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Higher caseloads are associated with better outcomes for many conditions treated in secondary and tertiary care settings, including colorectal cancer (CRC). There is little known whether such volume-outcome relationship exist in primary care settings. The purpose of this paper is to examine general practitioner (GP) CRC-specific caseload for possible associations with referral pathways, disease stage and CRC patients’ overall survival.

The paper retrospectively analyses a prospectively maintained CRC database for 2009-2014 in a single district hospital providing bowel cancer screening and tertiary rectal cancer services.

Of 1,145 CRC patients, 937 (81.8 per cent) were diagnosed as symptomatic cancers. In total, 210 GPs from 44 practices were stratified according to their CRC caseload over the study period into low volume (LV, 1-4); medium volume (MV, 5-7); and high volume (HV, 8-21 cases). Emergency presentation (LV: 49/287 (17.1 per cent); MV: 75/264 (28.4 per cent); HV: 105/386 (27.2 per cent); p=0.007) and advanced disease at presentation (LV: 84/287 (29.3 per cent); MV: 94/264 (35.6 per cent); HV: 144/386 (37.3 per cent); p=0.034) was more common amongst HV GPs. Three-year mortality risk was significantly higher for HV GPs (MV: (hazard ratio) HR 1.185 (confidence interval=0.897-1.566), p=0.231, and HV: HR 1.366 (CI=1.061-1.759), p=0.016), but adjustment for emergency presentation and advanced disease largely accounted for this difference. There was some evidence that HV GPs used elective cancer pathways less frequently (LV: 166/287 (57.8 per cent); MV: 130/264 (49.2 per cent); HV: 182/386 (47.2 per cent); p=0.007) and more selectively (CRC/referrals: LV: 166/2,743 (6.1 per cent); MV: 130/2,321 (5.6 per cent); HV: 182/2,508 (7.3 per cent); p=0.048).

Higher GP CRC caseload in primary care may be associated with advanced disease and poorer survival; more work is required to determine the reasons and to develop targeted intervention at local level to improve elective referral rates.

The Kennedy Report will almost certainly become a defining moment in the history of UK healthcare. On the whole the NHS is poor at learning from history and there is a wealth of important information to be drawn from the report and the whole experience of Bristol. This article distils the essential clinical governance messages that risk being lost. While many of the issues can be viewed from an economic perspective, much of what is required is a change in attitude across whole health economies. The contribution that economics can make is to design appropriate incentive mechanisms to bring about desired behavioural change. It can also continue to promote informed debate on the proper meaning of efficiency and to highlight the features required for an appropriate and effective regulatory framework.

The purpose of this paper is to examine the impact of volume flexible strategies on organizational performance in academic medical centers (AMCs). Volume flexible strategies represent a variety of methods where organizations use their portfolio of resources and capabilities to meet fluctuating customer demand while improving organizational performance.

A path model is developed and tested based on a survey of AMCs in the USA as listed in the American hospital directory.

The results indicate that desired levels of volume flexibility have a positive impact on organizational capabilities that in turn, positively influence how internal sources of volume flexibility are leveraged. In addition, volume flexible capability and the use of internal strategies were found to have a positive influence on customer‐related performance that in turn, positively impacts financial and market share performance.

This research was exploratory in nature and limited to a sample of AMCs. To improve the generalizability of these results, future studies should evaluate these constructs using a larger sample of health care organizations.

The deployment and use of volume flexible strategies is germane to any health care organization's strategy and performance. This study offers some guidance to administrators who need both a clear understanding of the underlying tradeoffs involved in deploying these strategies and a prescriptive model to help guide their use.

This work answers the recent calls for more empirical research in general, and specifically, for more operations strategy research on flexibility in service industries. It should assist future researchers who focus on flexibility in health care services and would also be of interest to practitioners interested in keeping up with academic literature.

Measuring attitudes of healthcare providers and managers toward change in health care organizations (HCOs) has been of widespread interest. The purpose of this paper is to evaluate the psychometric characteristics and usability of an abbreviated German version of the Change Attitude Scale.

The Change Attitude Scale was used in a survey of healthcare providers and managers in German hospitals after the implementation of a breast cancer center concept. Reliability analysis, confirmatory factor analysis, structural equation modeling and bivariate analysis were conducted.

Data from 191 key persons in 82 hospitals were analyzed. The item-scale structure produced an acceptable model fit. Convergent validity was shown by significant correlations with measures of individuals’ general opinions of the breast center concept. A non-significant correlation with a scale measuring the hospital’s hierarchical structure of leadership verified discriminant validity. The interaction of key persons’ change attitude and hospitals’ change performance through change culture as a mediator supported the predictive validity.

The study found general support for the validity and usability of a short version of the German Change Attitude Scale.

Since attitudes toward change influence successful implementation, the survey may be used to tailor the design of implementation programs and to create a sustainable culture of high readiness for change.

This is the first study finding that a short instrument can be used to measure attitudes toward change among healthcare providers and managers in HCOs.

