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An Integrated Framework for Patient Access Staffing Decision

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The challenge of healthcare delivery has attracted widespread attention since the report published by the World Health Organization in 2000, ranking the US 37th in overall health systems performance among

The challenge of healthcare delivery has attracted widespread attention since the report published by the World Health Organization in 2000, ranking the US 37th in overall health systems performance among 191 Member States. In addition, Davis et al. (2007) demonstrated that healthcare costs in the US were higher than all other countries, despite the fact that care was not the better than all other countries. The growing population in the US, combined with continued medical advances, has increased the demand for quality healthcare services. With this growth, however, comes the challenge of managing rising costs and maintaining efficient operations while satisfying patient's service level. Research has explored methods of improvement from system engineering, lean and process improvement, and mathematical programming of healthcare operations, to improve healthcare operations. In this project, we are interested in a patient access (patient registration) problem. The key research question is: what is an optimal decision in terms of patient admitting points considering both hospital cost and service level of patient access? To answer this question, we propose the use of the Queueing Theory to evaluate scenarios in a multi-objective decision setting implemented by Excel VBA (Visual Basic for Application). The first objective is to provide a "generic" Excel-based model with user-friendly interface such that users are able to visualize outcomes by changing chosen parameters and understand model sensitivities. The second objective is to evaluate the use Queueing in this patient access staffing decision. The data was provided by Healthcare Excellence Institute (HEI), a Phoenix-based consulting company which has experience in improving healthcare operation for more than 8 years. HEI has several hospital clients interested in determining the "optimal" number of admitting points which motivates us to develop this research project. Please note due to business confidentiality, the date used in this thesis has been modified.

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  • 2012-05

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Hidden death and social suffering: a critical investigation of suicide, death surveillance, and implications for addressing a complex health burden in Nepal

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Suicide is one of the fastest-growing and least-understood causes of death, particularly in low and middle income countries (LMIC). In low-income settings, where the technical capacity for death surveillance is

Suicide is one of the fastest-growing and least-understood causes of death, particularly in low and middle income countries (LMIC). In low-income settings, where the technical capacity for death surveillance is limited, suicides may constitute a significant portion of early deaths, but disappear as they are filtered through reporting systems shaped by social, cultural, and political institutions. These deaths become unknown and unaddressed. This dissertation illuminates how suicide is perceived, contested, experienced, and interpreted in institutions ranging from the local (i.e., family, community) to the professional (i.e., medical, law enforcement) in Nepal, a country purported to have one of the highest suicide rates in the world. Drawing on a critical medical anthropology approach, I bridge public health and anthropological perspectives to better situate the problem of suicide within a greater social-political context. I argue that these complex, contestable deaths, become falsely homogenized, or lost. During 18 months of fieldwork in Nepal, qualitative, data tracing, and psychological autopsy methodologies were conducted. Findings are shared through three lenses: (1) health policy and world systems; (2) epidemiology and (3) socio-cultural. The first investigates how actors representing familial, legal, and medical institutions perceive, contest, and negotiate suicide documentation, ultimately failing to accurately capture a leading cause of death. Using epidemiologic perspectives, surveillance data from medical and legal agencies are analyzed and pragmatic approaches to better detect and prevent suicidal death in the Nepali context are recommended. The third lens provides perceived explanatory models for suicide. These narratives offer important insights into the material, social, and cultural factors that shape suicidal acts in Nepal. Findings are triangulated to inform policy, prevention, and intervention approaches to reduce suicidal behavior and improve health system capabilities to monitor violent deaths. These approaches go beyond typical psychological investigations of suicide by situating self-inflicted death within broader familial, social, and political contexts. Findings contribute to cultural anthropological theories related to suicide and knowledge production, while informing public health solutions. Looking from the margins towards centers of power, this dissertation explicates how varying institutional numbers can obfuscate and invalidate suffering experienced at local levels.

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  • 2017