Search results

This quantitative phase of a mixed-methods study aims to describe the effect of the Transitional Care Bridge (TCB) programme on functional decline, mortality, health-care utilisation and health outcomes compared to usual care in a regional hospital in the Netherlands.

In a pre- and post-cohort study, patients aged ≥70 years, admitted to the hospital for ≥48 h and discharged home with an Identification of Seniors at Risk score of ≥2, were included. The TCB programme, started before discharge, encompassed six visits by the community nurse (CN). Data were obtained from the hospital registry and by three questionnaires over a three months period, addressing activities of daily living (ADL), self-rated health, self-rated quality of life and health-care utilisation.

In total, 100 patients were enrolled in this study, 50 patients in the TCB group and 50 patients in the usual care group. After three months, 36.7% was dependent on ADL in the TCB group compared to 47.1% in the usual care group. Mean number of visits by the CN in the TCB group was 3.8. Although the TCB group had a lower mortality, this study did not find any statistically significant differences in health outcomes and health-care utilisation.

Challenges in the delivery of the programme may have influenced patient outcomes. More research is needed on implementation of evidence-based programmes in smaller research settings. A qualitative phase of the study needs to address these outcomes and explore the perspectives of health professionals and patients on the delivery of the programme.

This study provides valuable information on the transitional care programme in a smaller setting.

Lean Six Sigma (LSS) implementation follows a structured approach called define-measure-analyze-improve-control (DMAIC). Earlier research about its application in emergency healthcare services shows that it requires organizational transformation, which many healthcare setups find difficult. The Kotter change management model facilitates organizational transformation but has not been attempted in LSS settings till now. This study aims to integrate the LSS framework with the Kotter change management model to come up with an integrated framework that will facilitate LSS deployment in emergency health services.

Two-stage Delphi method was conducted by using a literature review. First, the success factors and barriers of LSS are investigated, especially from an emergency healthcare point of view. The features and benefits of Kotter's change management models are then reviewed. Subsequently, they are integrated to form a framework specific to LSS deployment in an emergency healthcare set-up. The elements of this framework are analyzed using expert opinion ratings. A new framework for LSS deployment in emergency healthcare has been developed, which can prevent failures due to challenges faced by organizations in overcoming resistance to changes.

The eight steps of the Kotter model such as establishing a sense of urgency, forming a powerful guiding coalition, creating a vision, communicating the vision, empowering others to act on the vision, planning for and creating short-term wins, consolidating improvements and producing still more change, institutionalizing new approaches are derived from the eight common errors that managers make while implementing change in the institution. The study integrated LSS principles and Kotter’s change management model to apply in emergency care units in order to reduce waste and raise the level of service quality provided by healthcare companies.

The present study could contribute knowledge to the literature by providing a framework to integrate lean management and Kotter's change management model for the emergency care unit of the healthcare organization. This framework guides decision-makers and organizations as proper strategies are required for applying lean management practices in any system.

The proposed framework is unique and no other study has prescribed any integrated framework for LSS implementation in emergency healthcare that overcomes resistance to change.

This study aims to identify problems connected to information classification in theory and to put those problems into the context of experiences from practice.

Five themes describing problems are discussed in an empirical study, having informants represented from both a public and a private sector organization.

The reasons for problems to occur in information classification are exemplified by the informants’ experiences. The study concludes with directions for future research.

Information classification sustains the basics of security measures. The human–organizational challenges are evident in the activities but have received little attention in research.

This paper aims to investigate the role of value measuring (VM) as an integrated part of a deal introduced to govern the cross-boundary relationship of state specialist- and primary care providers in the Norwegian health sector.

Drawing on a longitudinal ethnographic case study, this study explores the role of payment for dischargeable patients (PDP), an incentive arrangement introduced as a mechanism of value appropriation intended to create stability in the relationship and support improved patient flows between care providers. The fieldwork took place over approximately 18 months, consisting of intensive participant observations, interviews and document studies.

