Proposition of a framework to reengineer and evaluate the hospital supply chain
Résumé
The objective of our research is the development of a modeling framework that permits decision makers to reengineer and evaluate their hospital supply chain. This research was first motivated by a strong collaboration with a Belgian hospital of 900 beds that is currently reengineering its logistical activities. The managers of this hospital intend to build a new logistical platform to group the clinical pharmacy, the sterilization and purchasing services in a same location. These units are currently situated in separated areas. The objectives of this reengineering project are the rationalization of expenses and the improvement of the quality of the care delivered to the patients. This new organization will change the current practices of the hospital in terms of purchasing, reception and distribution activities as well as in terms of inventory management. It will also impact the medico-technical units and the care services as well impact numerous human and technical resources. The new platform will manage a huge number of pharmaceutical references and should correctly collaborate with the different logistical units that have their different working rules. We therefore decide to focus our study on the pharmaceuticals (pharmaceuticals and medical materials) dedicated to two specified medico-technical units, the emergency rooms and the operating rooms. These units are indeed critical in the care process of patients and are major costs center of the hospital. We demonstrate that this reorganization will have an impact upon the product flow, the distribution and the inventory management. It will also have an influence upon the working of the medico-technical units. Because numerous people, products and care units are implied in this project, we need to have a framework to describe the working of the actual system, to diagnose its working and quantify the possible failure. Different solutions can be proposed thanks to optimization models and these ones should be evaluated through the performance indicators. These indicators should be established in accordance with a common and shared vision of the hospital performance, which one is not obvious to define due to the different stakeholders' perspectives. The decision makers can then take the decision based on these indicators; they can evaluate the consequences of their decision in time and space before the implementation. We first readapt the definition of fundamental concepts as value and performance in healthcare supply chain context. We then propose an approach that should help the hospital managers to lead such reengineering project, as the reorganization of the supply chain, mainly the medical products supply chain, while taking into account the patients' flow. The suggested framework will provide guidance to build a knowledge model based on the ASDI methodology and enriched with the value and performance definition. The knowledge model is aimed at understanding the working of the system, identifying the critical activities, defining the performance indicators to assess the system based on metrics in accordance with the value system of the hospital, describing processes and management rules and identifying resources. In a second phase, based on the knowledge gathered, we develop an optimization tool of the medical products flow while taking into account the patient's flow. Because the demand patterns are very different in the two medico-technical units we consider, we propose two solutions. For the emergency room, we evaluate the implementation of an automated dispensing system and we propose a two-echelon inventory management model to control this new system. In the operating room, we propose a two-step approach. We determine the planning and scheduling of the surgical operations taking into account the resources constraints and then we apply a MRP approach based on a stochastic bill of resources. The performance indicators defined in a first step will serve to assess the proposed solutions. Different balanced score cards will suggested to capture the performance of the considered processes. Doing so, the proposed approach will ensure that the suggested changes improve the working of the pharmaceuticals supply chain and contribute to the global interest of the hospital. For illustration purposes, we experience our models on a pedagogical data set derived from a real life application encountered in the Belgian hospital mentioned above.
L'objectif de notre recherche est le développement d'un cadre de modélisation pour permettre aux décideurs de réorganiser et d'évaluer la chaîne logistique hospitalière. Notre démarche se déroule en plusieurs étapes. Tout d'abord, nous réadaptons la définition des concepts fondamentaux de la valeur et de la performance dans le contexte de la chaîne logistique hospitalière. Nous proposons ensuite une approche pour aider les preneurs de décisions à mener un projet de réorganisation dans le domaine hospitalier et en particulier la réorganisation de la chaîne des produits pharmaceutiques en prenant en compte le flux des patients. Le cadre de modélisation proposé sert de guide dans l'élaboration d'un modèle de connaissance basé sur la méthodologie ASCI et enrichie de la définition de la valeur et de la performance. Le modèle de connaissance a pour objectif de faciliter la compréhension du fonctionnement du système, d'identifier les activités critiques, de définir les indicateurs de performance servant à évaluer le système sur base de mesures reflétant de manière adéquate le système de valeur de l'hôpital. Le modèle de connaissance fournit également une description des processus, des règles de gestion et l'identification des ressources. Lorsque le modèle de connaissance a été élaboré, il est possible de développer un outil d'optimisation du flux des produits médicaux tout en considérant le flux des patients. Les indicateurs de performance définis lors de l'élaboration du modèle de connaissance servent à évaluer les solutions proposées. Différents tableaux de bord équilibrés sont proposés pour apprécier la performance des processus considérés. De la sorte, l'approche que nous avons développée permet de s'assurer que les changements suggérés améliorent le fonctionnement de la chaîne logistique pharmaceutique et contribue à améliorer la performance globale de l'hôpital. Ce modèle a été validé sur des données provenant de l'hôpital belge avec lequel nous collaborons.
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