Dra. Bull-Torres, Maria

All decision-making processes are complex and include a high number of variables. Particularly, decisions related to disaster risk reduction despite having an inherent uncertainty, depend on many factors associated with the inhabitants in danger, risk disaster management authorities, previous experiences, among others. Although considerable research has been carried out to understand the evacuation processes undergoing among different types of natural hazards, few of them consider psychosocial variables under a dynamic approach. This research proposes a novel way of representing decision making using the risk homeostasis theory approach. We developed a multi-method simulation model to gain an understanding of how individuals react and what are the decision-making processes undergoing a volcanic eruption. For this, we developed a system dynamics (SD) model that captures the psychosocial decision-making process of individuals facing a volcanic eruption. This theory proposes that individuals will make decisions to balance their levels of perception and acceptance of risk and that, in addition, they depend on certain motivational and cognitive variables. Once the evacuation decision making was captured by the SD model, we represented the evacuation process through agent-based simulation based on the relationship between evacuation probability and the diference between risk perception and risk acceptance levels. For experimentation and validation methods, we worked with the 2008 Chaitén (southern Chile) volcanic eruption and further population evacuation as a use case scenario.

This research seeks to improve the service quality provided in Operating Rooms through a Key Performance Indicators (KPI) system based on the analysis of processes and resources used in three surgical units in Chile. This methodology integrates two frameworks: Lean Healthcare and Activity Based Costing. We analyzed these Operating Rooms to establish standard procedures and surgical costs. The proposed methodology includes the following four stages: (i) Identifying macro-processes in the Health Care Unit; (ii) Describing the macro-processes and their healthcare objectives; (iii) Analyzing and standardizing the described processes; and (iv) Generating indicators aimed at cost-control and indicators aimed at reducing activity-duration variability. The KPIs support the reduction of surgery variability, maintain low overhead costs, and set appropriate goals for the: (i) pre-operative; (ii) intraoperative; and (iii) postoperative stages. The implementation of Activity Based Costing, Ishikawa Diagram, and Value Stream Map allowed to identify the resources used in each activity performed, the costs of the activities, and the processes required to provide each surgery. Sample results, of the methodology and proposed application, include the identification of the three most expensive activities, which are: Provide total intravenous anesthesia, Perform postoperative nursing care and Monitor vital signs. These activities represent 29% of the total cost of an operating room. In addition, twelve process indicators were defined, such as Patient transfer time to OR and Extended use of OR. All of these indicators, processes and cost indicators, will likely improve the management of the operating rooms.