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Or Management Kjeld H. Aij Mba

dr. Kjeld H. Aij MBA
dr. Kjeld H. Aij MBA

This document provides biographical information about Kjeld H. Aij and discusses his work managing operating rooms. It addresses several key aspects of operating room management, including planning and scheduling surgical procedures across different time horizons from strategic to operational levels. It also discusses challenges in the healthcare industry like variability in patient needs and the shortage of operating room staff.

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Operating Room Planning & Scheduling Kjeld H. Aij MBA 1
Paspoort Kjeld H. Aij Geboren in 1973 in Schiedam Studeerde Biomedische Wetenschappen, verpleegkunde en bedrijfskunde Verkreeg in 2008 de graad van Master of Business Administration aan de Business School Nederland Promotietraject applications of LEAN in Healthcare Getrouwd met Michelle; 辿辿n zoon Steyn Hoofd Operatiekamers VUmc, Spreker, Ondernemer, Investeerder in zilver 2
3
Kjeld H. Aij MBA 4
Kjeld H. Aij MBA 5
Healtcare: a business unlike all others Financial model does not reward ef鍖ciency Patients are customer and product at the same time Patients cannot be refused Interventions cannot be preempted More variability than in any other industry Many different types of care providers Different types of hospitals, different strategies Academic hospitals do almost everything Specialized clinics are often seen as cream skimmers Multiple decision makers (doctors managers) Doctors are private entrepreneurs within hospital They cheat the system to advance patients Stakeholders often have con鍖icting goals 6
Kjeld H. Aij MBA 7
Kjeld H. Aij MBA 8
Operating Room Layout 9
10
Operating Rooms Signi鍖cant source of hospitals income Majority of hospital admissions undergo surgery Cost intensive (capital and labor) Determines the pace of the hospital If the OR sneezes, the hospital has a cold Are a dangerous place >10% of the patients experience complications or an incident Increased less invasive surgery (endoscopic, robotic) more daycare / outpatient treatments Have a lot of variability Diversity surgical procedures, complications, every patient is different, emergencies Capacity is determined by availability of trained staf 11
Surgery is a complex process where many resources act together Kjeld H. Aij MBA 12
Shortage of OR staff Cyclical shortage (4-5 years) of personnel Causes of shortage Oscillation in training capacity due to shortsighted planning Drop-out in training school Increase of part-time percentage during occupational life Aging Fortifying effect: occurrence of employment agencies Effects: Closure of operating rooms Increase working pressure Increase of labor costs: employment agencies, salary raises, additional income elements 13
Roughly speaking, Generation Y is defined as - 1977 < Birth Date > 2000 31 < Current Age > 8 Kjeld H. Aij MBA 14
