A case mix simulation decision support system model for negotiating hospital rates

The institution of prospective payment systems by many health care insurers has drawn increased attention to case-based financial planning in hospitals. When hospital revenues are directly linked to patient diagnoses rather than to the types and quantities of services supplied to patients, managers must be aware of the financial implications of different case mixes and must be prepared to influence insurers' price structures. A case-based financial planning model is presented here for the purpose of assisting managerial decision making in the strategic areas of case mix planning and pricing. The computerized model characterizes hospitals as product manufacturers, the product being discharged patients. Diagnosis serves to differentiate the "products"; however, diagnoses are grouped by payor and similar treatment cost experiences to create a limited set of managerially meaningful case types. Diagnostic and treatment costs are also aggregated to facilitate the modeling of the hospital production process. The computerized model projects the number of patients of each case-type and total patient volume, based on estimated patient volume growth rates. The model also projects prices and contribution margins for each case-type, as well as total contribution to hospital overhead. Testing the model with a hypothetical example of a hospital strategic planning problem demonstrates the model's potential as a decision-making aid in case mix planning and case-type pricing. It also reveals several model shortcomings that require further developmental effort.

Diversity in the use of electronic mail: a preliminary inquiry

This paper describes a series of interviews that examine the ways that professional office workers use electronic mail to manage their daily work. The purpose is to generate hypotheses for future research. A number of implications for the design of flexible mail systems are discussed.

Two principal claims are made. First, the use of electronic mail is strikingly diverse, although not infinitely so. Individuals vary both in objective measures of mail use and in preferred strategies for managing work electronically. Feelings of control are similarly diverse and are related to the size of the user's inbox, numbers of folders, and subscriptions to distribution lists. This diversity implies that one's own experiences with electronic mail are unlikely to provide sufficient understanding of other's uses of mail. Mail designers should thus seek flexible primitives that capture the important dimensions of use and provide flexibility for a wide range of users.

The second claim is that electronic mail is more than just a communication system. Users archive messages for subject retrieval, prioritize messages to sequence work activities, and delegate tasks via mail. A taxonomy of work management is proposed in which mail is used for information management, time management, and task management activities. Directions for future research are suggested.

Organizational issues of end-user computing

End-user computing environments are rapidly growing in many organizations. This growth is due primarily to the proliferation of microcomputers and the availability of user-friendly software. However, the end-user computing environment is still poorly understood by practitioners, academics, and vendors. Most managers agree that a basic understanding of the end-user computing environment is necessary in order to effectively manage it. This article attempts to define the scope of the end-user computing and integrate a variety of publications into a common research framework. Several managerial frameworks are presented which address the risks of end-user development. Finally, implications are drawn from the available literature in order to provide managerial direction to firms with growing end-user computing environments.

I/S attitudes: toward theoretical and definitional clarity

There has long been a recognized need to measure the "success" or efficacy of information systems and the implementation process. Various constructs related to success have been suggested such as user attitudes, use, performance, and value. The attitude construct has received a great deal of attention for both theoretical and operational reasons. This paper focuses on the need for a convincing theoretical model linking systems or policies and user attitudes on the one hand, and user attitude and performance or value on the other. Using job satisfaction research as a reference discipline for understanding the relationship between attitudes and performance, a model of I/S attitudes, beliefs, and performance is developed. This model suggests that performance is affected by the correspondence or "fit" between the task requirements and the functionality of the I/S environment. In addition a distinction between beliefs and attitudes is recommended. While satisfaction might be best determined by measuring attitudes, the correspondence between task and functionality is best determined by measuring beliefs. The implications of this model for future research are discussed.

Designing real-time, decision support computer-human interaction

Many complex software-intensive systems are being developed today. When developing complex systems, operations and support development must form a third complementary component of system development, along with hardware and software development. This paper proposes four key components of operations and support development which are needed for successful design of real-time, decision support computer-human interaction.

Utilization as a dependent variable in MIS research

Utilization of an information system is an important and frequently measured is the conduit through which informationtechnology can affect performance. This paper addresses measurement issues associated with utilization variables. The discussion is motivated by a review of the literature and an examination of four relevant reference theories. It is asserted that utilization can be measured effectively if the measures chosen correspond to the measures suggested by an appropriate reference theory.

