A labor relations research agenda for health care settings

Inadequate attention has been given to labor-management relations in health care organizations. Bacause of the labor-intensive nature of health care and the great dependence on human resources, health services researchers should place greater emphasis on labor-management issues. This article develops a framework and suggests methodologies for examining labor relations in health care organizations. Specifically, six cirtical issues are suggested for attention by researchers: (1) the quality of the union-management relationship; (2) union organizing drives; (3) collective bargaining and contract negotiations; (4) impasse resolution; (5) contract administration and grievance handling; and (6) labor-management cooperation. These areas of research have been dominated by industrial relations researchers who have focused primarily on the manufacturing sector. Given cost containment and competitive pressures, it is timely to bridge the gap between the health services research community and the accumulating body of knowledge in industrial relations.     

An examination of anti-violence human resource management practices in the context of health care and aged care

Although accumulated research has demonstrated the negative impacts of workplace violence and called for effective solutions from a human resource management (HRM) perspective, a valid measure of anti-violence HRM practices is missing. In this paper, we develop a scale of anti-violence HRM practices that is critical for both theoretical advancement and managerial practices in health care and aged care contexts. Through an inductive approach in Study 1, we generated items for the scale to be used in health care and aged care contexts, which we then subjected to a content validity test in Study 2. Using the newly developed scale, we further demonstrated in Study 3 that anti-violence HRM practices that are implemented in aged care facilities reduce workers' experienced violence, improve workers' emotional wellbeing, and enhance workers' organisational and career commitment.     

Public Contracts as Accountability Mechanisms: Assuring quality in public health care in England and Wales

Contracting in the public sector is designed to enhance the accountability of service providers to their funders. The idea is that quality is improved by the use of service specifications, monitoring of performance and imposition of contractual sanctions. Socio-legal and economic theories of contract indicate that it will be difficult to make and enforce contracts to achieve this. The results of a study of National Health Services contracting in England and Wales are reported. We conclude that contracts alone are not sufficient to improve accountability – collibration of various regulatory measures (including more hierarchical mechanisms such as performance targets) is required.     

Promoting shared health care decision making using the analytic hierarchy process

Recent developments in medical technology and bioethics have led to a shift in the traditional framework of physician–patient responsibility in health care decision making. Patients are increasingly participating in serious health care decisions, resulting in a “shared decision-making model“ that both patients and their doctors agree is a significant improvement over the traditional system in which a doctor served as the primary decision maker. However, patients are finding they need to develop strategies that allow them to understand and evaluate their health care options in a clear manner. T.L. Saaty’s “Analytic Hierarchy Process” (AHP) is a decision methodology that has been successfully applied to a wide variety of situations and has great potential as a methodology for improved shared health care decision making. This paper reports the results of an experimental use of AHP as a tool to facilitate shared decision making for two specific health care populations. Both groups of patients were deciding amongst their options in terms of two important elective health care procedures: estrogen replacement therapy and cosmetic eyelid surgery. After using AHP, the majority of both patients and physicians agreed that this technique improved physician–patient communication, thus greatly assisting shared health care decisions. When considering other criteria in addition to physician–patient communication, including the entire physician–patient relationship, the patients felt that AHP was preferable to the conventional doctor-patient mode of decision making.     

The how and why of integrated reporting in a public health care organization: The stakeholders' perspective

Despite the widespread calls for in‐depth case studies on adoption of the International Integrated Reporting Council Framework, in practice, it appears to be underexplored, above all in the public sector. Our aim is to explore how and why a public health care organization (PHO) has chosen to adopt the practice of integrated reporting, and we then delve into whether the PHO's perception of the document's value coincides with that of the stakeholders, who are its recipients. Often, society's perception of value can differ considerably from an organization's. Thus, for our research purposes, a case study was examined, adopting a qualitative approach and action research methodology. Our findings demonstrate the centrality of the value created for patients and of the “normative” scenario that takes place during the implementation of an integrated report in a PHO. Moreover, the concept of legitimacy was found to be virtually synonymous with institutionalization.     

Client organizations and the management of professional agency work: The case of English health and social care

A growing reliance on agency workers can lead to significant risks for client organizations, especially in core organizational roles. It has been suggested while these risk can be mitigated through investments in human resource management (HRM) directed at agency workers, in reality these will be hard to implement. This article draws upon Lepak and Snell's (1999) HR architecture model and uses a comparative case study method to explore this issue, focusing on agency working in core nursing and qualified social worker roles. The findings illustrate how client organizations can become more involved in the management of agency workers than has previously been acknowledged. Our analysis also identifies the conditions that shape this client‐side involvement, including the nature of agency worker contracts, the role of temporary work agencies, competing organizational cost‐control priorities, and perceptions of the regulatory context. These conditions are brought together in a general model for understanding the largely neglected role that client organizations play in the HR management of agency workers.     

