Search results

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.

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.

The paper aims to investigate the cardiology department’s operational system for improving flexibility by minimizing the patient waiting time and simultaneously maximizing the utilization of service capacity in an uncertain environment. This article also proposes a policy framework that suggests a pool of additional resources and inter-firm collaboration can boost healthcare service delivery excellence.

A discrete event simulation (DES) approach is followed for modeling patient flow and determining the service capacity to respond to demand variability and uncertainty. The model's outputs are used to minimize patient waiting time, maximize the utilization of the resources and match the service capacity with the patient demand.

This research has tested two hypotheses and proved that an increase in waiting time decimates the throughput rate, and additional resources deployment in bottleneck activity positively impacts the throughput rate. The simulated scenarios prescribe an enhanced service capacity with quality care and further contribute to operational performance in reduced waiting time and cost. The results indicate that flexibility reduces the patient waiting time and maximizes the throughput rate.

The study guides the healthcare policymakers to develop flexible competence and facilitate service mechanisms that are adaptive and robust while operating under a volatile environment. The article contributes to the healthcare literature that conjoins flexibility through simulation and resource utilization.

This research is based on real-life primary data collected from healthcare providers. This study adds value to the healthcare systems to adopt strategic decisions to build flexibility through resource allocation, sharing and coordinated care.

The public healthcare system faces challenges and limitations regarding the supply and delivery of healthcare services. The private healthcare system is expensive and only affordable for some. Due to the increasing population, developing countries face a greater degree of demand–supply mismatch. The existing healthcare services in developing countries need to be more sustainable due to high out-of-pocket expenditures and low-income levels. The research design used in this chapter is a case study approach based on qualitative data. The study focuses on two objectives: (1) to have a detailed understanding of the nature of healthcare cooperatives in Spain and their contribution to meeting healthcare requirements; and (2) to make suggestions and recommendations for an improved and sustainable healthcare cooperative for developing countries. Inspired by the healthcare cooperative model of Spain and keeping in mind the ground reality of the lack of healthcare facilities and services accessible and affordable in developing countries, the authors have developed a conceptual framework with the foundation of an insurance cooperative. The Spain Model is sustainable for developing countries as it serves the interest of all income brackets, not leaving the low-income population behind. Concepts like cooperative worker insurance embedded in the model can ensure that the beneficiaries receive timely and good quality health services at an affordable price. It empowers individuals by allowing them to make small amounts of investments as premiums to secure a hopeful future for a healthy life.

This study investigated the relationship between last-mile distribution or delivery (LMD) and commodity access through the mediating role of commodity availability and commodity security and the moderating effect of supply chain integration (SCI).

The study adopted the survey research design and employed the questionnaire instrument in collecting primary data from respondents in Eastern Regional Health Institutions in Ghana. The total number of valid responses received was 204. The partial least squares structural equation modeling (PLS-SEM) approach was adopted to analyze the relationship between the study variables.

The findings showed that there is a positive and significant relationship between LMD and commodity availability as well as LMD and commodity security. Moreover, while the relationship between commodity availability and commodity access is positive and significant, that between commodity security and commodity access is positive but insignificant. Furthermore, there is a positive and statistically significant relationship between LMD and commodity access. The study discovered that the interaction between LMD and commodity access is insignificant and negatively affected by SCI.

To the best of the authors' knowledge, no previous studies have empirically verified the effect of LMD on commodity access in the presence of mediating factors such as commodity availability and commodity security and SCI as the moderating factors.

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.

Patient-centric exchanges, a major type of Health Information Exchange (HIE), empower patients to aggregate and manage their health information. This exchange model helps patients access, modify and share their medical information with multiple healthcare organizations. Although existing studies examine patient engagement, more research is required to investigate patients' attitudes and willingness to play an active role in patient-centered information exchange. The study's main objective is to develop a model based on the belief-attitude-intention paradigm to empirically examine the effects of patients' attitudes toward engagement in care on their willingness to participate in patient-centric HIE.

The authors conducted an online survey study to identify the antecedents and consequences of patients' attitudes toward engagement in care. To empirically test the research model, the authors collected data from a national sample (n = 357) of individuals in the United States. The data were analyzed using structural equation modeling (SEM).

The proposed model categorizes the antecedents to patients' attitudes toward engagement in patient-related and healthcare system factors. The results show that patient-related factors (perceived health literacy and perceived coping ability) and health system factors (perceived experience with the healthcare organization and perceived patient-provider interaction) significantly shape patient attitude toward care management engagement. The results indicate that patients' attitudes toward engaging in their healthcare significantly contribute to their willingness to participate in medical information sharing through patient-centric HIE initiatives. Moreover, the authors’ findings also demonstrate that the link between patient engagement and willingness to participate in HIE is stronger for individuals who perceive lower levels of privacy and security concerns.

