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Leadership in Health Services, vol. 24 no. 3
Type: Research Article
ISSN: 1751-1879

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Article
Publication date: 11 March 2019

Elizabeth A. Cudney, Raja Anvesh Baru, Ivan Guardiola, Tejaswi Materla, William Cahill, Raymond Phillips, Bruce Mutter, Debra Warner and Christopher Masek

In order to provide access to care in a timely manner, it is necessary to effectively manage the allocation of limited resources. such as beds. Bed management is a key to…

Abstract

Purpose

In order to provide access to care in a timely manner, it is necessary to effectively manage the allocation of limited resources. such as beds. Bed management is a key to the effective delivery of high quality and low-cost healthcare. The purpose of this paper is to develop a discrete event simulation to assist in planning and staff scheduling decisions.

Design/methodology/approach

A discrete event simulation model was developed for a hospital system to analyze admissions, patient transfer, length of stay (LOS), waiting time and queue time. The hospital system contained 50 beds and four departments. The data used to construct the model were from five years of patient records and contained information on 23,019 patients. Each department’s performance measures were taken into consideration separately to understand and quantify the behavior of departments individually, and the hospital system as a whole. Several scenarios were analyzed to determine the impact on reducing the number of patients waiting in queue, waiting time and LOS of patients.

Findings

Using the simulation model, it was determined that reducing the bed turnover time by 1 h resulted in a statistically significant reduction in patient wait time in queue. Further, reducing the average LOS by 10 h results in statistically significant reductions in the average patient wait time and average patient queue. A comparative analysis of department also showed considerable improvements in average wait time, average number of patients in queue and average LOS with the addition of two beds.

Originality/value

This research highlights the applicability of simulation in healthcare. Through data that are often readily available in bed management tracking systems, the operational behavior of a hospital can be modeled, which enables hospital management to test the impact of changes without cost and risk.

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International Journal of Health Care Quality Assurance, vol. 32 no. 2
Type: Research Article
ISSN: 0952-6862

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Book part
Publication date: 24 October 2019

Susan P. McGrath, Emily Wells, Krystal M. McGovern, Irina Perreard, Kathleen Stewart, Dennis McGrath and George Blike

Although it is widely acknowledged that health care delivery systems are complex adaptive systems, there are gaps in understanding the application of systems engineering…

Abstract

Although it is widely acknowledged that health care delivery systems are complex adaptive systems, there are gaps in understanding the application of systems engineering approaches to systems analysis and redesign in the health care domain. Commonly employed methods, such as statistical analysis of risk factors and outcomes, are simply not adequate to robustly characterize all system requirements and facilitate reliable design of complex care delivery systems. This is especially apparent in institutional-level systems, such as patient safety programs that must mitigate the risk of infections and other complications that can occur in virtually any setting providing direct and indirect patient care. The case example presented here illustrates the application of various system engineering methods to identify requirements and intervention candidates for a critical patient safety problem known as failure to rescue. Detailed descriptions of the analysis methods and their application are presented along with specific analysis artifacts related to the failure to rescue case study. Given the prevalence of complex systems in health care, this practical and effective approach provides an important example of how systems engineering methods can effectively address the shortcomings in current health care analysis and design, where complex systems are increasingly prevalent.

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Structural Approaches to Address Issues in Patient Safety
Type: Book
ISBN: 978-1-83867-085-6

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Article
Publication date: 1 August 1997

John Øvretveit

Describes the experiences of several public hospitals which have implemented quality methods and management and lists some of the lessons they learned that could be…

Abstract

Describes the experiences of several public hospitals which have implemented quality methods and management and lists some of the lessons they learned that could be usefully adopted by other services. Asks: how do you introduce a quality programme into an organization whose employees are already empowered, and who view themselves as the sole arbiters of quality? Is a quality programme doomed if the preconditions proposed by the “quality gurus” are absent ‐ such as top management commitment and constancy of purpose? Which type of quality programme is feasible when there is no time and money for quality investment, and customer satisfaction is only one of the many determinants of organizational survival in a political environment? Concludes that generally, the hospitals which had a greater success found ways to involve different professions and adapted the methods to their particular circumstances.

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International Journal of Service Industry Management, vol. 8 no. 3
Type: Research Article
ISSN: 0956-4233

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Article
Publication date: 1 February 2003

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Business Process Management Journal, vol. 9 no. 1
Type: Research Article
ISSN: 1463-7154

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Article
Publication date: 17 October 2008

Profiles Jeff Bezos's past and future strategy at the helm of Amazon.

Abstract

Purpose

Profiles Jeff Bezos's past and future strategy at the helm of Amazon.

Design/methodology/approach

This briefing is prepared by an independent writer who adds their own impartial comments.

