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Decision making in management
  for large medical equipment

     Ilya Ivlev and Peter Kneppo
          ilya.ivlev@fbmi.cvut.cz
Number of MRI units per million population




                                Source: OECD Health Data
The difference in the availability
            of MRI



                       41
Japan                       Mexico
MRI units/mill: 43,1        MRI units/mill: 1,5
                                   Source: OECD Health Data
Financial losses in health care




                   Source: WHO “World health statistics 2010”
WHO: causes of inefficiency and
      recommendations

CAUSES OF INEFFICIENCY
● EXCESSIVE PURCHASING and use of EQUIPMENT
● Financial drain etc.

                 SOLUTION
                       ● DEVELOPMENT OF SYSTEMS SELECTION AND
                       PROCUREMENT
                       ● Control government expenditure on health care
                       ● Implementing new regulations etc.


Source: WHO “The world health report: health systems financing: the path to universal coverage 2010”
Development of a system for rational
 choice of large medical equipment
Difficulties in decision making
  Suppler                 Objectives of                             Specifi-
  policies               the application                            cations
                                                                  more than
 difference in
                                                                      900
purchase price
                                                                 specifications
                             specialization
                               of health
                                facility                          difficult for
heterogeneous
 information                                                     understandin
about the units                                                         g


             Source: XJ., Zhou, How can I Purchase My Dream MRI Scanner?
Questionnaire for evaluation of expert's
                                 competence
                       Objective evaluation - ho                                                Subjective evaluation - hs




                                                                     Work experience




                                                                                                           participation in
                                                                      in the problem
     Job position




                                                                                                            the problem
                                                        Total work
                                                        experience
                                   Education




                                                                                                              Level of
                       Grades




                                               Grades




                                                                          Grades




                                                                                       Grades




                                                                                                                                      Grades
                                                          (years)




                                                                            area
Head of                                                                                         Expert specializes in the given
                        1       Ph.D.          0.6        >10        1      >10         1                                         1
organization                                                                                    issue
                                                                                                Expert participates in practical
                Higher                                                                          work on solving the issue but
Deputy head 0.8 education                      0.4       10-5        0.8   10-5        0.8      the issue does not belong to     0.8
                (master)                                                                        expert's indicated
                                                                                                specialization
                           Higher
Head of                                                                                         The issue belongs to experts
                       0.6 education 0.2                   <5        0.6    <5         0.6                                            0.6
department                                                                                      specialization
                           (bachelor)
Deputy head
                                                                                                The issue does not belong to
of          0.4                                                                                                                       0.3
                                                                                                experts specialization
department
                                                                                                                       Golupkov, Е., 1998
Reference table of indices of
               argumentation (ka)
                                          Level of source's influence on the expert's
Sources of arguments                                        opinion
                                           high       medium          low      zero
Conducted theoretical analysis              0.3          0.2          0.1        0
Work experience                             0.5          0.4          0.2        0
Summarizing papers by local authors        0.05         0.05         0.05        0
Summarizing papers by foreign authors      0.05         0.05         0.05        0
First-hand experience with state of the
                                           0.05         0.05         0.05           0
problem abroad
Expert's intuition                         0.05         0.05         0.05           0




                                                                     Fedoraev, S.V., 2010
General competence index for a
             specific experts




hjo; hjs - objective and subjective indices
kа – index of argumentation
ki – index of familiarity with the problem
Private weights of experts
The overall competence of the experts
                 0.75       0.67
                 0.70
                                   0.60
Main weighting




