Hospital capacity planning for disaster emergency management

Hospitals are an integral part of a society's critical functions designed to respond to man-made and natural disasters. Effective hospital capacity planning can significantly enhance the capability and effectiveness of treatment for emergency patients with injuries resulting from a disaster. Such information can be used for patient/ambulance routing, resource planning, and emergency operations management. In the current paper, we develop a generic simulation model that is capable of representing the operations of a wide range of hospitals given an earthquake disaster situation. Using results from our simulations, generalized regression equations are fitted to obtain steady-state hospital capacities. A parametric metamodel is then developed to predict transient capacity for multiple hospitals in the disaster area in a timely manner, as demanded by emergency operations management for guiding the routing and treatment of injured people.     

A decision support system to improve the efficiency of resource allocation in healthcare management

Limitations in healthcare funding require hospitals to find more effective ways to utilize resources. An effective patient management system is critically dependent on the accurate analysis of individual patient outcomes and resource utilization. In the current paper, a management-oriented decision support model is thus proposed to assist health system managers in improving the efficiency of their systems. In the first stage of the model, the key variables affecting system efficiency, as well as their causal relationships, are identified through causal maps. Efficiency is measured by the total time spent in the system. In the second stage, a Bayesian Belief Network (BBN) is employed to represent both the conditional dependencies and uncertainties of the key variables. In the third stage, a sensitivity analysis is performed using a BBN to determine the most critical variable(s) in terms of impact on the system. Finally, strategies to improve system efficiency are proposed. The suggested decision support system is applied to the tomography section in the radiology department of a private hospital in Turkey.     

Ownership effects on operating strategies: Evidence of expense-preference behavior in the hospital industry

Expense preference offers an alternative to profit-maximization theory in explaining firms' operating strategies (Williamson, 1963; Rees, 1974). Expense-preference theory suggests that when disctretionary behavior is allowed, corporate managers may choose to maximize individual utility instead of corporate profit. Expense-preference behavior tends to be evidenced by higher expenditures on items for which managers have a positive personal preference than would be justified by profit maximization. Conditions under which significant managerial discretion can emerge include weak competition, strictly controlled entry, a high degree of regulation, separation of ownership and control, and existence of a strong public interest character for the firm or industry (Awh and Primeaux, 1985; Edwards, 1977). The hospital industry may be characterized as operating under all the above conditions. Hospital ownership can be classified as being either not-for-profit or proprietary. Profit-maximization influences are generally not present in not-for-profit hospitals, thus further increasing managerial discretion with respect to operating expenses. This study provides support for the contention that expense-preference behavior exists in not-for-profit hospitals as compared to proprietary hospitals. Specifically, we present evidence of considerable managerial discretion in the allocation of resources in not-for-profit hospitals.     

医院个性化关怀电子商务整体解决方案——以民营医院为例

病人是医院的命脉,只有赢得客户,才能赢得未来。病人就诊,除了关心医院本身的医疗实力,考虑最多,最影响决策的因素,就是医院的服务了。很显然,病人的需求在人满为患的公立医院是无法实现的。本文从电子商务的内涵及发展出发,分析了当今民营医院发展的处境和遇到的问题,并指出了在电子商务发展时代,加强客户关系管理是解决民营医院实际问题的最佳途径;本文还重点提出了民营医院个性化关怀通过电子商务实现的解决方式和发展策略。     

Public-private partnerships in health care services: Do they outperform public hospitals regarding quality and access? Evidence from Portugal

Public-private partnerships (PPPs) are widely spread long-term arrangements between governments and strategic private partner(s). One of their objectives is to reduce the financial pressure on the public treasury with regard to new investments. PPPs have been employed within the health care sector which, in turn, carries a huge social burden. In Portugal, for instance, PPPs in health care concern bundling hospital infrastructure and clinical services management. Notwithstanding the need to ensure sustainability and efficient use of hospital resources, it is clearly compulsory to guarantee that patients receive appropriate and timely care, with maximum security, and equitable manner. Still, little or even no attention has been paid in the literature to the clinical response capacity of PPP hospitals and to the populism arguing that these entities have a lower social performance than typical public hospitals. This study uses robust benchmarking methodologies alongside recent data about Portuguese hospitals (FY2012-FY2017) to demystify this idea and to demonstrate that, actually, PPP hospitals can deliver health care services with social performance levels at least as good as public hospitals.     

