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Most OECD countries will have a considerable challenge ahead with an ageing population and necessary health care produced for retired people. Healthcare costs have increased continuously from the mid-1990’s in Finland, and growth is likely to continue in the future, as the amount of older inhabitants is increasing. Furthermore, transportation of patients and their visitors between homes and hospitals is a large component of the total health carehealth care related costs. This paper aims to estimate transport-related costs and develop ways to decrease these costs.

A system dynamics simulation model was developed to examine different scenarios for patients and their visitor transportation to hospitals until the year 2040. Model is driven by age distribution of the region and likely by development of the total population. All parameter values were defined based on real-life observations.

Patients’ need to travel to hospitals is likely to continue to grow. In addition, quality of travel will change as older retired people are not willing or able to use their own transportation equipment or public transportation modes – this is the main reason for higher transportation costs of patients. Transportation is typically conducted via taxis, private cars and ambulances. Therefore, it is critical that people from the region are able to access hospital services with short proximity.

Simulation study is limited to one hospital investment decision in Finland. Distances and population densities as well as transportation mode alternatives differ from more populous regions in the world.

Research findings stressed the importance of keeping their own hospital operations within the region and placing them in a better location. In an alternative case, where a hospital decision would have been abandoned, total transportation costs during 2012-2040 would have increased by at least the same amount that a new hospital is assumed to cost.

This research is one of the first from the health care sector, where patient transportation modes and ageing is being dealt with in the context of new investments. Patient transportation is often an overlooked issue, which bears significant costs, especially as people age.

This paper deals with the issue of patient transportation inside large public hospitals and its costs. This cost is often related to transportation within departments, wards and outpatient clinics. The aim of this paper is to demonstrate through a qualitative case study how particular tools derived from Lean Thinking such as spaghetti chart, value stream mapping and activity worksheet can help to reduce costs related to patient transportation and other kinds of wastes. In particular the case study analyses the patient path in case of trauma with suspected fractures from the emergency department to patient discharge or hospitalisation.

The paper is based on a qualitative case study. Although the case study has been carried out in a large Italian public hospital, the results can be generalised to all hospitals that are trying to reduce the cost of patient transportation and other kinds of wastes. Indeed, the Lean Thinking tools used here are suitable for all healthcare industries.

The paper demonstrates how tools that were typically derived from the manufacturing sector can also be suitable for the healthcare sector. The results achieved have reduced the average lead time of the patient from the emergency department to hospitalisation or discharge. Considering that the patient paths are made with a stretcher or with a wheelchair pushed by a nurse, the reduced lead time leads to an interesting cost reduction.

This paper is particularly helpful for healthcare practitioners. Managers and practitioners inside healthcare organisations could apply the same logistic solutions and the same tools to analyse the cost of many processes and specifically those in patient path and transportation.

The paper addresses the literature gap regarding the use of specific tools such as spaghetti chart and activity worksheet in the large hospitals.

This paper aims to present a prototype of medical transportation robot whose positioning accuracy can reach millimeter-level in terms of patient transportation. By using this kind of mobile robot, a fully automatic image diagnosis process among independent CT/PET devices and the image fusion can be achieved.

Following a short introduction, a large-load 4WD-4WS (four-wheel driving and four-wheel steering) mobile robot for carrying patient among multiple medical imaging equipments is developed. At the same time, a specially designed bedplate with self-locking function is also introduced. For further improving the positioning accuracy, the authors proposed a calibration method based on Gaussian process regression (GPR) to process the measuring data of the sensors. The performance of this robot is verified by the calibration experiment and Image fusion experiment. Finally, concluding comments are drawn.

By calibrating the robot’s positioning system through the proposed GPR method, one can obtain the accuracy of the robot’s offset distance and deflection angle, which are 0.50 mm and +0.21°, respectively. Independent repeated trials were then set up to verify this result. Subsequent phantom experiment shows the accuracy of image fusion can be accurate within 0.57 mm in the front-rear direction and 0.83 in the left-right direction, respectively, while the clinical experiment shows that the proposed robot can practically realize the transportation of patient and image fusion between multiple imaging diagnosis devices.

The proposed robot offers an economical image fusion solution for medical institutions whose imaging diagnosis system basically comprises independent MRI, CT and PET devices. Also, a fully automatic diagnosis process can be achieved so that the patient’s suffering of getting in and out of the bed and the doctor’s radiation dose can be obviated.

