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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 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.

Focuses on a simple question: should Zimmer develop a gender-specific artificial knee? The decision is complicated because while the idea seems to make sense, there is little clinical evidence that a gender-specific knee produces superior patient outcomes, and orthopedic surgeons are likely to be skeptical of the innovation.

To teach new product strategy and growth strategy, and introduce students to the medical device industry.

The purpose of this paper is to examine the use of fused deposition modelling (FDM) models and finite element analysis (FEA) related to dysplastic hip orthopaedic surgery.

The study involved the use of Mimics and Abaqus softwares. Mimics was used to process the CT scan patient data to STL format before producing FDM models which were for before and after surgery. FEA was done to study the two different type of implant biomaterials used in dysplastic hip surgery.

The use of FDM pre models for preplanning of dysplastic hip surgery by orthopaedic surgeons and viewing of the surgery outcome via FDM post models. Different implant biomaterials used gave different results in reduction of stresses that were achieved.

This is original work involving patients in hospital, which got ethical approval and was funded by a university grant. The paper describes a new kind of research in the university.

Developing and communicating a positioning strategy covering issues on market positioning, product lifecycle, product differentiation strategies and developing the marketing mix strategies in order to compete with competitors.

Advanced undergraduate and MBA student, taking courses of marketing management, strategic marketing, and brand management.

GranuLab is a private limited company based in Shah Alam, about 30 km from Malaysia's capital city of Kuala Lumpur; it was a producer of synthetic bone graft substitute GranuMaS. GranuMaS was launched in the Malaysian market in late 2010. At that time, the company aimed to capture 50-70 percent of the Malaysian bone graft substitute market by the end of 2015. However, by the end of 2012, GranuLab was experiencing low sales and the company had suffered a two-year loss due to manufacturing at low capacity. GranuLab also faced stiff competition from multinational competitors that had penetrated the Malaysian market earlier with competitive product offerings. The pressure to increase the sale ofGranuMaS was mounting for Mr Romli Ishak, the Managing Director of GranuLab, Mr Fadil Dalal, the new General Manager of Marketing, and GranuLab's management team. This is especially so since the company's contract to supply GranuMaS to government hospitals under the Ministry of Health (MOH) program would end soon. These situations forced the company to make a quick decision. In December 2012, Mr Romli and his team pondered upon the best strategy that the company should pursue to achieve its objective of being a dominant player in the Malaysian bone graft substitute industry. This teaching case is designed to stimulate case analysts' thinking on positioning a medical device product in a market which was already conquered by established multinational companies.

Understanding of the concept of product positioning, product lifecycle, marketing mix strategies, and social exchange theory, enables case analysts to extend the concepts to analyzing many other products and services in organizational settings.

Teaching notes are available for educators only. Please contact your library to gain login details or email support@emeraldinsight.com to request teaching notes.

A fundamental problem in articulating the societal benefits of technology transfer is the lack of hard empirical evidence on the economic gains associated with this activity. To fill this gap, we apply the framework and methods developed by Griliches and Mansfield et al. to assess the social returns to university-based inventions. This methodology can be used to derive explicit measures of key metrics, such as social rates of return and benefit-to-cost ratios characteristic of specific new technologies. A case study is used to illustrate the application of this method.

The purpose of this paper is to explore how leadership is practiced across four different hospital units.

The study is a comparative case study of four hospital units, based on detailed observations of the everyday work practices, interactions and interviews with ten interdisciplinary clinical managers.

Comparing leadership as configurations of practices across four different clinical settings, the author shows how flexible and often shared leadership practices were embedded in and central to the core clinical work in all units studied here, especially in more unpredictable work settings. Practices of symbolic work and emotional support to staff were particularly important when patients were severely ill.

Based on a study conducted with qualitative methods, these results cannot be expected to apply in all clinical settings. Future research is invited to extend the findings presented here by exploring leadership practices from a micro-level perspective in additional health care contexts: particularly the embedded and emergent nature of such practices.

This paper shows leadership practices to be primarily embedded in the clinical work and often shared across organizational or professional boundaries.

This paper demonstrated how leadership practices are embedded in the everyday work in hospital units. Moreover, the analysis shows how configurations of leadership practices varied in four different clinical settings, thus contributing with contextual accounts of leadership as practice, and suggested “configurations of practice” as a way to carve out similarities and differences in leadership practices across settings.

Rapid prototype models are directly integrated into non‐engineering applications such as medicine. Medical models are used to plan complex procedures prior to surgery with potential to optimise patient treatment in the operating theatre. This paper presents results following a 12 month National Health Service Executive research project to assess the feasibility of using rapid prototype medical models. A total of 16 medical models were created. Nine anatomical sites were reconstructed from patient data acquired from five London hospitals. The purpose of the models is described and the commissioning surgeons as part of a questionnaire assessed their usefulness. Future developments are discussed and conclusions about the use of medical models are made.

The results of introducing a new licensed local anaesthetic drug, ropivacaine, into routine practice were evaluated by measuring the efficacy and adverse effects of patient controlled epidural analgesia (PCEA), using ropivacaine 2mg/ml (R), or the mixtures in current use: fentanyl 5 (μg/ml with bupivacaine 1mg/ml (BF5) and fentanyl 10 (μg/ml) with bupivacaine 1mg/ml (BF10). All patients were nursed on general wards after surgery. For two months, 102 consecutive patients were studied. Pain scores at rest were significantly better in the fentanyl and bupivacaine groups, (mean rank R: 35.5, BF5: 22.7, BF10: 26.9, P<0.05). There was a significant correlation between patient controlled boluses and pain at rest and (p < 0.001), and pain on moving (p < 0.001). Nausea and vomiting was worse in the BF10 (p < 0.05). Older patients demanded less analgesia (p < 0.001). Postoperatively BF5 provided better pain relief with trends demonstrating fewer side‐effects and complications than BF10 or R. We now use fentanyl 5 (μg/ml and bupivacaine 1mg/ml as our standard epidural infusion mixture.

To explore the perceptions of surgical team members in a tertiary hospital in Jordan toward the factors influencing patient safety culture (PSC).

This was a qualitative descriptive study intended to characterize the factors that influence PSC. Interviews were conducted with health-care providers in the operation room (OR) in a tertiary Jordanian hospital. Participants included surgeons, anesthetists, nurses and senior surgical residents who had worked for three years minimum in the OR. Thematic analysis was used to analyze the data.

A total of 33 interviews were conducted. Thematic analysis of the content yielded four major themes: (1) operational factors, (2) organizational factors, (3) health-care professionals factors and (4) patient factors. The respondents emphasized the role of the physical layout of the OR, implementing new techniques and new equipment, and management support to establish a safety culture in the operating room setting.

The present research study will have implications for hospitals and health-care providers in Jordan for developing organizational strategies to eliminate or decrease the occurrence of adverse events and improve patient safety in the OR.