By Philip Trum
When Vedat Verter applied for NSERC funding, he illustrated his vision using recent research done by his doctoral students and post-doctoral fellows in the Desautels Faculty of Management. One such example was the work of Beste Kucukyazici, who graduated in 2009 and is now assistant professor of supply chain management with MIT-Zaragoza and a CREATEHOIM collaborator.
By studying patient files at the Montreal Neurological Institute, Kucukyazici determined that the longer a stroke patient stays in emergency before being transferred to the stroke unit, the longer they’ll stay in hospital overall. “It’s a loop,” she explains. “A patient waits in emergency, where they’re not getting the specialized care they need right after they’ve had their stroke, because there isn’t an empty stroke unit bed. When they finally get to the unit, they spend longer there because they didn’t get that early specialized care—and thus cause the next stroke patient to wait in emergency.” Further, she found these patients have “worse functionality when they are discharged, compared to patients admitted quicker to the stroke unit, to the degree that, instead of going home, they may need to go to a long-term-care facility.”
The solution isn’t as easy as just adding more beds; patients need the specialized care that goes with those beds, too. Working with Dr. Richard Riopelle, chair of the Department of Neurology and Neurosurgery, Kucukyazici adapted some management techniques traditionally used for manufacturing systems, in order to develop a flexible bed allocation policy. “Instead of having, say, eight beds reserved for stroke patients, and eight reserved for non-stroke neurological patients, our simulation model showed that you can increase your capacity by making all 16 beds flexible for all types of patients in that ward. You reduce the waiting time in emergency and you improve outcomes.”
Kucukyazici presented her findings to Riopelle in May 2009. He was impressed, but the project remains very much a work-in-progress. Riopelle describes CREATE-HOIM as “critical in terms of advancing the health system from the perspective of effectiveness and efficiency,” but stresses that change is necessarily slow. “We’re beginning to get the evidence, like Beste’s work, but now we need to build the expertise to implement these great initiatives—and that just takes a lot of time.” ■