Annals of Community Health (ISSN 2347-5455, eISSN 2347-5714), Peer Reviewed, Indexed Journal focusing exclusively on Community Medicine and Public Health

Operational Research

Plan of Presentation

  • Introduction
  • Definition
  • Goals of Operational Research (OR)
  • Phases of OR
  • Examples for OR
  • Problems with OR
  • Article related with OR
  • References

Introduction

  • The term “Operational Research” was first coined during the 2nd World War.
  • The success of OR in the 2nd world war demonstrated that many apparently complex problems could be usefully analyzed using simple models to approximate the critical variables and relationships.
  • Attracted the attention of industrial managers who also were seeking solution to their complex executive problems.
  • Today it has found application in most of the disciplines such as management, public administration, health, engineering etc.

Operational Research

  • OR is defined as “ Application of quantitative methods to the solution of management problems which includes a systems approach in which a large number rather than a few factors are considered by a groups of scientists from different fields”.
  • OR does not press upon the need of new techniques and new inventions, their demand is for systems composed of currently available techniques which give the optimal utilization of scarce economic resources.
  • Any formalized quantitative analysis whose purpose is to improve the efficiency in a situation where ‘efficiency’ is clearly defined.
  • Whenever social medicine passes from the stage of observation & classification to that of discovering & recommending appropriate action, it is involved in OR.

Goals of Operational Research

  • To provide information to programme managers that they can use to make decisions for improving their programme operations.
  • To help managers to decide alternative courses of actions by identifying and taking advantages of opportunities and by solving the identified service delivery problems.
  • For optimising resource allocation and mobilisation.
  • To study the quality of care.

The ultimate objective of OR is to develop new knowledge about institutions, programmes, use of facilities, the people working in these activities and the individuals and communities served by them in order to secure optimal utilization of resources in men, materials and money in the service of the community.

Nature of Operational Research

  • Research techniques to diagnose and correct operational problems.
  • Pilot project to demonstrate new approaches.
  • Evaluation of ongoing programmes.
  • Experimental efforts to test different activities.

Operational Research and Systems Analysis:

Phases of Operational research

  • Adopted from Churchman & associates and Houlden:
  • Formulation of the problem including definitions of the objectives.
  • Collection of relevant data, if necessary by a suitable sample.
  • Analysis of data and formulation of hypothesis.
  • Deriving solutions from the hypothesis or model.
  • Choosing the optimal solution and forecasting the results.
  • Testing of solution eg : Pilot projects.
  • Implementing the solution in the whole system.

Phases of Operational research

Formulation of the problem including definitions of the objectives.

  • What is the system under study?
  • Does it comprise the entire health field in the nation?
  • Or can the team at least confine itself to that part which is under direct public control?
  • Can it evaluate public health output without comparisons with results of alternative investments?
  • Once the objectives have been set these has to be specified perhaps in the form of indices.

Collection of relevant data, if necessary by a suitable sample.

  • It must be strictly economical and strictly relevant to the objectives and the hypothesis.
  • The research team will have to employ special investigators like MO, paramedical technicians, accountants, social investigators, demographic investigators.

Analysis of data and formulation of hypothesis.

  • The formulation of the hypothesis or the construction of the model to represent the system under study may be considered the pivotal procedure of OR.
  • The model is a simplified explicit description of the existing services, the elements and factors of which it consists and the relationships between them.

Model

It summarizes the input of resources-money, materials, personal training, preventive, curative, and educational services; and administrative decision making and evaluating machinery.

It outlines the geographical and functional distribution of such resources. It also summarizes output partly with regard to operation achievement, public participation in services and number of relevant health personnel actions and partly in relation to fulfillment of declared objectives including disease control, consumer satisfaction, demographic changes and economic effects.

Input-Output Model

Input - Total health budget, inflow and outflow of personnel, quantity & quality of training, storage and consumption of durable and non durable goods (Drugs & supplies), distribution of all types oif health services, qeues of patients waiting to be seen in OPD, Total number of beds in the health facility.

Output- Clinic attendance, vaccinations performed, number and type of institutional deliveries, number of well constructed, number of drugs distributed. It may be in the form of indices : Demographic indicators – crude or age specific death rates and birth rates. Epidemiologic indicators- Prevalence of diseases. Educational indicators.

The logistics and methodology will be contributed by mathematician and the statistician; material knowledge by the public health administrator, the epidemiologist, economist and the sociologist.

Deriving solutions from the hypothesis or model

Based on Team’s choice of key variable in the system. Economically feasible.

Choosing the optimal solution and forecasting the results.

How it is different from the existing one.

Whether it is fulfilling the objectives. The team is now in a position to present the executive with a set of specified proposals for interventions with details of changes needed in the system and consequences of these changes.

Testing of solution

Key role in the application of OR to public health services.

The test run area should be manageable size, but it should be sufficiently large to provide observations for proper statistical inference.

Implementing the solution in the whole system.

The last link in the chain of OR is application of the solution to the whole system and establishment of evaluation machinery with an apparatus for new decision making when the key variables changes beyond predetermined limits.

It depends on the political will.

Operational Research Team

  • The composition of the team varies with the type of research.
  • The minimum composition in social medicine applications is probably a public health administrator, an epidemiologist, a statistician and a social scientist. This is in addition to ancillary workers such as clerks, peons and field workers.

Examples for Operational Research

DOTS has evolved through years of research-much of it was done in India.

The goal here is to improve the diagnosis and treatment of TB by translating the results of research into policy and practice.

  • NTI at Bangalore demonstrated the efficacy & feasibility of case detection by sputum microscopy and not by X ray as tool for diagnosis.
  • TB research centre in Chennai demonstrated the efficiency and safety of home treatment of TB, the effectiveness of intermittent chemotherapy and necessity & feasibility of direct observation in the community.
  • The use of supervised treatment-now known as DOTS.

Other examples for Operational Research

  • Enhancing coverage and quality of routine immunization, ANC, post natal & neonatal care by integration of health and ICDS systems.
  • Promotion of institutional deliveries by setting up of delivery rooms in subcentres and PHCs.
  • Public private partnership in health care delivery.
  • Alternate methods of delivery of ORS packets, Chloroquine tablets and contraceptives at village level.
  • Devolution of power to village Panchayats to manage subcentres.
  • Optimal size of area and population to be covered by a midwife, or basic health unit.
  • Ideal vehicle for local health worker.
  • Architectural design of hospitals and health centers.
  • Queuing problem in OPD and hospital waiting lists.
  • Study of bed load and nursing services in hospitals.
  • Length of stay in hospitals, length of sickness absence.
  • Effectiveness or the extent to which the stated objective of a programme eg : malaria eradication, family planning is achieved.
    • Different opinions among different observers about the input output system with regard to medical services.
    • Everything cannot be quantified (Patient satisfaction, quality of care, health status).
    • Many of the projects were never implemented or only implemented with half hearted support from key decision makers in the organization studied.

Montgomery Country’s Public Health Service Uses Operations Research to Plan Emergency Mass Dispensing and Vaccination Clinics Interfaces : Vol.36, No.6,November-December2006,pp.569-579

  • Need for the study
  • Methodology
  • Clinic Simulation Models
  • Results
  • Conclusions


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