Accidental,unprepared, and unsupported: clinical nurses becoming managers

To what extent have hospitals developed their skilled clinicians to perform the administrative and human resources (HR) manager role of the ward manager? We consider this research question through an analysis of an acute hospital called ‘The Hospital’ where the executive team is aiming to adopt a form of high-performance work system (HPWS). We focus primarily on explanations in terms of conditions, rather than the personalities of individual managers, which are most powerful in shaping their behaviour. There has long been a failure of hospitals (and other employing organisations) to develop fully the skills required by employees before they become line managers. Line managers are a critical link in the high-performance chain and this study illustrates that, despite their rhetoric, hospitals may still have much potential for implementing schemes to develop nurses further to prepare them for line-manager positions and to support them after they move into such roles. We infer from this study that such hospitals may not yet have completed the journey to having HPWS. Hence, there is still much scope for such hospitals to progress and enjoy the benefits that proponents claim for HPWS.     

民营医院构建虚拟团队的可行性实证研究

人才问题是民营医院发展的瓶颈,随着虚拟团队理论的成熟,借鉴已有的远程诊疗技术的发展,民营医院可以考虑构建自己的虚拟团队,实现人才资源的共享。本文就民营医院构建虚拟团队的可行性进行了实证研究,通过对四个不同区域的民营医院的实际调查,分析不同类型的医疗成员对于民营医院构建虚拟团队的认识,得出民营医院构建虚拟团队是可行的,为民营医院管理者提供决策依据。     

有关医院信息系统集成平台建设的目的及效果探究

医院在信息技术高速发展的过程中,考虑到新时期对医院提出的要求,搭建信息系统平台,提高各项服务的管理效率。但是医院当下在信息系统建设方面仍存在不足之处,不同医院的信息建设速度不同,信息系统质量存在明显的差异、信息系统平台建设表现不足、没有规范科学的建设标准等,此类问题的存在影响到信息系统整合性的发展,使得资源无法得到合理的应用,造成严重的资源浪费,降低医院医疗服务水平。鉴于社会对医院服务工作提出的要求,医院必须根据实际需求搭建信息系统集成平台,以构建安全、灵活、高效的集成平台为工作首要目标,提出构建信息系统集成平台的建议,希望对医院信息化建设有一定的帮助。     

Regional hospital needs projection: An input-output approach

Steeply rising medical costs and the inadequacies of health care for the needy have recently stirred up unprecedented concern over the health industry in this country. In order to achieve more efficient allocation of medical resources and, hence, more equitable distribution of medical services, regional planning and regulatory authorities have been established and periodically reorganized in the health field in this country. This paper develops a systematic input-output model utilizing a clinical approach to project the impatient services needed for a given population by age, sex, residence and medical specialty. On the basis of empirical discharge data, relationships between regional demographic characteristics and diagnoses, between diagnoses and inpatient services, and between inpatient services and the production capacity of hospitals were derived. Given the projected regional population, the coefficients so derived are adjusted and employed to project future inpatient service needs. By comparing the existing to projected capacity, the location and investment decisions for hospitals can then be properly made, and the possibility of resource misallocation may be minimized. The applicability of this model is demonstrated in forecasting the hospital needs in the Kansas City Metropolitan Area, 1975–1995.     

Dispatching and routing of emergency vehicles in disaster mitigation using data fusion

The aim of this paper is to develop a robust methodology for the dispatching and routing of emergency vehicles (EVs) in a post-disaster environment with the support of data fusion. In this work, we consider an earthquake scenario with a large number of casualties needing medical attention. Given an influx of information (regarding casualties, road, traffic conditions, etc.), data are fused to provide estimates of the entities under consideration. We use this information to dispatch and route EVs to casualty pickup locations, followed by delivery to appropriate hospitals. Key factors here include patient priorities, clustering criteria, and distance. Similarly, factors affecting the dispatching of EVs from patient locations to hospitals include waiting time at hospital emergency rooms, hospital capacity, and distance. Routes must be generated for EVs by accounting for real-world road networks, existing road damage, congestion, and related issues. We develop a dispatching and routing simulation model, and utilize a case study to evaluate the performance of our proposed methodology.     

