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Book part

Maria Cristina Longo

The research analyzes good practices in health care “management experimentation models,” which fall within the broader range of the integrative public–private partnerships…

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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Article

John A. Piper, Barry Muir, Allister Stewart and John Willetts

Effective strategic analysis of existing and potential services requires a framework which is relevant and understandable to both clinicians and senior managers. Our work…

Abstract

Effective strategic analysis of existing and potential services requires a framework which is relevant and understandable to both clinicians and senior managers. Our work with NHS trusts has developed a framework based on analysis of services into four principal service streams ‐ emergency general hospital, non‐emergency general hospital, specialist general hospital and tertiary. Relating service streams to clinical specialties provides a matrix which can provide a basis for an initial analysis of the current and prospective clinical services portfolio, allowing drilling down into the detail and back up to the overall picture. Portfolio effectiveness is assessed by considering overall viability consisting of three interrelated elements ‐ clinical, market and financial viability. The inter‐relationship of service streams, clinical specialties and viability allows the trust board and key clinicians to share insights into the current and potential systemic linkages between these three elements and to develop a vision of future strategic direction.

Details

Health Manpower Management, vol. 23 no. 5
Type: Research Article
ISSN: 0955-2065

Keywords

Content available

Abstract

Details

International Journal of Health Care Quality Assurance, vol. 26 no. 8
Type: Research Article
ISSN: 0952-6862

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Article

Maria Crema and Chiara Verbano

The purpose of this paper is to describe the Italian state of art of Health Lean Management (HLM) and to analyze the Italian projects that connect this approach with…

Abstract

Purpose

The purpose of this paper is to describe the Italian state of art of Health Lean Management (HLM) and to analyze the Italian projects that connect this approach with clinical risk management (CRM).

Design/methodology/approach

After introducing Italian healthcare system and its main challenges, relevant Italian experiences have been searched investigating regional health plans (RHPs), managerial reports, books, workshops, conference proceedings and hospital web sites. The degree of experience of each Italian region has been first studied. Further, field of applicability, objectives, tools, practices and results of the projects with first signs of HLM and CRM integration have been analyzed.

Findings

Although interest in new managerial approaches is spreading in almost all the territory and new managerial solutions are fostered in many RHPs, HLM projects are implemented patchy in Italy. For what regards HLM projects with CRM connections, the Italian context seems aligned with the international one, apart from few features. First indications for the implementation of HLM projects with CRM connections emerged.

Originality/value

Healthcare systems are facing multiple challenges in a context where public funds decrease but quality of care must be guaranteed. Combining different managerial approaches could solve these issues. In this research, for the first time, a map about Italian HLM adoption has been drawn, and Italian HLM projects with CRM connections have been analyzed. The results constitute one of the first contributions useful to develop guidelines for the implementation of projects pursuing efficiency, quality and safety objectives.

Details

Business Process Management Journal, vol. 21 no. 5
Type: Research Article
ISSN: 1463-7154

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Case study

Julie Hennessy

Dr. Juan Caicedo was educated in general medicine and surgery at Universidad Nacional de Colombia and practiced transplant medicine in Bogota. He determined that he would…

Abstract

Dr. Juan Caicedo was educated in general medicine and surgery at Universidad Nacional de Colombia and practiced transplant medicine in Bogota. He determined that he would need to go to the United States to advance his training, and ultimately was awarded a fellowship in transplant surgery at Northwestern Memorial Hospital.

During his three years as a fellow, Caicedo was struck by the number of Hispanic patients on the kidney transplant waiting list. Not only were Hispanics the highest growth group on the transplant waiting list, they also waited longer for transplants and died while waiting at higher rates than non-Hispanic whites or African-Americans. Caicedo also was alarmed by Hispanic patients' lower utilization of living donors for transplantation they were underrepresented not only as live donor transplant patients, but also as donors.

As he neared the end of his fellowship in 2006, Caicedo wondered if the Hispanic population encountered unique barriers to transplantation and living donor usage, and began to think about creating a program to address these barriers.

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Article

Geoffrey C. Williams, Marylène Gagné, Alvin I. Mushlin and Edward L. Deci

To assess the effect of diagnostic testing for coronary artery disease (CAD) on motivation for change, and on lifestyle change for patients with chest pain.

Abstract

Purpose

To assess the effect of diagnostic testing for coronary artery disease (CAD) on motivation for change, and on lifestyle change for patients with chest pain.

Design/methodology/approach

This observational study followed patients with chest pain suggestive of CAD for three years. Constructs of autonomous and controlled motivation for lifestyle change, autonomous orientation, and autonomy support from self‐determination theory were assessed. Self‐reported tobacco use, physical activity, and diet were assessed at baseline and three years later. Physician rating of pre‐ and post‐test probability of CAD were also assessed. CAD diagnosis was established after three years.

