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Brix MAK, Järvinen J, Bode MK, Nevalainen M, Nikki M, Niinimäki J, Lammentausta E. Financial impact of incorporating deep learning reconstruction into magnetic resonance imaging routine. Eur J Radiol 2024; 175:111434. [PMID: 38520806 DOI: 10.1016/j.ejrad.2024.111434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 03/19/2024] [Indexed: 03/25/2024]
Abstract
PURPOSE Artificial intelligence and deep learning solutions are increasingly utilized in healthcare and radiology. The number of studies addressing their enhancement of productivity and monetary impact is, however, still limited. Our hospital has faced a need to enhance MRI scanner throughput, and we investigate the utility of new commercial deep learning reconstruction (DLR) algorithm for this purpose. In this work, a multidisciplinary team evaluated the impact of the widespread deployment of a new commercial deep learning reconstruction (DLR) algorithm for our magnetic resonance imaging scanner fleet. METHODS Our analysis centers on the DLR algorithm's effects on patient throughput and investment costs, contrasting these with alternative strategies for capacity expansion-namely, acquiring additional MRI scanners and increasing device utilization on weekends. We provide a framework for assessing the financial implications of new technologies in a trial phase, aiding in informed decision-making for healthcare investments. RESULTS We demonstrate substantial reductions in total operating costs compared to other capacity-enhancing methods. Specifically, the cost of adopting the deep learning technology for our entire scanner fleet is only 11 % compared to procuring an additional scanner and 20 % compared to the weekend utilization costs of existing devices. CONCLUSIONS Procuring DLR for our existing five-scanner fleet allows us to sustain our current MRI service levels without the need for an additional scanner, thereby achieving considerable cost savings. These reductions highlight the efficiency and economic viability of DLR in optimizing MRI service delivery.
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Affiliation(s)
- Mikael A K Brix
- Research Unit of Health Sciences and Technology, University of Oulu, Aapistie 5A, Oulu FI-90220, Finland; Department of Diagnostic Radiology, Oulu University Hospital, Kajaanintie 50, Oulu FI-90220, Finland.
| | - Jyri Järvinen
- Research Unit of Health Sciences and Technology, University of Oulu, Aapistie 5A, Oulu FI-90220, Finland; Department of Diagnostic Radiology, Oulu University Hospital, Kajaanintie 50, Oulu FI-90220, Finland
| | - Michaela K Bode
- Research Unit of Health Sciences and Technology, University of Oulu, Aapistie 5A, Oulu FI-90220, Finland; Department of Diagnostic Radiology, Oulu University Hospital, Kajaanintie 50, Oulu FI-90220, Finland
| | - Mika Nevalainen
- Research Unit of Health Sciences and Technology, University of Oulu, Aapistie 5A, Oulu FI-90220, Finland; Department of Diagnostic Radiology, Oulu University Hospital, Kajaanintie 50, Oulu FI-90220, Finland
| | - Marko Nikki
- Department of Diagnostic Radiology, Oulu University Hospital, Kajaanintie 50, Oulu FI-90220, Finland
| | - Jaakko Niinimäki
- Department of Diagnostic Radiology, Oulu University Hospital, Kajaanintie 50, Oulu FI-90220, Finland
| | - Eveliina Lammentausta
- Department of Diagnostic Radiology, Oulu University Hospital, Kajaanintie 50, Oulu FI-90220, Finland
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Vijverberg JRG, Rouppe van der Voort MBV, van der Nat PB, Mosselman MJ, Rigter S, Biesma DH, van Merode F. How to Use Lean Thinking for the Optimization of Clinical Pathways: A Systematic Review and a Proposed Framework to Analyze Pathways on a System Level. Healthcare (Basel) 2023; 11:2488. [PMID: 37761685 PMCID: PMC10530850 DOI: 10.3390/healthcare11182488] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 08/19/2023] [Accepted: 09/05/2023] [Indexed: 09/29/2023] Open
Abstract
Lean Thinking and clinical pathways are commonly used concepts to improve healthcare. However, little is known on how to use Lean Thinking for the optimization of pathways or the quantification of both concepts. This study aims to create a framework to analyze pathways with Lean Thinking on a system level, by quantifying the seven wastes, flow and pull. A systematic literature review was performed. Inclusion criteria were the focus of the article on a well-defined group of patients and studied a pathway optimization with Lean Thinking. Data were extracted on measured outcomes, type of intervention and type of researched pathway. Thirty-six articles were included. No articles described the implementation of the Lean Thinking philosophy or studied the development of their people and partners ("4 P" model). Most articles used process optimization tools or problem-solving tools. The majority of the studies focused on process measures. The measures found in the review were used as input for our suggested framework to identify and quantify wastes, flow, and pull in a clinical pathway. The proposed framework can be used to create an overview of the improvement potential of a pathway or to analyze the level of improvement after an enhancement is introduced to a pathway. Further research is needed to study the use of the suggested quantifications.
