We use dynamic programming to model ambulance systems. Our model can potentially assist ambulance dispatchers to proactively avoid states at which most, or all, of scheduled ambulances are busy by taking appropriate actions timely. Possible actions that we consider are: Calling in additional ambulances from neighbouring cities, expediting the service, and repositioning available ambulances following a desired compliance table. The objective is to maximize the expected proportion of time that the system spends in states with low utilizations by using reward functions that penalize being in high-utilization states. We use a detailed simulation model to validate our results.
Project Manager: Amir Rastpour, Gregory S. Zaric
The Centre is currently working with the Fowler Kennedy Sports Medicine Clinic to develop a new strategic growth plan, examining potential options such as site relocation and establishing an out-of-hospital surgical centre. By connecting key stakeholders within the London and Ontario health care sector, and examining best practices from comparator organizations across the globe, the Centre is leading this research to develop a replicable model for establishing centres of clinical excellence across Canada.
The current project examines how and when product recall impacts technological product innovation by the focal firm and its competitors. The empirical context of this study is the U.S. medical device industry. The data comprise nearly 100,000 medical device innovations (ranging from incremental to novel to radical) and about 35,000 recalls across nearly 3,000 product categories and 19 medical specialties, spanning more than 17,000 firms headquartered in 62 countries. The findings will provide evidence on innovation effects of product recall.
Researcher: Vivek Astvansh
In partnership with Ontario’s Ministry of Government and Consumer Services, the Centre is leading a global search for best practices in health sector supply chain management. Involving participants from across Canada, the United States, the United Kingdom, Australia, and Finland, this study is pooling together the best policies and practices. This research is focused on the specific health system challenges of driving product standardization and categorization, clinician engagement, and public sector back office reform. Ultimately, the findings from this study will promote effective and informed decision making for our provincial supply chain strategy and knowledge sharing between health system stakeholders.
In highly congested hospitals, it may be common for patients to overstay at Intensive care units due to unbalanced downstream capacity. Step-down beds, also known as Level 2 beds, have become an increasingly popular and cheaper alternative to deal with this delicate issue. We developed a discrete event simulation model that estimates Level 2 bed needs for a university hospital (LHSC). The model innovates by simulating the daily Death/Stay/Step-down stochastic routine at the ICU based on nursing workload scoring, i.e. NEMS. We show our model provides a useful, more realistic framework for bed capacity panning in hospitals.
Researchers: Felipe Rodrigues, Gregory S. Zaric, David Stanford, Judy Kojlak, Fran Priestap, Claudio Martin
In collaboration with the MINDS (Mental Health Initiative for Disruptive Solutions) and the MaRS Solutions Lab, the Centre is working on developing a proposal for a project that will have a positive impact on improving access to housing for transitional age who are experiencing mental health and addiction issues.
The healthcare industry has been relatively slow at adopting global standards for supply chain product identification when compared with other industries. Adoption of unique device identifiers and barcoding standards is becoming mandatory in most developed nations, yet approaches to standardization still vary country to country. The lack of a consistent approach to standardization has led to increased inefficiencies for both product vendors and purchasers. The Centre’s research will identify and examine different current state models of standardization from multiple countries and industries, conduct an objective analysis on which model is most efficient from a health system perspective, and make recommendations for the future state model selection/design and deployment in Canada taking into account enablers, capabilities and capacity for adoption.
London’s Healthcare Materials Management Services (HMMS) is currently undergoing a transformative shift in its supply chain processes, transitioning from a traditional push model of supply chain (projection-driven) to a pull supply chain (demand-driven) for all of London Health Sciences Centre. The Centre is working with HMMS, providing project steering and developing a best practices guide to share the learnings from this initiative with other hospitals across Canada. Unique to this approach is its low-cost nature – while many supply chain transformation projects require heavy IT investment, HMMS’ strategy achieves many of the same outcomes (point-of-use data capture, SSO asset management, accurate case costing, standardized physician preference items, and automatic requisitioning) without relying on expensive software solutions. The findings from this study will help other hospitals and health care organizations, regardless of budget, reap the benefits associated with supply chain transformation effectively.
The Centre has entered into a collaborative partnership with the London Health Sciences Centre. The projects undertaken through this collaboration will be focused on health system improvements that are strategically aligned with both parties and enable patients to experience greater value from the health system. Currently, this partnership has projects in two areas care:
1. Stroke rehabilitation: Currently, Ontario’s rehabilitation system struggles to provide accessible and comprehensive care to patients recovering from stroke. To address this challenge, this project suggests a vision for a more patient-focused system that incorporates the use of health information technology, proper incentives, and greater accountability to improve the quality and efficiency of care.
2. Care for patients with infectious complications from Injection Drug Use. The objective for the project focused on patients with infectious complications from Injection Drug Use is to create a more timely and integrated system that incorporates community-based services to address acute and ongoing medical needs, as well as social psychological, spiritual and personal wellness needs.
The Centre is leading a national study examining how organizations across Canada are currently embedding patient-reported outcomes in the decision-making process for material purchases. Traditional hospital tendering processes are most often conducted at a distance from the patient. Hospital clinical teams or procurement leaders set minimum performance criteria, and vendors are incentivized only to reach those criteria. In an effort to enhance value-based procurement, many procurement departments are beginning to involve patients in the tendering process through patient-reported outcome testing. Patient-reported outcome tendering has the opportunity for hospitals to improve patient outcomes and reduce costs by making procurement decisions based on the total cost of care rather than price alone. This research will encourage collaboration and sharing of resources/knowledge across the system so that a shared set of best practices can be adopted as system stakeholders are ready. The study is currently being funded by the Ministry of Government and Consumer Services.
The Centre has partnered with Dr. Richard Kim on his project Pharmacogenomics Technologies and Patient-Centered Approaches for Enhancing Drug Safety and Effectiveness, which has been successfully funded by The Ontario Research Fund. The objective of this project is to demonstrate that Dr. Kim’s innovative Personalized Medicine-based health care model can be implemented hospital-wide and that the resultant integrated model is adoptable, cost-effective, and scalable for Ontario hospitals and beyond. In particular, the Centre will be leading the creation of a business plan and commercialization strategy for the wide-scale distribution of the model based on the varying needs of urban and rural health care facilities in Ontario and throughout Canada.
Facilitated by the Health Care group at MaRS, the project pairs health care providers (generally hospitals) with vendors who are early stage customers to bring new and innovative solutions to market. The goal is to use Design Thinking to develop solutions that transfer to practice better. Dr. Darren Meister is investigating best practices for the improvement of this approach to procurement for possible broader adoption in the health sector.
We examine performance-based payment contracts to promote the use of an optional diagnostic test for newly diagnosed cancer patients. Our work is inspired by three ongoing trends: tremendous increases in the cost of new advanced cancer drugs, development of new diagnostic tests to allow physicians to tailor treatment to patients, and changes in healthcare funding models that reward quality care. Our study suggests that advent of new diagnostic tests necessitates new reimbursement models. We also find that physicians should not use the test for all patients, even if the diagnostic test can be available for free. Furthermore, we demonstrate the importance of understanding the behavioral effects of physicians’ concerns about their treatment decisions by showing that the social welfare may increase from an increase in reputational concerns and altruistic behaviour of a provider.
Researchers: Salar Ghamat, Gregory S. Zaric, Hubert Pun
The development of a microsimulation model of alcohol consumption to determine if pharmacological and/or psychosocial interventions are cost-effective for reducing alcohol consumption in the general Canadian population, and in underserved populations.
Researchers: Estefania Ruiz-Vargas, Gregory S. Zaric