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      Application of Portfolio Theory to Healthcare Capacity Management

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          Abstract

          Healthcare systems worldwide are faced with continuously increasing demand for care, while simultaneously experiencing insufficient capacity and unacceptably long patient waiting times. To improve healthcare access and availability, it is thus necessary to improve capacity utilization and increase the efficiency of existing resource usage. For this, variations in healthcare systems must be managed judiciously, and one solution is to apply a capacity pooling approach. A capacity pool is a general, collaborative capacity that can be allocated to parts of the system where the existing workload and demand for capacity are unusually high. In this study, we investigate how basic mean-variance methodology from portfolio theory can be applied as a capacity pooling approach to healthcare systems. A numerical example based on fictitious data is used to illustrate the theoretical value of using a portfolio approach in a capacity pooling context. The example shows that there are opportunities to use capacity more efficiently and increase service levels, given the same capacity, and that a mean-variance analysis could be performed to theoretically dimension the most efficient pooling organization. The study concludes with a discussion regarding the practical usefulness of this methodology in the healthcare context.

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          Most cited references45

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          Portfolio Selection

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            The effects of stress and stress hormones on human cognition: Implications for the field of brain and cognition.

            In this review, we report on studies that have assessed the effects of exogenous and endogenous increases in stress hormones on human cognitive performance. We first describe the history of the studies on the effects of using exogenous stress hormones such as glucocorticoids as anti-inflammatory medications on human cognition and mental health. Here, we summarize the cases that led to the diagnosis of glucocorticoid-induced 'steroid psychosis' in human populations and which demonstrated that these stress hormones could thus cross the blood-brain barrier and access the brain where they could influence cognition and mental health. We then summarize studies that assessed the effects of the exogenous administration of glucocorticoids on cognitive performance supported by the hippocampus, the frontal lobes and amygdala. In the second section of the paper, we summarize the effects of the endogenous release of glucocorticoids induced by exposure to a stressful situation on human cognition and we further dissociate the effects of emotion from those of stress on human learning and memory. Finally, in the last section of the paper, we discuss the potential impact that the environmental context to which we expose participants when assessing their memory could have on their reactivity to stress and subsequent cognitive performance. In order to make our point, we discuss the field of memory and aging and we suggest that some of the 'age-related memory impairments' observed in the literature could be partly due to increased stress reactivity in older adults to the environmental context of testing. We also discuss the inverse negative correlations reported between hippocampal volume and memory for young and older adults and suggest that these inverse correlations could be partly due to the effects of contextual stress in young and older adults, as a function of age-related differences in hippocampal volume.
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              Impact of Workload on Service Time and Patient Safety: An Econometric Analysis of Hospital Operations

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                Author and article information

                Journal
                Int J Environ Res Public Health
                Int J Environ Res Public Health
                ijerph
                International Journal of Environmental Research and Public Health
                MDPI
                1661-7827
                1660-4601
                14 January 2021
                January 2021
                : 18
                : 2
                : 659
                Affiliations
                [1 ]Department of Pediatric Anesthesiology, Intensive Care and Neonatology, Sahlgrenska University Hospital, 413 45 Gothenburg, Sweden; carina.fagefors@ 123456vgregion.se
                [2 ]Technology Management and Economics, Chalmers University of Technology, 412 96 Gothenburg, Sweden
                [3 ]Department of Engineering Science, University West, 461 86 Trollhättan, Sweden
                Author notes
                [* ]Correspondence: bjorn.lantz@ 123456hv.se ; Tel.: +46-(0)768-606-024
                Author information
                https://orcid.org/0000-0001-6816-582X
                Article
                ijerph-18-00659
                10.3390/ijerph18020659
                7828818
                33466716
                ee2d6113-8f8b-415a-b18d-3b126230517a
                © 2021 by the authors.

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

                History
                : 28 September 2020
                : 12 January 2021
                Categories
                Article

                Public health
                portfolio theory,capacity pooling,healthcare management,capacity planning
                Public health
                portfolio theory, capacity pooling, healthcare management, capacity planning

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