Findings

Physicians' autonomy‐supportive style and patients' autonomous orientations both predicted greater patient autonomous motivation, which in turn predicted improved diet, more exercise, and marginally less smoking. High probability of CAD also led patients to become more autonomously motivated for lifestyle change.

Research limitations/implications

The observational nature of the study and the self‐report measures of health behaviors preclude causal conclusions from this study. Findings from this study suggest that patient motivation and risk behavior are affected by results of cardiac testing, by physicians' support of autonomy, and by patients' personalities.

Practical implications

Physicians may be effective in motivating behavior change around time of testing for CAD.

Originality/value

The self‐determination theory model for health behavior change accounted for change in patient health risk behavior change around the time of testing for CAD. Physicians and researchers might use these results to design and test interventions for practitioners to effectively motivate behavior change around the time of medical tests.

Details

Health Education, vol. 105 no. 4
Type: Research Article
ISSN: 0965-4283

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Article

Anita Medhekar, Ho Yin Wong and John Edward Hall

The purpose of this paper is to explore the demand-side factors that influence the inbound medical tourists’ (MTs) decision to travel abroad for medical treatment/surgery.

Abstract

Purpose

The purpose of this paper is to explore the demand-side factors that influence the inbound medical tourists’ (MTs) decision to travel abroad for medical treatment/surgery.

Design/methodology/approach

The researchers conducted thematic analysis of in-depth interviews in India with 24 foreign MTs’ to generate the themes, identify factors and propose a model with hypothesis for future quantitative survey.

Findings

The findings conclude that patients ranked in ascending order less waiting time for surgery, healthcare quality and accreditation, staff/surgeons expertise, healthcare information, hospital facilities and services, patient safety, travel risk, surgical costs and holiday opportunity as important factors that influence the decision to travel abroad for medical treatment/surgery.

Research limitations/implications

Foreign patients from six private hospitals were willing to be interviewed with the permission of the hospital. Due to confidentiality and privacy policy, many hospitals declined interviews with foreign patients.

Practical implications

The findings are generalised in case of foreign patients as MTs and all private hospitals treating foreign patients in India and other global healthcare destinations. Policy implications suggest that private hospitals in developing countries need to provide first-class quality of healthcare as foreign patients look for internationally accredited quality, no waiting time, patient safety, qualified and experienced surgeons, healthcare workers education and experience hospital facilities and post-surgery care with positive healthcare outcomes.

Originality/value

There is little empirical research on the views of inbound MTs, about factors influencing their decision to travel abroad for surgery to India.

Details

Journal of Health Organization and Management, vol. 33 no. 2
Type: Research Article
ISSN: 1477-7266

Keywords

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Abstract

Details

Latino College Presidents: In Their Own Words
Type: Book
ISBN: 978-1-78350-142-7

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Article

Joy Mekechuk

Strong evidence exists that compliance with the treatment regimen is a major problem for many transplant patients. Noncompliance with the treatment regimen is particularly…

Abstract

Strong evidence exists that compliance with the treatment regimen is a major problem for many transplant patients. Noncompliance with the treatment regimen is particularly evident among kidney‐transplanted adolescents. Research has not examined the adolescents' experience of living with a kidney transplant. Provides a review of the literature seeking to explain the causes of noncompliance in the population group. Although the studies referred to here provide insights into the situation, many lack reliability and validity because of methodological limitations. They also point to a gap in understanding the condition from the point of view of the adolescent. A more useful approach, therefore, is to use a qualitative research methodology. Such an approach has been shown to be useful in a study of diabetic adolescents, and offers promise for the greater understanding of kidney‐transplanted adolescents and the impact the medical regimen has on them. With improved understanding comes the ability of health practitioners to better meet their needs in terms of improving the quality of their post‐operative lives.

Details

Leadership in Health Services, vol. 17 no. 3
Type: Research Article
ISSN: 1366-0756

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Article

William Barnett and Michael Saliba

There is a significant body of literature explaining how a free market for kidneys would eliminate both the economic and the medical shortage of kidneys and thus, in…

Abstract

There is a significant body of literature explaining how a free market for kidneys would eliminate both the economic and the medical shortage of kidneys and thus, in addition to supplying sufficient kidneys for those who become needy in the future, remove the entire backlog of 40,000+ patients waiting for a kidney transplant in the United States. This article is an attempt to fathom the financial and market processes that would evolve were a free market for kidneys to be permitted. Issues addressed include the types of institutions that would likely develop, how transactions would be facilitated, and what would happen to the price of kidneys both in the short and long term.

Details

Managerial Finance, vol. 30 no. 2
Type: Research Article
ISSN: 0307-4358

Keywords

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