Realities of Using Drones to Transport Laboratory Samples: Insights from Attended Routes in a Mixed-Methods Study.

Purpose: Drones are an emerging technology with the potential to improve laboratory logistics. This study is based on the hypothesis that the implementation of drones will benefit from an understanding of the current system and that existing transport solutions should be optimized before drone solutions are considered. It focuses on carriers transporting biological material today by car along a traditional circular route. It aims to explore how the current transport service is organized, identify areas for improvement, and investigate carriers' perceptions of how drones could be integrated into or substituted for their services. Methods: A mixed-methods approach was applied, combining a questionnaire, shadowing of nine transport trips, semi-structured interviews, and time assessments. Results: The carriers shared insights into how to optimize existing transport solutions in terms of structure, culture, attitudes, and overall functionality. Most carriers expressed in the questionnaire that they were little involved in innovation work. The time assessment revealed that not the driving times, but the loading times had the highest deviations from plans and thus represented the area with the greatest potential for simple improvements. Questions about the use and organizational impact of drones are generated, and their prospects are discussed from a broad sociotechnical perspective. Conclusion: Our concept was to broaden our understanding of implementing drones into existing systems in a fairly simple setting. Although improved logistics may take place without complex processes, future research opportunities such as the impact of drones on organizational processes and social dynamics in the adoption of drones may be needed if more complex systems are involved. The paper proposes experimenting with, and learning from, transport with "road vehicles" and drones in combination and suggests that improvements should be made to existing transport solutions before drones are implemented.

The Moderating Role of Pro-Innovative Leadership and Gender as an Enabler for Future Drone Transports in Healthcare Systems.

Drones have been suggested as an emerging technology that has the potential to disrupt and improve healthcare. The attitude among healthcare workers towards the use of drones is important for its successful implementation. Our aim was to examine individual and institutional variables among employees that may be relevant for the successful implementation of drones. This study used a self-administered questionnaire to investigate the expectations and beliefs among 400 employees at three Norwegian healthcare organizations regarding the future role of drones in the provision of healthcare. The results showed that the use of drones in healthcare is positively perceived across professional groups, age, and location. Working in an innovative environment, having experienced previous technological change in one's working environment, and having leadership that supports new ideas were identified as drivers of individual beliefs regarding the use of drones as an innovative solution in future healthcare services. Men had significantly higher scores than women, and this was associated with reporting innovative leadership. This may indicate that a future implementation of drone usage should focus on local system environments and may depend on the presence of innovative leadership. Our results are harvested from a developed health care system and should be applicable for similar technologically advanced systems where the full potential of drone solutions may benefit from the integration of drones into the overall socio-technical system.

A Drone Logistic Model for Transporting the Complete Analytic Volume of a Large-Scale University Laboratory.

We present a model for drone transport of the complete annual analytic volume of 6.5 million analyses-(routine and emergency) between two inner-city university laboratories at Oslo University Hospital located 1.8 km apart and with a time restriction for the analyses of no more than 60 min. The total laboratory activity was analyzed per min for the complete year of 2018. The time from the clinical ordering of tests to the loading of the drone, drone transport time, and analysis time after the sample arrived at the analyzing laboratory were assessed using the lead time of emergency analyses of C-reactive protein, troponin, and the international normalized ratio. The activity had characteristic diurnal patterns, with the most intensive traffic between 8 and 12 a.m. on weekdays and there being considerably less traffic for the rest of the day, at night and on weekends. Drone schedules with departures 15-60 min apart were simulated. A maximum of 15 min between flights was required to meet the emergency demand for the analyses being completed within 60 min. The required drone weight capacity was below 3.5 kg at all times. In multiple simulations, the drone times were appropriate, whereas variations in the clinic- and laboratory-related time intervals caused violations of the allowed time 50% of the time. Drone transport with regular schedules may potentially improve the transport time compared with traditional ground transport and allow the merging of large laboratories, even when the demand for emergency analyses restricts the maximum transport time. Comprehensive economic evaluations and robust drone technology are needed before such solutions can be ready for implementation.

Pathologic Blood Samples Tolerate Exposure to Vibration and High Turbulence in Simulated Drone Flights, but Plasma Samples Should be Centrifuged After Flight.

