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Publicações

Publicações por Mário Amorim Lopes

2015

A decision support system for the operational production planning and scheduling of an integrated pulp and paper mill

Autores
Figueira, G; Amorim, P; Guimaraes, L; Amorim Lopes, M; Neves Moreira, F; Almada Lobo, B;

Publicação
COMPUTERS & CHEMICAL ENGINEERING

Abstract
Production planning and scheduling in the process industry in general and in the pulp and paper (P&P) sector in particular can be very challenging. Most practitioners, however, address those activities relying only on spreadsheets, which is time-consuming and sub-optimal. The literature has reported some decision support systems (DSSs) that are far from the state-of-the-art with regard to optimization models and methods, and several research works that do not address industrial issues. We contribute to reduce that gap by developing and describing a DSS that resulted from several iterations with a P&P company and from a thorough review of the literature on process systems engineering. The DSS incorporates relevant industrial features (which motivated the development of a specific model), exhibits important technical details (such as the connection to existing systems and user-friendly interfaces) and shows how optimization can be integrated in real world applications, enhanced by key pre- and post-optimization procedures.

2016

Comparing comparables: an approach to accurate cross-country comparisons of health systems for effective healthcare planning and policy guidance

Autores
Lopes, MA; Soares, C; Almeida, A; Almada Lobo, B;

Publicação
HEALTH SYSTEMS

Abstract
With rising healthcare costs, using health personnel and resources efficiently and effectively is critical. International cross-country and simple worker-to-population ratio comparisons are frequently used for improving the efficiency of health systems, planning of health human resources and guiding policy changes. These comparisons are made between countries typically of the same continental region. However, if used imprudently, inconsistencies arising from frail comparisons of health systems may outweigh the positive benefits brought by new policy insights. In this work, we propose a different approach to international health system comparisons. We present a methodology to group similar countries in terms of mortality, morbidity, utilisation levels, and human and physical resources, which are all factors that influence health gains. Instead of constructing an absolute rank or comparing against the average, the method finds countries that share similar ground, upon which more reliable comparisons can then be conducted, including performance analysis. We apply this methodology using data from the World Health Organization's Health for All database, and we present some interesting empirical relationships between indicators that may provide new insights into how such information can be used to promote better healthcare planning and policy guidance.

2018

Forecasting the medical workforce: a stochastic agent-based simulation approach

Autores
Lopes, MA; Almeida, AS; Almada Lobo, B;

Publicação
Health Care Management Science

Abstract
Starting in the 50s, healthcare workforce planning became a major concern for researchers and policy makers, since an imbalance of health professionals may create a serious insufficiency in the health system, and eventually lead to avoidable patient deaths. As such, methodologies and techniques have evolved significantly throughout the years, and simulation, in particular system dynamics, has been used broadly. However, tools such as stochastic agent-based simulation offer additional advantages for conducting forecasts, making it straightforward to incorporate microeconomic foundations and behavior rules into the agents. Surprisingly, we found no application of agent-based simulation to healthcare workforce planning above the hospital level. In this paper we develop a stochastic agent-based simulation model to forecast the supply of physicians and apply it to the Portuguese physician workforce. Moreover, we study the effect of variability in key input parameters using Monte Carlo simulation, concluding that small deviations in emigration or dropout rates may originate disparate forecasts. We also present different scenarios reflecting opposing policy directions and quantify their effect using the model. Finally, we perform an analysis of the impact of existing demographic projections on the demand for healthcare services. Results suggest that despite a declining population there may not be enough physicians to deliver all the care an ageing population may require. Such conclusion challenges anecdotal evidence of a surplus of physicians, supported mainly by the observation that Portugal has more physicians than the EU average. © 2016 Springer Science+Business Media New York

2015

Handling healthcare workforce planning with care: where do we stand?

