International Best Practices in Health Care Management: Volume 17

Cover of International Best Practices in Health Care Management
Subject:

Table of contents

(19 chapters)
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Preface

Pages xvii-xx
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Section I: Commentaries on International Research and Best Practices

Purpose

This commentary argues in favor of international research in the 21st century. Advances in technology, science, communication, transport, and infrastructure have transformed the world into a global village. Industries have increasingly adopted globalization strategies. Likewise, the health sector is more internationalized whereby comparisons between diverse health systems, international best practices, international benchmarking, cross-border health care, and cross-cultural issues have become important subjects in the health care literature. The focus has now turned to international, collaborative, cross-national, and cross-cultural research, which is by far more demanding than domestic studies. In this commentary, we explore the methodological challenges, ethical issues, pitfalls, and practicalities within international research and offer possible solutions to address them.

Design/methodology/approach

The commentary synthesizes contributions from four scholars in the field of health care management, who came together during the annual meeting of the Academy of Management to discuss with members of the Health Care Management Division the challenges of international research.

Findings

International research is worth pursuing; however, it calls for scholarly attention to key methodological and ethical issues for its success.

Originality/value

This commentary addresses salient issues pertaining to international research in one comprehensive account.

Purpose

Interest has grown among U.S. academic medical centers in developing international benchmarks for excellence in process and outcomes. Drivers behind this trend, as well as barriers to the development of useful benchmarks, are explored in this invited commentary.

Design/methodology/approach

The commentary is based on the authors’ conversations with members of the U.S. Cooperative for International Patient Programs as well as the University Healthsystem Consortium (UHC).

Findings

Six key themes are summarized in this commentary, including four key drivers and two barriers.

Originality/value

The practice-based perspectives this commentary summarizes provide a useful starting point for researchers and practitioners interested in establishing international comparison with the United States.

Purpose

Explores recent approaches to international best practices and how they relate to context and innovation in health services.

Design/methodology/approach

Critical review of existing research on best practices and how they created, diffused, and translate in the international setting.

Findings

Best practices are widely used and discussed, but processes by which they are developed and diffused across international settings are not well understood.

Research implications

Further research is needed on innovation and dissemination of best practices internationally.

Originality/value

This commentary points out directions for future research on innovation and diffusion of best practices, particularly in the international setting.

Section II: International Best Practices Across Health Systems

Purpose

While there is established research that explores individual innovations across countries or developments in a specific health area, there is less work that attempts to match national innovations to specific systems of health governance to uncover themes across nations.

Design/methodology/approach

We used a cross-comparison design that employed content analysis of health governance models and innovation patterns in eight OECD nations (Australia, Britain, Canada, France, Germany, the Netherlands, Switzerland, and the United States).

Findings

Country-level model of health governance may impact the focus of health innovation within the eight jurisdictions studied. Innovation across all governance models has targeted consumer engagement in health systems, the integration of health services across the continuum of care, access to care in the community, and financial models that drive competition.

Originality/value

Improving our understanding of the linkage between health governance and innovation in health systems may heighten awareness of potential enablers and barriers to innovation success.

Purpose

The research analyzes good practices in health care “management experimentation models,” which fall within the broader range of the integrative public–private partnerships (PPPs). Introduced by the Italian National Healthcare System in 1991, the “management experimentation models” are based on a public governance system mixed with a private management approach, a patient-centric orientation, a shared financial risk, and payment mechanisms correlated with clinical outcomes, quality, and cost-savings. This model makes public hospitals more competitive and efficient without affecting the principles of universal coverage, solidarity, and equity of access, but requires higher financial responsibility for managers and more flexibility in operations.

Methodology/approach

In Italy the experience of such experimental models is limited but successful. The study adopts the case study methodology and refers to the international collaboration started in 1997 between two Italian hospitals and the University of Pittsburgh Medical Center (UPMC – Pennsylvania, USA) in the field of organ transplants and biomedical advanced therapies.