Findings

Back in 1995 financial analyst Jeff Bezos decided to try taking advantage of the fact internet usage was growing at the rate of 2,300 percent a year. He came up with the idea of selling books online, and thanks to investments from friends and family, he launched an online business from Seattle. He called it Amazon. Just eight years later Bezos had the wealth to seriously investigate pursuing a life‐long interest in making space tourism possible. Five years on from that, Bezos is worth an estimated $8.2 billion, head of a company that recently offered a 134.8 percent return to shareholders. But Wall Street remains wary.

Practical implications

Offers practical advice from the CEO of Amazon.

Originality/value

Focuses on Amazon and Bezos's continuously successful business philosophy.

Details

Strategic Direction, vol. 24 no. 11
Type: Research Article
ISSN: 0258-0543

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Article
Publication date: 15 February 2011

Wendy L. Currie and David J. Finnegan

This paper seeks to report the findings from a seven‐year study on the UK National Health Service on the introduction of an electronic health record for 50 million…

Abstract

Purpose

This paper seeks to report the findings from a seven‐year study on the UK National Health Service on the introduction of an electronic health record for 50 million citizens. It explores the relationship between policy and practice in the introduction of a large‐scale national ICT programme at an estimated value of £12.4bn.

Design/methodology/approach

Using a longitudinal research method, data are collected on the policy‐practice nexus. The paper applies institutional theory using a conceptual model by Tolbert and Zucker on the component processes of institutionalisation.

Findings

The findings suggest that institutional forces act as a driver and an inhibitor to introducing enabling technologies in the health‐care environment. A process analysis shows that, as electronic health records force disruptive change on clinicians, healthcare managers and patients, culturally embedded norms, values and behavioural patterns serve to impede the implementation process.

Research limitations/implications

This research is limited in its generalisability to national, regional and local ICT implementations due to the complexity of the policy and practical issues at stake. Despite the longitudinal research approach, the use of institutional theory can only offer a flavour of how institutionalised values, norms and behaviours influence health IT policy and practice.

Practical implications

The paper demonstrates the complexity of translating centralised ICT policy in healthcare to practical solutions for clinicians and other stakeholders. It shows how a large‐scale ICT programme based on procurement of technology is unlikely to succeed where important issues of user engagement and a sound “business case” have not been achieved.

Originality/value

This research contributes to the theoretical literature on institutionalism by addressing the dichotomy between institutional and technical environments. While technology is often discussed in isolation of an institutional process, it may become embedded in organisational practices, reaching a process of sedimentation (institutionalisation) or fail to take hold and fade from view.

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Journal of Enterprise Information Management, vol. 24 no. 2
Type: Research Article
ISSN: 1741-0398

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Article
Publication date: 9 September 2013

Robert Bogue

The purpose of this paper is to provide an introduction to micro-electromechanical systems (MEMS) sensors and their commercialisation and to consider a number of recent…

Abstract

Purpose

The purpose of this paper is to provide an introduction to micro-electromechanical systems (MEMS) sensors and their commercialisation and to consider a number of recent applications, markets and product developments.

Design/methodology/approach

Following an introduction and a brief historical background to MEMS sensors and their commercialisation, the paper describes a selection of recent applications, with an emphasis on high volume uses. Various market figures are included to place these applications in a commercial context. Sensors for both physical variables and gases are considered.

Findings

The paper shows that MEMS sensor applications continue to grow in the automotive, consumer electronics and other industries, which consume many millions of sensors annually. New product developments reflect the requirement for smaller and lower-cost sensors with enhanced performance and greater functionality. Markets for physical sensors dominate but MEMS technology is making progressive inroads in the gas sensing field.

Originality/value

This article provides a timely review of a selection of recent MEMS sensor applications, markets and product developments.

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Article
Publication date: 2 August 2013

Margaret Flynn and Vic Citarella

This paper concerns the fall‐out from a TV programme which exposed the arbitrariness of cruelty at a private hospital that purported to provide assessment, treatment and…

Abstract

Purpose

This paper concerns the fall‐out from a TV programme which exposed the arbitrariness of cruelty at a private hospital that purported to provide assessment, treatment and rehabilitation to adults with learning disabilities, autism and mental health problems. The paper seeks to address the issues involved.

Design/methodology/approach

It describes the principal findings of a Serious Case Review which was commissioned after the TV broadcast, and outlines some of the activities designed to reduce the likelihood of such abuses recurring.

Findings

From policy, commissioning, regulation, management, service design and practice perspectives, events at Winterbourne View Hospital highlight a gulf between professionals, professionals and their organisations, and leadership shortcomings.

Originality/value

The English government responded promptly and encouragingly to the wretched circumstances of patients at Winterbourne View Hospital with a “Timetable of Actions”. The Serious Case Review which was commissioned after the TV broadcast contributed to the growing scepticism of “out of sight, out of mind” placements. It covered wide‐ranging territory.

Details

The Journal of Adult Protection, vol. 15 no. 4
Type: Research Article
ISSN: 1466-8203

Keywords

Content available

Abstract

Details

International Journal of Pharmaceutical and Healthcare Marketing, vol. 5 no. 4
Type: Research Article
ISSN: 1750-6123

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