Winasti Windi, Berden Hubert, van Merode Frits
IQ Healthcare, Radboudumc, 6525 EP Nijmegen, The Netherlands.
Elisabeth-TweeSteden Ziekenhuis, 5022 GC Tilburg, The Netherlands.
Entropy (Basel). 2023 Oct 14;25(10):1447. doi: 10.3390/e25101447.
A redesign of hospitals (i.e., partitioning departments and delegating decision authority) may be needed to deal with variable demand. Uncertain demands and throughput times often need short reaction times. In this study, we develop quantitative methods to guide a redesign through an information-processing approach. To demonstrate how the methods can be used in practice, we tested them by applying them to a large perinatology care system in the Netherlands. We used the following two methods: 1. portfolio optimization and 2. efficient coordination of workload and reallocation of nurses. Our case study of a large perinatology care system showed that several designs of clustered units minimized the demand uncertainty in the perinatology care system. For the coordination strategy, the information and decision uncertainty is minimized when the decision power is positioned at the operation level and with the help of a centralized information system. When the operation decision-making power is not supplemented with the centralized and system-wide information system, hospitals can better use the hierarchy model, where the manager holds decision-making power with a system-wide overview. We also found that the speed of decision-making in real-time depends on the level of information aggregation set up by the system. We conclude that combining the correlation perspectives and the entropy theory is a way of quantifying how organizations can be (re)designed.
可能需要对医院进行重新设计（即划分科室并下放决策权）以应对多变的需求。不确定的需求和周转时间通常需要短反应时间。在本研究中，我们开发了定量方法，通过信息处理方法来指导重新设计。为了演示这些方法在实践中如何使用，我们将其应用于荷兰的一个大型围产医学护理系统进行测试。我们使用了以下两种方法：1. 组合优化；2. 工作量的有效协调和护士的重新分配。我们对一个大型围产医学护理系统的案例研究表明，几种集群单元设计将围产医学护理系统中的需求不确定性降至最低。对于协调策略，当决策权位于运营层面并借助集中式信息系统时，信息和决策不确定性最小化。当运营决策权没有辅以集中式全系统信息系统时，医院可以更好地使用层级模型，即管理者在具备全系统概览的情况下拥有决策权。我们还发现，实时决策的速度取决于系统设置的信息聚合水平。我们得出结论，结合相关性视角和熵理论是一种量化组织如何进行（重新）设计的方法。