OBJECTIVE: Most of the previous studies of drone transport of blood samples examined normal blood samples transported under tranquil air conditions. We studied the effects of 1- and 2-hour drone flights using random vibration and turbulence simulation (10-30 g-force) on blood samples from 16 healthy volunteers and 74 patients with varying diseased. METHODS: Thirty-two of the most common analytes were tested. For biochemical analytes, we used plasma collected in lithium heparin tubes with and without separator gel. Gel samples were analyzed for the effect of separation by centrifugation before or after turbulence. Turbulence was simulated in an LDS V8900 high-force shaker using random vibration (range, 5-200 Hz), with samples randomly allocated to 1- or 2-hour flights with 25 or 50 episodes of turbulence from 10 to 30 G. RESULTS: For all hematologic and most biochemical analytes, test results before and after turbulence exposure were similar (bias < 12%, intercepts < 10%). However, aspartate aminotransferase, folate, lactate dehydrogenase and lipid index increased significantly in samples separated by gel and centrifugation prior to vibration and turbulence test. These changes increased form 10 G to 30 G, but were not observed when the samples were separated after vibration and turbulence. CONCLUSIONS: Whole blood showed little vulnerability to turbulence, whereas plasma samples separated from blood cells by gel may be significantly influenced by turbulence when separated by spinning before the exposure. Centrifugation of plasma samples collected in tubes with separator gel should be avoided before drone flights that could be subject to turbulence.

Improving accessibility for outpatients in specialist clinics: reducing long waiting times and waiting lists with a simple analytic approach.

BACKGROUND: Lack of resources is often cited as a reason for long waiting times and queues in health services. However, recent research indicates these problems are related to factors such as uncoordinated variation of demand and capacity, planning horizons, and lower capacity than the potential of actual resources. This study aimed to demonstrate that long waiting times and wait lists are not necessarily associated with increasing demand or changes in resources. We report how substantial reductions in waiting times/wait lists across a range of specialties was obtained by improvements of basic problems identified through value-stream mapping and unsophisticated analyses. METHODS: In-depth analyses of current operational processes by value-stream mapping were used to identify bottlenecks and sources of waste. Waiting parameters and measures of demand and resources were assessed monthly from 12 months before the intervention to 6 months after the intervention. The effect of the intervention on reducing waiting time and number of patients waiting were evaluated by a difference-in-differences analysis. RESULTS: Mean waiting time across all clinics was reduced from 162 + 69 days (range 74-312 days) at baseline to 52 + 10 days (range 41-74 days) 6 months after the intervention. The time needed to achieve a waiting time of 65 days varied from 4 to 21 months. The number of new patients waiting was reduced from 15,874 (range 369-2980) to 8922 (range 296-1650), and the number of delayed returning patients was reduced from 18,700 (310-3324) to 5993 (40-1337) (p < 0.01 for all). Improvement in waiting measures paralleled a significant increase in planning horizon. CONCLUSIONS: Significant improvements in accessibility for patients waiting for service may be achieved by applying unsophisticated methods and analyses and without increasing resources. Engagement of clinical management and involvement of front line personnel are important factors for improvement.

Assessing physician productivity following Norwegian hospital reform: A panel and data envelopment analysis.

BACKGROUND: Although health care reforms may improve efficiency at the macro level, less is known regarding their effects on the utilization of health care personnel. Following the 2002 Norwegian hospital reform, we studied the productivity of the physician workforce and the effect of personnel mix on this measure in all nineteen Norwegian hospitals from 2001 to 2013. METHODS: We used panel analysis and non-parametric data envelopment analysis (DEA) to study physician productivity defined as patient treatments per full-time equivalent (FTE) physician. Resource variables were FTE and salary costs of physicians, nurses, secretaries, and other personnel. Patient metrics were number of patients treated by hospitalization, daycare, and outpatient treatments, as well as corresponding diagnosis-related group (DRG) scores accounting for differences in patient mix. Research publications and the fraction of residents/FTE physicians were used as proxies for research and physician training. RESULTS: The number of patients treated increased by 47% and the DRG scores by 35%, but there were no significant increases in any of the activity measures per FTE physician. Total DRG per FTE physician declined by 6% (p < 0.05). In the panel analysis, more nurses and secretaries per FTE physician correlated positively with physician productivity, whereas physician salary was neutral. In 2013, there was a 12%-80% difference between the hospitals with the highest and lowest physician productivity in the differing treatment modalities. In the DEA, cost efficiency did not change in the study period, but allocative efficiency decreased significantly. Bootstrapped estimates indicated that the use of physicians was too high and the use of auxiliary nurses and secretaries was too low. CONCLUSIONS: Our measures of physician productivity declined from 2001 to 2013. More support staff was a significant variable for predicting physician productivity. Personnel mix developments in the study period were unfavorable with respect to physician productivity.

Physicians' engagement in dual practices and the effects on labor supply in public hospitals: results from a register-based study.

