Mathematics: The key to better and cheaper healthcare

December 13, 2012, University of Twente

Efforts to achieve higher efficiency in healthcare delivery are often assumed to be forced by budget cuts that are in the end harmful to patients. However, quality improvements and cost savings can in fact go side-by-side, argues Nikky Kortbeek in his thesis on which he was recently awarded a PhD with distinction.

He performed his research at the Center for Health Operations Improvement Research (CHOIR) of the University of Twente and at the Quality Assurance & Process Innovation Department (KPI) at the Academic Medical Center Amsterdam (AMC). It is precisely by getting a better grip on the logistics behind that a higher quality of care can be realized. In his thesis he demonstrates, for example, that the productivity of staff and beds in nursing ward can be improved by 10 to 20% while at the same time increasing the reliability of the quality of care.

Healthcare organizations face huge challenges during the upcoming years: the constant cost increases must be halted, while at the same time patients are becoming more and more demanding, and hospitals nationwide still cope with some 2000 avoidable deaths each year. Simultaneously improving efficiency and quality of care would seem to be a contradiction in terms. Yet Kortbeek shows in his thesis, along a number of case studies, that this is absolutely doable. The key is developing and applying mathematical models.

Uncertain versus unpredictable

It sounds plausible that a nursing ward cannot be prepared for every scenario possible: the number of patients arriving during a certain day is unknown, some recover more quickly than others, and complications may occur. But this, Kortbeek explains, does not mean that it is impossible to plan ahead: "Variability is not the same as unpredictability. It is the goal of our research field, stochastic operations research, to help problem owners make the best possible decisions in complex and uncertain environments."

Politically charged

Mathematical models also facilitate decision-making processes in hospitals, claims Kortbeek. As healthcare environments are often politically charged, experimenting with a new approach in practice straight away is a high-risk strategy. Mathematical models have a quantitative predictive value. This makes healthcare professionals more ready to acknowledge and understand the need for the proposed measures: they provide insight in why a new approach works better.

Flexible staffing

Kortbeek's thesis describes a number of cases where he and his fellow researchers supported hospitals to organize processes in the healthcare chain as a whole so as to make better use of scarce resources such as beds, operating theatres and staff. For instance, they can predict bed occupancies on an hourly level if they take relevant information on operating theatre schedules into account. They also propose flexible nurse staffing strategies, meaning that is it only at the start of their shifts decided in which they will be working. This makes it easier to accurately respond to the fluctuating patient population. Applying this methodology to four surgical nursing wards at the AMC shows, for instance, that productivity can be improved by 10 to 20% with higher quality of care.

Paediatric neuromuscular centre

Kortbeek and a group of students also worked on establishing the AMC's center for children with chronic neuromuscular diseases, "The Childrens' Muscle Center Amsterdam', which opened on 20 November. Having to visit the hospital several times in succession places a great strain on them. The question was, why not schedule all the consultations and therapies on the same day? This would mean taking all the required treatments, diagnostic test, and consultations into account, as well as the availability of specialists, to create optimal day schedules. This was done successfully, resulting in better coordinated and less stressful treatments.

Nikky Kortbeek (1983) did his PhD research – he gained his PhD with distinction on 23 November – in Prof. Richard Boucherie's Stochastic Operations Research Group, which is part of the University of Twente's CTIT research institute. The research for healthcare institutions took place under the auspices of the Center for Health Operations Improvement Research (CHOIR), which is now working together with many medical centres in the Netherlands.

The thesis, "Quality-Driven in Healthcare," for which Kortbeek was recently awarded a PhD with distinction, is available in digital form.

Explore further: Better together - The RN and the EHR

Related Stories

Better together - The RN and the EHR

January 17, 2012
With the prodding of new federal legislation, electronic health records (EHRs) are rapidly becoming part of the daily practice of hospital nurses – the frontline providers of care. In the first large study of its kind, ...

Fewer patient deaths after surgery in hospitals known for good nursing care

October 22, 2012
Patients treated in magnet hospitals (specially designated for their nursing excellence) had 14 percent lower odds of death than those in non-magnet hospitals in a four-state study of 564 hospitals led by the University of ...

Beds in pediatric intensive care unit could be used more efficiently with improved flow

April 16, 2012
The pediatric intensive care unit (PICU) is a precious resource. With limited number of beds and resource-intensive services, it is a key component of patient flow. A new study published in the Journal of Hospital Medicine ...

Low staffing and poor quality of care at nation's for-profit nursing homes

November 29, 2011
The nation's largest for-profit nursing homes deliver significantly lower quality of care because they typically have fewer staff nurses than non-profit and government-owned nursing homes.

Recommended for you

Marijuana use does not lower chances of getting pregnant

January 22, 2018
Marijuana use—by either men or women—does not appear to lower a couple's chances of getting pregnant, according to a new study led by Boston University School of Public Health (BUSPH) researchers.

Americans are getting more sleep

January 19, 2018
Although more than one in three Americans still don't get enough sleep, a new analysis shows first signs of success in the fight for more shut eye. According to data from 181,335 respondents aged 15 and older who participated ...

Wine is good for you—to a point

January 18, 2018
The Mediterranean diet has become synonymous with healthy eating, but there's one thing in it that stands out: It's cool to drink wine.

Sleep better, lose weight?

January 17, 2018
(HealthDay)—Sleeplessness could cost you when it's time to stand on your bathroom scale, a new British study suggests.

Who uses phone apps to track sleep habits? Mostly the healthy and wealthy in US

January 16, 2018
The profile of most Americans who use popular mobile phone apps that track sleep habits is that they are relatively affluent, claim to eat well, and say they are in good health, even if some of them tend to smoke.

Improvements in mortality rates are slowed by rise in obesity in the United States

January 15, 2018
With countless medical advances and efforts to curb smoking, one might expect that life expectancy in the United States would improve. Yet according to recent studies, there's been a reduction in the rate of improvement in ...


Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.