ICT 3% 8% 0% Taal en Cultuur 3% 2% 4% Chemie 1% 1% 2% Natuur 1% 0% 2% Finance 1% 1% 1% Landbouw 0% 0% 0% Dat geld verdienen de belangrijkste reden is om te gaan werken, is bijna vanzelfsprekend: de schoorsteen moet tenslotte roken. Daarnaast vertoont generatie Y verrassende verschillen in de diverse opleidingsniveaus. BELANGRIJKSTE REDENEN OM TE GAAN WERKEN % totaal Laagopgeleid Middelhoogopgeleid Hoogopgeleid Geld verdienen 89,7% 95,3% 87,3% 90,3% Zelfontplooiing 48,9% 32,6% 52,7% 58,1% 65% van de jongeren zegt in eerste instantie Kennis opdoen 41,3% 41,9% 42,7% 35,5% op de hoogte van het salaris te letten bij het Iets betekenen voor de maatschappij 28,8% 32,6% 29,1% 22,6% kiezen van een (volgende) baan. Mensen leren kennen 28,8% 41,9% 28,2% 12,9% 8 15
BELANGRIJKE FACTOREN BIJ KIEZEN BAAN 80% 70% 60% 50% % totaal 40% mannen 30% 20% 53,3% van de jongeren heeft al vrouwen 10% tussen de 2 en 5 werkgevers gehad. 0% .. ris er en rk e. rk se n aa k ala sfe ed we im we us z S de jkh nd rtt tti g Bo n de oe eli ele pa nu va n G og iss tot jk o em w eid eli ut i竪r Af h p A ar r lijk ap C e tsch og aa M M 16
17
Goed werkgeverschap Eerlijk Binden Beloftes nakomen en waarmaken Modern werkgeverschap Inspelen op de multiculturele arbeidsmarkt Talent management Inspelen op sabbatical Flexibele werktijden/thuiswerken Open minded Alumni netwerken Bijdragen leveren aan de work/life balans Een opdracht/uitdaging aanbieden ipv baan 18
vertrouwen hebben in elkaar trots zijn op wat we doen plezier hebben met collega's met wie we samenwerken 19
Strategic level (year, quarter) Allocation of OR capacity to surgical specialties Tactical level (month) Weekly allocation of OR-days to specialties Operational (of鍖ine) level (weeks) Elective & semi-urgent surgery scheduling Operational (online) level (days) Monitoring and control Emergency surgery scheduling Kjeld H. Aij MBA 20
Strategic OR planning Capacity dimensioning Operating rooms, equipment Staff Division of the capacity pie Contract: board OR management specialties 21
OR Blueprint 22
Kjeld H. Aij MBA 23
Strategic OR planning Emergency operating rooms or not? 24
Tactical OR planning Open block planning (common in US) First come 鍖rst serve operation Different specialties operate successively in OR Long changeover time, unbalanced workload, overtime Emergency operating room Closed block planning (common in Netherlands) Each specialty / surgeon gets blocks of time (ORday morning session, afternoon session) Each specialty / surgeon schedules its patients in these blocks, at least 1 week in advance More ef鍖cient, less waiting time for patients Remaining time cannot be redistributed Semi-open block planning: combination 25
Process from admission to discharge 26
Process within an OR session F.Boer, LUMC 27
OR utilization Kjeld H. Aij MBA 28
29
Planning based on surgeons estimate 30
Stochastic Surgery durations Kjeld H. Aij MBA 31
32
Flaw of averages 33
34
You are not going to get the elephant to shrink or change its size. You need to face the fact that the elephant is 8 OR tall and 11 hr wide. Steven Shafer, MD 35
Rooster-methodieken Flexibele Zelfroosteren werktijden Matching R u i Intekenrooster l e n Voorkeurrooster Repeterend rooster Vaste werktijden weinig veel zeggenschap zeggenschap 36
Performance of an Operating Room Productivity, e.g. Utilization Ratio: procedure time / capacity Changeover time Throughput time % Cancellations, related to: patient anesthesia preparation organization Waiting time of emergency patients Overtime Effectiveness (eg. revisits of patient, complications) 37
Kjeld H. Aij MBA 38