                 0.65                     0.57
 coefficient




                 0.60                            0.54

                 0.55                                   0.49 0.49 0.49
                 0.50                                                    0.45
                 0.45
                 0.40
                        0           2             4           6           8
                                    Serial number of expert
MAUT;
AHP
      ELECTRE
MAUT;
AHP
        ELECTRE




       adding new
ease
       alternatives
MAUT;
AHP
      ELECTRE
MAUT;
   AHP
              ELECTRE




  level of   no hard and
preference   preferences
             adding new
  ease
             alternatives
MAUT;
AHP
      ELECTRE
MAUT;
    AHP
                   ELECTRE




evaluation of   measurement of
inconsistency       quality
    level of     no hard and
  preference     preferences
                 adding new
    ease
                 alternatives
MAUT;
AHP
      ELECTRE
Aim                     Level 1        Lvl. 2                          Level 3                  Level 4
                                                                                             Magnetic field
                                                                                               Strength
                                                                     Мain magnet




                                         Technical features
                                                                                              Uniformity
                                                                                               Stability
                                                                                             Magnetic field
                                                                Gradient coil systems          gradient
                                                                                              Slew rate
                                                              Parallel imaging techniques
                                                               Number of independent
                                                                  channels (RF coils)
choose a new MRI




                   The adequacy of                                      Shimming
                   the selection                                                            Size of aperture
                                       Ease of use                  Patient comfort
                                       and safety
                                                                                             Size of tables
                                                                                            Active shielding
                                                                        Safety
                                                                                              Noise level
                                                                     Dimensions
                                                                    Compatibility
                                                                       Training
                                       Customer
                                        support




                                                                Operator and reference
                                                                      manuals
                                                                   Service contract
                                                                 Remote diagnostics
                     Scientific and
                    Technical level
                   The efficiency of              Proposed decision hierarchy
                          use
                      Cost of use                          for MRI
Pairwise comparisons
Results of paired comparisons
                                      serial number of the specifications
serial number of the specifications
Mutual dependence of the
                                                 characteristics
                                      serial number of the specifications
serial number of the specifications




                                             Independent characteristics
                                             Dependent characteristics
Mutual dependence
(network structure)
Ranked by priority list of MRI
                  • SIEMENS MAGNETOM
                     Aera;
                  • SIEMENS MAGNETOM
                     Avanto;
                  • GE HEALTHCARE Optima
                     MR450w;
                  • PHILIPS INTERA;
                  • TOSHIBA1.5 T Vantage
                     Atlas;
                  • PHILIPS Achieva;
                  • PHILIPS Ingenia;
                  • SIEMENS MAGNETOM
                     Espree…
                  etc.
Examination design and the prediction
   of the characteristics weights
Summary
• Method for experts' competence identification.
• Defined the raked list of the experts.
• AHP method with network elements can be
  applied;
• The way how to predict changes of weights.
• Web-system for identification of experts'
  preferences.
• Defined a list of 16 key parameters.
• Algorithm for selection of preferences of
  experts, processing and evaluation of results.
Thank you




ilya.ivlev@fbmi.cvut.cz

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Decision making in management for large medical equipment

