MODELING AND ANALYSIS OF PUBLIC HEALTHCARE SERVICES

Abstract

This research has attempted to fill some of the voids in the body of the knowledge. An exhaustive and comprehensive literature review has been conducted to identify the gaps in the existing literature in this area. This research is aimed to identify and analyze the different issues of rural and urban healthcare systems in India. System dynamic technique has been used to model the rural healthcare supply chain and the services in the urban public hospital considering various risks and uncertainties. Various brainstorming sessions have been organized to identify, relate and examine the various factors related to the rural and urban healthcare systems. Structural models have been developed using interpretive structural modeling (ISM) approach followed by MICMAC analysis. The developed models may be helpful to select the significant issues related to supply chain and services in public hospitals. The main contribution of this research can be summarized as follows:  An extensive and comprehensive literature review has been conducted to identify the research gaps and research issues related to healthcare supply chain and services provided a concrete platform to explore into future directions.  Questionnaires related to rural healthcare supply chain and urban healthcare services have been developed.  System dynamic (SD) modelling of five echelon rural healthcare supply chain has been done. Primarily, SD model representing the existing supply chain has been developed and validated with real system using t-test. The causal loop diagram shows the positive or negative interrelationships between various parameters is developed. Two stock-flow diagrams; Model I and II, are designed considering demand and lead time uncertainties along with all quantity discount offers and minmax (s,S) inventory policy.  SD model of outpatient service management of a district hospital has been developed. A casual loop diagram with a total of ten loops is formed showing the structure of entire OPD services. The effect of server leaves on hiring registration capacity and hiring rate is demonstrated. It also shows the effect of shortage of sitting space on patient satisfaction and space addition. The stock- flow diagram and (SFD) is developed for all processes for OPD services.  Structural modelling of rural healthcare systems has been done using ISM. Nineteen factors are identified from the literature survey and by the expert’s suggestion during the site survey. vi The ISM shows the hierarchy level of each factor followed by MICMAC analysis representing the driving and dependence factors.  The ISM model has been developed for effective inventory management process in a district hospital. Out of sixteen factors thirteen are identified from existing literatures and three are suggested by the experts during the questionnaire and survey. The ISM is developed followed by the MICMAC analysis showing the driving and dependence factors for successful inventory management in hospital. Keywords: System dynamics, interpretive structural modeling, rural healthcare in India, healthcare supply chain, healthcare service ,management, MICMAC analysis, causal loop diagram, stock-flow diagram.