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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.

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.

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.

For this study 334 patients during their stay in the recovery room were assigned to the following groups: ‘comfortable’, in ‘pain’ and in ‘severe pain’. Fourteen per cent of patients awoke from anaesthesia in ‘pain’ and 10% were discharged to the ward in ‘pain’. Thirty‐seven per cent of patients using patient‐controlled analgesia (PCA) in the recovery room were discharged in ‘pain’; 63% of these patients had neither been prescribed nor given a ‘loading dose’ in the recovery room. Forty‐eight per cent of patients receiving sole intramuscular opioid analgesia were discharged in ‘pain’. Ninety per cent who received nurse‐administered ‘prn’ intravenous bolus opioids were discharged ‘comfortable’. An algorithm was therefore developed for the administration of loading doses of intravenous opioids in the recovery unit to be used by recovery nursing staff prior to PCA or other analgesic methods. An early re‐audit established that the algorithm became widely adopted by anaesthetists, was safe and produced comparable discharge pain scores.

The purpose of this paper is to increase efficiency in ORs without affecting quality of care by improving the workflow processes. Administrative processes independent of the surgical act can be challenging and may lead to clinical impacts such as increasing delays. The authors hypothesized that a Lean project could improve efficiency of surgical processes by reducing the length of stays in the recovery ward.

Two similar Lean projects were performed in the surgery departments of two hospitals of the Centre Hospitalier Universitaire de Québec: Hôtel Dieu de Quebec (HDQ) and Hôpital de l'Enfant Jesus (HEJ). The HDQ project designed around a Define, Measure, Analyse, Improve and Control process revision and a Kaizen workshop focused on patients who were hospitalized in a specific care unit after surgery and the HEJ project targeted patients in a post-operative ambulatory context. The recovery ward output delay was measured retrospectively before and after project.

For the HDQ Lean project, wasted time in the recovery ward was reduced by 62 minutes (68 percent reduction) between the two groups. The authors also observed an increase of about 25 percent of all admissions made in the daytime after the project compared to the time period before the project. For the HEJ Lean project, time passed in the recovery ward was reduced by 6 min (29 percent reduction).

These projects produced an improvement in the flow of the OR without targeting clinical practices in the OR itself. They demonstrated that change in administrative processes can have a great impact on the flow of clinical pathways and highlight the need for comprehensive and precise monitoring of every step of the elective surgery patient trajectory.

After knee replacement surgery, rehabilitation is needed to recover to normal levels of mobility. A continuous passive motion (CPM) machine is usually introduced at this stage to aid rehabilitation. However, the redundant structure and complex mechanism of the existing machine has resulted in irregular use. The purpose of this paper is to redesign the current machine.

The mechanical and electrical systems of the current machine were studied alongside interviews with stakeholders. Problems with the existing machine were identified. Related information was gathered in both the engineering and medical aspects. The redesign concept of the equipment was specified following engineering analyses to develop the final model. Finite element analysis was performed to ensure the appropriate size and dimension of the equipment. The prototype of the redesigned CPM was manufactured in-house. Product testing was conducted with 40 volunteers including experienced therapists, nurses, university students and working-age people.

Compared to the previous machine, the newly designed model was improved in both functioning and manufacturing costs. The redesigned machine is more durable and consists of a less complex structure.

The redesigned machine introduces some new features and removes unnecessary functions. As a result, the model costs less and hence, is considered beneficial to the general public. More utilization is expected which could eventually reduce the therapists’ workload at the hospital. This research provides well-defined processes of the product development starting from the users’ requirement analysis to the prototype testing stage.