ارزش: تحقیق در عملیات و الگوی مراقبت‌های بهداشتی جدید

Despite some differences in ethos and funding mechanisms, health care worldwide is remarkably similar in developed countries and increasingly the preoccupations in both developed and developing countries are converging. The prevailing paradigm in health care can usually be summed up in one word. In the 1970s and 1980s, the word was evidence; in the first decade of the 21st century, the word was quality. Paradigms shift sometimes because of intellectual leadership, but paradigms also change due to external pressures. The economic pressures affecting the global economy are putting value on the agenda of every health service except perhaps those countries whose economies are still expanding and who are starting from a very low base. For these countries, the paradigm is still that “more is better”. In all the countries spending 7% or more of GDP on health care, the paradigm is changing from quality to value. In this article I discuss the shifting paradigms of health care and highlight the key role that Operations Research could play in achieving good value health care.

In high-income settings, over the last ten years there has been a welcome focus on the quality and safety of health care and, more recently, on its sustainability or carbon footprint. The challenge of designing and implementing safer, cheaper and greener processes for health care whilst delivering high quality services in terms of clinical outcomes and patient experience is one that has been met with partial success. Operations Research (OR) has had a clear role to play in this endeavour. The improvements to be made in patient experience and/or service efficiency through smarter scheduling of outpatient clinics and operating theatres, better location of key resources and a richer understanding of the impact of variability and randomness on the operation of complex systems are well documented, at least in the OR press. However, did OR achieve in the era of quality, safety and sustainability all that it could, and if not, why not? It is important for operations researchers to ask themselves these questions at this time because the paradigm is shifting and much greater challenges lie ahead for health care and for those conducting Operations Research for health care