASs.

High leverage interventions: three cases of defensive action and their lessons for OR/MS today.

This paper has two aims. First, to present cases in which scientists developed a defensive system for their homeland: Blackett and the air defense of Britain in WWII, Forrester and the SAGE system for North America in the Cold War, and Archimedes’ work defending Syracuse during the Second Punic War. In each case the historical context and the individual’s other achievements are outlined, and a description of the contribution’s relationship to OR/MS is given. The second aim is to consider some of the features the cases share and examine them in terms of contemporary OR/MS methodology. Particular reference is made to a recent analysis of the field’s strengths and weaknesses. This allows both a critical appraisal of the field and a set of potential responses for strengthening it. Although a mixed set of lessons arise, the overall conclusion is that the cases are examples to build on and that OR/MS retains the ability to do high stakes work.

The National Audit Office uses OR to assess the value for money of public services

Supreme audit institutions (SAIs) have an important role in assessing value for money in the delivery of public services. Assessing value for money necessarily involves assessing counterfactuals: good value for money has been achieved if a policy could not reasonably have been delivered more efficiently, effectively, or economically. Operations research modelling has the potential to help in the assessment of these counterfactuals. However, is such modelling too arcane, complex, and technically burdensome for organisations that, like SAIs, operate in a time- and resource-constrained and politically charged environment? We report on three applications of modelling at the UK's SAI, the National Audit Office, in the context of studies on demand management in tax collection, end-of-life care, and health-care associated infections. In all cases, the models have featured in the audit reports and helped study teams come to a value-for-money judgment. We conclude that OR modelling is indeed a valuable addition to the value-for-money auditor's methodological tool box.

Modeling bidding competitiveness and position performance in multi-attribute construction auctions

Currently, multi-attribute auctions are becoming widespread awarding mechanisms for contracts in construction, and in these auctions, criteria other than price are taken into account for ranking bidder proposals. Therefore, being the lowest-price bidder is no longer a guarantee of being awarded, thus increasing the importance of measuring any bidder’s performance when not only the first position (lowest price) matters. Modeling position performance allows a tender manager to calculate the probability curves related to the more likely positions to be occupied by any bidder who enters a competitive auction irrespective of the actual number of future participating bidders. This paper details a practical methodology based on simple statistical calculations for modeling the performance of a single bidder or a group of bidders, constituting a useful resource for analyzing one’s own success while benchmarking potential bidding competitors.