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Bundled payments for care are an efficient mechanism to align payer, provider, and patient incentives in the provision of health care services for an episode of care. In this chapter, we use agency theory to examine the evolution of bundled payment programs in private and public payer arrangements, and postulate future directions for bundled payment development as a key component in the provision and payment of health care services.

Healthcare in the public and private sectors is facing increasing pressure to become more cost‐effective. Time‐based competition and work‐in‐progress have been used successfully to measure and improve the efficiency of industrial manufacturing. Seeks to address this issue.

Presents a framework for time based management of the total cost of a patient episode and apply it to the six sigma DMAIC‐process development approach. The framework is used to analyse hip replacement patient episodes in Päijät‐Häme Hospital District in Finland, which has a catchment area of 210,000 inhabitants and performs an average of 230 hip replacements per year.

The work‐in‐progress concept is applicable to healthcare – notably that the DMAIC‐process development approach can be used to analyse the total cost of patient episodes. Concludes that a framework, which combines the patient‐in‐process and the DMAIC development approach, can be used not only to analyse the total cost of patient episode but also to improve patient process efficiency.

Presents a framework that combines patient‐in‐process and DMAIC‐process development approaches, which can be used to analyse the total cost of a patient episode in order to improve patient process efficiency.

Drawing on normal accident and high-reliability organizational theories, this study examines the impact of magnitude and likelihood of disruptions on surgical procedure performance. More importantly, the authors investigate the moderating role played by information exchange and risk management infrastructure in mitigating the negative effect of disruption on performance.

A nationwide multi-respondent survey was administered to operating room personnel to collect information on their experiences with disruptions experienced in surgeries. The survey data are analyzed to examine the relationship between operational disruptions and procedure performance. Additionally, the moderating roles of risk management infrastructure and information exchange on the relationship between disruptions and performance are investigated. The results obtained from the empirical analysis are validated using data from an ethnographic investigation of surgeries at a major hospital.

The results show that both the magnitude and the likelihood of a disruption adversely impact procedure performance. Interestingly, the authors find that risk management infrastructure and information exchange play different roles in mitigating the effect of disruptions on performance. The authors find that while risk management infrastructure helps mitigate the effect of magnitude of service disruptions, information exchange helps reduce the effects of likelihood of disruptions. The findings lend strong support to the theoretical assertions. By means of the participant–observer data collected from over 100 surgeries as part of the ethnographic investigation, the authors validate the key findings. The findings suggest that disruptions are common occurrences in surgical settings, but their performance impact may be lessened or altogether avoided with the proper information and risk management mechanisms in place.

This survey research extends the understanding of risk management by considering a context that is highly prone to disruptions. The authors adopt existing constructs pertaining to supply chain disruptions within this context and find new insights. The findings of the study show differential roles played by information exchange and risk management infrastructure in mitigating disruptions. This nuanced understanding provides directions for aligning efforts towards risk mitigation in surgical settings in a more focused way. This study supplements findings from survey data analysis with an examination of data collected by means of ethnographic investigation.

The purpose of this paper is to present a conceptual framework that would enable the effective application of time based competition (TBC) and work in process (WIP) concepts in the design and management of effective and efficient patient processes.

This paper discusses the applicability of time‐based competition and work‐in‐progress concepts to the design and management of healthcare service production processes. A conceptual framework is derived from the analysis of both existing research and empirical case studies.

The paper finds that a patient episode is analogous to a customer order‐to‐delivery chain in industry. The effective application of TBC and WIP can be achieved by focusing on through put time of a patient episode by reducing the non‐value adding time components and by minimizing time categories that are main cost drivers for all stakeholders involved in the patient episode.

The paper shows that an application of TBC in managing patient processes can be limited if there is no consensus about optimal care episode in the medical community.

In the paper it is shown that managing patient processes based on time and cost analysis enables one to allocate the optimal amount of resources, which would allow a healthcare system to minimize the total cost of specific episodes of illness. Analysing the total cost of patient episodes can provide useful information in the allocation of limited resources among multiple patient processes.

This paper introduces a framework for health care managers and researchers to analyze the effect of reducing through put time to the total cost of patient episodes.

This chapter analyzes detailed 24-hour diary data from the United States to provide evidence on the relationship between workers' effort and well-being while at work. In doing so, we first measure workers' effort in terms of the amount of on-the-job leisure, number of on-the-job leisure episodes, and the time working until consuming on-the-job leisure. Second, we link these three measures of worker effort to data on instantaneous well-being while at work. We find that the less time devoted to on-the-job leisure and the number of on-the-job leisure episodes, and the more time workers spend working until on-the-job-leisure, the higher the levels of stress during their work tasks. In analyzing workers' effort and stress during market work activities, we contribute to the scant literature on the determinants of worker happiness while at work, positing the consumption and the frequency of on-the-job leisure as affective factors.

The scientific literature evidences that the quality of care must be improved. However, little research has focused on investigating how health care managers – who are responsible for the implementation of quality interventions – define good and poor quality. The purpose of this paper is to develop an empirically informed taxonomy of quality care as perceived by US managers – named the Integrative Quality Care Assessment Tool (INQUAT) – that is grounded in Donabedian’s structure, process and outcome model.

