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The purpose of this paper is to examine the association between outpatient orthopedic surgery costs and Japan’s healthcare facilities using a large-scale Japanese medical claims database.

The authors obtained reimbursement claims data for 8,588 patients who underwent orthopedic surgery between April 1 and September 30, 2014 at 3,347 Japanese healthcare facilities. Regression analysis, using ordinary least squares, examined the association between outpatient orthopedic surgery costs and healthcare facility characteristics. By using surgical fees as proxy for the surgical costs, the authors defined three dependent variables: surgical cost for each outpatient orthopedic surgery; pre- and post-operative cost one month before and after a surgical operation; and total cost for each patient. The authors also defined five independent variables, which capture healthcare facility characteristics and patient-specific factors: bed count; whether healthcare facilities are reimbursed in a diagnosis procedure combination system; patient’s age; sex; and anatomical surgical sites.

The authors analyzed 6,456 outpatient orthopedic surgical cases performed at 3,085 healthcare facilities. There were significant differences in the surgical costs for outpatient orthopedic surgery among different healthcare facilities by total beds (p=0.000). Multivariate regression analysis shows that surgical costs for outpatient orthopedic surgery are positively and significantly associated with healthcare facilities classified by total beds after adjusting for patient-specific characteristics (p<0.05).

This is the first research to examine the association between costs for outpatient orthopedic surgery and healthcare facility characteristics in Japan. This study via the multivariate regression method showed that outpatient orthopedic surgery is likely to cost higher as healthcare facility size increased. The average incremental costs for each outpatient orthopedic surgery per 100 beds were calculated at $48.5 for surgery, $40.7 for pre- and post-operative care, and $89.2 total cost.

The purpose of this paper is to explore the drivers of healthcare waste management from literature review and field survey and model these drivers for understanding the inter-relationships among the drivers to enhance healthcare waste management in the Indian context.

In view of the need of the study, the interpretive structural modelling (ISM) method has been applied to model the drivers. The ISM method helps in depicting the relationships among the drivers and filtration of drivers on the basis of their driving and dependence power.

The findings of the study reveal that the type of a healthcare facility and its management structure, size of a healthcare facility, human resource management of a healthcare facility, healthcare facility’s management monitoring and control, and the effective re-enforcement of government regulation and policy implementation in a healthcare facility play a vital role in the enhancement of HCWM.

The application of the findings of this study would enhance the hospital’s waste management by ultimately leading to a good ambience and satisfied patients and personnels. Additionally, the study would aid in the policy formulation by government and decision making of medical facilities, thereby strengthening HCWM scenario in the country.

The drivers filtered in this study would be useful for ranking the hospitals’ healthcare waste management in a region/country. This ranking may play a vital role in earmarking the hospitals which are managing their healthcare waste according to the guidelines of Central Pollution Control Board (CPCB) and Ministry of Environment and Forest (MoEF) of a country. With the help of this study, the problem of inadequate human resource can be effectively addressed for CPCB and MoEF, in India.

Healthcare waste management is a vital issue which needs attention from the management perspective in India. Therefore, an interpretive structural model, i.e. ISM digraph, has been developed which would help in the filtration of drivers and attaining the better healthcare waste management in an economically and timely manner.

The purpose of this study is to create a knowledge base for decision-making in healthcare design by seeking, analyzing and discussing the preferences of facility managers of healthcare facilities regarding floor finishes and their selection criteria. The goal is to enable a simplified and holistic selection of floor finishes based on multiple criteria. The authors studied floor finish selection in three healthcare units: emergency, surgery and in-patient units.

The authors completed a literature review to identify types of floor finishes currently used in healthcare facilities and the criteria applied for their selection. Using the literature survey results, a questionnaire was designed and administered to healthcare facility managers. The descriptive statistical analysis and the Friedman and Wilcoxon signed-ranks tests were used for reporting and analyzing the survey data.