This study investigates the stability of the “hospital effect” on performance over time by administrative health data as a source of evidence. Using 78,907 heart failure adult records from 117 hospitals in the Lombardy Region (Northern Italy) over three years (2010–2012), we analyzed hospital performance in terms of 30-day mortality and 30-day unplanned readmissions to gather evidence about the stability of the “hospital effect.” Best/worst performers were identified through multi-level models that combine both patient and hospital covariates. Our results confirm that managerial choices affect hospital performance, and that the “hospital effect” is not, contrary to expectations, stable over the short term. Performance improvement/worsening over the three years has been also analyzed.

The use of hospitalists in the care of in‐patients is a relatively new phenomenon in the USA – hospitalists are delivering medical care to patients in private practice, public hospitals, and academic medical centers. Several obstacles hinder understanding of the characteristics of academic medical center‐based hospitalists. These include differences in definitions and nomenclature, differences in job descriptions, roles and administration across hospitalist programs, and in qualifications and credentialing of hospitalists versus other physicians. These differences derive from the heterogeneity of AMCs by bed size, level of local and regional competition, and cultural, utilization and referral patterns. The field needs an agreed definition of the term “hospitalist”. Assuming a good definition, one could take advantage of already good descriptive data on AMCs to quantify hospitalists within AMCs and to study how hospitalist programs vary by AMC characteristics.

Examines health‐care restructuring activities undertaken across North American hospitals over the past decade related to hospital care by nursing professionals (i.e. hospital nurses versus practical nurses or aides). Identifies fundamental lessons learned and highlights important priority research areas that must be undertaken to ensure that future initiatives achieve the intended effect of improving patient outcomes.

The purpose of this paper is to examine empirically how operational performance and contextual factors contribute to differences in overall patient care costs across different hospitals.

Administrative data are employed from a sample of hospitals in New York State to construct measures of contextual factors, operational performance, and cost per patient. Operational performance and cost variables are adjusted to account for case mix differences across hospitals. Hierarchical regression is used to analyze the effects of contextual and operational variables on cost performance.

Increased length of stay, increased patient volume, and educational mission were associated with higher cost per patient. Mortality performance was associated with lower cost per patient. However, it was not found that location, size, or ownership status had a significant relationship with cost performance.

This paper identifies several significant relationships between contextual and operational variables and hospital costs. From a managerial perspective, these findings highlight the fact that some drivers of cost in hospitals are under the control of managers. One of the primary cost drivers in the study is length of stay, which implies that there is significant room for improvement in healthcare performance through a focus on operational excellence.

For researchers, the present study highlights the relative importance of operational versus contextual factors, with respect to cost performance in hospitals. The results of this study also provide direction for additional research into the role operational performance might play in determining the overall organizational performance in a hospital.

The purpose of this paper is to understand how buyers and suppliers in supply chains learn to align their performance objectives and incentives through contracting.

Two longitudinal case studies of the process of supply chain alignment were conducted based on 26 semi-structured interviews and 25 key documents including drafts of contracts and service level agreements.

The dynamic interplay of contracting and learning contributes to supply chain alignment. Exchange-, partner- and contract framing-specific learning that accumulates during the contracting process is used to (re)design pay-for-performance provisions. Such learning also results in improved buyer-supplier relationships that enable alignment, complementing the effect of contractual incentives.

The study demonstrates that the interplay of contracting and learning is an important means of achieving supply chain alignment. Supply chain alignment is seen as a process, rather than as a state. It does not happen automatically or instantaneously, nor is it unidirectional. Rather, it is a discontinuous process triggered by episodic events that requires interactive work and learning.

Development of performance contracting capabilities entails learning how to refine performance incentives and their framing to trigger positive responses from supply chain counterparts.

The paper addresses supply chain alignment as a process. Accordingly, it stresses some important features of supply chain alignment.

The purpose of this paper is to analyze how specialization in hospitals affects operational performance, measured by the length of stay and readmission rate. The authors assess a public policy change in the Danish healthcare sector from 2011 which required that some hospital services had to be centralized leading to specialization within the merged departments.

Taking an institutional theory perspective, the authors conduct a natural experiment. The data include 24,694 observations of urological patient treatments from 2010 to 2012.

The econometric difference-in-difference analysis finds that the readmission rate decreases by approximately four percentage points in the departments affected by the policy change. Contrary to expectations, the length of stay increases by 0.38 days. The authors complement the natural experiment with a mixed-methods approach that includes proprietary data from the management control system of the hospital, public documentation on the policy change, as well as interviews with key informants. These data suggest that operational deficiency is related to the fact that specialization was externally enforced through the public policy change. The authors illustrate how the hospital staff struggle for legitimacy after this policy change, and how cost savings obstructed the specialized department in achieving its goals.

The authors conclude that the usual economies-of-scales-based logic of (higher)volume-(better)outcome studies cannot easily be transferred to specialization in hospitals, unless one accounts for the institutional reason of the specialization.