  • 1. Decision making in management for large medical equipment Ilya Ivlev and Peter Kneppo ilya.ivlev@fbmi.cvut.cz
  • 2. Number of MRI units per million population Source: OECD Health Data
  • 3. The difference in the availability of MRI 41 Japan Mexico MRI units/mill: 43,1 MRI units/mill: 1,5 Source: OECD Health Data
  • 4. Financial losses in health care Source: WHO “World health statistics 2010”
  • 5. WHO: causes of inefficiency and recommendations CAUSES OF INEFFICIENCY ● EXCESSIVE PURCHASING and use of EQUIPMENT ● Financial drain etc. SOLUTION ● DEVELOPMENT OF SYSTEMS SELECTION AND PROCUREMENT ● Control government expenditure on health care ● Implementing new regulations etc. Source: WHO “The world health report: health systems financing: the path to universal coverage 2010”
  • 6. Development of a system for rational choice of large medical equipment
  • 7. Difficulties in decision making Suppler Objectives of Specifi- policies the application cations more than difference in 900 purchase price specifications specialization of health facility difficult for heterogeneous information understandin about the units g Source: XJ., Zhou, How can I Purchase My Dream MRI Scanner?
  • 8.
  • 9.
  • 10. Questionnaire for evaluation of expert's competence Objective evaluation - ho Subjective evaluation - hs Work experience participation in in the problem Job position the problem Total work experience Education Level of Grades Grades Grades Grades Grades (years) area Head of Expert specializes in the given 1 Ph.D. 0.6 >10 1 >10 1 1 organization issue Expert participates in practical Higher work on solving the issue but Deputy head 0.8 education 0.4 10-5 0.8 10-5 0.8 the issue does not belong to 0.8 (master) expert's indicated specialization Higher Head of The issue belongs to experts 0.6 education 0.2 <5 0.6 <5 0.6 0.6 department specialization (bachelor) Deputy head The issue does not belong to of 0.4 0.3 experts specialization department Golupkov, Е., 1998
  • 11. Reference table of indices of argumentation (ka) Level of source's influence on the expert's Sources of arguments opinion high medium low zero Conducted theoretical analysis 0.3 0.2 0.1 0 Work experience 0.5 0.4 0.2 0 Summarizing papers by local authors 0.05 0.05 0.05 0 Summarizing papers by foreign authors 0.05 0.05 0.05 0 First-hand experience with state of the 0.05 0.05 0.05 0 problem abroad Expert's intuition 0.05 0.05 0.05 0 Fedoraev, S.V., 2010
  • 12. General competence index for a specific experts hjo; hjs - objective and subjective indices kа – index of argumentation ki – index of familiarity with the problem
  • 14. The overall competence of the experts 0.75 0.67 0.70 0.60 Main weighting 0.65 0.57 coefficient 0.60 0.54 0.55 0.49 0.49 0.49 0.50 0.45 0.45 0.40 0 2 4 6 8 Serial number of expert
  • 15. MAUT; AHP ELECTRE
  • 16. MAUT; AHP ELECTRE adding new ease alternatives
  • 17. MAUT; AHP ELECTRE
  • 18. MAUT; AHP ELECTRE level of no hard and preference preferences adding new ease alternatives
  • 19. MAUT; AHP ELECTRE
  • 20. MAUT; AHP ELECTRE evaluation of measurement of inconsistency quality level of no hard and preference preferences adding new ease alternatives
  • 21. MAUT; AHP ELECTRE
  • 22. Aim Level 1 Lvl. 2 Level 3 Level 4 Magnetic field Strength Мain magnet Technical features Uniformity Stability Magnetic field Gradient coil systems gradient Slew rate Parallel imaging techniques Number of independent channels (RF coils) choose a new MRI The adequacy of Shimming the selection Size of aperture Ease of use Patient comfort and safety Size of tables Active shielding Safety Noise level Dimensions Compatibility Training Customer support Operator and reference manuals Service contract Remote diagnostics Scientific and Technical level The efficiency of Proposed decision hierarchy use Cost of use for MRI
  • 24. Results of paired comparisons serial number of the specifications serial number of the specifications
  • 25. Mutual dependence of the characteristics serial number of the specifications serial number of the specifications Independent characteristics Dependent characteristics
  • 27.
  • 28. Ranked by priority list of MRI • SIEMENS MAGNETOM Aera; • SIEMENS MAGNETOM Avanto; • GE HEALTHCARE Optima MR450w; • PHILIPS INTERA; • TOSHIBA1.5 T Vantage Atlas; • PHILIPS Achieva; • PHILIPS Ingenia; • SIEMENS MAGNETOM Espree… etc.
  • 29. Examination design and the prediction of the characteristics weights
  • 30. Summary • Method for experts' competence identification. • Defined the raked list of the experts. • AHP method with network elements can be applied; • The way how to predict changes of weights. • Web-system for identification of experts' preferences. • Defined a list of 16 key parameters. • Algorithm for selection of preferences of experts, processing and evaluation of results.