This assignment accounts for 65% of the overall mark for the ASDM Class (the individual assignment accounts for the remaining 35%).
The aims of the assignment are to engender a good understanding of, and skills in, the following aspects of the ASDM class:
- Using a spreadsheet to make sense of data;
- Conducting and interpreting statistical analyses on a data set of reasonable size; Using multi-criteria decision analysis to structure and inform a decision.
- Presenting your analyses in visual and written form;
The assignment is group based. Because of the amount of work involved in this assignment you should work with a group of other students on this assignment.
The report for this assignment should have three parts. The division of marks and a page length guide for the three parts is summarised below. All parts are compulsory – your group will not receive an overall mark unless you submit a credible attempt for each part.
The overall report length must not exceed 30 pages, including appendices.
|Report Part||Description||Marks||Page Guide|
|1||Executive Report for Senior
|2||Technical Report on Data Analysis||45||10 pages including charts, diagrams, tables and appendices|
|3||Technical Report on MultiAttribute Value Analysis||40||8 pages, including charts, diagrams, tables and appendices|
Note: we assume a page to be A4, single-spaced, 11 point characters – i.e. around 300 words.
You should submit one report per group. You should also include:
- A copy of the Excel file used for your analysis for Part 2.
- A copy of your VISA file used for your analysis for Part 3.
You will be advised of the deadline for submission of this assignment, and subsequent return of marks, by your MBM Administrator.
A copy of the blank assignment feedback form is available on Myplace so that you have visibility of the marking criteria and marks breakdown.
This assignment has been set by the ASDM Teaching Team 2020-21.
Introduction to the Assignment Context
The Manager of a local hospital has asked for your help. Data has been collected for the last 4 months in the hospital on patients who have had a blood transfusion. The data have been input into a spreadsheet. Unfortunately there is no-one in the Department with the necessary skills to analyse the data. You have been asked to analyse the data and provide a suitable management report for the Manager.
Note: the data provided is real and comes from a Scottish hospital but the name of the actual hospital has been kept confidential.
Background to the Problem
As most people are aware, blood and blood products are a key resource for a health service and are used in providing emergency treatment, in surgical treatment (operations) and in routine care. There are 4 main blood groups (known as ABO): A, B, O and AB. In addition, people either have, or do not have, the Rhesus factor on the surface of their red blood cells. This is usually indicated by ‘RhD positive’ (does have) or ‘RhD negative’ (does not have) suffix to the ABO blood group. This means that generally there are 8 main blood types. (Note; this is an oversimplification for the purpose of this assignment. There are in fact over 30 different blood types). Table 1 shows the 8 main blood types and the percentage of the UK population in each blood type category. Table 2 shows a number of international comparisons.
Table 1 Blood types and UK population
Source: Blood Transfusion Service website
Table 2 ABO and Rh distribution by country
|ABO an||d Rh blood type distribution by nation (population averages)|
|Hong Kong SAR||40%||26%||27%||7%||0.31%||0.19%||0.14%||0.05%|
Transfusion medicine is a specialized branch of haematology that is concerned with the study of blood groups, along with the work of a blood bank to provide a transfusion service for blood and other blood products. Across the world, blood products must be prescribed by a medical doctor (licensed physician or surgeon) in a similar way as medicines. Much of the routine work of a blood bank involves testing blood from both donors and recipients to ensure that every individual recipient is given blood that is compatible and is as safe as possible. If a unit of incompatible blood is transfused between a donor and recipient, a severe acute haemolytic reaction, renal failure and shock are likely to occur, and death is a possibility.
Patients should ideally receive their own blood or type-specific blood products to minimize the chance of a transfusion reaction. Risks can be further reduced by cross-matching blood, but this step may be omitted when blood is required for an emergency. Cross-matching involves mixing a sample of the recipient’s serum with a sample of the donor’s red blood cells and checking if the mixture agglutinates, or forms clumps. If agglutination is not obvious by direct vision, blood bank technicians usually check for agglutination with a microscope. If agglutination occurs, that particular donor’s blood cannot be transfused to that particular recipient.
Although ideally patients should receive matched blood products, in practice some blood group types are compatible with others. Table 3 shows the compatibility between donor and recipient. So for example, a patient who is A- can be given A- blood (their own type) but also O- blood. In fact, examination of Table 3 indicates that O- blood is compatible with all the other blood types and can be used on all patients. O- blood products are often referred to as “universal” as they can be used for all patients. This can be extremely useful, for example, in emergencies when a blood transfusion is needed urgently and there may not be time to identify the patient’s actual blood type.
In the UK, for example, blood supplies are generally obtained through a national blood donor service where citizens voluntarily donate blood, usually twice a year. After donation, the blood goes off to specialist laboratories for routine testing. In Scotland there are two testing labs, in Glasgow and Edinburgh, both working round the clock. The following tests are carried out on every donation:
- HIV – All donations are tested for antibodies to the HIV1 and HIV2 viruses which cause AIDS
- Hepatitis viruses – Hepatitis is an inflammation of the liver which may cause jaundice and sometimes liver failure. All donations are tested for hepatitis B and C.
- Syphilis – Syphilis, a sexually transmitted disease, can be passed on through blood, so all donations are tested.
Typically a donation will have been processed and tested and ready for use within 48 hours. Blood has a very short shelf life of around 35 days and has to be stored and distributed under stringent conditions.
The hospital manager you have been asked to help faces a difficulty. Although O- blood is universal, in the sense that it can be used safely with virtually all patents, it is also in short supply. Table 1 indicates that only around 7% of the UK population is O- and, by implication, only around 7% of blood donations will be O-. The manager would prefer medical staff to be using appropriately matched blood wherever possible and restricting the use of O- blood to those patients who really need it: those patients who are actually O- (since from Table 3 there are no other compatible blood types) and patients who require emergency blood transfusion where there is no time to check their blood type.
