Relating focus to quality and cost in a healthcare setting

Focus in healthcare has been heralded as the next frontier in improving its efficiency and efficacy (Herzlinger 2004). Focus takes several different forms, ranging from standalone specialty centers to a hospital that places a strategic emphasis on a clinical area. We adopt this latter perspective and define focus as a disproportionate emphasis on a particular clinical area in a hospital. We use secondary data from hospitals providing cardiology care in New York State to examine the relationship between focus and performance. We develop two measures of focus. Proportional focus is defined to be the proportion of cases treated in a particular clinical specialty. Expertise focus is defined to be specific evidence that a hospital has taken action to build expertise in treating diseases in that specialty. We operationalize hospital performance along cost and quality dimensions, and we use hierarchical regression to examine the impact of focus on performance. Our results indicate that proportional focus, but not expertise focus, is associated with better cost performance. Quality performance, on the other hand, was associated only with the interaction between proportional focus and expertise focus, which means that only hospitals exhibiting higher levels of both proportional and expertise focus achieve better quality performance. These findings support the notion that not only is focus important in healthcare, but also that researchers and practitioners need to recognize that relationships are contingent on the performance and focus measures used and thus, findings may not be generalizable from one metric to another.     

Child Health Corporation of America: a different perspective on materiel management

Today, based on current programs and services, CHCA is recognized as one of the leading specialty hospital alliances in the country. This is made possible by the excellent support and commitment of its shareholder hospitals. As CHCA looks toward the future, it is anticipated that it will expand its horizons with additional programs and member hospitals.     

The impact of service design and process management on clinical quality: An exploration of synergetic effects

While service design and process management have received research attention in the past, there is limited empirical work examining both factors in the hospital setting. Through operationalizing focus as a service design approach and quality improvement (QI) initiatives as process management efforts, we hypothesize that focus and QI initiatives affect clinical quality both individually and collectively. Utilizing heart attack procedures as the study context, we examine a set of hypotheses based on a panel dataset consisted of 201 hospitals from 2005 to 2011 in the state of Florida. After accounting for potential lag effects and endogeneity biases, we find empirical support to the proposed hypotheses.     

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。     

The effects of environmental characteristics on the structure of hospital clusters

The population ecology view that variation in sets or clusters of organizations should be isomorphic with variation in cluster environment was used here to explain structural variation among hospital clusters. The structural characteristics studied were range of services offered within the cluster, average size of hospitals in the cluster, and cluster differentiation. In the causal model that was developed and evaluated, variation in the patient environment and variation in the supplier environment were compared. Four lagged panels of data on a national sample of fifteen hospital clusters demonstrated the relative superiority of supplier variables over patient variables. Supplier group preferences were more powerful than patient needs in determining the range of services offered by the cluster. Furthermore, increasing the range of services in the cluster had a positive, significant effect on average hospital size, whereas size apparently exerted no effect on range of cluster facilities. Cluster differentiation seems to be causally affected by range of services, average hospital size, and by the periodic closing of hospitals over time.     

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.     

Branding without Unique Brands: Managing similarity and difference in a public sector context

Abstract

Corporate branding requires organizations to focus on uniqueness and differentiation. At the same time, public institutions must provide equal services in order to gain legitimacy. Hence, corporate branding in the public sector organizations has to handle two concerns simultaneously – securing legitimacy and building reputation. We examine this tension through interviews with communication managers in Norwegian hospitals. Despite large investments in techniques borrowed from corporate branding, the informants were reluctant to talk about branding. Instead, they were more oriented towards the universal character of their hospitals. Four explanations are put forward for why branding has an ambiguous position in Norwegian hospitals.     

Factors to consider in the delivery of quality services by hospitals

The focus of any health care provider, such as a hospital, is on assessing and improving the well-being of the people in the system's target area, and it is this focus that differentiates health care providers from other enterprises. The purpose of this article is to identify the essential factors in the delivery of quality services by hospitals. These factors include patients' active participation in their delivery, the nature of the clinical procedures, and the management of the interaction of all the customers involved in the process.     

Measuring performance in the presence of stochastic demand for hospital services: an analysis of Belgian general care hospitals

Since demand for hospital services is subject to substantial variability, the relationship between uncertain demand, excess capacity, hospital costs and performance should be investigated thoroughly. In this paper a waiting time indicator to proxy hospital standby capacity is incorporated into a multi-product translog cost function for Belgian general care hospitals. The indicator is derived from queuing theory and improves on the conventionally used (inverse of the) occupancy rate. The multi-product stochastic frontier specification allows calculation of cost elasticities and marginal cost of seven hospital departments, as well as the degree of economies of scale and scope and enables identification of differences in efficiency.