The authors validate the proposed model explaining patients' perceptions about their characteristics and the healthcare system significantly influence their attitude toward engaging in their care. This study also suggests that patients' favorable attitude toward engagement can bring patient-centric HIE efforts onto a path to success. The authors’ research attempts to shed light on the importance of patients' roles in adopting patient-centric HIE initiatives. Theoretical and practical contributions of this study are noticeable since they could result in a deeper understanding of the concept of patient engagement and how it may affect healthcare services in an evolving digital world. The authors’ findings can help healthcare organizations provide public citizen-centric services by introducing user-oriented approaches in healthcare delivery systems.

This study aims to measure the level of satisfaction among women with childbirth services provided at public health facilities. Further, to analyse the impact of their socio-economic and obstetric characteristics on their level of satisfaction.

To accomplish these objectives a cross-sectional survey was conducted in two districts of an Indian state, Bihar. Structured questionnaire was developed based on the scale proposed by Okumu and Oyugi (2018) both for vaginal and caesarean birth patients. For empirical analysis multiple linear regression model was employed.

Results suggest that majority of mothers are satisfied with the care they received during childbirth, regardless of whether they chose a caesarean (55%) or vaginal delivery (53%). Women report the lowest levels of satisfaction with postpartum care and the privacy that was preserved by healthcare personnel at health facility. Further the study also confirms the association between patient’s socio-economic characteristics and their satisfaction level.

This is the first study of its kind to highlight the situation of public healthcare system in Bihar, which is the third most populated state in India with poor social and health indicators.

This study investigates the pathways for adopting IoTs and BDA technologies to improve healthcare management.

The study relied on 445 healthcare professionals' perspectives to explore different causal pathways to IoTs and BDA adoption and usage for daily healthcare management. The Fussy-set Qualitative Comparative Analysis was adopted to explore the underlying pathways for healthcare management.

The empirical analysis revealed six different configural paths influencing the acceptance and use of IoTs and BDA for healthcare improvement. Two key user topologies from the six configural paths, digital literacy and ease of use and social influence and behavioural intentions, mostly affect the paths for using digital health technologies by healthcare physicians.

Despite this study's novel contributions, limitations include the fsQCA methodology, perceptual data and the context of the study. The fsQCA methodology is still evolving with different interpretations, although it reveals new insights and as such further studies are required to explain the configural paths of social phenomena. Additionally, future research should consider other constructs beyond the UTAUT and digital literacy to illustrate configural paths to healthcare technology acceptance and usage. Again, the views of healthcare professionals are perceptual data. Hence future research on operational data will support significant contributions towards pathways to accept and use emerging technologies for healthcare improvement. Lastly, this study is from a developing country perspective where emerging digital healthcare technology is still emerging to support healthcare management. Hence, more investigation from other cross-country analyses of configural paths for digital technology deployment in healthcare will enhance the conversation with IoTs and BDA for healthcare management.

Holistically, the acceptance and use of healthcare technologies and platforms is not solely on their capabilities, but a combination of distinct factors driven by users' perspectives. This offers healthcare administrators and institutions to essentially reflect on the distinct combinations of conditions favourable to health professionals who can use IoTs and BDA for healthcare improvement.

This study is among the few scholarly works to empirically investigate the configural paths to support healthcare improvement with emerging technologies. Using fsQCA is a unique contribution to existing information system literature for configural paths for healthcare improvement with emerging digital technologies.

High-quality nursing home (NH) care has long been a challenge within the United States. For decades, policymakers at the state and federal levels have adopted and implemented regulations to target critical components of NH care outcomes. Simultaneously, our delivery system continues to change the role of NHs in patient care. For example, more acute patients are cared for in NHs, and the Center for Medicare and Medicaid Services (CMS) has implemented value payment programs targeting NH settings. As a part of these growing pressures from the broader healthcare delivery system, the culture-change movement has emerged among NHs over the past two decades, prompting NHs to embody more person-centered care as well as promote settings which resemble someone's home, as opposed to institutionalized healthcare settings.

Researchers have linked culture change to high-quality outcomes and the ability to adapt and respond to the ever-changing pressures brought on by changes in our regulatory and delivery system. Making enduring culture change within organizations has long been a challenge and focus in NHs. Despite research suggesting that culture-change initiatives that promote greater resident-centered care are associated with several desirable patient outcomes, their adoption and implementation by NHs are resource intensive, and research has shown that NHs with high percentages of low-income residents are especially challenged to adopt these initiatives.

This chapter takes a novel approach to examine factors that impact the adoption of culture-change initiatives by assessing knowledge management and the role of knowledge management activities in promoting the adoption of innovative care delivery models among under-resourced NHs throughout the United States. Using primary data from a survey of NH administrators, we conducted logistic regression models to assess the relationship between knowledge management and the adoption of a culture-change initiative as well as whether these relationships were moderated by leadership and staffing stability. Our study found that NHs were more likely to adopt a culture-change initiative when they had more robust knowledge management activities. Moreover, knowledge management activities were particularly effective at promoting adoption in NHs that struggle with leadership and nursing staff instability. Our findings support the notion that knowledge management activities can help NHs acquire and mobilize informational resources to support the adoption of care delivery innovations, thus highlighting opportunities to more effectively target efforts to stimulate the adoption and spread of these initiatives.