A revised version of the critical incident technique was used to collect 135 written narratives of good and poor quality care from 74 health care managers in the USA. The episodes were thematically analyzed.

In total, 804 units were coded under the 135 written narratives of care. They were grouped under structure (9 percent, n=69), including organizational, staff and facility resources; process (52 percent, n=419), entailing communication, professional diligence, timeliness, errors, and continuity of care; outcomes (32 percent, n=257), embedding process- and short-term outcomes; and context (7 percent, n=59), involving clinical and patient factors. Process-related categories tended to be described in relation to good quality (65 percent), while structure-related categories tended to be associated with poor quality (67 percent). Furthermore, the data suggested that managers did not consider their actions as important factors influencing quality, but rather tended to attribute the responsibility for quality care to front-line practitioners.

The INQUAT provides a theoretically grounded, evidence-based framework to guide health care managers in the assessment of all the components involved with the quality of care within their institutions.

Identifying the factors that contribute or hinder the provision of good quality care within healthcare institutions, from the managers’ perspective, is important for the success of quality improvement initiatives. The purpose of this paper is to test the Integrative Quality Care Assessment Tool (INQUAT) that was previously developed with a sample of healthcare managers in the USA.

Written narratives of 69 good and poor quality care episodes were collected from 37 managers in Italy. A quantitative content analysis was conducted using the INQUAT coding scheme, to compare the results of the US-based study to the new Italian sample.

The core frame of the INQUAT was replicated and the meta-categories showed similar distributions compared to the US data. Structure (i.e. organizational, staff and facility resources) covered 8 percent of all the coded units related to quality aspects; context (i.e. clinical factors and patient factors) 10 percent; process (i.e. communication, professional diligence, timeliness, errors and continuity of care) 49 percent; and outcome (i.e. process- and short-term outcomes) 32 percent. However, compared to the US results, Italian managers attributed more importance to different categories’ subcomponents, possibly due to the specificity of each sample. For example, professional diligence, errors and continuity of care acquired more weight, to the detriment of communication. Furthermore, the data showed that process subcomponents were associated to perceived quality more than outcomes.

The major limitation of this investigation was the small sample size. Further studies are needed to test the reliability and validity of the INQUAT.

The INQUAT is proposed as a tool to systematically conduct in depth analyses of successful and unsuccessful healthcare events, allowing to better understand the factors that contribute to good quality and to identify specific areas that may need to be targeted in quality improvement initiatives.

Co-existing health conditions and frequent hospital usage are pervasive in homeless populations. Without a home to be discharged to, appropriate discharge care and treatment compliance are difficult. The Medical Respite Centre (MRC) model has gained traction in the USA, but other international examples are scant. The purpose of this paper is to address this void, presenting findings from an evaluation of The Cottage, a small short-stay respite facility for people experiencing homelessness attached to an inner-city hospital in Melbourne, Australia.

This mixed methods study uses case studies, qualitative interview data and hospital administrative data for clients admitted to The Cottage in 2015. Hospital inpatient admissions and emergency department presentations were compared for the 12-month period pre- and post-The Cottage.

Clients had multiple health conditions, often compounded by social isolation and homelessness or precarious housing. Qualitative data and case studies illustrate how The Cottage couples medical care and support in a home-like environment. The average stay was 8.8 days. There was a 7 per cent reduction in the number of unplanned inpatient days in the 12-months post support.

The paper has some limitations including small sample size, data from one hospital only and lack of information on other services accessed by clients (e.g. housing support) limit attribution of causality.

MRCs provide a safe environment for individuals to recuperate at a much lower cost than inpatient admissions.

There is limited evidence on the MRC model of care outside of the USA, and the findings demonstrate the benefits of even shorter-term respite post-discharge for people who are homeless.

The purpose of this paper is to explore different units of analysis applicable to the analysis of healthcare service supply chains.

The paper is based on a literature review, conceptual analysis and two case studies based on process mapping and longitudinal analysis of patient episodes.

Process management is appropriate in situations where there is a structured flow with a sufficient volume of similar repetitions. In the case where there are significant amounts of exceptions, a process can be decomposed into service events that can be defined and managed as part of a supply chain.

The cases are based on data sets that do not allow empirical generalization.

The use of longitudinal patient episode data elicits problems in the process flow, such as delays and variable sequences. The use of events as a unit of analysis enables routinization in situations with exceptions and irregular sequences.

The service event is an original concept that links healthcare operations management to service‐oriented architectures and the service‐dominant logic.

Describes a way of characterizing the progress of a patient into and out of acute care. Presents a model of the process which resulted from a study of the interface between tertiary care and resettlement in the home community in a single health district. After discussion of the problems relating to patient discharge as described in the literature, briefly describes the origins of and setting for the study. The method of data collection (through documentary analysis, individual and group interview and case study) involved over 100 staff and patients on both sides of the interface. Does not present the substantive findings in detail, as these remain confidential to the organizations involved. However, outlines the process whereby the data gave rise to a model of patient progress and discusses in detail the essential feature of that model – the care frame – both as a theoretical entity and as a basis for practical action. Concludes with a demonstration of how the care‐frame model can be used to manage the interface between successive phases in the provision of care and, especially, how it helps to define and manage the interface between acute care and care in the home community.