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This article documents the experience of addressing improvements in the operational parameters of an ophthalmology clinic in central India. Shortcomings in the operating parameters of throughput, capacity use and patient waiting times required the immediate attention of senior management. Based on elementary data analysis, the present study advocates a scheduling system that improves all three of these operating parameters. Several administrative options to improve the overall performance of the system were identified. For a deeper understanding of the design issues, a simulation-based model was developed. The results of the simulation model were used to prioritise action areas that needed system improvement.

Operation Management and Quantitative Techniques

World University root node

British Journal of Healthcare Management

Managing operating performance at an ophthalmology clinic

Mafia offer is an unbelievably good offer that a company makes to its customers; the attractiveness of the offer makes it impossible for the customers to decline the offer and difficult for the competitors to match it [Cox, James, III, and John Schleier. 2010. Theory of Constraints Handbook. McGraw-Hill]. This study analyses the performance of one such offer that a producer of deteriorating items can make to its customers in the supply chain, such as retailers and distributors. The results from the analytical model show that the mafia offer increases the profits of both the producer and the retailer in a deteriorating items' supply chain. The efficacy of the proposed offer is tested for multiple combinations of ordering cost, wholesale price, and the retailer's cash constraints. The experimental results suggest that the producer would be able to increase its profits by more than 60%, for a given level of retailer's profits, owing to the mafia offer. The availability of the existing items offered by the retailer will increase significantly, despite a reduction in the retailer's inventory levels. The offer will result in an average increase of over 56% in the variety of items held by the retailer. The producer will also be able to command significantly higher margins (more than 44%) from the retailer for the existing items without adversely affecting the retailer's profitability.

International Journal of Production Research

Theory of constraints based mafia offer for supply chains of deteriorating products

This research describes in detail an application of theory of constraints (TOC) and its resulting benefits on the supply chain performance of India's largest lock manufacturing company over a period of seven years. Using TOC's thinking process, the core constraints that had limited the company's performance in the areas of production, distribution, supply group and projects were identified and eliminated. TOC's unique approach helped the company achieve a significant reduction in its finished goods, raw material and work-in-process inventories at various levels across the supply chain. The stock-outs and excess in the distribution system nearly disappeared. The existing lead times saw a drastic reduction while the availability of items increased to nearly 100% despite significant decrease in inventory levels in the supply chain. The inventory turns of the distributors and retailers more than tripled and their profitability increased significantly. The overall sales of the company grew nearly three times during the six years post TOC implementation. TOC's holistic approach helped the company to double its profits and improve its cash position during the Great Recession.

Information Systems

Revolutionizing supply chain management the theory of constraints way: a case study

Much of the research in perishable items inventory management has focused on the first-in-first-out issue process. However, motivated by the technical characteristics of the blood unit issue process, we model an order-up-to-level policy under periodic review setting with random issue of items from inventory. We provide empirical evidence in support of the random issuing assumption using real data on serial numbers of blood units issued from a blood bank. For general demand distribution we derive exact expressions for per period expected shortage, expected wastage and expected cost as functions of the policy parameters R (order-up-to-level) and T (review period). Since the exact model becomes computationally burdensome with increase in the number of periods of life of the perishable item an approximate model for the random issuing process is developed. The accuracy of the approximation is affirmed using simulation analysis. A gradient search-based heuristic is provided to identify the optimum policy parameters for the approximate model. A real life application of the model is demonstrated in determining the optimum frequency and order-up-to-level for blood collection at a blood bank.

Economics

Journal of the Operational Research Society

Analysis of an order-up-to-level policy for perishables with random issuing

The purpose of this research is to demonstrate an application of TOC's thinking process (TP) in a blood bank environment. We take an example of a real-life blood bank which is struggling with the problems of high shortage and wastage of blood products, large inventory levels, poor and erratic blood collection, limited product variety, high error rate, high turnover of technicians, high operating expenses and low revenue levels. We show using the TOC approach how these seemingly unrelated problems faced by the bank are in fact highly inter-related and how they all originate from a single root-cause. A current reality tree (CRT) is used to identify the root cause responsible for all the major blood bank problems. A conflict resolution diagram (CRD) is constructed to identify the core-conflict(s) responsible for the blood bank's poor performance. A simple yet powerful solution is generated for the given bank by breaking the core-conflict resulting from a paradigm constraint in blood banking. A future reality tree (FRT) is then constructed to show how the TOC approach will help the blood bank in lowering its shortage and wastage levels in spite of collecting lesser number of units in blood donation camps. The bank will be able to significantly cut down its inventories and can issue fresher units to the patients. Blood bank's revenue levels will increase while its operating expense will decrease due to the TOC approach. The error rate as well as the turnover of technicians in the blood bank laboratory will also reduce considerably. A simulation model shows that the proposed TOC solution will reduce the annual shortage of red blood cells by 66% and platelets by 82% at the bank. Similarly, the wastage of red blood cells will decrease by 93%, plasma by 99% and platelets by 98%. The average inventory level of the red blood cells will drop by 41%, plasma by 95% and platelets by 10%. The major contribution of this research is to show that TP tools can be extremely powerful in constructing win-win solutions for complex systems like blood banks by addressing their major problems in an integrated fashion. The TOC approach reveals how one widely-held belief in the blood banking world is the main reason behind the blood banks' poor state of affairs. The solutions presented in this research should be readily applicable to other blood banks which are struggling to improve their operational and financial performance.

