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1 – 10 of over 16000Michael Sony, Jiju Antony and Olivia McDermott
The pandemic has reinforced the need for revamping the healthcare service delivery systems around the world to meet the increased challenges of modern-day illnesses. The use of…
Abstract
Purpose
The pandemic has reinforced the need for revamping the healthcare service delivery systems around the world to meet the increased challenges of modern-day illnesses. The use of medical cyber–physical system (MCPS) in the healthcare is one of the means of transforming the landscape of the traditional healthcare service delivery system. The purpose of this study is to critically examine the impact of MCPS on the quality of healthcare service delivery.
Design/methodology/approach
This paper uses an evidence-based approach, the authors have conducted a systematic literature review to study the impact of MCPS on healthcare service delivery. Fifty-four articles were thematically examined to study the impact of MCPS on eight characteristics of the healthcare service delivery proposed by the world health organisation.
Findings
The study proposes support that MCPS will positively impact (1) comprehensiveness, (2) accessibility, (3) coverage, (4) continuity, (5) quality, (6) person-centredness, (7) coordination, (8) accountability and (9) efficiency dimension of the healthcare service delivery. The study further draws nine propositions to support the impact of MCPS on the healthcare service delivery.
Practical implications
This study can be used by stakeholders as a guide point while using MCPS in healthcare service delivery systems. Besides, healthcare managers can use this study to understand the performance of their healthcare system. This study can further be used for designing effective strategies for deploying MCPS to be effective and efficient in each of the dimensions of healthcare service delivery.
Originality/value
The previous studies have focussed on technology aspects of MCPS and none of them critically analysed the impact on healthcare service delivery. This is the first literature review carried out to understand the impact of MCPS on the nine dimensions of healthcare service delivery proposed by WHO. This study provides improved thematic awareness of the resulting body of knowledge, allowing the field of MCPS and healthcare service delivery to progress in a more informed and multidisciplinary manner.
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John Parnaby and Denis R. Towill
Taking the physician sourced observation that “wasting time is always more expensive than saving it” leads naturally to the conclusion that effective and efficient patient‐centred…
Abstract
Purpose
Taking the physician sourced observation that “wasting time is always more expensive than saving it” leads naturally to the conclusion that effective and efficient patient‐centred healthcare delivery systems are highly desirable targets for the National Health Service (NHS) and similar providers. But has “joined up healthcare” even been achieved, and if so, how? What procedures must be in place to maximise the chances of its occurrence? This paper aims to investigate these issues.
Design/methodology/approach
This paper answers these questions experientially via “Insider Action Research” projects plus careful critique of published case studies.
Findings
Recurring themes for effective improvement of healthcare delivery organisations emerge in the paper, as do identification of the inevitable barriers to change.
Originality/value
The paper takes stock of NHS service developments in a broader theoretical light.
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The purpose of this paper is to provide a comprehensive description, justification and modus operandi for implementation of cellular operations within healthcare delivery supply…
Abstract
Purpose
The purpose of this paper is to provide a comprehensive description, justification and modus operandi for implementation of cellular operations within healthcare delivery supply chains. The methodology outlined has a sound theoretical basis, has been proven in a wide range of market sectors (including hospitals) and hence qualifies for consideration as a contribution to “new management theory”.
Design/methodology/approach
Approach is based on the well established management‐by‐projects (MBP) methodology for analysis, design and effective implementation of change. There is detailed coverage of the five‐step MBP programme with specific applications in healthcare. The importance of “people involvement” as a core requirement is demonstrated via the set‐up of task forces to design and operate such cells. These groups integrate cognate activities so as to provide seamless patient flow within the healthcare delivery process. MBP is derived from a systems perspective. This in turn is concerned with maintaining quality, reducing uncertainty, smooth transference, synchronisation, schedule adherence, and minimisation of throughput times.
Findings
The outputs from case studies executed in a large UK teaching hospital confirm the substantial benefits accruing from cellular operation. In both materials supplies and urology admission processes significant improvements result form adoption of the MBP change methodology. This includes substantive 50 per cent reduction in patient throughput times, plus 25 per cent increase in bed utilisation. Measurable cost benefits are achieved in materials supply, especially via simplification of ordering systems.
Research limitations/implications
The healthcare applications demonstrate the applicability of MBP within this specialised scenario. However, the solutions depend on the innovatory capability of the relevant task forces who execute the projects. Since these necessarily include participation by coal‐face “players”, i.e. doctors, nurses, support staff, etc. advised by internal “change experts” the solutions adopted are shaped to be the best and most appropriate “local” schema.
Practical implications
It is essential that task forces be properly constituted, well trained, well advised, and actively practice the plan‐do‐check‐act cyclic route of well‐tested improvement. “Train‐Do” is the key. However, in healthcare especially, the “Elephant Must Be Eaten in Bite Sized Chunks”. In other words the organisation needs visible progressive change, unit‐by‐unit, thus avoiding saturation of scarce resources.
Originality/value
Brings together the MBP methodology and cellular organisational concepts into an integrated, sustainable, systems based approach to the analysis, design and implementation of effective change.
