Tactical planning for hospital at home : prospects and challenges

Abstract

In order to cope with the growing demand for hospitalisation and to improve patient satisfaction, alternatives to traditional hospitalisation are being developed all over the world. One of them is the hospital at home. Therefore, the objective of this thesis is to highlight promising research questions in the area of tactical planning for the hospital at home and to see what implications this has at the short-term level. More specifically, this thesis aims to answer the question: How can tactical planning models for the hospital be adapted to take into account the case of the hospital at home and what are the impacts at the operational level?. To this end, the thesis will begin with a literature review that will focus on decisions made in hospitals and home health care institutions. All three levels of decisions will be studied, but particular attention will be paid to the tactical level. Then, more information about hospital at home will be given. This part will include a reminder of the differences between home health care and hospital at home. The development of hospital at home in several countries will also be analysed. Finally, the results of the interviews conducted in the framework of this thesis will be presented. These interviews were carried out in various Belgian hospitals offering a service of hospital at home. The last part of the thesis will discuss the adaptations to be made to the hospital’s decision‐making models when the case of hospital at home is considered and will also address the impact of these modifications on the operational level. As a result, it was seen that there were fewer changes at the tactical level than expected. But that the few changes impacted more strongly on the operational level. Moreover, the changes mainly concern nurses, who are one of the most important resources of the hospital. In addition, the hospital at home could increase the capacity to admit patients, but on the other hand, the hospital would be faced with a lack of staff. At the tactical level, it is therefore wise to think carefully about the selection of shifts and the number of staff per shift, so as not to complicate the daily/weekly management of the nurses.