Working at Johns Hopkins University in the Business and Medial schools over a decade or so resulted in a number of published works that you may use to develop understanding, and generate ideas about process improvement. We provide links to many of these works here for your reference. We seek no compensation for any of this work, as these are all publicly available. Works are presented here in chronological order for ease of reference. Comments are added to give an idea of what each publication is about.
- Patient punctuality and clinic performance: observations from an academic-based private practice pain centre: a prospective quality improvement study – BMJ open (2014). Reports on the implementation of a policy to alter patient arrival times and explains how it affected the patient experience. Williams, et.al. 2012
- Applying JIT principles to resident education to reduce patient delays: a pilot study in an academic medical center pain clinic – Pain Medicine (2014). Reports on the implementation of pre-processing, which in this context is the approach of moving some resident teaching offline to improve clinic flow. Williams, et.al. 2012
- Using Process Analysis to Assess the Impact of Medical Education on the Delivery of Pain Services A Natural Experiment – Anesthesiology (2014). Compares clinic performance in an academic setting and in private practice to show how differences in process structure affect system performance. Williams, et.al. 2012
- Defining Clinical Process Value in Radiation Oncology – International Journal of Radiation Oncology (2015). Defines an approach to using data and simulation models as tools to monitor patient flows and improve operational performance. This process is one of the central building blocks for my courses on process improvement. Elnahal, et.al. 2015b.
- The use of flexible manufacturing capacity in pharmaceutical product introductions – Decision Sciences, (2009). Presents a way to evaluate strategic options created by using flexible production resources as part of a larger approach to risk management in the introduction of pharmaceutical products. The setting later serves as a major assignment in the simulation course. Chambers, Snir, Ata 2009.
- Changes to physician processing times in response to clinic congestion and patient punctuality: a retrospective study – BMJ open (2016). Highlights why managers must augment theoretical queuing models with an understanding of human adaptations, because health care providers do not behave like perfectly consistent machines. They adjust their behavior based on system status. Chambers, et.al. 2016.
- Managing Shoulder Dystocia Using Data Envelopment Analysis – Journal of the Society of Reproductive Investigations (2017). Highlights a way for practitioners to use a rigorous tool to evaluate medical units, or to facilitate benchmarking, and serves as an example to introduce the subject of DEA.
- Using a Real-time Location System to Measure Patient Flow in a Radiation Oncology Outpatient Clinic. – Practical radiation oncology (2018). Describes a rigorous approach for data collection for process measurement, and explains how this data can be used to implement an Activity-Based Costing system. Conley, et. al. 2018.
- Managing Clinical Appointments in an Academic Medical Center – in Advances in Service Science (2019) Lays out a detailed approach to developing an appointment schedule for outpatient clinics accounting for a teaching mission, multi-dimensional variability, and costs. Chambers, et.al. 2018
- Using Analytics to Improve Patient Flow in Outpatient Clinics – in Essentials of Business Analytics (2020). Used as a reading at the end of several courses focused on Health Care management to summarize many course findings in the context of an integrated approach to process improvement. Dada, Chambers 2019.
- A model for an institutional response to the opioid crisis – Journal of Opioid Management, (2019). Lays out a framework for a coordinated response to the opioid crisis at the level of a major hospital network. Hanna et.al. 2019.
- Tips from the field: How to Enhance Practice Efficiency – Practical Pain Management (August 2020). Provides guidelines to improve patient flow and resource utilization in outpatient clinics. Chambers 2020.
- Improving Processes for Health Care Delivery: Lessons from Johns Hopkins Medicine. (With M. Dada, and K. Williams) In process with Springer publishing. (Table of Contents and sample chapters attached) Designed to serve as the main text in courses on Health Care delivery as well as Immersion projects in Health Care improvement. Topics include: A Primer on Process Analysis, Data Envelopment Analysis, Discrete Event Simulation, Costing of Health Care Services, Data Visualization, and Appointment Scheduling. Chambers, Dada, Williams 2022.
- Equitable Appointment Scheduling at a Healthcare Clinic: A Date-Driven Markov Chain Approach – SSRN. This work presents a technically rigorous approach to coming up with an appointment schedule that balances waiting times, overtime cost, and adds a constraint to ensure that no patient on the schedule has an excessive expected waiting time. Chambers, Dada, Semple 2023
- Implications for cost and access of site-of-service referrals for ancillary medical services in a US Medicaid population: analysis of claims data from Maryland, USA. Many payors seek to motivate patients to seek treatment at alternate sites to reduce the total cost of care provided to a large population. Implementing such a policy requires an understanding of fee structures, travel times, and population densities. Singh, et.al. 2023
- Managing prior approval for site-of-service referrals: an algorithmic approach. BMC Health Services Research 2022. Considers detailed payment data from a large insurer serving patients across the state of Maryland as part of an effort to adjust the sites of service to reduce cost and increase access. Dada, et.al. 2022.
- Comment on Crowdsoursing anaesthesia care. This commentary is included in the British Journal of Anaesthesia on efforts to use a crowsources blog structure to share information within an anaesthesia unit to help prepare providers for upcoming surgical cases. Nguyen, Chambers, Dada 2016.
- Modeling and Managing the Percentage of Satisfied Customers in Hidden and Revealed Waiting Line Systems. Production and Operations Management 2009. Develops queueing models to predict the percentage of customers whose waiting times are less than their expectations. This includes systems where customers can see the length of the line, as well as those where they cannot. Chambers, Kouvelis 2009.
- Treatment Machine Workload is Associated with Near-Miss and Safety Incidents: Analyzing Safety With a Novel Operations Management Data System. International Journal of Radiation Oncology 2015. Treatment delays are analyzed to show that capacity enhancement cuts near miss and safety incidents in a large radiation oncology clinic. Elnahal, et.al. 2015.
- Increased Treatment Capacity and a Balanced Machine Load are Associated with Fewer Safety Incidents in a Radiation Oncology Clinic. American Journal of Medical Quality (2015). Reports on a process in which capacity is increased by adding machines and loads across machines are rebalanced to ensure a more uniform workload. This results in greater patient safety. Elnahal, et.al. 2015c
For additional info
Feel free to study, use, and reference any of these works. For a broad discussion of these and other projects you should read Chambers, Dada, Williams 2022. You can also contact us for unpublished items including teaching notes, readings and the like.