Mathematical methods to assist with hospital operation and planning.

摘要

Within health Operational Research, the use of 'computer package' methods such as simulation and system dynamics is becoming so prevalent that it feels somewhat old hat to use analytical methods to develop explicit mathematical formulae or even to explore the mathematical structure of problems. This paper will discuss the use of such 'back of the envelope' analysis illustrating its usefulness. It will be shown that not only does this approach yield considerable insight, but also that it can give rise to powerful and practical solution methods. Examples of this will be discussed in relation to issues such as bed needs estimation, admissions and facilities planning. The author is Director of the Clinical Operational Research Unit (CORU) which was established in 1983, receiving core funding from the UK Department of Health. The concept of a full time university-based research unit dedicated to applying expertise in Operational Research (OR) to problems in health care provides a relatively rare research resource. Yet, the scope for such research, applied to an increasing range of health care activity, is enormous. Issues such as treatment evaluation, performance measures, clinical governance, evidence based medicine and health service delivery are all amenable to OR. Further, OR often provides an immensely cost effective alternative to traditional methods of clinical research based on randomised controlled trials or large scale epidemiological studies. The nature of OR, and one of its main strengths, is that it encompasses a wide range of analytical and scientific methods. Mathematical modeling, statistics, computer-based methods, trial design and analysis all contribute to health OR and, under both of its Directors since 1983, a conscious effort has been made within CORU to foster a diversity of research methodologies. Particular emphasis is put on developing new mathematical methods and computer software. This is somewhat at odds with what seems to be a growing trend in health OR towards researchers specialising in just one or two areas of methodology; thus Tom does queueing theory, Dick does simulation and Harry does System Dynamics. Of course there are exceptions, but for whatever reason, the trend towards specialisation seems real. In this paper, benefits of a more diverse approach to health OR is advocated, particularly the use of 'back of envelope' mathematical methods as an alternative to the use of proprietary software packages. Three case studies are described to illustrate this approach.