The top five floor finishes used in the healthcare sector were identified as vinyl flooring, vinyl composite tile (VCT), rubber, linoleum and ceramic flooring. The top five selection criteria for floor finishes were durability, infection control, ease of maintenance, maintenance cost and user safety. The non-parametric test results show that the floor finish rankings and selection criteria were similar in the three healthcare units under study.

The most significant contribution of this research is to the design decision-making process of healthcare facilities. These results offer an understanding of what floor finishes are preferred by healthcare facility managers and why. This knowledge is crucial for designers and facility managers to make informed choices and floor finish manufacturers to keep their product line relevant to the industry.

The purpose of this paper is to determine the characteristics of healthcare facilities that produce the most efficient inpatient orthopedic surgery using a large-scale medical claims database in Japan.

Reimbursement claims data were obtained from April 1 through September 30, 2014. Input-oriented Banker-Charnes-Cooper model of data envelopment analysis (DEA) was employed. The decision-making unit was defined as a healthcare facility where orthopedic surgery was performed. Inputs were defined as the length of stay, the number of beds, and the total costs of expensive surgical devices. Output was defined as total surgical fees for each surgery. Efficiency scores of healthcare facilities were compared among different categories of healthcare facilities.

The efficiency scores of healthcare facilities with a diagnosis-procedure combination (DPC) reimbursement were significantly lower than those without DPC (p=0.0000). All the efficiency scores of clinics with beds were 1. Their efficiency scores were significantly higher than those of university hospitals, public hospitals, and other hospitals (p=0.0000).

This is the first research that applied DEA for orthopedic surgery in Japan. The healthcare facilities with DPC reimbursement were less efficient than those without DPC. The clinics with beds were the most efficient among all types of management bodies of healthcare facilities.

The case is particularly well suited to entrepreneurship, marketing, technology, innovation, or strategy courses.

This teaching case is aimed at postgraduate students in management or business programmes.

This case follows the Kenyan healthcare tech company Savannah Informatics as they contemplate how the company will continue to grow in a post-pandemic world. Savannah is the market leader in electronic claims validation solutions for the Kenyan healthcare system. Their flagship product, the digital platform Slade 360, allows health insurers, healthcare providers, and patients to share claims information for health services in real time, drastically reducing payment transfer times, incidents of fraud, and account errors. The Covid-19 pandemic and the subsequent lockdown mandates from the Kenyan government have reduced short-term revenues by driving down hospital visits for citizens overall, but they have also created a demand for telemedicine and more online healthcare solutions. CEO John Muthee and his co-founders are left to consider their options for growing Savannah Informatics: expanding into new markets, creating more solutions for their insurance and provider customers in Kenya, or diversifying.

Identify the key challenges facing Savannah

Analyse the organisation using the 5Cs model (company, customers, competitors, collaborators and context) and VRIO (value, rarity, imitability, and organisation) analysis

Assess the growth opportunities available to Savannah and make recommendations

Several studies have described health-seeking behaviour within the context of various diseases, the health status and age group. However, knowledge on patient health-seeking behaviour in the use of public and private hospitals and socio-demographic characteristics in developing countries is still scarce. This paper examines the influence of socio-demographic behavioural variables on health-seeking behaviour and the use of public and private health facilities in Ghana.

Quantitative research approach uses the modified SERVQUAL dimension as a data collection tool. Descriptive statistics with Pearson's chi-square test were conducted to determine the relationship between socio-demographic behavioural variables and health-seeking behaviour of patients using public and private hospitals.

The results showed that there is a significant relationship between the socio-demographic characteristics (sex, marital status, education, level of income) and the health-seeking behaviour of patients in regard to the utilisation of public and private health facilities (p < 0.000).

There is a significant relationship between patients' socio-demographic variables and their choice and utilisation of public and private healthcare services. This information is of value to policy makers so that they have an idea on the socio-demographic behavioural variables that influence patients' health-seeking behaviour.

The purpose of this paper is to introduce and discuss potential applications of emerging Building Information Model (BIM) and related technologies as applied to healthcare facilities. The paper presents example of applications of digital tools enabled by BIM that support more integrated outcomes for complex healthcare projects.