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Phil Joyce, Rosamund Green and Graham Winch
Purpose – The core theme of this paper is that, to provide the best kind of process systems to support a “quality” healthcare provider, it is essential to “engineer‐in” quality as…
Abstract
Purpose – The core theme of this paper is that, to provide the best kind of process systems to support a “quality” healthcare provider, it is essential to “engineer‐in” quality as early as possible – effectively at the specification and design phase. It extends to the healthcare context a novel approach, which provides a transparent model of how an envisioned structure delivers services and fulfils stakeholders' needs. Design/methodology/approach – In the paper a new construct, developed by the authors, is described and then extended to the healthcare sector. The underpinning theories of the new construct are discussed and examples for a health care service are presented. Findings – The paper finds that there is a full literature on quality and TQM, but relatively little offers practical tools for supporting design and implementation processes that enhance the likelihood of achieving quality operations. The presentation and discussion of the construct presented argue that the approach presented here can achieve this aim. Practical implications – In the paper, as with many ventures, organisations charged with healthcare delivery are presently facing the dual challenges of seeking to satisfy widely extended stakeholder groups and implement complex ICT systems to support e‐fulfilment. To ensure that quality is “engineered‐in”, a holistic, integrated and quality approach is required, and Total Quality Management (TQM) principles are the obvious foundations for this. Originality/value – The paper shows that electronically delivered information and funds transaction systems do offer healthcare organisations great potential, but many large integrated ICT systems have notoriously disappointed the stakeholder health care service. An integrative view of the delivery system design, based on the literature from strategic management, business process design, e‐business design, and TQM, has yielded a unique construct, which integrates these views in a transparent model readily accessible to the various domain experts. The specific role of this in healthcare fulfilment system design applications is demonstrated.
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D.R. Towill and M. Christopher
Aims to show that material flow concepts developed and successfully applied to commercial products and services can form equally well the architectural infrastructure of effective…
Abstract
Purpose
Aims to show that material flow concepts developed and successfully applied to commercial products and services can form equally well the architectural infrastructure of effective healthcare delivery systems.
Design/methodology/approach
The methodology is based on the “power of analogy” which demonstrates that healthcare pipelines may be classified via the Time‐Space Matrix.
Findings
A small number (circa 4) of substantially different healthcare delivery pipelines will cover the vast majority of patient needs and simultaneously create adequate added value from their perspective.
Research limitations/implications
The emphasis is firmly placed on total process mapping and analysis via established identification techniques. Healthcare delivery pipelines must be properly engineered and matched to life cycle phase if the service is to be effective.
Practical implications
This small family of healthcare delivery pipelines needs to be designed via adherence to very specific‐to‐purpose principles. These vary from “lean production” through to “agile delivery”.
Originality/value
The proposition for a strategic approach to healthcare delivery pipeline design is novel and positions much currently isolated research into a comprehensive organisational framework. It therefore provides a synthesis of the needs of global healthcare.
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Archie Lockamy and Douglas L. Smith
The purpose of this paper is to provide a conceptual framework along with underlying propositions for the design and deployment of telemedicine projects which provide healthcare…
Abstract
Purpose
The purpose of this paper is to provide a conceptual framework along with underlying propositions for the design and deployment of telemedicine projects which provide healthcare organizations with strategic benefits.
Design/methodology/approach
Field research conducted at four healthcare organizations along with academic literature in the areas of telemedicine and process management form the basis for the conceptual framework and propositions provided in this paper.
Findings
Telemedicine can be used as a process enabler for enhanced healthcare‐delivery systems. However, there are several challenges which must be considered prior to its implementation. The framework and propositions provided in the paper can be used to facilitate successful telemedicine project deployments.
Research limitations/implications
The framework and propositions are derived from a small sample and must be validated through more rigorous empirical research studies.
Practical implications
The concepts presented in the paper can be used by healthcare planners to increase the likelihood of telemedicine deployment success within their organizations.
Originality/value
This paper begins to fill a void in the literature concerning how telemedicine can be used as a process enabler for improving healthcare‐delivery systems.
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At the beginning of the 21st century, multiple and diverse social entities, including the public (consumers), private and nonprofit healthcare institutions, government (public…
Abstract
At the beginning of the 21st century, multiple and diverse social entities, including the public (consumers), private and nonprofit healthcare institutions, government (public health) and other industry sectors, began to recognize the limitations of the current fragmented healthcare system paradigm. Primary stakeholders, including employers, insurance companies, and healthcare professional organizations, also voiced dissatisfaction with unacceptable health outcomes and rising costs. Grand challenges and wicked problems threatened the viability of the health sector. American health systems responded with innovations and advances in healthcare delivery frameworks that encouraged shifts from intra- and inter-sector arrangements to multi-sector, lasting relationships that emphasized patient centrality along with long-term commitments to sustainability and accountability. This pathway, leading to a population health approach, also generated the need for transformative business models. The coproduction of health framework, with its emphasis on cross-sector alignments, nontraditional partner relationships, sustainable missions, and accountability capable of yielding return on investments, has emerged as a unique strategy for facing disruptive threats and challenges from nonhealth sector corporations. This chapter presents a coproduction of health framework, goals and criteria, examples of boundary spanning network alliance models, and operational (integrator, convener, aggregator) strategies. A comparison of important organizational science theories, including institutional theory, network/network analysis theory, and resource dependency theory, provides suggestions for future research directions necessary to validate the utility of the coproduction of health framework as a precursor for paradigm change.
