Paul Robert Harper

Bio: Paul Robert Harper is an academic researcher from Cardiff University. The author has contributed to research in topics: Population & Health care. The author has an hindex of 28, co-authored 105 publications receiving 3579 citations. Previous affiliations of Paul Robert Harper include Brunel University London & University of Southampton.

An analysis of the academic literature on simulation and modelling in health care

Abstract: This article describes a multi-dimensional approach to the classification of the research literature on simulation and modelling in health care. The aim of the study was to analyse the relative frequency of use of a range of operational research modelling approaches in health care, along with the specific domains of application and the level of implementation. Given the vast scale of the health care modelling literature, a novel review methodology was adopted, similar in concept to the approach of stratified sampling. The results provide new insights into the level of activity across many areas of application, highlighting important relationships and pointing to key areas of omission and neglect in the literature. In addition, the approach presented in this article provides a systematic and generic methodology that can be extended to other application domains as well as other types of information source in health-care modelling.

Modelling for the planning and management of bed capacities in hospitals

Abstract: The internal dynamics of a hospital represent a complex non-linear structure. Planning and management of bed capacities must be evaluated within an environment of uncertainty, variability and limited resources. A common approach is to plan and manage capacities based on simple deterministic spreadsheet calculations. This paper demonstrates that these calculations typically do not provide the appropriate information and result in underestimating true bed requirements. More sophisticated, flexible and necessarily detailed capacity models are needed. The development and use of such a simulation model is presented in this paper. The modelling work, in conjunction with a major UK NHS Trust, considers various types of patient flows, at the individual patient level, and resulting bed needs over time. The consequence of changes in capacity planning policies and management of existing capacities can be readily examined. The work has highlighted the need for evaluating hospital bed capacities in light of both bed occupancies and refused admission rates. The relationship between occupancy and refusals is complex and often overlooked by hospital managers.

Using industrial processes to improve patient care

Abstract: Might industrial processes improve quality, reduce waiting times, and enhance the working environment?

A framework for operational modelling of hospital resources.

Abstract: The provision of hospital resources, such as beds, operating theatres and nurses, is a matter of considerable public and political concern and has been the subject of widespread debate [1, 2, 3]. The political element of healthcare emphasises the need for objective methods and tools to inform the debate and provide a better foundation for decision-making. There is considerable scope for operational models to be widely used for this purpose. An appreciation of the dynamics governing a hospital system, and the flow of patients through it, point towards the need for sophisticated capacity models reflecting the complexity, uncertainty, variability and limited resources. Working alongside managers and clinicians from participating hospitals, this paper proposes a generic framework for modelling of hospital resources in the light of perceived user-needs and real-life hospital processes. The proposed framework incorporates the need for patient classification techniques to be adopted, which forms a key differentiator between this approach and other attempts to produce practical capacity planning and management tools. Statistically and clinically meaningful patient groupings may then be fed into developed simulation models and individual patients from each group passed through the particular hospital system of concern. The effectiveness of the framework is demonstrated through the development and use of an integrated hospital capacity tool.

Reduced outpatient waiting times with improved appointment scheduling: a simulation modelling approach

Abstract: An outpatient department represents a complex system through which many patients with varying needs pass each day. An effective appointment system is a critical component in controlling patient waiting times within clinic sessions. Current waiting times are often unacceptable and place great stress on clinic staff. This paper describes the development and use of a detailed simulation model of an Ear, Nose and Throat (ENT) outpatient department. The simulation allows various appointment schedules to be examined and their effects on the clinic evaluated. The model has been used to identify a number of critical factors that influence patient waiting times and the build up of queues in the clinic. Alternative appointment schedules have been shown to drastically reduce patient waiting times, without the need for extra resources, and enable the department to move towards meeting the UK Government's Patient's Charter.