Autores
Lopes, MA; Almeida, AS; Almada Lobo, B;

Publicação
HUMAN RESOURCES FOR HEALTH

Abstract
Background: Planning the health-care workforce required to meet the health needs of the population, while providing service levels that maximize the outcome and minimize the financial costs, is a complex task. The problem can be described as assessing the right number of people with the right skills in the right place at the right time, to provide the right services to the right people. The literature available on the subject is vast but sparse, with no consensus established on a definite methodology and technique, making it difficult for the analyst or policy maker to adopt the recent developments or for the academic researcher to improve such a critical field. Methods: We revisited more than 60 years of documented research to better understand the chronological and historical evolution of the area and the methodologies that have stood the test of time. The literature review was conducted in electronic publication databases and focuses on conceptual methodologies rather than techniques. Results: Four different and widely used approaches were found within the scope of supply and three within demand. We elaborated a map systematizing advantages, limitations and assumptions. Moreover, we provide a list of the data requirements necessary to implement each of the methodologies. We have also identified past and current trends in the field and elaborated a proposal on how to integrate the different methodologies. Conclusion: Methodologies abound, but there is still no definite approach to address HHR planning. Recent literature suggests that an integrated approach is the way to solve such a complex problem, as it combines elements both from supply and demand, and more effort should be put in improving that proposal.

2018

A labor requirements function for sizing the health workforce

Autores
Cruz Gomes, S; Amorim Lopes, M; Almada Lobo, B;

Publicação
HUMAN RESOURCES FOR HEALTH

Abstract
Background: Ensuring healthcare delivery is dependent both on the prediction of the future demand for healthcare services and on the estimation and planning for the Health Human Resources needed to properly deliver these services. Although the Health Human Resources planning is a fascinating and widely researched topic, and despite the number of methodologies that have been used, no consensus on the best way of planning the future workforce requirements has been reported in the literature. This paper aims to contribute to the extension and diversity of the range of available methods to forecast the demand for Health Human Resources and assist in tackling the challenge of translating healthcare services to workforce requirements. Methods: A method to empirically quantify the relation between healthcare services and Health Human Resources requirements is proposed. For each one of the three groups of specialties identified-Surgical specialties, Medical specialties and Diagnostic specialties (e.g., pathologists)-a Labor Requirements Function relating the number of physicians with a set of specialty-specific workload and capital variables is developed. This approach, which assumes that health managers and decision-makers control the labor levels more easily than they control the amount of healthcare services demanded, is then applied to a panel dataset comprising information on 142 public hospitals, during a 12-year period. Results: This method provides interesting insights on healthcare services delivery: the number of physicians required to meet expected variations in the demand for healthcare, the effect of the technological progress on healthcare services delivery, the time spent on each type of care, the impact of Human Resources concentration on productivity, and the possible resource allocations given the opportunity cost of the physicians' labor. Conclusions: The empirical method proposed is simple and flexible and produces statistically strong models to estimate Health Human Resources requirements. Moreover, it can enable a more informed allocation of the available resources and help to achieve a more efficient delivery of healthcare services.

2019

Advancing the science of unfinished nursing care: Exploring the benefits of cross-disciplinary knowledge exchange, knowledge integration and transdisciplinarity

Autores
Jones, T; Willis, E; Amorim Lopes, M; Drach Zahavy, A;

Publicação
Journal of Advanced Nursing

Abstract
Aims: The aims of this paper are to explore the role of cross-disciplinary knowledge exchange and integration in advancing the science of unfinished nursing care and to offer preliminary guidance for theory development activities for this growing international community of scholars. Background: Unfinished nursing care, also known as missed care or rationed care is a highly prevalent problem with negative consequences for patients, nurses and healthcare organizations around the world. It presents as a ‘wicked’ sustainability problem resulting from structural obstacles to effective resource allocation that have been resistant to conventional solutions. Research activity related to this problem is on the rise internationally but is hindered by inconsistencies in conceptualizations of the problem and lack of robust theory development around the phenomenon. A unified conceptual framework is needed to focus scholarly activities and facilitate advancement of a robust science of unfinished nursing care. Design: Discussion paper. Data Sources: This discussion paper is based on our own experiences in international and interdisciplinary research partnerships related to unfinished nursing care. These experiences are placed in the context of both classic and current literature related to the evolution of scientific knowledge. Implications for Nursing: The problem of unfinished nursing care crosses multiple scientific disciplines. It is imperative that the community of scholars interested in solving this wicked problem engage in meaningful cross-disciplinary knowledge integration and move towards transdisciplinarity. Conclusion: Metatheorizing guided by structuration theory should be considered as a strategy to promote transdiciplinarity around the problem of unfinished nursing care. © 2019 John Wiley & Sons Ltd

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