Paper formulation by a transdisciplinary author group with ideas and approaches developed through discussions and writing to explore future research directions. Initial ideas are supplemented by a literature review with examples introduced where relevant.

BIM as a front-end construction engineering tool is quite mature. Application of BIM and related tools to support complex healthcare at the precinct scale, for facilities management (FM), including improved user experience (UX) has been limited but shows great promise to support complex healthcare projects.

The research presented is limited and exploratory as it represents the first step by this group to investigate an integrated approach to digital healthcare design and FM.

The paper introduces the considerable benefits of BIM models, and related tools for FM and/or UX (both staff and patients) to save time, money and improves efficiency and accuracy in healthcare facilities.

The transdisciplinary author group brought broad perspectives to the potential benefits of combining accurate data-rich legacy building models with other digital tools for increased integration and co-ordination at all life stages of a healthcare precinct.

With ageing hospital facilities spanning the USA, the healthcare construction business continues to grow. Today, questions about replacing existing facilities are becoming more common in hospital boardrooms. Given the above situation, TriBrook Healthcare Consultants were recently retained to determine the market, operational and financial impact which facility redevelopment has had on other hospitals and health systems. Out of that effort came this paper. This paper assesses: the factors which are fuelling replacement facility growth; the impact that redevelopment has on market, operational and financial performance; an integrated development process to help organisations determine the feasibility of designing a new facility; and lessons learned working with clients who have pursued a replacement facility strategy. The objective of this effort is to provide hospital executives and board leaders with information that will be useful in reaching a final decision regarding execution of a replacement strategy.

The challenges arising from the reform of the social and healthcare sector call for efficient, effective and novel processes in both public and private health and medical care. Facilities need to be designed to suit the new processes and to offer usable workspaces at different levels of healthcare services. Along with traditional construction, modular facility innovations could be one solution to these pressures. The paper aims to discuss these issues.

This case study analyzed the different usability characteristics of the work environment in modular and non-modular healthcare facilities (HCFs). The qualitative research method was based on semi-structured interviews of employees and observations of the case buildings.

According to the results, the usability characteristics were divided into four main categories: functionality, healthiness, safety/security and comfort. The main differences between the modular and non-modular facilities appeared to be room size, soundproofing, safety issues and the utilization of colors and artwork, which were all perceived as better realized in the non-modular facilities. The staff highlighted functionality as the most important characteristic in their work environment. They even considered functionality as a feature of a comfortable work environment.

This paper presents new knowledge and a detailed description of the opinions and experiences of healthcare professionals concerning a user-centric, usable environment in the context of modular and non-modular HCFs.

The UK Government has now adopted Private Finance Initiative (PFI) as a major vehicle for the delivery of additional resources to the health sector in order to achieve a greater investment in healthcare facilities. The purpose of this paper is to examine the trends and risk assessment of the PFI in the healthcare sector.

The paper employed secondary data and interviews of key participants in two hospital PFI projects to highlight developments in healthcare PFI and the risk management of hospital projects.

The results show that the use of PFI in the provision of healthcare is increasing in terms of number, capital value and size of projects. What emerged in the healthcare PFI project was a usage of a plethora of risk management techniques, albeit to varying degrees. Experience appeared to be the prime risk assessment technique employed, while risk avoidance was first explored before pricing and allocating any residual risks. “Risk prompts”, such as using checklists and risk registers were also useful in the identification of risks. Among all participants, insurance cover and sub‐contracting appear to be the most prominent strategies employed for managing out the risks.

The negotiations that precede the signing of a healthcare PFI project contract had an impact on the final choice of facilities or their specifications. The two contracting parties sought a balance between an optimal allocation of risks, choice of facilities and project price. Although the risk management techniques being used are generic in nature, there is still no evidence at the moment to show that these are appropriate for PFI projects. It is important that further investigation is undertaken to assess the level of current skills in risk management techniques to deal with PFI projects and the extent to which these techniques are appropriate to tackle complex healthcare PFI projects.