Development of an integrated medical supply information system

The integrated medical supply inventory control system introduced in this study is a hybrid system that is shaped by the nature of medical supply, usage and storage capacity limitations of health care facilities. The system links demand, service provided at the clinic, health care service provider's information, inventory storage data and decision support tools into an integrated information system. ABC analysis method, economic order quantity model, two-bin method and safety stock concept are applied as decision support models to tackle inventory management issues at health care facilities. In the decision support module, each medical item and storage location has been scrutinised to determine the best-fit inventory control policy. The pilot case study demonstrates that the integrated medical supply information system holds several advantages for inventory managers, since it entails benefits of deploying enterprise information systems to manage medical supply and better patient services.     

An optimization model for planning community health services.

This article reports results of a project to develop methods of planning health care delivery for a community with emphasis on ambulatory services in a health maintenance organization setting. Some of the special difficulties of the problem are discussed and a linear optimization model is presented that addresses the problem of planning the ambulatory service mix for a specified population. The model accounts for population characteristics, financial data, and system dynamics (including referral patterns). An application is shown for the case of a “model cities” population in Buffalo, New York, and some implications for further research are presented.     

An aggregative resource allocation model for hospital administration

One of the most pressing social problems in the United States today is the delivery of adequate health care services to every American. Despite the phenomenal rate of increase in hospital costs, the quality and depth of hospital service have been far from satisfactory. Yet, systematic analysis of hospital administration has been generally neglected by decision scientists, hospital administrators, and economists. This paper presents a methodology for an aggregative resource allocation in hospital administration. More specifically, it applies goal programming to design a general model and demonstrates its practical application for an optimum resource allocation in hospital administration through an empirical study.     

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.     

Design of a terminal solution for integration of in-home health care devices and services towards the Internet-of-Things

In-home health care services based on the Internet-of-Things are promising to resolve the challenges caused by the ageing of population. But the existing research is rather scattered and shows lack of interoperability. In this article, a business-technology co-design methodology is proposed for cross-boundary integration of in-home health care devices and services. In this framework, three key elements of a solution (business model, device and service integration architecture and information system integration architecture) are organically integrated and aligned. In particular, a cooperative Health-IoT ecosystem is formulated, and information systems of all stakeholders are integrated in a cooperative health cloud as well as extended to patients’ home through the in-home health care station (IHHS). Design principles of the IHHS includes the reuse of 3C platform, certification of the Health Extension, interoperability and extendibility, convenient and trusted software distribution, standardised and secured electrical health care record handling, effective service composition and efficient data fusion. These principles are applied to the design of an IHHS solution called iMedBox. Detailed device and service integration architecture and hardware and software architecture are presented and verified by an implemented prototype. The quantitative performance analysis and field trials have confirmed the feasibility of the proposed design methodology and solution.     

A healthcare facility location problem for a multi-disease,multi-service environment under risk aversion

This paper presents a stochastic optimisation model for locating walk-in clinics for mobile populations in a network. The walk-in clinics ensure a continuum of care for the mobile population across the network by offering a perpetuation of services along the transportation lines, and also establishing referral systems to local healthcare facilities. The continuum of care requirements for different diseases is modelled using coverage definitions that are designed specifically to reflect the adherence protocols for services for different diseases. The risk of not providing the required care under different realisations of health service demand is considered. In this paper, for a multi-disease, multi-service environment, we propose a model to determine the location of roadside walk-in clinics and their assigned services. The objective is to maximise the total expected weighted coverage of the network subject to a Conditional-Value-at-Risk (CVaR) measure. This paper presents developed coverage definitions, the optimisation model and the computational study carried out on a real-life case in Africa.     

Hospital service quality evaluation with IVIF-PROMETHEE and a case study

Measuring satisfaction of patients and understanding their perceptions are important for the hospital management to respond to customers' growing demands for acceptable quality of healthcare services. The main purpose of this paper is to present a methodology that can be used in the healthcare service quality evaluation. IVIF-PROMETHEE method is applied for service quality evaluation based on patients' views in a real-life case study of a public hospital in Istanbul and the results are compared with the results from IVIF-TOPSIS method. Interval Valued Intuitionistic Fuzzy (IVIF) set is considered an appropriate tool because of the complexity and vagueness of the evaluation of healthcare services. The evaluation of the quality level of the healthcare service provides detailed information about the effects of considered criteria as well as creates opportunities in implementing effective procedures to overcome service quality problems via analysing the patients' views. The proposed methodology can be a useful tool for hospital management.     

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.     