Findings

The research allows identifying what constitutes good management practices and factors associated with higher clinical performance. Thus, it allows to understand whether and how the management experimentation model can be implemented on a broader basis, both nationwide and internationally. However, the implementation of integrative PPPs requires strategic, cultural, and managerial changes in the way in which a hospital operates; these transformations are not always sustainable.

Originality/value

The recognition of ISMETT’s good management practices is useful for competitive benchmarking among hospitals specialized in organ transplants and for its insights on the strategies concerning the governance reorganization in the hospital setting. Findings can be used in the future for analyzing the cross-country differences in productivity among well-managed public hospitals.

Purpose

Amid increasing interest in how government regulation and market competition affect the cost and financial sustainability in health care sector, it remains unclear whether health care providers behave similarly to their counterparts in other industries. The goal of this chapter is to study the degree to which health care providers manipulate accruals in periods of financial difficulties caused, in part, by the rising costs of labor.

Methodology

We collected the financial information of health care providers in 43 countries from 1984 to 2013 and conducted a pooled cross-sectional study with country and year fixed-effects.

Findings

The empirical evidence shows that health care providers with higher wage costs are more likely to smooth their earnings in order to maintain financial sustainability.

Originality/value

The finding of this study not only informs regulators that earnings management is pervasive in health care organizations around the world, but also contributes to the studies of financial book-tax reporting alignment, given the existing empirical evidence linking earnings management to corporate tax avoidance in this very sector.

Purpose

Hospitals in North America consistently have employee injury rates ranking among the highest of all industries. Organizations that mandate workplace safety training and emphasize safety compliance tend to have lower injury rates and better employee safety perceptions. However, it is unclear if the work environment in different national health care systems (United States vs. Canada) is associated with different employee safety perceptions or injury rates. This study examines occupational safety and workplace satisfaction in two different countries with employees working for the same organization.

Methodology/approach

Survey data were collected from environmental services employees (n = 148) at three matched hospitals (two in Canada and one in the United States). The relationships that were examined included: (1) safety leadership and safety training with individual/unit safety perceptions; (2) supervisor and coworker support with individual job satisfaction and turnover intention; and (3) unit turnover, labor usage, and injury rates.

Findings

Hierarchical regression analysis and ANOVA found safety leadership and safety training to be positively related to individual safety perceptions, and unit safety grade and effects were similar across all hospitals. Supervisor and coworker support were found to be related to individual and organizational outcomes and significant differences were found across the hospitals. Significant differences were found in injury rates, days missed, and turnover across the hospitals.

Originality/value

This study offers support for occupational safety training as a viable mechanism to reduce employee injury rates and that a codified training program translates across national borders. Significant differences were found between the hospitals with respect to employee and organizational outcomes (e.g., turnover). These findings suggest that work environment differences are reflective of the immediate work group and environment, and may reflect national health care system differences.

Purpose

Health care institutions in many Western countries have developed preoperative testing and assessment guidelines to improve surgical outcomes and reduce cost of surgical care. The aims of this chapter are to (1) summarize the literature on the effect of preoperative testing on clinical outcomes, efficiency, and cost; and (2) to compare preoperative testing guidelines developed in the United States, the United Kingdom, and Canada.

Design/methodology/approach

We reviewed the literature from 1975 to 2014 for studies and preoperative testing guidelines.

Findings

We identified 29 empirical studies and 8 country-specific guidelines for review. Most studies indicate that preoperative testing is overused and comes at a high cost. Guidelines are tied to payment only in one country studied. This is the most recent review of the literature on preoperative testing and assessment with a focus on quality of care, efficiency, and cost outcomes. In addition, this chapter provides an international comparison of preoperative guidelines.

Purpose

Point-of-care testing (POCT) at the Emergency Department (ED) attains better objectives in patient care while aiming to achieve early diagnosis for faster medical decision-making. This study assesses and compares the benefits of POCT in the ED in Germany and Malta, while considering differences in their health systems.

