Fraser Health Uses Mathematical Programming to Plan Its Inpatient Hospital Network

Fraser Health (FH), a British Columbia health authority that serves more than 1.5 million people, must increase its acute care capacity significantly over the next 15 years because of anticipated population growth and aging. The distribution of the projected capacity over each of FH's 12 hospitals depends on the mix of clinical services to be provided at each site, a decision guided by population needs and clinical practices. We present a multiperiod mathematical programming model that we developed to provide options for configuring the system, specifically the location of clinical services and allocation of bed capacity across the hospitals. The decisions in the model are based on population access, critical mass standards, and clinical adjacencies. We describe its application in a long-term planning initiative that FH undertook. Extensive scenario analyses allowed administrators, clinicians, and planners to test multiple system configurations, gain a robust understanding of the trade-offs between these configurations, and formalize the planning process for acute care services.