2. Paspoort Kjeld H. Aij
• Geboren in 1973 in Schiedam
• Studeerde Biomedische Wetenschappen,
verpleegkunde en bedrijfskunde
• Verkreeg in 2008 de graad van Master of
Business Administration aan de Business
School Nederland
• Promotietraject ‘applications of LEAN in
Healthcare’
• Getrouwd met Michelle; één zoon Steyn
• Hoofd Operatiekamers VUmc, Spreker,
Ondernemer, Investeerder in zilver
•
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6. Healtcare: a business unlike all others
• Financial model does not reward efficiency
• Patients are customer and product at the same time
Patients cannot be refused
Interventions cannot be preempted
• More variability than in any other industry
• Many different types of care providers
Different types of hospitals, different strategies
Academic hospitals do almost everything
Specialized clinics are often seen as “cream skimmers”
• Multiple decision makers (doctors managers)
Doctors are private entrepreneurs within hospital
They cheat the system to advance patients
• Stakeholders often have conflicting goals
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11. Operating Rooms
• Significant source of hospital’s income
• Majority of hospital admissions undergo surgery
• Cost intensive (capital and labor)
• Determines “the pace” of the hospital
“If the OR sneezes, the hospital has a cold”
• Are a dangerous place
>10% of the patients experience complications or an incident
• Increased less invasive surgery (endoscopic, robotic)
more “daycare” / outpatient treatments
• Have a lot of variability
Diversity surgical procedures, complications,
every patient is different, emergencies
• Capacity is determined by availability of trained staf
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12. Surgery is a complex
process where many
resources act together
Kjeld H. Aij MBA
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13. Shortage of OR staff
• Cyclical shortage (4-5 years) of personnel
• Causes of shortage
Oscillation in training capacity due to shortsighted planning
Drop-out in training school
Increase of part-time percentage during occupational life
Aging
• Fortifying effect: occurrence of employment agencies
• Effects:
Closure of operating rooms
Increase working pressure
Increase of labor costs: employment agencies, salary raises,
additional income elements
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14. Roughly speaking,
Generation Y is defined as -
1977 < Birth Date >
2000
31 < Current Age >
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Kjeld H. Aij MBA
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15. ICT 3% 8% 0%
Taal en Cultuur 3% 2% 4%
Chemie 1% 1% 2%
Natuur 1% 0% 2%
Finance 1% 1% 1%
Landbouw 0% 0% 0%
Dat geld verdienen de belangrijkste reden is om te gaan werken, is bijna vanzelfsprekend: de schoorsteen moet
tenslotte roken. Daarnaast vertoont generatie Y verrassende verschillen in de diverse opleidingsniveaus.
BELANGRIJKSTE REDENEN OM TE GAAN WERKEN
% totaal Laagopgeleid Middelhoogopgeleid Hoogopgeleid
Geld verdienen 89,7% 95,3% 87,3% 90,3%
Zelfontplooiing 48,9% 32,6% 52,7% 58,1%
65% van de jongeren zegt in eerste instantie
Kennis opdoen 41,3% 41,9% 42,7% 35,5%
op de hoogte van het salaris te letten bij het
Iets betekenen voor de maatschappij 28,8% 32,6% 29,1% 22,6%
kiezen van een (volgende) baan.
Mensen leren kennen 28,8% 41,9% 28,2% 12,9%
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15
16. BELANGRIJKE FACTOREN BIJ KIEZEN BAAN
80%
70%
60%
50%
% totaal
40%
mannen
30%
20% 53,3% van de jongeren heeft al vrouwen
10% tussen de 2 en 5 werkgevers gehad.
0%
..
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18. Goed werkgeverschap
• Eerlijk
Binden • Beloftes nakomen en waarmaken
Modern werkgeverschap
• Inspelen op de multiculturele arbeidsmarkt
• Talent management
• Inspelen op sabbatical
• Flexibele werktijden/thuiswerken
• Open minded
• Alumni netwerken
• Bijdragen leveren aan de work/life balans
• Een opdracht/uitdaging aanbieden ipv baan
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19. vertrouwen hebben in elkaar
trots zijn op wat we doen
plezier hebben met collega's
met wie we samenwerken
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20. Strategic level (year, quarter)
Allocation of OR capacity to surgical specialties
Tactical level (month)
Weekly allocation of “OR-days” to specialties
Operational (offline) level (weeks)
Elective & semi-urgent surgery scheduling
Operational (online) level (days)
Monitoring and control
Emergency surgery scheduling
Kjeld H. Aij MBA
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21. Strategic OR planning
• Capacity dimensioning
Operating rooms, equipment
Staff
• Division of the “capacity pie”
Contract: board – OR management – specialties
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25. Tactical OR planning
• Open block planning (common in US)
First come first serve operation
Different specialties operate successively in OR
Long changeover time, unbalanced workload, overtime
Emergency operating room
• Closed block planning (common in Netherlands)
Each specialty / surgeon gets blocks of time
(ORday morning session, afternoon session)
Each specialty / surgeon schedules its patients in these blocks, at
least 1 week in advance
More efficient, less waiting time for patients
Remaining time cannot be redistributed
• Semi-open block planning: combination
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35. “You are not going to get the elephant to shrink or change its size.
You need to face the fact that the elephant is 8 OR tall and 11 hr wide.”
Steven Shafer, MD
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36. Rooster-methodieken
Flexibele
Zelfroosteren
werktijden
Matching
R
u
i Intekenrooster
l
e
n
Voorkeurrooster
Repeterend rooster
Vaste
werktijden
weinig veel
zeggenschap zeggenschap
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37. Performance of an Operating Room
• Productivity, e.g.
Utilization
Ratio: procedure time / capacity
• Changeover time
• Throughput time
• % Cancellations, related to:
patient
anesthesia preparation
organization
• Waiting time of emergency patients
• Overtime
• Effectiveness (eg. revisits of patient, complications)
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