Improvement of the clinical-care pathway of inguinal hernia surgery: a mathematical model for implementing a feasibility study

The best public sector performance has long been a topic at the core of political, social and economic debate. Public management policies and the growing adoption of corporate governance principles support the transition towards models capable of guaranteeing greater control of results in terms of efficiency, effectiveness, and outcome. Healthcare systems are an example of public service. Due to their high management costs, healthcare systems are often under pressure, especially when there is a need to widen access, to improve their efficiency and their care quality and to reduce inequalities. Operations Management (OM) approaches actively support this path. This article describes a retrospective analysis, in which a surgical rescheduling plan of a hospital in northern Italy (consisting of 6 structures distributed throughout wide provincial area serving over 530,000 inhabitants) has been produced, with particular reference to inguinal hernia surgery as health service subject to optimization. The current situation ("as is" scenario) is characterized by a strong concentration of complex and urgent surgical interventions in two hospital facilities of the hospital network, which are further burdened by less complex planned interventions. A linear integer model has been developed, to determine a possible optimized scenario for the redistribution of surgical interventions, trying to leave complex and urgent cases in the two reference structures, but relieving them of the other cases through a better distribution in the other structures of the network. The costs were the driver used for the scheduling, which resulted to be considerably reduced in the new proposed configuration.