BACKGROUND: Physician dual practice, a combination of public and private practice, has attracted attention due to fear of reduced work supply and a lack of key personnel in the public system, increase in low priority treatments, and conflicts of interest for physicians who may be competing for their own patients when working for private suppliers. In this article, we analyze both choice of dual practice among hospital physicians and the dual practices' effect on work supply in public hospitals. METHODS: The sample consisted of 12,399 Norwegian hospital physicians working in public hospitals between 2001 and 2009. We linked hospital registry data on salaries and hospital working hours with data from national income and other registries covering non-hospital income, including income from dual work, cohabiting status, childbirths and socioeconomic characteristics. Our dataset also included hospital variables describing i.e. workload. We estimated odds ratio for choosing dual practice and the effects of dual practice on public working hours using different versions of mixed models. RESULTS: The percentage of physicians engaged in dual practice fell from 35.1% for men and 17.6% for women in 2001 to 25.0% and 14.2%, respectively, in 2009. For both genders, financial debt and interest payments were positively correlated and having a newborn baby was negatively correlated with engaging in dual practice. Larger family size and being cohabitating increased the odds ratio of dual practice among men but reduced it for women. The most significant internal hospital factor for choosing dual practice was high wages for extended working hours, which significantly reduced the odds ratio for dual practice. The total working hours in public hospitals were similar for both those who did and did not engage in dual practice; however, dual practice reduced public working hours in some specialties. CONCLUSION: Economic factors followed by family variables are significant elements influencing dual practice. Although our findings indicate that engagement in dual practice by public hospital physicians in a well-regulated market may increase the total labor supply, this may vary significantly between medical specialties.

Individual and hospital-specific factors influencing medical graduates' time to medical specialization.

Previous studies of gender differences in relation to medical specialization have focused more on social variables than hospital-specific factors. In a multivariate analysis with extended Cox regression, we used register data for socio-demographic variables (gender, family and having a child born during the study period) together with hospital-specific variables (the amount of supervision available, efficiency pressure and the type of teaching hospital) to study the concurrent effect of these variables on specialty qualification among all 2474 Norwegian residents who began specialization in 1999-2001. We followed the residents until 2010. A lower proportion of women qualified for a specialty in the study period (67.9% compared with 78.7% of men, p < 0.001), and they took on average six months longer than men did to complete the specialization qualification (p < 0.01). Fewer women than men entered specialties providing emergency services and those with longer working hours, and women worked shorter hours than men in all specialties. Hospital factors were significant predictors for the timely attainment of specialization: working at university hospitals (regional) or central hospitals was associated with a reduction in the time taken to complete the specialization, whereas an increased patient load and less supervision had the opposite effect. Multivariate analysis showed that the smaller proportion of women who qualified for a specialty was explained principally by childbirth and by the number of children aged under 18 years.

Variations in labor supply between female and male hospital physicians: results from a modern welfare state.

In industrialized countries, female physicians have up to 10h lower labor supply a week than male physicians. At the same time, the number of female physicians is increasing. The question analyzed in this article is whether these differences in labor supply for female and male hospital physicians persist in a modern welfare society, such as Norway, where comprehensive welfare reforms aim to reduce gender inequality are implemented. Information on weekly working hours from all hospital physicians in Norway during the period 2001-2007 was merged with economic variables (wages, income from other sources, net personal dept), demographic variables (age, sex, marital status, children born in the year, number of children), managerial positions and variables describing the hospital, specialty and time (year). The estimation method employed both random and fixed-effects models. Labor supply for women was 10-11 percent or 4-4.5 h per week lower than among men. The effects of children diverged strongly between the sexes. For instance, childbirth in a given year reduced the supply of working hours by women by approximately 80% but had no effects for men. After controlling for children and other factors, female physicians worked some 3-4% or 1-1.5 fewer hours than comparable male physicians. Although significant, variation in labor supply between female and male physicians is much lower in Norway then in other advanced industrialized countries.

[Salary and clinical productivity among physicians in Norwegian somatic hospitals 2001-2008]. / Lønn og produktivitet blant leger i norske helseforetak 2001 - 08.

BACKGROUND: Analysis of the future need for medical doctors necessitates an assessment of their productivity. The goals of this study were to analyze the relation between doctors' work force and the increased activity in hospitals, and to describe the development of working hours and salary for hospital doctors in a gender perspective. MATERIAL AND METHODS: Information about man-labour years, working time and salary for doctors in Norwegian somatic hospitals was retrieved for the period 2001-2008. Number of hospital stays, DRG points and outpatient consultations per man-labour year are used as measures of doctors' clinical productivity. RESULTS: The percentage of female doctors increased from 34.7 % to 42.2 %. The mean annual salary increased more for men (14.4 % higher in 2001 and 16.6 % higher in 2008) than women. Total salary costs for doctors increased by 69.9 % (from 3.66 bill to 6.22 bill. NOK); 42.6 % of this increase was generated by new positions (1 306 man-labour years, + 21.2 %). Labour years from extended working hours increased by 6.8 % (constituting 1043 labour years in 2008; 12.2 % of the total), but the average extended labour time per doctor decreased (-16.7 % for women and -9.6 % for men). The number of hospital stays increased by 13.2 %, DRG points increased by 12.4 % and outpatient consultations increased by 9.3 % per doctor's work year in the period 2001-2008. INTERPRETATION: Higher salaries for men may be explained by age, more men in senior positions and longer working hours than for women. The productivity of Norwegian doctors still increased from 2001 to 2008 (taking into account the increase in salary).