Methodology/approach

This chapter utilizes multiple case study approach using Six Sigma. The German case study assesses the use of POCT in acute coronary syndrome patients, compared to the central lab setting. The Maltese case study is a pilot study of the use of medical ultrasonography as a POCT to detect abdominal free fluid in post-blunt trauma.

Findings

This study provides clear examples of the effectiveness of POCT in life-threatening conditions, as compared to the use of traditional central lab or the medical imaging department. Therapeutic quality in the ED and patient outcomes directly depend upon turnaround time, particularly for life-threatening conditions. Faster turnaround time not only saves lives but reduces morbidity, which in the long-term is a critical cost driver for hospitals.

Originality/value

The application of Six Sigma and the international comparison of POCT as best practice for life-threatening conditions in the ED.

Section III: Basics and Principles of Benchmarking

Purpose

Hospitals worldwide are facing the same opportunities and threats: the demographics of an aging population; steady increases in chronic diseases and severe illnesses; and a steadily increasing demand for medical services with more intensive treatment for multi-morbid patients. Additionally, patients are becoming more demanding. They expect high quality medicine within a dignity-driven and painless healing environment.

The severe financial pressures that these developments entail oblige care providers to more and more cost-containment and to apply process reengineering, as well as continuous performance improvement measures, so as to achieve future financial sustainability. At the same time, regulators are calling for improved patient outcomes. Benchmarking and best practice management are successfully proven performance improvement tools for enabling hospitals to achieve a higher level of clinical output quality, enhanced patient satisfaction, and care delivery capability, while simultaneously containing and reducing costs.

Approach

This chapter aims to clarify what benchmarking is and what it is not. Furthermore, it is stated that benchmarking is a powerful managerial tool for improving decision-making processes that can contribute to the above-mentioned improvement measures in health care delivery. The benchmarking approach described in this chapter is oriented toward the philosophy of an input–output model and is explained based on practical international examples from different industries in various countries.

Findings

Benchmarking is not a project with a defined start and end point, but a continuous initiative of comparing key performance indicators, process structures, and best practices from best-in-class companies inside and outside industry.

Benchmarking is an ongoing process of measuring and searching for best-in-class performance:

  • Measure yourself with yourself over time against key performance indicators

  • Measure yourself against others

  • Identify best practices

  • Equal or exceed this best practice in your institution

  • Focus on simple and effective ways to implement solutions

Measure yourself with yourself over time against key performance indicators

Measure yourself against others

Identify best practices

Equal or exceed this best practice in your institution

Focus on simple and effective ways to implement solutions

Comparing only figures, such as average length of stay, costs of procedures, infection rates, or out-of-stock rates, can lead easily to wrong conclusions and decision making with often-disastrous consequences. Just looking at figures and ratios is not the basis for detecting potential excellence. It is necessary to look beyond the numbers to understand how processes work and contribute to best-in-class results. Best practices from even quite different industries can enable hospitals to leapfrog results in patient orientation, clinical excellence, and cost-effectiveness.

Originality/value

Despite common benchmarking approaches, it is pointed out that a comparison without “looking behind the figures” (what it means to be familiar with the process structure, process dynamic and drivers, process institutions/rules and process-related incentive components) will be extremely limited referring to reliability and quality of findings.

In order to demonstrate transferability of benchmarking results between different industries practical examples from health care, automotive, and hotel service have been selected.

Additionally, it is depicted that international comparisons between hospitals providing medical services in different health care systems do have a great potential for achieving leapfrog results in medical quality, organization of service provision, effective work structures, purchasing and logistics processes, or management, etc.

Concluding Remarks

Pages 253-255
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Cover of International Best Practices in Health Care Management
DOI
10.1108/S1474-8231201517
Publication date
2015-02-23
Book series
Advances in Health Care Management
Editors
Series copyright holder
Emerald Publishing Limited
ISBN
978-1-78441-279-1
eISBN
978-1-78441-278-4
Book series ISSN
1474-8231