Do quality perceptions of health and social services vary for different ethnic groups? An empirical investigation

The United States is now more ethnically diverse than any other time in its history. In 2000, minority ethnic groups comprised 26% of the US population; by 2010, they comprise 35%, and in 2080 they will form the majority of American citizens. And among these ethnic groups, African Americans (12.4%), Hispanics (15.4%) and Asians (4.4%) were the most predominant in 2000. The growth of this segment of the population is not only in terms of numbers but also in terms of economic development. Minority groups are showing marked improvement in income and education levels leading to greater purchasing power. As a result, for‐profit companies are increasingly targeting minority populations with products and promotions specifically designed for specific minority groups. Even non profit organizations such as educational programs, social service and healthcare agencies are striving to design specific services and culturally competent outreach models in order to serve this increasingly diverse marketplace. But despite the strides made by non profit agencies, several studies note the tremendous disparities between the ethnic and racial groups in the seeking and the receipt of health‐care and social services. Additionally, there is limited empirical information about the perceptions of minority consumers. In order to effectively serve minority groups, it is essential to understand their experiences with the non profit service industry and to assess their ongoing concerns. In this study, we focus on two critical components of the non profit world – healthcare and social services. We conducted a survey to compare and contrast the social service and health‐care quality perceptions of three ethnic groups: Caucasians, African‐Americans and Hispanics. Our study, undertaken in collaboration with community health centers, reveals distinct differences in perceptions between the three ethnic groups. Based on our findings, we outline a set of implementable strategies for social service and community health organizations. Copyright © 2010 John Wiley & Sons, Ltd.     

An application of organizational input–output analysis to hospital management

The main components of an acute-care hospital and the relationships among them are used to construct an organizational input–output model similar to those based on the interdependence among industries in an economy. The basic model makes it possible to forecast the personnel needed by each component in order to provide the services expected from it by the external environment and by the other hospital departments. Extensions of the basic model can be applied to health care organizations in general, used to analyze the implications of different organizational reforms or extended to include physical, financial, and other resources. The methods presented and the results obtained are of particular interest to managers of health care organizations, managers in general, and researchers in the theory of organization.     

体育赛事物流服务能力评估研究

探讨了体育赛事物流服务的基本内容和主要特征,构建体育赛事物流服务能力的评价指标体系,并采用信息熵和未确知测度模型方法,结合案例具体地评估了体育赛事物流的综合服务能力,为科学、客观地评价体育物流服务能力提供一种新的方法。     

Accounting and the ‘Insoluble’ Problem of Health-Care Costs

Health service accounting reforms are frequently promoted, explained or justified with reference to aging populations, expensive medical technologies and their purported implications for the cost of health care. Drawing on Foucault’s genealogical method, we examine the emergence of concerns regarding health expenditure in the wake of the creation of the British National Health Service in 1948, and their relationship with health service accounting practices. We argue that concerns regarding the cost of health care are historically contingent rather than inescapable consequences of demographic and technological change, and that health service accounting practices are both constitutive and reflective of such concerns. We conclude by relating our analysis to current attempts to control costs and increase efficiency in the health services.     

Bridging social and technical interfaces in organizations: An interpretive analysis of time-space distanciation

Contemporary organizations increasingly rely upon information technologies as platforms for their core work processes. The Internet age has witnessed the creation of new business models based almost entirely on electronically-mediated business processes involving multiple organizations. Information systems link suppliers, manufacturers, logistics companies, and other partners, allowing organizations to add value using smaller investments in physical assets. The creation of these linkages establishes both technical and social interfaces between organizations and their business partners. We apply Giddens’ concept of time-space distanciation to analyze the interfaces in iTalk, an organization in Silicon Valley hosting Internet voicemail services. iTalk achieved initial success in bridging external social and technical interfaces with the major regional telephone companies in US, allowing their voicemail service to attract millions of subscribers. In effect, iTalk used information technologies to dis-embed social and technical elements from global systems (the telephone companies) and re-embed them as part of iTalk’s local organizational presence. However, iTalk was unable to provide a sufficiently reliable service to customers as volume increased. Ironically, bridging external interfaces created internal interfaces within iTalk, which in turn produced technical problems and social conflicts that were not satisfactorily resolved by the time iTalk was acquired by a larger media company in 2001. The study provides theoretical understanding of the challenges associated with creating and sustaining social and technical interfaces in organizations that rely heavily upon electronically-mediated business processes that cross organizational boundaries.     