Analysis of different public policies through simulation to increase total social utility in a healthcare system

Public and private hospitals are seen to co-exist in several countries and they have different levels of service, waiting times and prices. Public hospitals, in general, are cheaper, but more crowded and offer lower quality service than private ones while private ones are underutilized because of the higher payments required for their services. These differences among hospitals affect patients’ choices in hospital selection and result in different levels of satisfaction in the community. Appropriate subsidy mechanisms can be developed to balance the capacity utilization of both sectors and to improve overall access to healthcare. The objective of this study is to develop an estimate of the magnitude of this improvement and differential effectiveness of various policies in achieving this improvement. For this purpose, we develop a simulation model that includes all the emergency departments of main public and private hospitals in a certain region of Turkey. We analyze the effects of different public policies on patients’ preferences regarding hospital choices and the results of these choices on social utility and public healthcare spending. Different capacity decisions, contracting and subsidy mechanisms are proposed and the optimal system parameters are determined under these mechanisms over this simulation model. After the validation and verification of the simulation model, several scenarios are designed and executed to increase social utility, decrease government expenses, improve patient satisfaction level and decrease waiting times. We compare the proposed scenarios based on multiple objective functions and present numerical results for different scenarios in this system.     

公立医院的绩效管理目标何去何从

近十年来,国内的医疗行业发生了显著的变化,大量民营医院迅速崛起,众多中外合资合作医院不断建立,公立医院的发展面临着前所未有的挑战。面对经济效益和社会效益的双重压力,公立医院必须建立一套适合自身的绩效考核制度。     

Hospital capacity in large urban areas: is there enough in times of need?

Excess capacity can be viewed as wasteful (an unnecessary cost) or as prudential (a ready source of supply). The role of excess capacity is an important issue at the individual firm level as well as at the community level. In this paper we explore hospital capacity for a sample hospitals operating in the 15 largest standard metropolitan statistical areas (SMSAs) in the U.S. during 2002. Using Johanson’s (1968, Production Functions and the Concept of Capacity, Namur, Belgium, Recherches Récentes sur le Fonction de Production (Collection, Economie Mathematique et Econometrie no. 2). [Reprinted in Finn R. Førsund (ed) (1987) The Collected Works of Leif Johanson, vol 1. Amsterdam, North-Holland, pp 350–282]) notion of capacity as the maximum rate of output possible from fixed inputs (i.e., without restrictions on variable inputs), we measure capacity in a frontier setting using directional distance functions. Rather than attempt to determine the “optimal” level of hospital capacity, we instead quantify capacity and capacity utilization rates at both the individual hospital and, by aggregating, the SMSA levels. After determining capacity and capacity utilization rates, we then introduce a model that calculates the changes in variable inputs that would be needed to utilize excess capacity. Finally, we introduce a simulation model that is used to examine whether each SMSA has enough “excess” hospital capacity to accommodate the loss of one of its five largest hospitals. The approach developed in this study should be of value to decision makers and planners in a variety of fields.     

Firm resources and joint ventures: what determines zero‐sum versus positive‐sum outcomes?

In this study, we are concerned with the resources that are brought to joint ventures, and whether or not the way in which those resources are combined can improve parent‐firm performance. We are also interested in whether or not the exposure of valuable resources through the permeable membrane of the joint venture can have an adverse effect on performance. These questions are explored using a sample of 74 domestic, dyadic joint ventures, and our findings suggest that the strategy can have zero‐sum and positive‐sum outcomes. Copyright © 2000 John Wiley & Sons, Ltd.     