The general bedplate presented in Section 2 that can be mounted on the CT and PET devices and the self-locking mechanism has realized the catching and releasing motion of the patient on different medical devices. They also provide a detailed method regarding patient handling and orientation maintenance, which was hardly mentioned in previous research. By establishing the positioning system between the robot and different medical equipment, a fully automatic diagnosis process can be achieved so that the patient’s suffering of getting in and out of the bed and the doctor’s radiation dose can be obviated.

The GPR-based method proposed in this paper offers a novel method for enhancing the positioning accuracy of the industrial AGV while the transportation robot proposed in this paper also offers a solution for modern imaging fusion diagnosis, which are basically predicated on the conjoint analysis between different kinds of medical devices.

The purpose of this paper is to evaluate the time, place and ambulance types specified on the ambulance patient registry forms for cases transferred through 112 EMS in the Bozcaada and Gökçeada island districts of the province of Çanakkale.

The universe of the descriptive – cross-sectional epidemiological study was composed of the ambulance patient registration forms of the cases which were transferred from Bozcaada and Gökçeada islands between January 1, 2009 and December 31, 2013.

Of the transfers made, 28.1 percent were in the year 2012, 39.5 percent were in summer, 16.6 percent were in July, 17.9 percent were on Monday, 37.1 percent were between 12.00 and 17.59 h and 61.5 percent were from Gökçeada island. Ground ambulances were more common in the transfers from Bozcaada island, while ambulance boat and helicopter ambulance were more common for transfers from Gökçeada island. Helicopter-Emergency Medical Service (HEMS) (p<0.001), which is commonly preferred for patient transfers, inversely affects the use of Ambulance Boat-Emergency Medical Service (BEMS) and ground ambulances. Transfers from Bozcaada island were found to be shorter in duration, and the number of transfers from Bozcaada island between 00.00 and 05.59 h were found to be higher than from Gökçeada island (p<0.001), while the number of transfers via ground ambulance between 00.00 and 05.59 h were found to be higher than the other ambulance types (p<0.001).

This study reveals the current state of the various referral routes from the islands.

This paper is the first study to demonstrate the characteristics of patients referred from the island belongs to Turkey.

The purpose of this study is to discuss the principles and factors that influence the site selection of emergency medical facilities for public health emergencies. This paper discusses the selection of the best facilities from the available facilities, proposes the capacity of new facilities, presents a logistic regression model and establishes a site selection model for emergency medical facilities for public health emergencies in megacities.

Using Guangzhou City as the research object, seven alternative facility points and the points' capacities were preset. Nine demand points were determined, and two facility locations were selected using genetic algorithms (GAs) in MATLAB for programing simulation and operational analysis.

Comparing the results of the improved GA, the results show that the improved model has fewer evolutionary generations and a faster operation speed, and that the model outperforms the traditional P-center model. The GA provides a theoretical foundation for determining the construction location of emergency medical facilities in megacities in the event of a public health emergency.

First, in this case study, there is no scientific assessment of the establishment of the capacity of the facility point, but that is a subjective method based on the assumption of the capacity of the surrounding existing hospitals. Second, because this is a theoretical analysis, the model developed in this study does not consider the actual driving speed and driving distance, but the speed of the unified average driving distance and the driving distance to take the average of multiple distances.

The results show that the method increases the selection space of decision-makers, provides them with stable technical support, helps them quickly determine the location of emergency medical facilities to respond to disaster relief work and provides better action plans for decision makers.

The results show that the algorithm performs well, which verifies the applicability of this model. When the solution results of the improved GA are compared, the results show that the improved model has fewer evolutionary generations, faster operation speed and better model than the intermediate model GA. This model can more successfully find the optimal location decision scheme, making that more suitable for the location problem of megacities in the case of public health emergencies.

The research findings provide a theoretical and decision-making basis for the location of government emergency medical facilities, as well as guidance for enterprises constructing emergency medical facilities.

Surgical services are settings where resilient performance (RP) is necessary to cope with a wide range of variabilities. Although RP can benefit from a supportive built environment (BE), prior studies have focused on the operating room, giving scant attention to support areas. This study takes a broader perspective, aiming at developing BE design knowledge supportive of RP at the surgical service as a whole.

Seven BE design prescriptions developed in a previous work in the context of internal logistics of hospitals, and thus addressing interactions between workspaces, were used as a point of departure. The prescriptions were used as a data analysis framework in a case study of the surgical service of a medium-sized private hospital. The scope of the study included surgical and support areas, in addition to workflows involving patients and family members, staff, equipment, sterile instruments and materials, supplies, and waste. Data collection included document analysis, observations, interviews, and meetings with hospital staff.

