Entropy Optimization by Redesigning Organization in Hospital Operations.

A redesign of hospitals (i.e., partitioning departments and delegating decision authority) may be needed to deal with variable demand. Uncertain demands and throughput times often need short reaction times. In this study, we develop quantitative methods to guide a redesign through an information-processing approach. To demonstrate how the methods can be used in practice, we tested them by applying them to a large perinatology care system in the Netherlands. We used the following two methods: 1. portfolio optimization and 2. efficient coordination of workload and reallocation of nurses. Our case study of a large perinatology care system showed that several designs of clustered units minimized the demand uncertainty in the perinatology care system. For the coordination strategy, the information and decision uncertainty is minimized when the decision power is positioned at the operation level and with the help of a centralized information system. When the operation decision-making power is not supplemented with the centralized and system-wide information system, hospitals can better use the hierarchy model, where the manager holds decision-making power with a system-wide overview. We also found that the speed of decision-making in real-time depends on the level of information aggregation set up by the system. We conclude that combining the correlation perspectives and the entropy theory is a way of quantifying how organizations can be (re)designed.