1. Managing performance of operating units Research Plan Antti Peltokorpi, MSc, Researcher, PhD candidate antti.peltokorpi@tkk.fi Helsinki University of Technology BIT Research Centre Institute of Healthcare Engineering, Management and Architecture

2. Measuring success in operating unit Depending on the system environment and internal requirements, typical measures for operating unit performance are capacity utilization, contribution to margin, and waiting time High personnel productivity can be seen as a shared enabling factor for all those measures Hi is working hours of profession i at the given period, dj is an average of duration of operation for operation type j, and Nj is a number of operations j at the given period. Cost-efficiency takes into account also additional costs due to delayed operations and overtime working ci is a hourly cost of work of profession i during office hours, x is a hourly cost of operating room overtime, O is a number of overtime hours, y is a cost of delayed elective operations, C is a number of delayed elective operations, w is a cost of delayed emergency operations, and D is a number of delayed emergency operations.

3. Production planning and control in operating unit Production planning Resource planning Demand management Master production scheduling Detailed capacity planning Detailed material planning Capacity and material plans Shop-floor scheduling systems Capacity requirement data (adapted from Vollmann et al.1997) Decisions to be made 1. What operations to provide and in which site? 2. How to design the operating unit process layout? 3. What operations and how many to perform during next 12 months? 4. How to staff operating unit for the next 12 months? 5. How to allocate resources to specialties for the next 1-6 months? 6. How to schedule operating room time blocks? 7. How to manage demand and resources during the day of operation?

4. Managerial challenges varied depending on the nature of surgical process Decreasing unit costs Increasing process definition Process variety Volume per unitLow High Local one surgeon providers Specialized elective hospitals Emergency units Multi-specialty regional hospitals (adapted from Johnston & Clark 2005) In terms of proportion of emergencies and number of specialties In terms of number of operating rooms and operations per year

5. Research questions The primary research question in that licentiate thesis is: ― How to manage productivity and cost efficiency in multi-specialty operating unit? The sub-questions related to primary problem are: ― How productivity and cost efficiency can be forecasted in the planning phase? ― What is the effect of non-planned factors, such like personnel absence and variation in emergency load, to productivity and cost efficiency? ― How the cost efficiency is consisted of the decisions in the surgical services management process? ― How operations and resources should be planned so that productivity and cost efficiency are maximized?

6. Research process Primary case study: Jorvi Hospital ― Considering daily productivity and cost-efficiency ― How decisions in the planning phase reflect on the daily performance? ― Path-analyses and regression analyses about factors affecting on daily performance Secondary case studies: Unfallkrankenhaus Berlin, Päijät- Häme Central Hospital, Department of Gynecology, Kaiser Permanente (?), Sutter Health (?) ― How the results from Jorvi case can be generalized to other operating units?

7. Example of data analysis Planned operations Planned personnel Cancelled cases Personnel absence Standby personnel Planning and estimating Load from previous days Changes on the day of surgery Performance Planned productivity Estimated productivity Estimated emergency load Emergencies from previous days Emergencies on the day of surgery Realized productivity Overutilized OR time Delayed elective and emergency cases Estimated operations Realized personnel Realized operations Cost efficiency Realized costs Additional care costs Allocated OR time Planned staff intensity Estimated OR utilization Regression analysis: How the decisions in the planning phases reflect on the daily performance?