On the other hand, the manager does not want donated blood to be wasted, which can happen if blood is not used within its shelf life (each unit of blood is marked with an expiry date). As a result, she has carried out some data collection in the hospital over the last six months. A record has been kept of every patient who received O- blood during that period. The following data has been collected on each patient (and is available in the accompanying Excel file for this assignment).
ID: a patient identifier
Age: of the patient in years
ABO: Blood group of the patient – O, A, B, AB
Rh: POS(itive) or NEG(ative)
Emergency: whether the patient was an emergency admission and so needed an O- transfusion. Y for Yes, otherwise blank
Units: total number of units of blood transfused
Reason: for patients whose blood group was not O-, the reason (if known) they were given O- blood.
- X means they were given O- blood because the blood available was close to its expiry date and would otherwise have been thrown away
- N means that the hospital blood bank had no supplies of the patient’s actual blood type in stock and so O- blood was used instead
- Z means there was some other medical reason for giving the patient O- blood; Note for some patients there is incomplete data and some cells may have been left blank/empty.
Part 1: Executive Report (15 marks)
The Executive Report will be used by the manager as well as senior management at the hospital. This report should present your recommendations and other key findings. This report should be supported by the evidence presented in the technical reports of your analysis.
Part 2: Technical Report on Data Analysis (45 marks)
Your first task is to conduct a thorough analysis of the data presented and to write a report for the hospital manager summarising the key findings in relation to use of O-blood within the hospital. The manager is interested in acquiring a better understanding of hospital’s demand for blood to inform purchasing and storage decisions. Your analysis should include, but not be restricted to, analysis of demand on a daily basis as well as the aggregate demand over a 35 day period which corresponds to shelf life. Your analysis should include an assessment of the uncertainty in demand.
HINT: carefully consider the role of the Central Limit Theorem in modelling daily demand compared with aggregate demand over a 35 day period.
The main report should be written for the manager whose knowledge of statistics and analysis is very limited. You may use appendices to the report to show any technical analysis that you have conducted.
Your report should address the following:
- Make a statement of any assumptions you make
- Use and interpret of visual displays and summary statistics
- Describe the selection and interpretation of inference for daily and aggregate demand
- Careful consider of your communication of your analysis and results to the Manager
Part 3: Technical Report on Multi-Attribute Value Analysis (40 marks)
As part of a wider improvement initiative, the hospital manager is considering how the hospital’s blood bank service can be made more efficient and more effective. At present, the main blood bank, where donated blood is stored, is at a large regional hospital about 80km away. The local hospital has only a small blood bank facility where typically only a few days’ supply of blood can be safely stored. The regional hospital routinely supplies blood on an anticipated or forecast basis and these stocks are replenished every few days or, in the event of a stock shortage at the local hospital, can be shipped through at a few hours notice (although at considerable cost). The hospital manager is reviewing a number of options and has heard (vaguely) about the use of multi-criteria methods. She has asked you to develop an outline multi-criteria model to help her reach a decision between the options.
The options under consideration are:
Option A: continue the existing system. In one sense this would be the easiest option. However, it also carries some risks as the hospital occasionally experiences times when it runs out of stocks of certain blood types and emergency supplies have to be sent across from the regional hospital. The cost of this is high (because of the specialist transportation needed) contributing to budget overspend and there are also clinical risks for patients. There have also been occasions in some winters where emergency supplies have not been able to be sent because of severe weather conditions.
Option B: expand the blood bank at the local hospital to allow it to carry its own stock requirements in full. The local blood bank would then be effectively independent which would contribute to minimising risk to patients of blood supply shortage. However, the capital cost of this would be high (roughly estimated at about £0.75 million) and in the current economic climate might be difficult to obtain. Once built the hospital would also incur higher annual running costs (again roughly estimated at around £175,000 per year). Senior medical staff might be unhappy at this, and have commented that the money would be better spent employing more doctors and nurses.
Option C: improve the local hospital’s Management Information System (MIS) and stock control system (SCS). At present the local hospital does little to try to predict blood use requirements or to manage its blood stocks effectively. This option would focus on two things. First, better analysis and forecasting of blood use requirements in the hospital linked to the scheduling of patient treatments and surgical operations. It is felt that this would enable the hospital to better and more accurately predict the blood it requires. Secondly, investing in an up-to-date stock control system so that blood supplies are more effectively tracked and monitored to reduce wastage, stock levels and associated costs. Most of the effort under this option would go into the development of better IT/IS systems. Anticipated development costs are around £100,000 with ongoing costs on an annual basis of around £50,000. The exact tangible benefits from this are very difficult to quantify although the manager thinks that wastage will be reduced.
Required: Analyse the decision problem facing the hospital manager using multi-attribute value analysis supported by the V.I.S.A software
HINT: Each group member should role-play different actors within this decision problem. For example, roles include the analyst/facilitator and different stakeholders. This will give you the opportunity to experience managing/participating in decision analysis.
Your report on the analysis should:
- Discuss the roles you played and how you used the CAUSE framework, or other approaches, to support your problem structuring
- Discuss the development of a value tree for the analysis of alternatives
- Explain the process of scoring and weighting you have used (and include a table or graph of values)
- Discuss the synthesis of information for each stakeholder or scenario and compare results across stakeholders / scenarios
- Carry out appropriate sensitivity analyses and outline what you learned from these
- Recommend a course of action (this may be a decision, a need to consider further alternatives, a need to design a more robust or better alternative etc …)
You should include carefully chosen visual displays to illustrate your report.