Fundamentals of Queueing Theory

Abstract: Praise for the Third Edition: "This is one of the best books available. Its excellent organizational structure allows quick reference to specific models and its clear presentation . . . solidifies the understanding of the concepts being presented."IIE Transactions on Operations EngineeringThoroughly revised and expanded to reflect the latest developments in the field, Fundamentals of Queueing Theory, Fourth Edition continues to present the basic statistical principles that are necessary to analyze the probabilistic nature of queues. Rather than presenting a narrow focus on the subject, this update illustrates the wide-reaching, fundamental concepts in queueing theory and its applications to diverse areas such as computer science, engineering, business, and operations research.This update takes a numerical approach to understanding and making probable estimations relating to queues, with a comprehensive outline of simple and more advanced queueing models. Newly featured topics of the Fourth Edition include:Retrial queuesApproximations for queueing networksNumerical inversion of transformsDetermining the appropriate number of servers to balance quality and cost of serviceEach chapter provides a self-contained presentation of key concepts and formulae, allowing readers to work with each section independently, while a summary table at the end of the book outlines the types of queues that have been discussed and their results. In addition, two new appendices have been added, discussing transforms and generating functions as well as the fundamentals of differential and difference equations. New examples are now included along with problems that incorporate QtsPlus software, which is freely available via the book's related Web site.With its accessible style and wealth of real-world examples, Fundamentals of Queueing Theory, Fourth Edition is an ideal book for courses on queueing theory at the upper-undergraduate and graduate levels. It is also a valuable resource for researchers and practitioners who analyze congestion in the fields of telecommunications, transportation, aviation, and management science.

The Web of Human Sexual Contacts

Abstract: Many ``real-world'' networks are clearly defined while most ``social'' networks are to some extent subjective. Indeed, the accuracy of empirically-determined social networks is a question of some concern because individuals may have distinct perceptions of what constitutes a social link. One unambiguous type of connection is sexual contact. Here we analyze data on the sexual behavior of a random sample of individuals, and find that the cumulative distributions of the number of sexual partners during the twelve months prior to the survey decays as a power law with similar exponents $\alpha \approx 2.4$ for females and males. The scale-free nature of the web of human sexual contacts suggests that strategic interventions aimed at preventing the spread of sexually-transmitted diseases may be the most efficient approach.

Best Care at Lower Cost: The Path to Continuously Learning Health Care in America

Abstract: America's health care system has become too complex and costly to continue business as usual. Best Care at Lower Cost explains that inefficiencies, an overwhelming amount of data, and other economic and quality barriers hinder progress in improving health and threaten the nation's economic stability and global competitiveness. According to this report, the knowledge and tools exist to put the health system on the right course to achieve continuous improvement and better quality care at a lower cost.The costs of the system's current inefficiency underscore the urgent need for a systemwide transformation. About 30 percent of health spending in 2009--roughly $750 billion--was wasted on unnecessary services, excessive administrative costs, fraud, and other problems. Moreover, inefficiencies cause needless suffering. By one estimate, roughly 75,000 deaths might have been averted in 2005 if every state had delivered care at the quality level of the best performing state. This report states that the way health care providers currently train, practice, and learn new information cannot keep pace with the flood of research discoveries and technological advances.About 75 million Americans have more than one chronic condition, requiring coordination among multiple specialists and therapies, which can increase the potential for miscommunication, misdiagnosis, potentially conflicting interventions, and dangerous drug interactions. Best Care at Lower Cost emphasizes that a better use of data is a critical element of a continuously improving health system, such as mobile technologies and electronic health records that offer significant potential to capture and share health data better. In order for this to occur, the National Coordinator for Health Information Technology, IT developers, and standard-setting organizations should ensure that these systems are robust and interoperable. Clinicians and care organizations should fully adopt these technologies, and patients should be encouraged to use tools, such as personal health information portals, to actively engage in their care.This book is a call to action that will guide health care providers; administrators; caregivers; policy makers; health professionals; federal, state, and local government agencies; private and public health organizations; and educational institutions.