City Research Online

Abstract

Clinical service configuration (CSC) concerns the distribution of services, capacity and patient demand across a hospital network. The thesis develops queueing and optimisation models to examine how economies of scale and economies of focus affect configuration under explicit service requirements. The principal mechanisms studied are operating cost, service heterogeneity and infection exposure.

A conceptual framework comprising distance, competition, economies of scale, economies of focus and economies of scope provides the basis for the models. Four models of a single service establish conditions under which concave costs favour centralised demand allocation and identify the associated capacity requirements. Models of two services then examine the effects of differences in length of stay and service variability on fully generalised, partially specialised and fully specialised configurations. The analysis extends to unequal capacities, heterogeneous costs and larger networks. Analyses of the service threshold establish its effects on feasibility, capacity reserves and configuration boundaries. A nosocomial transmission model represents infection exposure through effective service requirements. Numerical experiments identify circumstances in which exposure increases the value of partial or full specialisation. A discrete event simulation compares the configurations selected by numerical and simulation-based optimisation.

The results identify how operating cost and service requirements determine feasible allocations of demand and capacity. The models provide conditional rules for comparing configurations and identify additional planning considerations for application in hospital networks.

Publication Type:	Thesis (Doctoral)
Subjects:	H Social Sciences > HD Industries. Land use. Labor H Social Sciences > HD Industries. Land use. Labor > HD28 Management. Industrial Management Q Science > QA Mathematics R Medicine > RA Public aspects of medicine
Departments:	Bayes Business School Bayes Business School > Bayes Business School Doctoral Theses Doctoral Theses

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