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1 – 10 of 14The research analyzes good practices in health care “management experimentation models,” which fall within the broader range of the integrative public–private partnerships (PPPs)…
Abstract
Purpose
The research analyzes good practices in health care “management experimentation models,” which fall within the broader range of the integrative public–private partnerships (PPPs). Introduced by the Italian National Healthcare System in 1991, the “management experimentation models” are based on a public governance system mixed with a private management approach, a patient-centric orientation, a shared financial risk, and payment mechanisms correlated with clinical outcomes, quality, and cost-savings. This model makes public hospitals more competitive and efficient without affecting the principles of universal coverage, solidarity, and equity of access, but requires higher financial responsibility for managers and more flexibility in operations.
Methodology/approach
In Italy the experience of such experimental models is limited but successful. The study adopts the case study methodology and refers to the international collaboration started in 1997 between two Italian hospitals and the University of Pittsburgh Medical Center (UPMC – Pennsylvania, USA) in the field of organ transplants and biomedical advanced therapies.
Findings
The research allows identifying what constitutes good management practices and factors associated with higher clinical performance. Thus, it allows to understand whether and how the management experimentation model can be implemented on a broader basis, both nationwide and internationally. However, the implementation of integrative PPPs requires strategic, cultural, and managerial changes in the way in which a hospital operates; these transformations are not always sustainable.
Originality/value
The recognition of ISMETT’s good management practices is useful for competitive benchmarking among hospitals specialized in organ transplants and for its insights on the strategies concerning the governance reorganization in the hospital setting. Findings can be used in the future for analyzing the cross-country differences in productivity among well-managed public hospitals.
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Susan Moffatt-Bruce, Ann Scheck McAlearney, Alison Aldrich, Tina Latimer and Edmund Funai
Clinical front-line staff are best positioned within the organizations to identify patient safety problems and craft solutions. However, in traditional models, safety committees…
Abstract
Purpose
Clinical front-line staff are best positioned within the organizations to identify patient safety problems and craft solutions. However, in traditional models, safety committees are led by senior executives who are not clinically responsible for patients. This top-down approach can result in missed opportunities to address patient-centered challenges and better manage the health of the defined populations served by these organizations.
Design/methodology/approach
To foster teamwork, enhance empowerment, and improve the patient care environment, Operations Councils led by trained front-line staff were deployed in 15 clinical areas at the Ohio State University Wexner Medical Center (OSUWMC) as a performance improvement tool.
Findings
Standardized training of Council facilitators was designed and implemented to guide the performance improvement process. Balanced scorecards were developed in each Council based on the risks and concerns of that particular clinical area. After initial implementation of the Operations Councils, patient safety events declined and team engagement improved by over 34% across the medical center; the highest changes were seen in areas where Operations Councils had been deployed. Additionally, outcome metrics including area-specific and system-wide mortality and readmissions improved after implementation.
Originality/value
We suggest that this type of approach may be an appropriate strategy to consider in other health care organizations as such institutions are challenged to better manage the health of their defined patient populations.
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Ethan W. Gossett and P. D. Harms
Acute and chronic pain affects more Americans than heart disease, diabetes, and cancer combined. Conservative estimates suggest the total economic cost of pain in the United…
Abstract
Acute and chronic pain affects more Americans than heart disease, diabetes, and cancer combined. Conservative estimates suggest the total economic cost of pain in the United States is $600 billion, and more than half of this cost is due to lost productivity, such as absenteeism, presenteeism, and turnover. In addition, an escalating opioid epidemic in the United States and abroad spurred by a lack of safe and effective pain management has magnified challenges to address pain in the workforce, particularly the military. Thus, it is imperative to investigate the organizational antecedents and consequences of pain and prescription opioid misuse (POM). This chapter provides a brief introduction to pain processing and the biopsychosocial model of pain, emphasizing the relationship between stress, emotional well-being, and pain in the military workforce. We review personal and organizational risk and protective factors for pain, such as post-traumatic stress disorder, optimism, perceived organizational support, and job strain. Further, we discuss the potential adverse impact of pain on organizational outcomes, the rise of POM in military personnel, and risk factors for POM in civilian and military populations. Lastly, we propose potential organizational interventions to mitigate pain and provide the future directions for work, stress, and pain research.