Prediction of donor lifetime value and the development of true segmented donor strategy

This paper is based on projects developed by WWAV Rapp Collins on behalf of two UK charities, Shelter and the NSPCC. The classic model used by nonprofit organisations for donor development programmes using the concept of lifetime value (LTV) is challenged and the paper describes the development of an alternative model. The paper assesses existing segmentation methodology and systems such as RFV, and analyses, step by step, how the new model was set up. There is particular emphasis on the scoring methods used and validation of the scores. Income from donors is likely to be maximised by efficiently separating the profitable from the unprofitable with the use of a more discriminating system.     

Health care facility planning: some developmental considerations.

A model of the provision of health care facilities is outlined. This model is based on a framework developed in central place theory and is concerned with the scale, frequency and service area structure of health care facilities. Certain modifications to the model are proposed and this provides a framework for dealing with the problem of adjustment in systems of service provision. Three types of adjustment, all involving different degrees of centralization, are considered. Each type of adjustment results in a particular modification to the spatial structure of the hierarchical system. Consideration is then briefly given to a number of ways in which this general approach may be made more realistic, in order to deal with actual systems of service provision.     

Maximizing value in healthcare partnerships: A case examining an inter-organizational relationship in the public and non-profit sectors

Healthcare organizations around the world are striving to find the right balance between using their resources effectively and providing personalized care to patients. Health care is shifting from a reactive, towards a more person-centric approach to improve health outcomes. To achieve quality improvements and efficiencies, health care organizations are forming inter-organizational relationships. Despite the benefits, little is known about how organizations capture value from strategic partnership. In this context, this paper aims to examine the processes that occur as part of a public and non-profit sector relationship within health care that directly relate to how the partnering organization acts to capture value. Using a qualitative case study of an Australian public-sector health service partnership, the study employs a value mapping framework to distinguish between different types of value (captured, missed, destroyed, and opportunity), and presents an integrated model consisting of three process phases: (1) inter-organizational cooperation effort, (2) organizational effect, and (3) social value. The study highlights the potential for negative and unintended consequences and discusses implications for management.     

A cost-benefit analysis of prior approvals for Medicaid services in New York state.

This study investigates the costs and benefits of a prior approval mechanism instituted by the New York State Health Department to review the need for the provision of selected types of costly health care and services. The review is made prior to the provision of the service and Medicaid payment for the service is contingent upon the result of the review. Costs include program administration and form processing. Benefits include the value of services which are either denied or modified as a result of the prior approval process. The analysis indicates that three of the seven prior approval categories are cost-beneficial without regard to deterrence benefits. For the other four categories, the results of this study have been used to propose new policies.     

Just-in-time and stockless programs for hospitals: fad or trend?

The JIT and stockless approach to provider-supplier relationships has proven to be a win-win proposition for the partners that have implemented it in many manufacturing industries and health care organizations as well. This strategy will fundamentally impact the entire cost structure within the hospital supply distribution chain. rewards have proven attainable and more comprehensive than had been hoped in the health care applications. The sweeping changes the health care industry experienced during the 1980s are leading creative materiel managers to seize the initiative to improve the current operating costs of their hospitals. They do not want to be left behind "holding the inventory."     

Too many theories,too few facts? What the data tell us about the link between span of control,compensation and career dynamics

In this paper, we use a unique personnel dataset from a large European firm in an high tech manufacturing industry that provides information about hierarchical relationships. This unusually rare feature allows us to identify the chain of command. We provide a few stylized facts about the link between span of control, compensation and career dynamics and relate our findings to the existing theoretical literature of hierarchies in organizations: the assignment model, the incentives model, the information processing model, the supervision model, and the knowledge-based hierarchy model. We observe an increase in the span, an increase in wage inequality between job levels, and the introduction of a new hierarchical level. We also find that higher spans of control are associated with higher wages. The knowledge-based hierarchy provides the most likely explanation for these results when communication costs are decreasing. However, we also find evidence of learning and reallocation of talent within and across job levels, a finding that can not be explained by a static model of knowledge based hierarchy but rather by dynamic models of careers in organizations. Finally, we provide a few suggestions to enrich the existing theoretical literature and reconcile it with the facts.     

Integration and Task Allocation: Evidence from Patient Care

Using the universe of patient transitions from inpatient hospital care to skilled nursing facilities and home health care in 2005, we show how integration eliminates task misallocation problems between organizations. We find that vertical integration allows hospitals to shift patient recovery tasks downstream to lower‐cost organizations by discharging patients earlier (and in poorer health) and increasing post‐hospitalization service intensity. Although integration facilitates a shift in the allocation of tasks and resources, health outcomes either improved or were unaffected by integration on average. The evidence suggests that integration solves coordination problems that arise in market exchange through improvements in the allocation of tasks across care settings.