Search results

The COVID-19 pandemic created a broad array of challenges for hospitals. These challenges included restrictions on admissions and procedures, patient surges, rising costs of labor and supplies, and a disparate impact on already disadvantaged populations. Many of these intersecting challenges put pressure on hospitals' finances. There was concern that financial pressure would be particularly acute for hospitals serving vulnerable populations, including safety-net (SN) hospitals and critical access hospitals (CAHs). Using data from hospitals in Washington State, we examined changes in operating margins for SN hospitals, CAHs, and other acute care hospitals in 2020 and 2021. We found that the operating margins for all three categories of hospitals fell from 2019 to 2020, with SNs and CAHs sustaining the largest declines. During 2021, operating margins improved for all three hospital categories but SN operating margins still remained negative. Both changes in revenue and changes in expenses contributed to observed changes in operating margins. Our study is one of the first to describe how the financial effects of COVID-19 differed for SNs, CAHs, and other acute care hospitals over the first two years of the pandemic. Our results highlight the continuing financial vulnerability of SNs and demonstrate how the factors that contribute to profitability can shift over time.

Dominant quality standards are present in all industries. Implicit in their use is the assumption that once adopted, there is little or no reason to replace them. However, there is evidence that, under certain circumstances, such standards do get replaced. The reasons for this action are not well-understood, either as they pertain to the displacement decision or to the selection and adoption of the alternative standard. The purpose of this study is to identify and explore these two issues (displacement and replacement) by drawing on data from the American healthcare system. This study is viewed through the theoretical lens of legitimacy theory. In addition, the process is viewed from a temporal perspective. The resulting findings are used to better understand how this displacement process takes place and to identify directions for interesting and meaningful future research.

This is an explanatory study that draws on data gathered from quality managers in 89 hospitals that had adopted a new healthcare quality standard (of these, some fifty percent had displaced the dominant quality standard – the Joint Commission – with a different standard – DNV Healthcare.

The combined literature review and case study data provide insights into the displacement process. This is a process that evolves over time. Initially, the process is driven by the need to meet customer demands. However, over time, as the organizations try to integrate the guidelines contained within the standards into the organization, gaps in the quality standard emerge. It is these gaps that motivate the need to displace standards. The legitimacy perspective is highly effective at explaining this displacement process. In addition, the study uncovers some critical issues, namely the important role played by the individual auditors in the certification process and the importance of fit between the standard and the context in which it is deployed.

The data for the propositions in this case study were derived from interviews and survey data from 89 healthcare organizations. It would be interesting to examine similar relationships with other quality standards and industries.

Our findings provide new insights related to motivations to decouple from a dominant quality standard. Results provide a cautionary tale for standards that hold a dominant market share such that perceived legitimacy of such standards is not as stable as originally thought.

This study illuminates the fragile nature of the stability of dominant standards and emphasizes the linkages between legitimacy concerns and divestiture of such standards.

Barriers to adequate healthcare in rural areas remain a grand challenge for local healthcare systems. In addition to patients' travel burdens, lack of health insurance, and lower health literacy, rural healthcare systems also experience significant resource shortages, as well as issues with recruitment and retention of healthcare providers, particularly specialists. These factors combined result in complex change management-focused challenges for rural healthcare systems. Change management initiatives are often resource intensive, and in rural health organizations already strapped for resources, it may be particularly risky to embark on change initiatives. One way to address these change management concerns is by leveraging socio-technical simulation models to estimate techno-economic feasibility (e.g., is it technologically feasible, and is it economical?) as well as socio-utility feasibility (e.g., how will the changes be utilized?). We present a framework for how healthcare systems can integrate modeling and simulation techniques from systems engineering into a change management process. Modeling and simulation are particularly useful for investigating the amount of uncertainty about potential outcomes, guiding decision-making that considers different scenarios, and validating theories to determine if they accurately reflect real-life processes. The results of these simulations can be integrated into critical change management recommendations related to developing readiness for change and addressing resistance to change. As part of our integration, we present a case study showcasing how simulation modeling has been used to determine feasibility and potential resistance to change considerations for implementing a mobile radiation oncology unit. Recommendations and implications are discussed.

Doctor–medical institution collaboration (DMIC) services are an emerging service mode in focal online health communities (OHCs). This new service mode is anticipated to affect user satisfaction and doctors' engagement behaviors. However, whether and how DMIC occurs is still ambiguous because the topic is rarely examined. To bridge this gap, this study explores doctors' participation in DMIC services and its effects on their online performance, as well as its effect on patients' evaluation of them on OHC platforms.

The authors propose hypotheses based on structural holes theory. A unique dataset obtained from one of the most popular OHCs in China is used to test the hypotheses, and difference-in-differences estimation is adopted to test the causality of the relationship.

The results demonstrate that providing DMIC services improves doctors' online consultation performance and patients' evaluations of them but has no significant effect on doctors' knowledge-sharing performance on OHC platforms. Doctors' knowledge-sharing performance and consultation performance mediate the relationship between participation in DMIC services and patients' evaluation of doctors. Regarding doctors' participation in DMIC services, its impact on doctors' consultation performance and patients' evaluation of them is weaker for doctors with higher professional titles than for doctors with lower professional titles.

The findings clarify the value creation mechanisms of online collaboration between doctors and medical institutions and thereafter facilitate doctors' participation in DMIC services and enhance the sustainable development of OHCs.