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The aim of this article is to provide health leaders with a clear unambiguous description of a proven modus operandi for analysis, design, planning, implementation, and start‐up…
Abstract
Purpose
The aim of this article is to provide health leaders with a clear unambiguous description of a proven modus operandi for analysis, design, planning, implementation, and start‐up of effective and efficient healthcare delivery systems.
Design/methodology/approach
The paper builds on previously published reviews of the successful TV series centred on Rotherham General Hospital. This featured Gerry Robinson (GR), a top executive from the public sector, and his endeavours to interact with, and improve, the NHS. Those reviews covered emergent lessons directed at hospitals and the Department of Health plus the de‐briefing carried out by GR. They also detailed the Healthcare Balanced Scorecard, and emphasised the importance of minimising elapsed time.
Findings
TV programmes inevitably lack description of an infrastructure since “headline metrics” (preferably disputed) make the news and add to the viewing figures. Missing are some important steps along the way, identification of various key factors; resourcing issues; process monitoring; time scales; and team building. By showing that the GR approach can be related to a proven and well‐documented “engineering of change” methodology, a fully integrated approach to healthcare delivery system enhancement is evident.
Research limitations/implications
The comprehensive approach is based on the systems engineering concept of seamless patient flow achieved by eliminating problems rather than finding ad‐hoc ways around them. This requires team‐based activities involving clinicians, nurses, managers, secretaries, and everyone associated with the healthcare process. “No involvement” usually means “no commitment”.
Practical implications
Emphasis is on “institutional change” achieved via a sequence of carefully selected improvement projects in which the first acts as an “exemplar”. This requires a proactive people‐first organisation practising open‐learning and a culture of continuous plan‐do‐check‐act activity. The “seven deadly sins” indicate what may go wrong and why.
Originality/value
This article assists in the exposure and exploitation of TV healthcare narrative and established “engineering of change” practice by carefully relating one to the other.
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Stuart Winby, Christopher G. Worley and Terry L. Martinson
This chapter integrates organization design and sustainability concepts to describe an accelerated transformational change at the Fairview Medical Group (United States).
Abstract
Purpose
This chapter integrates organization design and sustainability concepts to describe an accelerated transformational change at the Fairview Medical Group (United States).
Design/methodology/approach
A case study of the transformation at Fairview Medical Group’s primary care clinics was developed from interviews and first-person accounts of the change. Objective data regarding outcomes was used to evaluate the effectiveness of the redesign process.
Findings
The Fairview Medical Group developed an innovation and change capability to transform 35 primary care clinics in six months. All of the clinics were certified by the state of Minnesota as complying with their healthcare standards. Clinical outcomes, costs, and employee and physician engagement also increased. All of the improved measures are sustained.
Originality/value
Healthcare reform in the United States struggles because the organization design challenges are great and the change difficulties even greater. Fairview’s experience provides important evidence and lessons that can help advance our understanding of effective healthcare and create more sustainable healthcare systems. This chapter provides healthcare system administrators evidence and alternatives in the pursuit of implementation.
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Devendra Dhagarra, Mohit Goswami, P.R.S. Sarma and Abhijit Choudhury
Significant advances have been made in the field of healthcare service delivery across the world; however, health coverage particular for the poor and disadvantaged still remains…
Abstract
Purpose
Significant advances have been made in the field of healthcare service delivery across the world; however, health coverage particular for the poor and disadvantaged still remains a distant dream in developing world. In large developing countries like India, disparities in access to healthcare are pervasive. Despite recent progress in ensuring improved access to health care in past decade or so, disparities across gender, geography and socioeconomic status continue to persist. Fragmented and scattered health records and lack of integration are some of the primary causes leading to uneven healthcare service delivery. The devised framework is intended to address these challenges. The paper aims to discuss these issues.
Design/methodology/approach
In view of such challenges, in this research a Big Data and blockchain anchored integrative healthcare framework is proposed focusing upon providing timely and appropriate healthcare services to every citizen of the country. The framework uses unique identification number (UID) system as formalized and implemented by the Government of India for identification of the patients, their specific case histories and so forth.
Findings
The key characteristic of our proposed framework is that it provides easy access to secure, immutable and comprehensive medical records of patients across all treatment centers within the country. The model also ensures security and privacy of the medical records based upon the incorporation of biometric authentication by the patients for access of their records to healthcare providers.
Originality/value
A key component of our evolved framework is the Big Data analytics-based framework that seeks to provide structured health data to concerned stakeholders in healthcare services. The model entails all pertinent stakeholders starting from patients to healthcare service providers.
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