Expert Decision-support Systems for Decision-making

Computers have made tremendous contributions towards transactional processing. However, the highest pay-off the computer can make is not in transactional processing but in decision-making. Recently, expert systems have just begun to be used in the decision-making process. Individual technologies alone are inadequate for an effective decision support. The purpose of this paper is to investigate the related issues in decision support and to develop an expert decision support system (EDSS) for combining decision support systems and expert systems into a unified whole for decision support. The emphasis will be on developing a DSS/ES model which can be used to integrate the traditional DSS database and ES knowledge-base for building a user-friendly EDSS.

Ethical issues associated with peer review in Medicare

Delegation of Medicare peer review authority to hospital committees contributed to the failure of Professional Standards Review Organizations. The financial incentives of prospective payment under Diagnosis-Related Groups are associated with partic ularly aggressive hospital-based review and ethical tensions between attending physicians, medical staff committees, and hospital administration. Peer Re view Organizations (PROs) are expected to mediate as well as monitor in this environment, but PROs are harshly judged in turn by the "SuperPRO," which finds them too permissive, and by administrative law judges who overturn the majority of their denials on appeal. Although PRO deliberations are held confi dential, release of denial statistics and hospital-spe cific mortality information raises serious concerns.

A simulation based decision support system for a health promotion center

This study represents the financial and qualitative evaluation of a Health Promotion Center of a private hospital located in a medium-sized town located in a predominantly agricultural area. The major objective of this study was to evaluate the impact of various pricing, advertising, and service strategies on profitability. The result is a pricing strategy which allows the center to reach their financial goal of breaking even while maintaining their service policies. The hospital, which serves a community of 500,000 people, recently developed a new concept called a "Health Promotion Center" (HPC). The HPC provides services such as fitness programs, nutrition awareness, rehabilitation and therapy, and child and adult care. For this purpose, a new building was constructed and the center became operational in June 1983. A variety of management options available to the center are described with evaluations of their usefulness. Evaluation methods include scenarios, stochastic simulations, and analyses of how the decision makers use these methods. The inclusion of risk management, model flexibility, and user involvement are stressed throughout the paper and are critical in the decision process.

People and organizations in software production: a review of the literature

The growing demand for software requires increasingly productive people and organizations, yet little is known about how best to select, train, organize, and manage people and organizations to produce software. Boehm's COCOMO software costing model has shown that people and organizations can have a dramatic effect on productivity and costs. Issues of project organization, education and training, professional development, career paths, personnel selection, evaluation, group dynamics, and motivation play a significant part in software productivity. As this review of 130 references to the recent research literature indicates, work is being done on these issues, however, some gaps need to be filled and methods developed to insure their effective use.

End-user computing by top executives

This paper examines the activities and perspectives of top executives towards end-user computing. End-user computing (EUC) is defined as "an information processing activity in which the person has direct personal control over all stage of the activity." Hence, the end user directly uses personal computers and related technology and does not necesarily have technical experience and training in the management information systems (MIS) area.The key issue is whether top executives from a unique group of users or whether they can be considered similar to other users in terms of support and control policies.A field study was conducted resulting in 239 respondents from a variety of organizations. Using the executive level of each respondent as the independent variable, eight other variables were examined such as: the extent of PC usage, exchange of data with others, use of programs developed by others, development of programs for use by others, access to corporate data remotely, etc.The data analysis show that, for the most part, executives do act and feel similar to others relative to end-user computing, which is a significant result. In other words, executives are active adopters of EUC technology and probably have a strong influence on EUC activities in their organizations. They frequently exchange PC data with others and develop programs or models for others. Therefore, considerations about executives as end users should be an important part of EUC policies, both for support and control.

Identifying early adopters of large software systems

In recent years the software industry has undergone rapid growth, yet little is known about the software acquisition process. This study examines the relationship between the acquisition of large data base management systems (DBMSs) and several characteristics of organizations and their personnel. Seven hypothesis related to the adoption of DBMSs are tested through a survey and the results are reported.

A COMPARISON OF TABULAR AND GRAPHICAL DISPLAYS IN FOUR PROBLEM-SOLVING DOMAINS

The effectiveness of graphical versus tabular displays on problem solving has been the focus of much research (DeSanctis, 1984). However, review of this research shows no systematic attempts have been made to identify how performance in specific problem solving domains are affected by tabular or graphical displays.