Dublin – 1979

Proceedings of the Fifth Meeting, Dublin Ireland, 23rd-27th July 1979
Edited by Dr. Duncan Boldy, Chairman and Dr, Cathal Lennon, Organiser

Opening Sessions

The fifth meeting of the EURO Working Group – Operations Research applied to health services was held in Dublin in July 1979.  The working group was first established in 1975 at the inaugural congress of EURO (the European Association of O.R. Societies).

The conference was attended by a total of 29 delegates representing ten European countries.  Fifteen papers were presented at the meeting.

The meeting was opened by the Secretary to the Department of Health, Dr. B. Hensey, who, on behalf of the Minister for Health, Mr. Haughey, welcomed the delegates to Ireland and expressed the hope that the meeting would be a successful one.

He pointed out that growth in O.R. in relation to health services had accelerated in the mid 1960’s following technical discussions on O.R. held during a meeting of the World Health Organisation in Geneva.  O.R. specialists were appointed to the World Health’s Organisation’s headquarters to provide briefing on some of the uses and concepts involved in Operations Research.  The growth in O.R. applied to health administration and management in relation to National Health Services followed on from this.

He went on to point out that Ireland, in common with many countries, is having to grapple with the problems of getting the right structures and systems for health services planning at national and regional level.  The aim is to seek an integrated health programme with particular emphasis on the positive and preventative aspects of health care.  This has to be accomplished within the constraints of limited financial resources.  He expressed the wish that the new approached to Health O.R. would be explored during the meeting and promised that the proceedings would be looked at with considerable interest by his own department.

The Chairman of the Working Group, Duncan Boldy then reviewed the progress of the Working Group from its conception in 1975.  The three main objectives of the Working Group are as follows:

1.                  The co-ordination and dissemination on information concerning Health O.R. work in Europe,

2.                  The organisation of European seminars on specific Health O.R. topics,

3.                  The setting up of joint European Health O.R. projects.

He reminded the meeting that contact people have been nominated for all participating countries to establish what Health O.R. projects are being conducted in their own country.  National registers have been drawn up for a number of countries and these are available on request.

A joint meeting between three EURO working groups is being planned.  The groups are those concerned with: Government and the Public Sector, Health, Regional and Urban Planning.  The likely venue of this meeting is the International Institute for Applied Systems Analysis, Vienna with a theme of “The Measurement of Output and Performance”.  The meeting was arranged as a 2-3 day event in January 1980.

The question of a venue for the 1980 meeting of the Working Group was then raised and Duncan Boldy informed the meeting that Jean Paul Dupinay had submitted an invitation to hold this meeting in Paris in Summer 1980.  Accommodation would be proved within the hospital complex where Jean Paul works.  It was agreed to accept this invitation and the sixth meeting of the Working Group has now been scheduled for June 9th-14th 1980 in Paris.

The possibility of a session on “Health Economics”, possibly in conjunction with health economists, was discussed and received general approval.

Invitations were received from both Einar Matson and Lars Bostrup to hold the 1981 meeting in either Norway or Denmark respectively.  It was agreed in principle to hold the meeting in one of these two countries and it was left to Einar and Lars to decide who should act as host and where the venue might be.

Formal Papers

Einar Matson reported to the meeting on an International Hospital Federation Congress that was held in Oslo in June 1979.  Einar presented a paper on the contribution of O.R. to cost containment and quality control.  The gathering was primarily non O.R. personnel and Einar spoke about the difficulties of getting across O.R. concepts to such a gathering.

Two papers were then presented on national planning and policy making.  The first was entitled “The National Role in the Planning of Local Health Services” by Tom Bowen, of the Department of Health and Social Security in London.  The second was delivered by Clemens Dietrich and was entitled “Strategies and Policy Making in the German Health Care System.”

Sune Petersen then delivered a paper on “Some Experiences in Trying to Apply Health Service Systems in Denmark and Some Outlines for Future Work.”  He referred in his paper to the problems which existed in Denmark with regard to the application of O.R. in Health Services and went on to describe particular areas where he felt O.R. could best be applied in the present environment there.