Unit determination: National Labor Relations Board rule making in the health care industry

This article reviews the events leading up to the National Labor Relations Board's (NLRB) historic decision to engage in substantive rule making over appropriate bargaining units in the health care industry. It describes the rule-making process and outcomes, and the reaction of hospital unions and management to the rules. Finally, the potential for the use of rule making for other issues facing the NLRB is analyzed. This analysis uses a cost/benefit framework from the agency's perspective to predict the likelihood of future rule making. The article concludes that rule making is sufficiently costly to make extensive use in other situations unlikely.The order of the author's names was determined randomly and should not be interpreted as implying an unequal contribution.     

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.     

石化行业全员成本目标管理系统的开发与应用

文章设计了一种全员成本目标管理系统,该系统功能强大,实用性强,有利于优化生产,开展劳动竞赛。通过实际应用证明,系统的建立为公司生产经营管理提供了有效的管理平台。     

Diverging trends in health care use between 2010 and 2016: Evidence from three groups of transition countries

This paper investigates changes in health care use in 28 transition countries using data on more than 60,000 households from the “Life in Transition” surveys II and III conducted in 2010 and 2016. Following the literature, the transition countries are divided into three groups – Eastern Europe, Southern Europe and the non-Baltic states of the former Soviet Union with Mongolia – based on the speed of their transformation. Regressions based on Andersen’s conceptual framework show no difference in public health care use between the three groups in 2010. By 2016, however, the share of households using the public health care system dropped by remarkable 17.1–22.2% points in Southern Europe and 13.5–27.1% points in the former Soviet Union with Mongolia compared to Eastern Europe. Moreover, by 2016, the probability of a household using the private health care system (with no use of public health care) in Southern Europe and the former Soviet Union was 7.5–18.7% points higher than in Eastern Europe, whereas it was 2.9–6.8% points lower than in Eastern Europe back in 2010. The analyses indicate that differences in household characteristics, as well as perceived corruption and quality of public health care, help to understand these diverging trends in health care use in the three groups of transition countries between 2010 and 2016.     

The Financial Implications of Using Decision Tree Analysis for Publicly Funded Health Care Screening in Canada

This article demonstrates that decision trees have several applications in screening for incidences of various cancers in the publicly funded health care system of Canada. This article reviews previous research on the design of various types of decision trees to identify the relevant decision-making parameters that should be incorporated into enhanced usage of decision trees. This article proposes a methodology for screening breast and prostate cancers. While an accounting is made for various financial costs and benefits, comments are made on the limitations of the modeling exercise through identification of problems in assigning probabilities, the use of samples in ascertaining population parameters, ethical concerns, and measuring a cost per life year. This article concludes with prospects for future research including private sector versus public sector financing and the incorporation of opportunity costs into the decision-making process.     

Mixed-effects models for health care longitudinal data with an informative visiting process: A Monte Carlo simulation study

Electronic health records are being increasingly used in medical research to answer more relevant and detailed clinical questions; however, they pose new and significant methodological challenges. For instance, observation times are likely correlated with the underlying disease severity: Patients with worse conditions utilise health care more and may have worse biomarker values recorded. Traditional methods for analysing longitudinal data assume independence between observation times and disease severity; yet, with health care data, such assumptions unlikely hold. Through Monte Carlo simulation, we compare different analytical approaches proposed to account for an informative visiting process to assess whether they lead to unbiased results. Furthermore, we formalise a joint model for the observation process and the longitudinal outcome within an extended joint modelling framework. We illustrate our results using data from a pragmatic trial on enhanced care for individuals with chronic kidney disease, and we introduce user-friendly software that can be used to fit the joint model for the observation process and a longitudinal outcome.     

The conservative equal costs rule, the serial cost sharing rule and the pivotal mechanism: asymptotic welfare loss comparisons for the case of an excludable public project

We examine the asymptotic behavior of two strategyproof mechanisms discussed by Moulin for public goods – the conservative equal costs rule (CER) and the serial cost sharing rule (SCSR) – and compare their performance to that of the pivotal mechanism (PM) from the Clarke–Groves family. Allowing the individuals’ valuations for an excludable public project to be random variables, we show under very general assumptions that expected welfare loss generated by the CER, as the size of the population increases, becomes arbitrarily large. However, all moments of the SCSR’s random welfare loss asymptotically converge to zero. The PM does better than the SCSR, with its welfare loss converging even more rapidly to zero.