International Journal of Production Economics

Revolutionizing blood bank inventory management using the TOC thinking process: An Indian case study

In 2015, the medical officer in charge of a blood bank in India needed to manage a chronic shortage of blood products that was likely to worsen over the summer months. The blood products were perishable and had a limited useful life which complicated matters when maintaining adequate stock. Furthermore, demand for blood products was unpredictable and varied widely each month. The blood blank attracted few blood donors and they were likely to become even fewer over the summer. A shortage of blood products could mean cancelled surgeries and, in worst-case scenarios, the loss of lives. The medical officer needed to decide whether the blood bank should optimize its inventory of perishable blood products by organizing large blood donation camps or by holding smaller but more frequent blood donation camps. This case can be used with the Blood Bank Game simulation tool. Originally Published: 09/29/2016

Richard Ivey School of Business Case Collection

Model Blood Bank, Indore: Supply Chain Management

This paper analyses the performance of an ordering policy for hospital blood banks (HBBs) that takes into account the information regarding the on‐hand stock along with the remaining life of blood products. The blood items are assumed to start aging as soon as they have been collected. We develop a simulation model to show that the combined age‐and‐stock‐based policy would outperform some of the popular periodic reviews and continuous review policies in controlling total costs by about 5% on an average basis. Our results show that the suggested policy will reduce the total operational cost of managing platelets, which have a very short shelf life, by about 27% at a real‐life HBB. The policy will also lead to about 7% reduction in the total cost of the negative blood groups, which are characterized by extremely erratic demand patterns. The implementation of the ordering policy will help HBBs to reduce their operational costs while ensuring a minimum desirable level of the availability of critical blood products.

International Transactions in Operational Research

A combined age-and-stock-based policy for ordering blood units in hospital blood banks

The Operations Research (OR) and Operations Management (OM) community has witnessed significant progress in the field of research in blood bank inventory management during the past few decades. The OR and OM community has studied blood inventory management problems at the level of both individual hospital blood banks (HBB) as well as regional blood banks (RBB). The OR and OM literature at the individual HBB level has mainly focused on the determination of optimal policies for collection, ordering, componentizing, cross-matching and issuing of blood and its products. The literature at the RBB level emphasizes on the optimal policies for transshipment, rotation, distribution and scheduling of blood deliveries from the RBB to the HBBs. The objective of this chapter is twofold. In the first place, it provides the readers with a basic understanding of inventory management related problems commonly faced by HBBs. In the second place, it shows how various OR techniques can be used to manage the inventory of blood products in an efficient manner with the help of a real-life case study. This chapter is organized into seven sections. The first section talks of blood and its components. The second section provides a description of the different types of blood groups. Functioning of a typical blood bank is explained in the third section. The fourth section describes various operational decision-making problems at HBBs. The fifth section details out a real-life case study. The penultimate section describes recommendations for real-life implementations based on the insights obtained from the real-life case study. The chapter concludes with a set of exercises from the area of blood bank inventory management.

International Series in Operations Research & Management Science

Inventory management in blood banks

bbgame.wpcarey.asu.edu

Blood Bank Game

Reality of Hospital Administration

Blood Bank

In this paper we provide an overview of the recent contributions in the area of blood bank inventory management and relate them to the challenges in the Indian context. We study the current blood-banking scenario in India and identify challenges that are peculiar to Indian blood banks. We review the role of formal methods in analyzing the complex blood bank inventory management problem and identify the existing research gaps in the context of blood banks. We conclude the paper by identifying several opportunities for micro modeling in the context of Indian blood banks.

OPSEARCH

Blood bank inventory management in India

Indore Management Journal

Indore Management Journal: Special issue on Selected Reviewed Papers from ORSI (2010) and SOM (2010) Conferences, 3(2).