Auditing Human Resource Management in the Global Environment

The globalization of business is making it increasingly important to understand how multinational enterprises (MNEs) can operate more effectively. Human resource management can be a critical determinant of corporate effectiveness, particularly as it plays out in the global arena. This article discusses how MNEs enhance their ability to utilize human resources and internal labour markets for competitive advantage through audits of the international human resource management (IHRM) function. A multidimensional auditing framework is developed and applied to the strategic aspects of IHRM in MNEs and international joint ventures.     

构建医院人力资源开发体系

现代医院管理是以人力资源管理为核心的管理。人力资源管理就是在医院管理中要坚持和贯彻"以人为本",将"人"和"工作"和谐地融合起来,实现医院和员工的双赢,达到利益最大化。但由于受计划经济的影响,医院的人事管理仍旧是传统意义上的人事管理,医院人事部门仅仅是一个行政部门,不能为医院的员工提供优质的人力资源产品和服务,这在很大程度上影响了医院的发展和整个医疗干部队伍素质的提高,并未实现医院和员工的双赢。为此,医院必须进行人事制度改革和加强人力资源管理。     

芯钢管混凝土节点的芯管壁厚与节点承载力关系的数值分析

对一种已经通过试验研究的钢管混凝土结构的新型节点进行数值分析。这种节点将钢管混凝土柱的钢管在节点区间断,在节点区设置芯钢管,使梁中的纵筋在节点中直通、梁与节点区混凝土成为一体可靠的传递梁中的弯矩、剪力及轴力。本文利用数值分析弥补模型试验数量少的缺陷。选择不同芯钢管壁厚的节点模型进行非线性有限元分析,得出芯钢管壁厚对节点承载力的影响规律。分析结果表明芯钢管壁厚是影响节点承载力的主要因素之一。     

Electronic medical record use and efficiency: A DEA and windows analysis of hospitals

We use data envelopment analysis (DEA) to examine the relationship between hospital electronic medical record (EMR) use and efficiency in a national sample of acute care hospitals. Data sources include the American Hospital Association (AHA), Health Information Management Systems Society (HIMSS), and Case Mix Index. Using two research approaches including a retrospective, cross-sectional design and a first differencing repeated measures design, we find limited evidence that EMRs can improve hospital efficiency. Small hospitals may benefit in the area of efficiency through EMR use, but medium and large hospitals generally do not demonstrate such a difference. Likewise, there does not appear to be a significant increase in efficiency over time associated with EMRs when compared to the efficiency of hospitals without such documentation.     

Empirical comparison of just-in-time and stockless materiel management systems in the health care industry

Despite the limitations, this study is the first comparative empirical investigation of two relatively new materiel management systems applied in hospitals. The results show that hospital managers have significantly rated the possibility that more effective use of some materiel management resources can be achieved by adopting either a JIT or stockless system over conventional materiel management systems.     

Physician and hospital funding options in a public system with decreasing resources

Methods of physician and hospital reimbursement have been the subject of many debates over the years. Structuring a method of payment for physicians under a publicly funded system is particularly difficult when considered in relation to methods of hospital funding. In this paper, we present a mathematical model that simulates physician and hospital behaviour in a publicly funded health care system under a variety of funding scenarios. The model assumes both doctors and hospitals are constrained profit satisficers. Given this assumption, and a reduction in funding to the institution, the model searches for a resource allocation that will achieve target incomes for both decision-making groups through changes to case mix and/or reductions in the fixed or variable costs of production.Results indicate that when physicians are funded on a fee-for-service basis, the hospital funding method in place may have little impact on resource allocation following a budget reduction. When physicians are funded via salary, conflict between the two groups is reduced, but under supply is more likely to occur. These results raise important questions regarding the type of hospital funding model that should be in place.Unlike earlier approaches, our model jointly simulates the behaviour of both hospitals and health care providers. By including both actors, it provides a mechanism for investigating the interaction between physicians and hospitals under a variety of funding scenarios. Given that hospital-physician systems respond to funding reductions by reducing the fixed costs of production or by decreasing the variable costs of production, the model can be used to identify a range of alternative case mix, case cost, and cost-sharing scenarios.