The VM integrated in the PDP deal between the hospital and municipality, on the surface level, appears simple. The VM, however, rests on a very complex practice of information sharing where accounts on patient status, procedures and activities form the basis of the integrated VM. The deal and its VM, despite its ambitious aims, were not able to fulfill the expectations of a smooth appropriation of value through the management of monetary flows or supporting information sharing for value creation. The VM of the PDP deal aimed at bringing the parties closer together, rather created a distance where money matters became a source of tension.

This study investigates the interconnections of deals and VM in a public sector service context, showing aspects of deals different from that of prior studies into private sector deals.

This paper aims to explore the relationship between market pricing and design quality within the development industry. Currently, there is a lack of research that examines real estate at the property level. Development quality is widely believed to have diminished over the past decades, while many investors seem uninterested in the design process. The study aims to address these issues through a pricing model that integrates design attributes. It is hoped that empirical findings will invite broader stakeholder interest in the design process.

The research establishes a framework for assessing spatial compliance across residential developments within London. Compliance is assessed across ten boroughs, with technical space guidelines used as a proxy for design quality. Transaction prices and spatial assessments are aligned within a hedonic pricing model. Empirical findings are used to establish whether undermining spatial standards presents a significant development risk.

Findings suggest a relationship between sale time and unit size, with “compliant” units typically transacting earlier than “non-compliant” units. Almost half of the 1,600 apartments surveyed appear to undermine technical guidelines.

It is suggested that an array of design attributes be explored that extend beyond unit size. Additionally, future studies may consider the long-term implications of design quality via secondary transaction prices.

Practical implications include the development of a more scientific approach to design valuation. This may enhance the position of product design management within the development industry and architectural services.

Social implications may include improvement in residential design.

An innovative approach combines a thorough understanding of both design and economic principles.

As the size of the population is growing and the capacity of the planet Earth is limited, human beings are searching for sustainable and technology-enabled solutions to support society, ecology and economy. One of the solutions has been developing smart sustainable cities. Smart sustainable cities are cities as systems, where their infrastructure, different subsystems and different functional domains are virtually connected to the information and communication technologies (ICT) and internet via sensors and devices and the Internet of Things (IoT), to collect and process real-time Big Data and make efficient, effective and sustainable solutions for a democratic and liveable city for its various stakeholders. This chapter explores the concepts and practices of sustainable smart cities across the globe and explores the use of technologies such as IoT, Blockchain technology and Cloud computing, etc. their challenges and then presents a view on business models for sustainable smart cities.

This study aims to validate a model to assess the level of lean maturity of Brazilian hospitals based on the adaptation of the SAE J4000/2021 standard.

The methodology was divided: (1) adaptation of the standard to the health context, (2) application of the questionnaire through a survey, and (3) comparison of the results of the level of maturity in the standard and by the clustering technique, using Minitab.

The research presents two contributions: (1) validation of a model to assess the level of lean maturity based on the SAE J4000/2021; (2) insights into the level of maturity of Brazilian hospitals. It was observed that only 10% of the sample was classified at maturity level 3 and 75% at level 2. Private and large hospitals showed greater maturity compared to the others.

This includes the limited number of hospitals that participated in the survey, given the difficulty of adherence to due constraints of time and staffing from hospitals, during the COVID-19 pandemic.

This article presents a lean maturity assessment proposal, adapting a consolidated standard in the automobile industry to the health context. Insights on the lean maturity of Brazilian hospitals can contribute to the development of policies to encourage the implementation of the lean philosophy directed to each specific environment.

This study serves as a guide for public agents interested in monitoring the quality of hospital indicators through the SAE J4000/2021 standard. From this lean maturity analysis, hospital managers can understand their opportunities for improvement in both human and organizational aspects. This favors the improvement of service delivery to society that depends on health services.

Due to the lack of research that validates lean maturity level assessment models in Brazilian hospitals, this study can be considered a pioneer in this Brazilian research by validating the SAE J4000/2021 standard in its updated version in the health context.

