Gréanne Leeftink - Rural Health & Mathematical Models

Rural Road to Health

Gréanne Leeftink is an assistant professor within the department Industrial Engineering and Business Information Systems, in the CHOIR research center at the University of Twente. Her research focus is on healthcare process optimization, using Operations Management/Operations Research techniques.

Episode summary:

01.14 Greanne tells us about her professional background and how she became more involved in healthcare in rural areas.

04.55 The University of Twente and the work of the CHOIR research center.

09:14 What can mathematical models bring to primary healthcare?

13.24 How do mathematical models apply when dealing with limited resources?

15:33 The importance of taking variability into account in those mathematical models.

22.08 The Virtual Care Centre of Isala.

27.08 What has the feedback been from healthcare staff and patients?

30.41 How were the healthcare professionals involved in implementing/developing that idea?

32:00 Were there any issues with digital literacy and how do you deal with these?

34.35 How do mathematical models have been applied to the challenge of freeing up clinical time?

37:08 How widely are these being used in the Netherlands and in Europe?

39.46 Key insights from Greanne’s research regarding how care is provided in rural areas.

41:49 What other research is planned at the CHOIR and the University of Twente.

Key messages:

CHIOR Research Centre is one of the world's largest research centers on healthcare logistics.

In industry and business all processes are optimized to the tiniest detail. People say that this can not be applied to the healthcare setting. However the same mathematical principles apply to healthcare and can be applied to healthcare settings.

CHIORs mission is to help healthcare organizations improve their quality of care and quality of labor and efficiency by redesigning their processes.

Rural health has challenges such as access to care, drug availability, supply chain reliability, emergency response, cost efficiency etc, which all have a logistic component to them. Rural populations deserve to have the same quality of care as the urban population.

They worked on a mobile care clinic which provided care in different villages. They needed to determine what the optimal location of the mobile care clinic would be to ensure that all the villages were served at least once every second week. They used mathematical models to determine this. Access once a week or every second week is often not enough, so they factored in having a van in an area that was more accessible in regard to distance every 48 hours.

Capacity management which entails planning and scheduling solutions which focus on efficient deployments. Using mathematical models they have created better work schedules with more evenly distributed workloads. This can reduce work pressure for employees and improve efficiency by 15-50%.

What can mathematical modeling bring to a primary care center? It can address the challenge of variability of workload. If we can quantify the variation to some extent, we can plan the work schedules in a better way.

Sometimes it is important to recognize that some things in healthcare can not be fully optimized, you have to accept that sometimes certain resources and staff will not be fully utilized, however this flexibility is important for staff satisfaction.

Rural care is by its nature less efficient, and sometimes the conversations stop here and the recommendation is to pool everything in cities. However this is not the best approach. A way to approach this is task differentiation or by taking on a different type of activity, for example having physical consultations combined with digital consultations.

They look at a process and try to grasp the notion of variability in that process, then they try to reduce that variability. However at some point you can not reduce this variability further. So we have to try to adjust your capacity to the variability and this can be done by having flexibility.

Allocating flexibility is unique to each situation, one way will not work for everyone. The solution that works for the neighbors may not work for us.

In the Netherlands women have the right to give birth at home. They used a simulation model to see how many midwives would be needed to provide good quality care to rural women. Long and variable travel times and an increase in the number of births affected availability of midwives particularly in summer months so pregnant women would be asked to go to the birthing center in the summer to reduce risks. During the rest of the year rural women can give birth at home.

Isala Hospital Virtual Care Centre has a program for connected care. The aim is to bring care closer to patients home using remote monitoring to reduce time spent in hospital or the need to attend clinic appointments.

Remote monitoring solutions are becoming more reliable and they provide opportunities for people to maintain independence and receive care in their homes.

Modeling and data analytics in healthcare has grown in recent years. In hospital settings this is used more often with dedicated capacity managment teams for planning and scheduling from strategic to planning level. Now primary care is also interested in exploring this approach.

CHIOR at the University of Twente: https://www.utwente.nl/en/choir/

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