The meeting was then addressed by Elvezio Montesarchio who described the work he was engaged on as a member of a large team measuring the effects of the chemical explosion which occurred in Seveso near Milan.  He mentioned in particular the problems which his team encountered, the absence of recognised ways in which to measure and monitor the effects and the problems of obtaining wide coverage both in the geographical sense and in terms of demography, within the time constraints existing.  Studies are continuing on the on-going effects of fall-out.

Duncan Boldy described to the meeting work which he, Clemens Dietrich and Marten Lagergren had been doing in developing terms of reference and a method of approach for a study on the cost effectiveness of difference policies related to the prevention on ill-health.  He circulated a copy of a draft report they had written on such a proposed study and invited comments from delegates on the approach.  A considerable amount of discussion ensued and it was concluded that there were a number of problems associated with the approach which still required sorting out.  Duncan agreed to reconsider the terms of reference and approach and thanked the meeting for their contributions.

One afternoon of the meeting was devoted entirely to the theme of Community Care.  J. O’ Dwyer of the Department of Health outlined how Community Care had developed in Ireland over the last ten years, described some of the lessons that have been learned, and drew attention to some of the issues which will have to be considered in developing Community Care Services in the future.

The Development of Community Care within one of the regions in Ireland was then covered by Denis O’Doherty, Programme Manager for Community Care in the North Western Health Board.  He described some of the problems associated with serving a community which is primarily rural and, therefore, a low density population.  He outlined areas of special interest and priority areas as seen by his own Board.

The third paper in this session was given by Raymond Burke of Stokes Kennedy Crowley who spoke of a study he had recently been involved in, in a particular area of Community Care, i.e. care of the handicapped.  He spoke of the problems encountered in quantifying the needs of the handicapped, described the methodology applied and the results.  He drew attention to the absence of general statistics in this area and the need to develop a data bank on national statistics.

Marten Lagegren then described recent developments in Community Care in Sweden and likely trends in the future.  He referred to the impact which increased levels of service in Community Care would have on employment levels and on the allocations of gross national product to Health Services, including Community Care.

A panel discussion then took place on the varying degrees of development of Community Care in the different countries represented and on particular problems encountered in different countries.  While it had been hoped to identify a particular role for O.R. in the development of Community Care Services, time did not permit the discussions to include this.

Two further papers were presented to the meeting from Sweden, one by Mans Rosen of the SPRI Institute on the Application of Health Statistics in Health Services Planning and another by Marten Lagergren on Care in Post Industrial Society – Some Reflections based upon a Simple Trend Extrapolation Model.

Anke Muller-Sloos read a paper on decision making in medical practice with particular reference to the family physician decision making behaviour.

Tom Collings described recent work which he carried out in the North of Scotland on future maternity bed requirements.  Part of this work relates to rural hospitals which are planned to be closed and replaced by a larger city hospital.

Ciaran O’Kane described the work he had done on policy with regard to patient length of stay and looked at some of the consequences of having a maximum length of stay policy in an acute care medical ward.

Richard Gault delivered a paper on the Role of Quality in Nursing Allocation and the impact this has on nursing levels within the ward at any particular time.  Observations were made about the limitations of traditional OR methodology in relation to both that particular problem, and in general.

Duncan Boldy chaired the closing session of the meeting and reviewed the progress of the Working Group since its formulation in 1975.  He then summarised the proceedings of the Dublin meeting and invited comment on the format adopted.

List of Participants

Philip C. Berman – Ireland

Duncan Boldy – England

T. Collings – Scotland

Tom Bowen – England

Lars Bostrup – Denmark

Raymond Burke – Ireland

Clemens Dietrich – West Germany

Leslie E. Daly – Ireland

J.P. Dupinay – France

R. Gault – Ireland

Cora Goff – Ireland

Bent Jorgensen – Denmark

Michael Kaliszer – Ireland

Michel Kirkels – The Netherlands

Marten Lagergren – Sweden

Cathal Lennon – Ireland

Dan Lynch – Ireland

Einar Matson – Norway

David F. McColl – Ireland

Elvezio Montesarchio – Italy

Anke J. Muller-Sloos – The Netherlands

B.C.F. Muller – Holland

Ciaran O’Kane – Ireland

Sune V. Petersen – Denmark

Michael Rooney

Mans Rosen – Sweden

Emer Shirley – Ireland

Aris Sissouras – Greece

A.V. Vincent – Ireland