This technical note describes the application of a spreadsheet-based model for student evaluation and grading. The note shows how a spreadsheet-based model can be used in automating the process of evaluating and grading in situations where advanced technologies like optical recognition are not available. The first part of the note describes how a spreadsheet can be used to evaluate course components, which involve multiplechoice type of questions (MCQs). The second part of the note describes how a spreadsheet can help instructors in determining the final grades for a course and its components, given the institutional grading guidelines. The model was successfully used for several courses at a premier management institute in central India. It was observed that the model helped in saving significant amount of time in student evaluation and grading and thus helped in speeding up the process of feedback from the instructor to the students.

Spreadsheet Model for Student Evaluation and Grading

Epigenetic processes control the packaging and function of the human genome and contribute to normal and pathologic states, including cancer. The time is ripe to undertake an international effort to identify all the chemical changes and relationships between chromatin constituents that provide function to the genetic code. A timely workshop of leading experts, convened by the American Association for Cancer Research (AACR), confirmed that the technology is at hand to begin defining human epigenomes at high resolution. (Cancer Res 2005; 65(24): 11241-6)

International Medical Journal

Managing the Outpatient Department Waiting Time at Rajas Eye Hospital

BACKGROUND: Blood component therapy is advantageous in terms of increasing the effective availability of blood units and reducing the transfusion-related risks. One unit of blood can be separated into components and made available to multiple patients by transfusing suitable components. It is often believed that most, if not all, of the blood should be fractionated. But the process of componentizing increases the availability of blood products at the expense of increased costs of holding, processing, and wastage at a blood bank. The objective of this study was to determine the optimum level of components to be produced at a blood bank given its objectives and context.STUDY DESIGN AND METHODS: We developed a simulation-based model to determine the optimum amount of fresh blood to be fractionated at a blood bank operating in southern India was developed. The simulation model is a virtual representation of an actual blood bank, and it can help the administrator to test the effects of changing the level of components production on the overall blood bank performance.RESULTS: The results from the model suggest that it may not be optimal for the chosen blood bank to componentize large amounts of fresh blood as it leads to high costs of operation and huge wastage in the system.CONCLUSIONS: The same methodology can be applied to determine the optimum level of componentizing at other blood banks by providing appropriate inputs to the simulation model.

Transfusion

A model for blood components processing

BACKGROUND: A typical blood bank gets its major supply of blood from organizing blood donation camps. The quantity of blood collected in the blood donation drives is random and it might be sensible to cut off the supply at some level to reduce the wastages by overcollection.STUDY DESIGN AND METHODS: In this paper we introduce two new cutoff level policies and compare their performance with the policy of collecting all the available supply at blood collection drives, which is quite prevalent among the blood banks. We develop a simulation model for collection that enables such comparison on the basis of shortages, wastages, and total costs.RESULTS AND CONCLUSION: The results obtained from the simulation model for a real-life situation show that the cutoff level policies are better than the unrestricted collection policy in controlling total costs. They also result in less wastage in the system for a given level of shortages.

Model for blood collections management

This research provides a new approach to blood bank administrators for managing the complex blood bank inventory problem. Our method primarily involves identifying and analyzing significant sub-problems from the blood bank context, which can then be integrated in a comprehensive model. We construct a set of stand-alone models for the problem of blood collection under random supply. These models are quite generic in nature and the insights obtained from these models will be useful in the context of a wide variety of blood banks involved in the activities related to collection. The results from our simulation model suggest that it is actually beneficial to stop collection at some level during the blood donation camps. Our results show that the cutoff level policies usually perform better in terms of managing shortages, wastages and total costs as compared to the policy of collecting all the available supply, which is quite prevalent among the blood banks.

Journal of Blood Services Management.

Integrated model for blood bank operations

A Simulation Based Model for Optimal Alignment of New Product… 23 A Simulation Based Model for Optimal Alignment of New Product (Scheme) to Market Segment: The Case of Indian Mobile Telephony1 Harshal Lowalekar and N. Ravichandran Indian Institute of Management, Indore ABSTRACT In order to realize dominant market share, and maximize revenue, the service providers offer a wide range of innovative schemes. Also, the schemes are judicious combination of price and features like free talk time, validity period etc. The technological environment of the industry is rapidly evolving. In a sense, the telecom sector is characterized by demanding customers, low product differentiation, severe intensity of competition and a rapidly changing technological environment.
 The Indian telecom sector is characterized by rapid growth and intensive price competition. This paper using a spreadsheet based simulation model demonstrates how a user can choose the most economical scheme among the available ones based on his usage. Based on this information, it is demonstrated as how a service provider can design the most suitable product (scheme) for a given category of users characterized by their age, income level and usage pattern. The spreadsheet model proposed here is generic and can be used in similar contexts characterized by intense competition, multiple players, diverse price sensitive customers, and rapidly changing technological environment.