Sarp Tahsin Kumlu, Emre Samancıoğlu and Emrah Özkul
The change in the technological environment within the macro-environment factors in recent years affects states, businesses, societies and individuals and concerns not only…
Abstract
The change in the technological environment within the macro-environment factors in recent years affects states, businesses, societies and individuals and concerns not only technology-based sectors but also many fields. In particular, trends such as artificial intelligence, metaverse, robotics, advanced connectivity, the Internet of Things, big data, small data, blockchain, cloud technologies and reality technologies, which are called new technology, are developing very quickly compared to the past and expanding their global usage areas. Creating strategies and policies without considering these factors creates problems in many areas. These problems are marketing, competition, cost, efficiency and productivity.
Reality technologies, which are the research area in this chapter and enable users to interact with the digital world, have a wide application area in the tourism industry. With technological tools such as smartphones and virtual reality (VR) glasses; personalisation, interactive experience, information gathering and decision-making; many different solutions are produced in areas such as education, service and security. Along with its many advantages, the disadvantages of reality technologies and the negative outputs of this transformation are significant for the understanding and future of the subject.
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James F. Burgess and Jr.
Research on hospital productivity has progressed over the last few decades considerably from early models where measurements of hospital services simply counted inpatient days…
Abstract
Research on hospital productivity has progressed over the last few decades considerably from early models where measurements of hospital services simply counted inpatient days, and perhaps outpatient visits or numbers of surgeries performed. This simplicity represents an extreme of aggregation, focuses the attention of the analysis entirely on the structure of the organization at the highest levels, and provides no insight into the specific services that might be provided to each patient as well as the characteristics of those patients, which might lead to specialization of their care. This process is fundamentally complex, which makes it especially difficult to model. This table-setting chapter will characterize some of the key contextual choices that must be made by researchers in this field which are then applied in subsequent chapters. The key point of this chapter will be to argue that there are very few “one size fits all” decisions in this process and thus the context of particular research objectives and questions will determine how modeling choices are made in practice. Some intuition about how these decisions have substantial implications for outcomes of measurement for hospital productivity will be provided; however, no attempt will be made to conduct a literature review of all the choices that have been made. Instead, we will suggest that new careful attention to the choices made can make future studies more effective in communicating to the communities implementing the research.
Irina Farquhar, Michael Kane, Alan Sorkin and Kent H. Summers
This chapter proposes an optimized innovative information technology as a means for achieving operational functionalities of real-time portable electronic health records, system…
Abstract
This chapter proposes an optimized innovative information technology as a means for achieving operational functionalities of real-time portable electronic health records, system interoperability, longitudinal health-risks research cohort and surveillance of adverse events infrastructure, and clinical, genome regions – disease and interventional prevention infrastructure. In application to the Dod-VA (Department of Defense and Veteran's Administration) health information systems, the proposed modernization can be carried out as an “add-on” expansion (estimated at $288 million in constant dollars) or as a “stand-alone” innovative information technology system (estimated at $489.7 million), and either solution will prototype an infrastructure for nation-wide health information systems interoperability, portable real-time electronic health records (EHRs), adverse events surveillance, and interventional prevention based on targeted single nucleotide polymorphisms (SNPs) discovery.
This chapter presents findings of ethnographic work in a neuro-oncology clinic in Israel. It is claimed that patients, close-ones and physicians engage in creating metaphorical…
Abstract
This chapter presents findings of ethnographic work in a neuro-oncology clinic in Israel. It is claimed that patients, close-ones and physicians engage in creating metaphorical visions of the brain and brain tumours that reaffirm Cartesian dualism. The ‘brain talk’ involved visible and spatial terms and results in a particular kind of objectification of the organ of the self. The overbearing presence of visual media (i.e., magnetic resonance imaging, computed tomography, angiographic studies) further gave rise to particular forms of interactions with patients and physicians where the ‘imageable’ (i.e., the image on the screen) became the ‘imaginable’ (i.e., the metaphor). The images mostly referred to a domain of mundane objects: a meatball in a dish of spaghetti, a topping of olives over a pizza, the surface of the moon, a stone, an egg, an animal, a dark cloud. Furthermore, conversations with family members showed that formal facts and informed compassion were substituted by concrete representations. For them, and especially for the patient, these representations redefined an ungraspable situation, where a tumour – an object – can so easily affect the organ of their subjectivity, into something comprehensible through the materialistic, often mechanistic actions of most mundane objects. This, however, also created alienated objects within the boundaries of their own embodied selves. Patients, on the one hand, did not reject their own sense of ‘own-ness’, of having a lifeworld (lebenswelt) as subjective agents, but on the other, did talk about their own interiors as being an ‘other’: an object visible, observable and imaginable from a third-person standpoint – a standpoint drawing its authority from biomedical epistemology and practice.