Changes in hospital efficiency and size: An integrated propensity score matching with data envelopment analysis

Turkey has made huge investments in city hospitals. The distinguishing feature of these hospitals is that they are physically large. Although many studies have investigated the efficiency of public hospitals, there are a few studies on the effect of hospital size on efficiency. This study examines the effect of hospital size on changes in public hospital efficiencies. The analysis is made up of three steps. First, using a bootstrap data envelopment analysis (DEA), the pure efficiency scores of each hospital were calculated. Second, propensity score matching (PSM) was used to ensure that any differences could be attributed to a particular class of hospital size, and not be due to differences in sample characteristics between the intervention and control groups. To highlight a potential time difference between small and large hospitals, the efficiencies of hospitals were examined from 2014 to 2017. Third, the Mann–Whitney U test was used to conduct a robustness check of the DEA and PSM results. Fourth, logistic regression was used on balanced data to examine the determinants of the efficiency of public hospitals. There are remarkable differences in the results obtained before and after matching the groups based on the bed-occupancy rate. Additionally, urban location is a key predictor of efficient and inefficient hospitals. This study also highlights that integrating DEA and PSM is a useful strategy in accurately identifying predictors of efficiencies of hospitals by creating balanced groups. Health policymakers should consider the efficiency advantages of high workload and service burden in the planning of public hospitals.     

Restructuring materiel management functions: a method for prioritizing changes and reducing costs

The success of any manager depends highly on the ability to seize on opportunities that will achieve the organization's goals. Hospitals are currently searching for ways to reduce costs while maintaining or enhancing the quality of services. Quality services are increasingly being defined as those that are most responsive to customer needs. It is important, as hospital management restructures materiel systems or methods of operation for reduced costs, to focus on the user departments as the customers. The consolidation of materiel management activity should not be seen as a loss of control at the user department level. Instead it can be seen as a new way of providing service with higher quality. User departments should see concrete benefits on a weekly basis, including reduced time spent on materiel management functions; increased planning of purchasing, inventory, and distribution functions; and assistance in meeting restricted supply budgets.     

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.     

The General NFP Hospital Model

Throughout the past 30 years, there has been a lot of controversy surrounding the proliferation of new forms of health care delivery organizations that challenge and compete with general NFP community hospitals. Traditionally, the health care system in the United States has been dominated by general NFP (NFP) voluntary hospitals. With the number of for‐profit general hospitals, physician‐owned specialty hospitals, and ambulatory surgical centers increasing, a question arises: “Why is the general NFP community hospital the dominant model?” In order to address this question, this paper reexamines the history of the hospital industry. By understanding how the “general NFP hospital” model emerged and dominated, we attempt to explain the current dominance of general NFP hospitals in the ever changing hospital industry in the United States.     

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。     

Understanding information propagation on online social tagging systems: a case study on Flickr

Online social networking services (SNS) have been regarded as one of the most powerful online communication channels to propagate information to other users. It means that the online social networking services are providing users with efficient features (e.g., searching, managing and visualizing new information). It is important for many online collaborative applications to understand how the information can be propagated via such social media. Thus, we want to focus on a social tagging system (e.g., Flickr) where users can easily exchange resources as well as their tags. In this paper, given a certain tag, a social pulse can be established by counting (i) the number of users and (ii) the number of resources over time. More importantly, we assume that information can be propagated by (iii) inducibility from other tags by comparing social pulses. To conduct experimentation, a tag-based searching system (called Tagoole) has been implemented to collect a dataset from Flickr.     

Fairness perceptions and work attitudes revisited: roles of employee specialty,hospital level and ownership

Compensation is widely acknowledged as an important job element in the eyes of employees. Health care is a special industry in which compensation received by employees differs greatly. This study examines empirically the relationships between hospital employees' perceptions of compensation fairness and their work attitudes, taking into account the roles of employee specialty, hospital level and ownership. Using data from 2,938 employees of thirty hospitals in Taiwan, the results indicate that fairness perceptions and work attitudes differ significantly among hospital employees according to their specialties. Hospital level and ownership exert impacts on employees' fairness perceptions, although not on their work attitudes. A positive relationship is observed between fairness perceptions and work attitudes of hospital employees.     