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Or Management Kjeld H. Aij Mba

  • 1. Operating Room Planning & Scheduling Kjeld H. Aij MBA 1
  • 2. Paspoort Kjeld H. Aij Geboren in 1973 in Schiedam Studeerde Biomedische Wetenschappen, verpleegkunde en bedrijfskunde Verkreeg in 2008 de graad van Master of Business Administration aan de Business School Nederland Promotietraject applications of LEAN in Healthcare Getrouwd met Michelle; 辿辿n zoon Steyn Hoofd Operatiekamers VUmc, Spreker, Ondernemer, Investeerder in zilver 2
  • 3. 3
  • 4. Kjeld H. Aij MBA 4
  • 5. Kjeld H. Aij MBA 5
  • 6. Healtcare: a business unlike all others Financial model does not reward ef鍖ciency Patients are customer and product at the same time Patients cannot be refused Interventions cannot be preempted More variability than in any other industry Many different types of care providers Different types of hospitals, different strategies Academic hospitals do almost everything Specialized clinics are often seen as cream skimmers Multiple decision makers (doctors managers) Doctors are private entrepreneurs within hospital They cheat the system to advance patients Stakeholders often have con鍖icting goals 6
  • 7. Kjeld H. Aij MBA 7
  • 8. Kjeld H. Aij MBA 8
  • 10. 10
  • 11. Operating Rooms Signi鍖cant source of hospitals income Majority of hospital admissions undergo surgery Cost intensive (capital and labor) Determines the pace of the hospital If the OR sneezes, the hospital has a cold Are a dangerous place >10% of the patients experience complications or an incident Increased less invasive surgery (endoscopic, robotic) more daycare / outpatient treatments Have a lot of variability Diversity surgical procedures, complications, every patient is different, emergencies Capacity is determined by availability of trained staf 11
  • 12. Surgery is a complex process where many resources act together Kjeld H. Aij MBA 12
  • 13. Shortage of OR staff Cyclical shortage (4-5 years) of personnel Causes of shortage Oscillation in training capacity due to shortsighted planning Drop-out in training school Increase of part-time percentage during occupational life Aging Fortifying effect: occurrence of employment agencies Effects: Closure of operating rooms Increase working pressure Increase of labor costs: employment agencies, salary raises, additional income elements 13
  • 14. Roughly speaking, Generation Y is defined as - 1977 < Birth Date > 2000 31 < Current Age > 8 Kjeld H. Aij MBA 14
  • 15. ICT 3% 8% 0% Taal en Cultuur 3% 2% 4% Chemie 1% 1% 2% Natuur 1% 0% 2% Finance 1% 1% 1% Landbouw 0% 0% 0% Dat geld verdienen de belangrijkste reden is om te gaan werken, is bijna vanzelfsprekend: de schoorsteen moet tenslotte roken. Daarnaast vertoont generatie Y verrassende verschillen in de diverse opleidingsniveaus. BELANGRIJKSTE REDENEN OM TE GAAN WERKEN % totaal Laagopgeleid Middelhoogopgeleid Hoogopgeleid Geld verdienen 89,7% 95,3% 87,3% 90,3% Zelfontplooiing 48,9% 32,6% 52,7% 58,1% 65% van de jongeren zegt in eerste instantie Kennis opdoen 41,3% 41,9% 42,7% 35,5% op de hoogte van het salaris te letten bij het Iets betekenen voor de maatschappij 28,8% 32,6% 29,1% 22,6% kiezen van een (volgende) baan. Mensen leren kennen 28,8% 41,9% 28,2% 12,9% 8 15
  • 16. BELANGRIJKE FACTOREN BIJ KIEZEN BAAN 80% 70% 60% 50% % totaal 40% mannen 30% 20% 53,3% van de jongeren heeft al vrouwen 10% tussen de 2 en 5 werkgevers gehad. 0% .. ris er en rk e. rk se n aa k ala sfe ed we im we us z S de jkh nd rtt tti g Bo n de oe eli ele pa nu va n G og iss tot jk o em w eid eli ut i竪r Af h p A ar r lijk ap C e tsch og aa M M 16
  • 17. 17
  • 18. Goed werkgeverschap Eerlijk Binden Beloftes nakomen en waarmaken Modern werkgeverschap Inspelen op de multiculturele arbeidsmarkt Talent management Inspelen op sabbatical Flexibele werktijden/thuiswerken Open minded Alumni netwerken Bijdragen leveren aan de work/life balans Een opdracht/uitdaging aanbieden ipv baan 18
  • 19. vertrouwen hebben in elkaar trots zijn op wat we doen plezier hebben met collega's met wie we samenwerken 19
  • 20. Strategic level (year, quarter) Allocation of OR capacity to surgical specialties Tactical level (month) Weekly allocation of OR-days to specialties Operational (of鍖ine) level (weeks) Elective & semi-urgent surgery scheduling Operational (online) level (days) Monitoring and control Emergency surgery scheduling Kjeld H. Aij MBA 20
  • 21. Strategic OR planning Capacity dimensioning Operating rooms, equipment Staff Division of the capacity pie Contract: board OR management specialties 21
  • 23. Kjeld H. Aij MBA 23
  • 24. Strategic OR planning Emergency operating rooms or not? 24
  • 25. Tactical OR planning Open block planning (common in US) First come 鍖rst serve operation Different specialties operate successively in OR Long changeover time, unbalanced workload, overtime Emergency operating room Closed block planning (common in Netherlands) Each specialty / surgeon gets blocks of time (ORday morning session, afternoon session) Each specialty / surgeon schedules its patients in these blocks, at least 1 week in advance More ef鍖cient, less waiting time for patients Remaining time cannot be redistributed Semi-open block planning: combination 25
  • 26. Process from admission to discharge 26
  • 27. Process within an OR session F.Boer, LUMC 27
  • 28. OR utilization Kjeld H. Aij MBA 28
  • 29. 29
  • 30. Planning based on surgeons estimate 30
  • 31. Stochastic Surgery durations Kjeld H. Aij MBA 31
  • 32. 32
  • 34. 34
  • 35. You are not going to get the elephant to shrink or change its size. You need to face the fact that the elephant is 8 OR tall and 11 hr wide. Steven Shafer, MD 35
  • 36. Rooster-methodieken Flexibele Zelfroosteren werktijden Matching R u i Intekenrooster l e n Voorkeurrooster Repeterend rooster Vaste werktijden weinig veel zeggenschap zeggenschap 36
  • 37. Performance of an Operating Room Productivity, e.g. Utilization Ratio: procedure time / capacity Changeover time Throughput time % Cancellations, related to: patient anesthesia preparation organization Waiting time of emergency patients Overtime Effectiveness (eg. revisits of patient, complications) 37
  • 38. Kjeld H. Aij MBA 38