Results identified 60 examples of using the prescriptions, 77% of which were related to areas other than the operating rooms. The developed design knowledge is framed as a set of prescriptions, examples, and their association to workflows and areas, indicating where it should be applied.

The design knowledge is new in surgical services and offers guidance to both BE and logistics designers.

Hospital at Home (HAH) is a concept slowly expanding over time. At first this type of organization was used to accomplish low‐technical tasks. The main objective was to increase bed availability in hospitals for new patients. Nowadays, HAH structures are able to undertake more technical complex care such as (but not limited to) end‐of‐life care, chemotherapy and rehabilitation. The purpose of this paper is to propose a new methodology to make an unbiased economic comparison between HAH structures and traditional hospitalization.

This article accomplishes two main objectives: in the first part the authors propose a comprehensive literature review dealing with the comparison between traditional hospital and home care structures from an economic standpoint, showing that results are highly dependent on initial conditions of the study (patient health state, territory settings, bio‐medical parameters); in the second part the authors propose an unbiased economic comparison approach between health care provided in traditional hospital and home care network using formal modelling with Petri nets and discrete event simulation. As an example for the comparison a multi‐session treatment is proposed. Various scenarios are tested to ensure that results will be maintained even if initial conditions change. Relevant performance indicators used for comparison are economic costs from the point of view of the insurance and economic costs related to the consumption of resources.

It is found that HAHS can be used to control and improve patients flow on hospitals. Decisions about offering a multi‐session treatments at home must be taken, not only because of economic impacts on hospitals, but also because it follows strategic goals of the organization. This decision must be issued following a strategic analysis. Some important questions are: How should newly available beds be used in the hospital? Which territories will be covered? What is the best logistic strategy for delivering the medicines?

Comparing HAH with traditional hospitalization can provide useful information to healthcare authorities when deciding to create, or not, new HAH structures.

The paper presents the main results of a benchmarking project involving eight Italian hospitals. The project sought to examine and compare the organisational processes adopted in different operating blocks, i.e. complex organisational units comprising many different actors whose performance often has a significant influence on the level of work of the overall structure. The organisational survey was carried out by means of interviews with head nurses, surgeons and anaesthetists. In order to identify the managerial significance of activities and processes, a theoretical model of the operating block was developed, together with an appropriate performance measurement system. On the basis of this model and using analytic hierarchy process, we together with experts from the sector were able both “to measure” the strategic importance of the activities and to identify the best practices.

The aims of this paper are to illustrate the use of Lean tools to reduce inpatient waiting time and to evaluate critical success factors of Lean implementation in an inpatient pharmacy in a Thai public hospital.

This study was carried out through action research methodology by following four key phases: identification of problems; planning action; taking action; and evaluation. In the “taking action” phase, Lean tools, including value stream mapping and 5S were implemented to improve dispensing process in an inpatient pharmacy. In the “evaluation phase”, the critical success factors of Lean implementation in an inpatient pharmacy were evaluated by the participants.

Lean methodology was successfully implemented to reduce the waiting time associated with a three days dose distribution system. As a result of Lean application, the average process time reduced from 8.81 to 7.2 min and the standard deviation reduced from 5.49 to 4.45 min. Moreover, the support of middle management and the leadership were the key success factors of Lean implementation in an inpatient pharmacy.

Hospitals can improve the dispensing process by using Lean tools which are easy to apply and use. This study is appropriate for hospital managers looking for changes in pharmacy services or other departments.

This is the first study that has applied Lean tools to improve the dispensing process in an inpatient pharmacy in Thai hospitals. This study offers important insights into the critical success factors of Lean employment in the inpatient pharmacy.

The paper aims at enriching the knowledge of the application of lean management (LM) in emergency department (ED), structuring the methodology for implementing LM projects and summarizing the relevant dimensions of LM adoption in ED.

In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, a systematic literature review has been performed, extracting a database of 34 papers. To answer the research purpose, a descriptive and content analyses have been carried out.

The descriptive analysis demonstrates that the dealt topic is worldwide emerging and multidisciplinary as it arouses interest by medical and engineering communities. Despite the heterogeneity in the adopted methodology, a framework can be grasped from the literature review. It points out the phases and activities, the tools and techniques and the enablers to be considered for guiding the developing of LM project in ED.

This paper provides a comprehensive overview on how to adopt LM in ED, contributing to fill in the gap emerged in the literature. From a practical perspective, this paper provides healthcare managers with a synthesis of the best managerial practices and guidelines in developing a LM project in ED.