What are the ethical conflicts faced by Mexican internists?

Background No studies have been conducted in Mexico to ascertain what ethical problems doctors working at hospitals deal with. This article aims to describe the ethical conflicts most commonly identified by Mexican internists and the importance they attribute to each of these conflicts. Methods Voluntary survey to the members of the Internal Medicine Association of Mexico. Results Responses were submitted by 347 internists. Half of those face ethical conflicts almost always or frequently. The most commonplace and relevant conflicts are those resulting from the clinical relationship (communication, confidentiality, informed consent, assessment of mental capacity, decisions involving incapacitated patients, and conflicts with family members), and secondly those problems related with the end of life (palliative care, withholding or withdrawing treatment, and “No CPR orders”). To resolve conflicts they seek support through protocols, Institutional Ethics Committees (IECs), and consultations with colleagues and, occasionally, with bioethics experts. Protocols and IECs are the tools most in demand among them. Conclusions 1) the most frequent and relevant conflicts are those caused by the clinical relationship, above all those due to doctor–patient communication, and secondly those due to problems which arise at the end of life; 2) though nearly all of them have doubts about how to resolve conflicts, the vast majority are satisfied with the way in which they do so; 3) to deal with conflicts, they seek support mainly in protocols, IECs, and consultation with colleagues; and 4) in order to resolve them better, what they most demand are protocols and IECs, but also bioethics consultants.

FROM BEST INTERESTS TO BETTER INTERESTS? VALUES, UNWISDOM AND OBJECTIVITY IN MENTAL CAPACITY LAW

The Mental Capacity Act 2005 governs personal decision-making for adults. It incorporates five overarching principles, including that incapacity may not be inferred merely from a person's unwise decisions and that where a person lacks capacity decisions must be made in her best interests. Through analysis of judicial treatment of unwisdom, best interests, subjectivity and objectivity, considered against parliamentary debates on the Mental Capacity Bill and philosophical critique of ideas of (un)wisdom, we argue that these principles are problematically irreconcilable. The Act's radical under-specificity means, paradoxically, that this comes to be resolved through abstracted values, rather than the centricity of the person herself.

Optimization-driven framework to understand health care network costs and resource allocation

In the last several decades, the U.S. Health care industry has undergone a massive consolidation process that has resulted in the formation of large delivery networks. However, the integration of these networks into a unified operational system faces several challenges. Strategic problems, such as ensuring access, allocating resources and capacity efficiently, and defining case-mix in a multi-site network, require the correct modeling of network costs, network trade-offs, and operational constraints. Unfortunately, traditional practices related to cost accounting, specifically the allocation of overhead and labor cost to activities as a way to account for the consumption of resources, are not suitable for addressing these challenges; they confound resource allocation and network building capacity decisions. We develop a general methodological optimization-driven framework based on linear programming that allows us to better understand network costs and provide strategic solutions to the aforementioned problems. We work in collaboration with a network of hospitals to demonstrate our framework applicability and important insights derived from it.

Integrated optimisation for production capacity, raw material ordering and production planning under time and quantity uncertainties based on two case studies

This paper develops a supply chain (SC) model by integrating raw material ordering and production planning, and production capacity decisions based upon two case studies in manufacturing firms. Multiple types of uncertainties are considered; including: time-related uncertainty (that exists in lead-time and delay) and quantity-related uncertainty (that exists in information and material flows). The SC model consists of several sub-models, which are first formulated mathematically. Simulation (simulation-based stochastic approximation) and genetic algorithm tools are then developed to evaluate several non-parameterised strategies and optimise two parameterised strategies. Experiments are conducted to contrast these strategies, quantify their relative performance, and illustrate the value of information and the impact of uncertainties. These case studies provide useful insights into understanding to what degree the integrated planning model including production capacity decisions could benefit economically in different scenarios, which types of data should be shared, and how these data could be utilised to achieve a better SC system. This study provides insights for small and middle-sized firm management to make better decisions regarding production capacity issues with respect to external uncertainty and/or disruptions; e.g. trade wars and pandemics.

A simulation model for managing customer waiting time in restaurants: scenarios and beyond

PurposeThe purpose of this paper is to investigate the effects of capacity decisions regarding the number of servers/chefs and tables on identifying a change in the number of wait-related anxious customers, customer losses and customers served to meet the waiting time standards of an actual upscale restaurant.Design/methodology/approachThe authors applied a simulation model to present the consequences of restaurant capacity decisions based on waiting time standards. Arena Simulation Software, licensed by Rockwell Automation, was used for modeling and identifying distributions of the data set provided by the restaurant. An experiment was designed for an upscale restaurant with existing five servers/chefs and 50 tables by changing these resources to measure the changes in customers' wait-related anxiety and other service performance indicators.FindingsThe results showed that an additional server/chef on weekends decreases the daily average number of anxious customers by nearly 33% and increases the daily average number of customers served by nearly 3% and has a little positive effect of decreasing customer losses. Table insertion for high- and low-requested seating areas had an only positive effect on decreasing customer losses.Originality/valueIn this study, the service capacity is dependent on waiting time, and it is addressed to study the relationship with customers' wait-related anxiety, which is a subjective metric. This study developed a point of view for identifying anxious customers whose waiting times are much longer than their cooking and delivery duration expectations regarding their meal preferences in the cooking stage and waiting experiences in the service entry.