Postnatal care in the community provides a good illustration of the challenges involved in delivering community-based healthcare. Although this mode of delivery may improve access to care, the travelling time for staff may be significant. There may be less continuity of care with patients being visited by several different midwives. Continuity of care can be critical in delivering safe, effective care but it can imply inefficiencies in allocating staff across the community.
The travelling nurses’ problem distinguishes patients’ preferences for staff, including a desire for continuity of staff over a series of home visits. We are examining the trade-offs between efficient routing and meeting patients’ preferences, using an approach adapted from the Clarke-Wright allocation and routing algorithm. While the algorithm is not always optimal, it is easily incorporated into a simulation and provides an effective basis for exploring options.
Imagine a case where there are 10 mothers and 3 community midwives: each mother has a preferred midwife from whom she would most like to receive a visit. The figure below uses the amended Clarke-Wright algorithm to select a “medium” preference-saving allocation (60% of mothers receive a visit from their preferred midwife). Higher preference-saving allocations incur additional costs in terms of staff travel time.
Bowers J, Cheyne H, Mould G, Page M (2014) Continuity of care in community midwifery, Health Care Management Science DOI 10.1007/s10729-014-9285-z