A stroke is a serious, life-threatening condition that occurs when the blood supply to a part of the brain is cut off. The earlier a stroke is treated, the less damage is likely to occur. One of the methods that can lead to faster treatment is timely and accurate prediction and diagnosis. This paper aims to compare the binary integer programming-data envelopment analysis (BIP-DEA) model and the logistic regression (LR) model for diagnosing and predicting the occurrence of stroke in Iran.

In this study, two algorithms of the BIP-DEA and LR methods were introduced and key risk factors leading to stroke were extracted.

The study population consisted of 2,100 samples (patients) divided into six subsamples of different sizes. The classification table of each algorithm showed that the BIP-DEA model had more reliable results than the LR for the small data size. After running each algorithm, the BIP-DEA and LR algorithms identified eight and five factors as more effective risk factors and causes of stroke, respectively. Finally, predictive models using the important risk factors were proposed.

The main objective of this study is to provide the integrated BIP-DEA algorithm as a fast, easy and suitable tool for evaluation and prediction. In fact, the BIP-DEA algorithm can be used as an alternative tool to the LR model when the sample size is small. These algorithms can be used in various fields, including the health-care industry, to predict and prevent various diseases before the patient’s condition becomes more dangerous.

This study investigated two key aspects: (1) how a hospital bundles limited resources for preventive care performance and (2) how to develop IS capabilities to enhance preventive care performance.

A case study method was adopted to examine how a hospital integrates its limited resources which leads to the need for resource bundles and an understanding of IS capabilities development to understand how they contribute to the delivery of preventive care in a Malaysian hospital.

This research proposes a comprehensive framework outlining resource-bundling and IS capabilities development to improve preventive care.

We acknowledge that the problem of transferring and generalizing results has been a common criticism of a single case study. However, our objective was to enhance the reader’s understanding by including compelling, detailed narratives demonstrating how our research results offer practical examples that can be generalized theoretically. The findings also apply to similar-sized public hospitals in Malaysia and other developing countries, facing challenges like resource constraints, HIS adoption levels, healthcare workforce shortages, cultural and linguistic diversity, bureaucratic hurdles, and specific patient demographics and health issues. Further, lessons from this context can be usefully applied to non-healthcare service sector domains.

This study provides a succinct strategy for enhancing preventive care in Malaysian public hospitals, focusing on system integration and alignment with hospital strategy, workforce diversity through recruitment and mentorship, and continuous training for health equity and inclusivity. This approach aims to improve resource efficiency, communication, cultural competence, and healthcare outcomes.

Efficiently using limited resources through HIS investment is essential to improve preventive care and reduce chronic diseases, which cause approximately nine million deaths annually in Southeast Asia, according to WHO. This issue has significantly impacted the socioeconomic development of developing countries.

This research refines resource orchestration theory with new mechanisms for resource mobilization, extends IS literature by identifying how strategic bundling forms specialized healthcare IS capabilities, enriches preventive care literature through actionable resource-bundling activities, and adds to HIS literature by advocating for an integrated, preventive care focus from the alignment of HIS design, people and institutional policies to address concerns raised by other research regarding the utilization of HIS in improving the quality of preventive care.

The primary objective of this paper is to show a systematic and methodological approach for the digitalization of critical clinical pathways (CPs) within the healthcare domain.

The methodology entails the integration of service design (SD) and action research (AR) methodologies, characterized by iterative phases that systematically alternate between action and reflective processes, fostering cycles of change and learning. Within this framework, stakeholders are engaged through semi-structured interviews, while the existing and envisioned processes are delineated and represented using BPMN 2.0. These methodological steps emphasize the development of an autonomous, patient-centric web application alongside the implementation of an adaptable and patient-oriented scheduling system. Also, business processes simulation is employed to measure key performance indicators of processes and test for potential improvements. This method is implemented in the context of the CP addressing transient loss of consciousness (TLOC), within a publicly funded hospital setting.

The methodology integrating SD and AR enables the detection of pivotal bottlenecks within diagnostic CPs and proposes optimal corrective measures to ensure uninterrupted patient care, all the while advancing the digitalization of diagnostic CP management. This study contributes to theoretical discussions by emphasizing the criticality of process optimization, the transformative potential of digitalization in healthcare and the paramount importance of user-centric design principles, and offers valuable insights into healthcare management implications.

The study’s relevance lies in its ability to enhance healthcare practices without necessitating disruptive and resource-intensive process overhauls. This pragmatic approach aligns with the imperative for healthcare organizations to improve their operations efficiently and cost-effectively, making the study’s findings relevant.

Tehran’s health-care system is growing, yet it lacks emergency planning procedures. The premise of this study is that the urban environment around a hospital is just as robust as the hospital itself. This study aims to look at hospital resilience in an urban setting to see where it may be improved to keep the hospital operational during a disaster.

The urban resilience (UR) of Amir-Alam Hospital was analyzed in this study using a customized version of the United Nations Office for Disaster Risk Reduction’s City Resilience Profiling Tool. The 34 indications were broken down into five categories.

The result revealed that the hospital’s UR score was 51.75 out of 100, indicating medium resilience. The results of this study enable the decision-makers to determine what measures they may take to improve the hospital’s resilience in terms of its surrounding urban context.

The originality of this research is based on the surrounding urban environment’s resilience as an integral part of hospital resilience.