The purpose of the study is to measure the performance of Indian hospitals, both operationally and financially, by using hospital KPI's. The assessment is predominantly done by linking it to the existing Lean practices in Indian hospitals.

An empirical study based on cross-sectional survey of hospital managers and specialists in various private healthcare facilities across India was conducted to validate the proposed Lean framework. From an extensive literature survey, the authors identified quality, delivery, efficiency, accessibility and patient centeredness to be the main operational performance (OP) indicators for hospitals. Business or financial performance was measured based on parameters which are average revenue per occupied bed (ARPOB), earnings before interest, tax, depreciation and amortization (EBITDA) and operating revenue. Confirmatory Factor Analysis (CFA) was carried out using a specialized technique, called Structural Equation Modelling(SEM) and an explicit factor structure was hypothesized.

Management commitment towards Lean in hospitals is statistically proven to have impacted operational and financial performance. However, leanness in technology and business processes showed no statistical significance on either operational or financial performance parameters. Hospital stakeholders showed statistical significance on though it had no impact on the financial performance. Results obtained from the statistical analysis indicate a positive impact of hospital Lean practices on timely delivery of services and improved service quality. Efficiency, accessibility of services and patient centered behavior in hospital operations could not be statistically proven to have impacted the financial performance.

Effectiveness of Lean management (LM) principles in improving hospital operations is largely dependent on patient centered behavior. Empowered employees who are trained to add value from a customer view point, make hospital operations safe and improved. Properly trained and communicated employees who are committed to quality improvements can make a positive impact on patients' quality of life and thus positively impact the society. The study lists ways to attain the required outcomes.

This paper is among the very few that has attempted to suggest ways to link implementation of Lean practices more effectively in Indian hospitals to improve hospital performance at operational and financial levels.

This paper reviews the evidence presented in the HHS report and challenges its characterization of the state of the market. The recent US Department of Health and Human Services (HHS) report on the blood industry, Adequacy of the National Blood Supply, provides evidence of and acknowledges that the industry has successfully met demand for blood. And yet the tone and takeaway message of the report of the industry is on the verge of collapse.

The approach of this paper is a critical review of the evidence presented in the HHS report as well as other recent analyses of the blood industry.

While acknowledging the successful performance of the industry to date, the HHS report offers hypothetical disaster scenarios and a lack of centralized data as the main causes for concern. These criticisms ignore the satisfactory response of the industry to prior disasters and fail to recognize that centralized information is not necessary for the efficient operation of a decentralized industry.

This paper offers a fresh assessment of a report repeating prior forecasts of doom for an industry which to date has very successfully met the United States' demand for blood.

Income from investment properties can fluctuate depending on the state of the economy. The idea that there is always a potential exit (sale) value whenever the property stops performing at its optimum or deflation in the economy will always appeal to investors. To determine housing prices, investors would rely on a direct comparison approach (DCA) of recent substitute sales in the open market. Appraisers use this approach to develop an opinion of value when there is a plethora of recent sales to analyse.

The study was designed to establish the use of the analytical hierarchy process (AHP) approach as a support tool for deciding property appraisals. A case study of an industrial single-storey stand-alone building with grade-level parking in the south-east of Calgary, Canada, was investigated with the AHP approach. The result was cross-referenced with the DCA.

Using a consistency index of 0.077321 and a consistency ratio of 0.085912, the matrix multiplication was determined to be 0.456706. The average valuations derived from the adjusted price per square foot using the direct comparison method and the unadjusted price per square foot using the AHP were deemed the best value estimate in the light of available comparables. The implications of the findings suggest that AHP, as a quantitative technique, can support and validate the use of similar non-recent sale comparables when appraising investment properties with the DCA.

AHP is an alternative aid in quantitatively deciding the most significant value attribute for comparison before subjective adjustments. When intuitively applied in the DCA, these subjective adjustments almost always lead to an overvaluation of properties.