Keynote 1 – Incentives and Coordination in Healthcare
by Greg Zaric, Ivey Business School, Western University, Canada
(26th February 2021, 3:30 PM GMT)
The healthcare system involves the actions and decisions of multiple parties, including patients, doctors, hospitals, payers, and regulators. The different parties may have different information and different objectives, resulting in decisions that are sub-optimal from the perspective of the entire system. In this talk I present several examples of research on contracts to coordinate the actions of independent decision makers in health care. In particular, I will discuss principal-agent models of pharmaceutical risk sharing contracts and hospital gain-sharing agreements; and empirical studies of the impact of incentive payments to physicians.
Greg Zaric, Ph.D., is a Professor of Management Science and Academic Director of the MSc program at the Ivey Business School, Western University, in London, Canada. He also holds an adjunct appointment in the Department of Epidemiology and Biostatistics at Western. He is the Editor-in-Chief of Health Care Management Science, and also serves on the editorial boards of Operations Research and Production and Operations Management. He is currently a member of the Ontario Steering Committee for Cancer Drugs. His research focuses on using mathematical and economic models to address problems in health policy and healthcare operations management. He has published over 100 peer-reviewed papers, as well as one textbook and one edited volume. He holds a B.Sc. from Western University, an M.ASc. from the University of Waterloo, and an MS and Ph.D. from Stanford University.
Keynote 2 – Improving access to care: Take-aways from two case studies
by Vedat Verter, Broad College of Business, Michigan State University, USA
(26th February 2021, 4:45 PM GMT)
Following hospital consolidation and bed closures as well as sustained transition from inpatient to outpatient care, there has been a significant reduction in hospital spending over the 90’s, which is now stabilized at its current level. This suggests that providing good access to care at any stage of the health continuum is a remaining challenge. Although continued efforts at the governmental level for improving the health sector are still necessary, they are not enough for achieving tangible success on the ground. To increase the efficiency of care delivery processes and the quality of care, healthcare providers and decision makers must implement health policies through concerted and sustained efforts at the operational level. During this talk, we will discuss our learnings through two research projects, which also received the support of practitioners in terms of implementation.
The first project focused on the Emergency Department (ED), which constitutes the point of entry to a hospital for the patients, except those who are scheduled for elective surgeries. ED managers are faced with a multitude of challenges including overcrowding, resource reductions, limited bed capacity, long waiting times, and low staff morale We developed a comprehensive simulation platform for a tertiary hospital in Montreal, Canada. Patient triage, performed by a registered nurse immediately upon arrival, aims to rapidly identify patients with urgent (possibly life threatening) conditions and to determine the most appropriate treatment area in ED. We will report on our work for nurse pooling at triage and patient pre-triage in order to improve access to ED. While a reduction can be achieved in the wait times for the ambulance patients by nurse pooling, this comes at a price of an associated increase in the mean and variability of the wait times to be experienced by the walk-in patients. Clearly, pre-triaging all arrivals is beneficial for both patient groups. Although combining pooling with pre-triage brings the triage wait times to desired levels, the expected nurse utilization of 39% constituted a sticking point in an environment plagued with limited resources.
In contrast, the second project focused on an outpatient clinic providing psychiatric care to treatment resistant depression patients. We wanted to determine whether the follow-up frequencies have an impact on clinical outcome of patients. The clinic randomly assigns a new patient to one of the four psychiatrists and evaluates the patient at every visit with structured questionnaires and scales. The demographic variables, prescriptions and the severity of patients across the four groups were similar at intake; whereas, the average times between appointments of the four groups were significantly different. These differences in outpatient follow-up frequency did not appear to be associated with clinical outcomes in this patient population. However, these differences in outpatient follow-up frequency has an important impact on the management of the volume of patients seeking care; using Little’s Law, it would be possible to eliminate the waiting list by a relative reduction of 23.9% or more in the follow-up frequencies of the three psychiatrists with the highest frequencies.
Vedat Verter joined Broad College of Business as the John McConnell Endowed Chair of Business Administration in July 2019. He also serves as Chairperson of the Supply Chain Management Department. He brings 24 years of experience at Desautels Faculty of Management, McGill University, where he was a James McGill Professor since 2013. Professor Verter specializes on the application of operations research for tackling challenges in the public sector. His areas of research are service chain design, hazardous materials logistics, sustainable operations and healthcare operations management. His work in these four areas culminated into 70+ research articles in refereed journals and is well recognized through invited presentations around the globe.
In his earlier work, Professor Verter focused on risk assessment models for dangerous goods shipments and policy making for rail and highway transportation of hazardous materials. His papers on designing transport networks for such shipments are considered seminal. In the area of sustainable operations, he focuses on evidence-based policy design for incentivizing firms’ product recovery initiatives; particularly for remanufacturing and recycling. He has published on the electronics industry extensively. In the area of healthcare, he focuses on preventive, primary, emergency, acute and chronic care processes, as well as their interaction.
He was Founding Director of the NSERC CREATE Program in Healthcare Operations and Information Management, a seven-University PhD/PDF training program across Canada. Professor Verter is Editor-in-Chief of Socio-Economic Planning Sciences, an international journal focusing on public sector decision making. He is also among the Senior Editors of Production and Operations Management.