Olsder, W. (Wendy) (2017) A planning and control framework for residents' activities. thesis, Other studies (UMCG).
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Abstract
Problem statement and research objective: Medicine residency is a challenging graduate medical training in which residents (in Dutch: AIOS: ‘Arts in Opleiding tot Specialist’) are exposed to one of the medical specialties. During the residency program, residents are considered both learners and providers of medical services. Many university medical centers face a difficult challenge of designing feasible schedules for their residents, because the schedules need to satisfy both the educational requirements and the demand of providing patient care. The challenge on scheduling residents can also be observed at the Radiology department of the University Medical Center Groningen (UMCG). At the Radiology department of the UMCG, approximately 25 residents are trained to become a specialist in the field of Radiology. Current schedules affect both performance of the residency program and effective employment of residents at the department. For instance, the residency program faces problems with guaranteeing the learning curve of internships, due to the tasks residents have to perform for the patient care services. Furthermore, the department faces problems with the high amount of evening, night and weekend shifts taken by residents, which also affects the quality of the residency program. Similar performance issues are observed at many other hospitals and are widely acknowledged in literature (Gaba & Howard, 2002; Güler, Idi & Güler, 2013; Prins, Hoekstra-Weebers & Van de Wiel, 2007). Typically, the scheduling issues faced are traced back to the setup and operation of scheduling systems. Researchers typify these scheduling systems as complex, due to the many parties with their often conflicting interests and requirements. Not surprisingly, observations made by these researchers suggest the development of residents’ schedules to be time consuming. Starting from their observations, researchers suggest the development of more efficient scheduling procedures. Unfortunately, little progress has been made on this so far. To deal with the issues faced in scheduling residents’ activities, the following research objective is determined: Develop a framework for the planning and control of residents’ activities in order to enhance the effectiveness, efficiency and job satisfaction of the department, the residency program and the residents. The developed framework is meant to serve as a reference architecture for designing systems for the planning and control of residents’ activities. The setup of the framework acknowledges the need to address problem complexity by a hierarchical decomposition of the planning and control tasks. By identifying planning levels, planning activities and performance criteria, it is meant to guide the planning and control system design. Research design: To reach the goal, various steps of the design methodology are used. In this design, the Radiology department of the UMCG is used as a research vehicle. The main objectives underlying the research design are underpinning the need for a planning and control framework, developing an initial framework and illustrating and evaluating the possible use of the framework. The research design consisted of the following four steps: Step 1) Describe current system Step 2) Analyze performance of current system and underpin need for framework Step 3) Design of framework Step 4) Illustrate and evaluate use of framework To support the findings from the case study, also observations from site visits to other hospitals and departments are used. Analysis: The performance of the planning and control of residents has been analyzed according to the performance indicators effectiveness, efficiency and job satisfaction. The performance analysis showed that especially effectiveness of the residency program has much room for improvement. For instance, the mean of the days spent at an internship is 3.48 days for a first-year resident, 2.84 days for a third-year resident and 2.54 days for a fifth-year resident. These means of the days spent at an internship are considered to be too low. In addition, 37.9% of the internships contain less than four consecutive weeks at one internship for all residents. This is not sufficient, since following less than four consecutive week’s causes fragmentation of the internships and affects the learning curve of residents. To identify the causes of the problems occurring at the Radiology department, a cause and effect analysis has been performed. In addition, the identified causes are rated by various stakeholders, to identify the most important causes at the Radiology department of the UMCG. The most important causes can be divided into four main categories. First, there is no explicit planning and control architecture. Second, there is no clear division of planning levels, horizons and tasks. Third, improvements on the planning and control of residents are stagnated due to problem complexity. This confirms the complexity of designing a schedule for residents, suggested by various researchers. Finally, there is a lack of integration between the schedules of the residency program and the patient care services. The identified causes of this analysis suggest to structure and to develop guidelines for the planning and control of residents. Thus, the observed performance underpins the need to develop a framework for the planning and control of residents. A specific requirement for the framework that follows from this analysis is a clear division between the various parties. Currently, there is a lack of overview, which should be provided by the framework. Furthermore, the framework should provide steps and deadlines that should be made at a specific time. Thus, besides a clear division of the parties, also a planning horizon should be included. Design of the framework: The planning and control framework for residents’ activities is developed by using the four hierarchical levels proposed by Hans, Houdenhoven & Hulshof (2011). These four levels are structural, tactical, offline operational and online operational planning and control. The four levels of planning and control are each decomposed in activities specific for the planning and control of residents. The proposed framework consists of two streams of activities; a stream for the residency program and a stream for the patient care services. The decomposition in two streams clarifies both roles of the resident, i.e. the graduate student and the employee. Illustration and evaluation of the framework: The proposed framework can be used to improve the performance of the planning and control system of the Radiology department of the UMCG. To improve the performance of the current system, various solution directions have been explored. These solution directions build on analyzing other departments of various hospitals, the opinions of stakeholders and available literature. The planning and control framework is used to organize the various possible solutions into three redesigns. The three proposed redesigns have been evaluated by various stakeholders. To evaluate the proposed redesigns, a survey was created and distributed among the Radiology department. In total 26 members of the Radiology department have filled in the survey, from which 11 residents. The main conclusion from this evaluation is that all stakeholders agree on introducing a structure with defined agreements and deadlines. This includes deadlines for the delivery of wishes and requests of internships, but also deadlines for days off, such as holidays. The most important element of the redesigns is that there is introduced a structure with defined agreements and deadlines. Therefore, the proposed framework presents a first step in improving the effectiveness, efficiency and job satisfaction of the schedule of residents at the Radiology department of the UMCG. Discussion: The designed framework for residents´ activities is a first step in guiding the planning and control system design. The framework addresses the problem complexity and the division of planning levels, tasks and horizons. However, more research is needed to expand the designed framework. The proposed planning and control framework can be used by any other department to create awareness about the planning and control of residents and to start evaluating their own planning and control system of residents. The arising problems around residents will force almost any department to redesign their planning and control system. When coping with these problems, the proposed framework can be used to guide the redesign of the planning and control system. Conclusion + recommendations: This study aimed to propose a framework for the planning and control of residents’ activities, in order to enhance the effectiveness, efficiency and job satisfaction of the department, the residency program and the residents. To reach its goal, a case study is performed on the Radiology department of the UMCG. The case study is used to underpin the need for a planning and control framework, develop requirements for the framework and illustrate and evaluate the possible use of the framework. During the case study, a planning and control framework is developed. The developed framework is meant to serve as a reference architecture for designing systems for the planning and control residents’ activities. The setup of the framework acknowledges the need to address problem complexity by a hierarchical decomposition of the planning and control tasks. By identifying planning levels, planning activities and performance criteria, it is meant to guide the planning and control system design. Further research is required to expand the proposed planning and control framework. Currently, the framework only includes one managerial area of the framework of Hans et al. (2011), namely the resource planning. However, the framework could be expanded in the other three levels: medical planning, materials planning and financial planning. For instance, the financial part of training residents and their delivery of patient care services could be investigated in future research. It would be interesting to know the total costs of residents and the financial effects of the various possibilities of restructuring tasks of residents. Furthermore, future research could investigate the application of the proposed framework for other departments. Finally, the proposed framework could be further detailed in future research.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Hoogstins, ir. T.J.J. |
| Supervisor name: | Zee, dr.ir. D.J. van der |
| Faculty: | Economics and Business |
| Date Deposited: | 25 Jun 2020 11:03 |
| Last Modified: | 25 Jun 2020 11:03 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/2317 |
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