The market for acute hospital services and the marketing contribution: A NHS trust experience

The White Paper ‘Working for patients’ (DoH 1989)¹ and subsequent legislation, including the National Health Service and Community Care Act (1990), has facilitated the introduction of an internal market into the NHS. In particular, the establishment of provider hospitals as NHS trusts providing secondary care services, and the introduction of GP fundholders as purchasers of healthcare, has allowed the internal market to thrive, particularly where these two are in high concentration within a defined locality. One such area is southern Derbyshire. NHS trusts in this area face an unprecedented range of market factors, which threaten their long-term viability. These factors are described, as are the efforts of one trust to undertake detailed market planning. The rise of the GE/Mackinsey inatrix as a planning tool is advocated as an efective way of presenting relevant prodrict and market irtforiiiation to an NHS Trust Board, in an attempt to introduce strategic marketing planning at the highest level of the organisation.     

The adoption,character and impact of strategic human resource management: a case study of two large metropolitan Vietnamese public hospitals

In this paper the researchers set out to explore the adoption, character and impact of strategic human resource management (SHRM) in two large metropolitan Vietnamese public hospitals using a multi-level qualitative research design. Data are analyzed from 21 interviews and 5 focus groups with key players from the hospitals and government authorities. Findings show that the State controls many of the core day-to-day HR functions of public hospitals, curtailing local autonomy and management innovation. This is compacted by inadequate government funding, poor training of medical staff, and inadequate management and business skills of hospital managers. Inhibiting greater experimentation with SHRM is the fear of developing management initiatives out of sync with the State. Consequently, many managers and clinicians held negative views of the HR department and their relevance for the day-to-day management of healthcare services. Respondents reported that they perceived these factors had a negative impact on the well-being of medical staff and the quality of patient care. The paper concludes with a discussion on the necessity for continued State reforms that can enable greater autonomy of the hospitals' HRM functions and greater investment in local HR capabilities to materialize the link between SHRM, employee well-being and quality of patient care.     

The temporal variation of cost-efficiency in Switzerland’s hospitals: an application of mixed models

This paper uses a mixed effects model to examine the temporal variation of cost efficiency in Switzerland’s general hospitals. The variations in total costs, the number of empty beds and the length of hospital stays are analyzed using financial data from a sample of 168 hospitals operating from 1998 to 2003, as well as hospitalization records disaggregated to Diagnosis Related Groups. Individual intercepts and random coefficients are used to account for the unobserved time-invariant heterogeneity and the differences in temporal patterns across hospitals and DRG categories. The analysis illustrates the usefulness of mixed models to account for unobserved factors such as quality, with a relatively weak assumption that their temporal variations, rather than their initial levels, be uncorrelated with efficiency changes. The results indicate that hospitals have adopted measures to curtail hospitalizations and reduce empty beds. The extent and effectiveness of these measures vary significantly across individual hospitals. However, there is no evidence in favor of a particular ownership type or subsidization regime. While the link between reduction rates of empty beds and gains in cost-efficiency is statistically significant, the expected association between shortening hospital stays and cost-efficiency cannot be clearly established in the data.

Efficiency analysis of emergency departments in metropolitan areas

The demand in the healthcare industry is increasing exponentially due to aging population of the world and this is leading to a rapid increase in the cost of healthcare. The emergency departments of the hospitals are the frontline of health care systems and play an additional critical role in providing an efficient and high-quality response for patients. The overcrowding at the emergency departments due to growing demand results in a situation where the demand for ED services exceeds the ability to provide care in a reasonable amount of time. This has led countries to reconsider their health policies in a way to increase their efficiency in their healthcare systems in general and in emergency departments, in particular. As in many countries, there has been a steady and significant increase in the number of patients that seek health services at the emergency departments of state hospitals of Turkey, due to the significant structural reforms in health services since 2003. While meeting this increasing demand, it is ever more important to provide these critical health services efficiently. Therefore, the efficiency of the emergency departments of seven general hospitals run by Istanbul's Beyoglu State Hospitals Association have been analyzed using categorical Data Envelopment Analysis (DEA) models. The analysis of DEA results is supported by a set of statistical methods to make it easier for the hospital administrators to interpret the analysis and draw conclusions. The analysis shows that less-equipped EDs are supported by better equipped, larger EDs, resulting in a hub-and-spoke type of structure among the EDs where “satellite” EDs serve an important referral function and thus evaluating their efficiency without taking the interoperability among these units into account would not be an accurate assessment of their performance.