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Affiliation(s)
- Joanna R. G. Vijverberg
- Care and Public Health Research Institute, Maastricht University, 6200 MD Maastricht, The Netherlands
- Maastricht University Medical Centre+, 6229 HX Maastricht, The Netherlands
- Department of Value Improvement, St. Antonius Hospital, 3435 CM Nieuwegein, The Netherlands
| | | | - Paul B. van der Nat
- Department of Value Improvement, St. Antonius Hospital, 3435 CM Nieuwegein, The Netherlands
- Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare (IQ Healthcare), Radboud University Medical Center, 6525 EP Nijmegen, The Netherlands
| | - Machteld J. Mosselman
- Department of Juiste Zorg, Juiste Plaats, Juiste Kosten, St. Antonius Hospital, 3435 CM Nieuwegein, The Netherlands
| | - Sander Rigter
- Department of Anesthesiology and Intensive Care, St. Antonius Hospital, 3435 CM Nieuwegein, The Netherlands
| | - Douwe H. Biesma
- Department of Internal Medicine, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
- Department of Internal Medicine, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
| | - Frits van Merode
- Care and Public Health Research Institute, Maastricht University, 6200 MD Maastricht, The Netherlands
- Maastricht University Medical Centre+, 6229 HX Maastricht, The Netherlands
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Steinmann G, Daniels K, Mieris F, Delnoij D, van de Bovenkamp H, van der Nat P. Redesigning value-based hospital structures: a qualitative study on value-based health care in the Netherlands. BMC Health Serv Res 2022; 22:1193. [PMID: 36138382 PMCID: PMC9502905 DOI: 10.1186/s12913-022-08564-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 09/09/2022] [Indexed: 11/21/2022] Open
Abstract
Background A crucial component of value-based health care concerns the redesign of organizational structures. In theory, hospital structures should follow value creation: addressing medical conditions for specific groups of patients over full cycles of care. In practice, however, it remains unclear how hospitals can reorganize themselves into value-based structures. The purpose of this study is to explore the ways in which Dutch hospitals are currently implementing and pursuing value-based redesign. Methods This qualitative exploratory study used semi-structured interviews and a focus group for data collection. Transcripts were analyzed through deductive coding, for which we used Mintzberg’s theory on organizational structures, particularly his work on design parameters. Results In their efforts to create more value-based structures, Dutch hospitals often employ a variety of liaison devices, such as project teams and committees. By contrast, the actual formation of units around medical conditions is much rarer. Outcome data are widely used within planning and control systems, and some hospitals partake in external benchmarking. Not all hospitals use cost indicators for monitoring performance. Conclusions Value-based redesign is not necessarily a matter of radical changes or binary choices. Instead, as Dutch hospitals show, it can be an incremental process, with a variety of potential knobs to turn to various degrees. Health care executives, managers, and professionals thus have a wide range of options when they aim for more value-based structures. Our conceptualization of “value-based design parameters” can help guide the selection and implementation of strategies and mechanisms for further coordination around medical conditions over full cycles of care. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08564-4.
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Affiliation(s)
- Gijs Steinmann
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, PO Box 1738, Rotterdam, 3000 DR, The Netherlands.
| | - K Daniels
- Department of Value-Based Healthcare, St. Antonius Hospital, Nieuwegein, Utrecht, The Netherlands.,Scientific Center for Quality of Healthcare (IQ Healthcare), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Fabio Mieris
- Department of Value-Based Healthcare, St. Antonius Hospital, Nieuwegein, Utrecht, The Netherlands
| | - Diana Delnoij
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, PO Box 1738, Rotterdam, 3000 DR, The Netherlands.,National Health Care Institute (Zorginstituut Nederland), Diemen, the Netherlands
| | - Hester van de Bovenkamp
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, PO Box 1738, Rotterdam, 3000 DR, The Netherlands
| | - Paul van der Nat
- Department of Value-Based Healthcare, St. Antonius Hospital, Nieuwegein, Utrecht, The Netherlands.,Scientific Center for Quality of Healthcare (IQ Healthcare), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
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Li D, Su M, Guo X, Zhang W, Zhang T. The Effect of Medical Choice on Health Costs of Middle-Aged and Elderly Patients with Chronic Disease: Based on Principal-Agent Theory. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:7570. [PMID: 35805231 PMCID: PMC9265286 DOI: 10.3390/ijerph19137570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 06/16/2022] [Accepted: 06/16/2022] [Indexed: 11/17/2022]
Abstract
(1) Background: The discussion on how to reduce the health costs of chronic disease patients has become an important public health issue. Limited research has been conducted on how chronic disease patients' medical choice of public and private medical institutions affect health costs. (2) Methods: This study used the panel data composed of the China Health and Retirement Longitudinal Survey (CHARLS) from 2011 to 2018, adopted the quasi-natural experimental research method, and set up a control group and an experimental group that chose public medical institutions and private medical institutions, to analyze the association between the medical choice and health costs of chronic disease patients. (3) Results: Compared with chronic disease patients who chose private medical institutions, patients who chose public medical institutions increased their total cost by 44.9%, total out-of-pocket cost by 22.9%, and decreased the total out-of-pocket ratio by 0.117%, total drug cost out-of-pocket ratio by 0.075%, and drug cost ratio by 0.102%. (4) Conclusions: According to the triple principal-agent relationships, the resource advantages given by the government to public medical institutions, the salary incentive system of medical institutions, and the information asymmetry advantage held by physicians may be important factors for the increase in health costs for chronic disease patients.
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Affiliation(s)
| | - Min Su
- School of Public Administration, Inner Mongolia University, Hohhot 010070, China; (D.L.); (X.G.); (W.Z.); (T.Z.)
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van der Ham A, Van Raak A, Ruwaard D, van Merode F. Exploring changes in integration, differentiation, rules, coordination and performance following the introduction of a hospital planning centre: a case study. J Health Organ Manag 2022; 36:158-178. [PMID: 35491486 PMCID: PMC10424640 DOI: 10.1108/jhom-10-2021-0375] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 01/31/2022] [Accepted: 03/13/2022] [Indexed: 11/17/2022]
Abstract
PURPOSE This study explores how a hospital works, which is important for further enhancing hospital performance. Following the introduction of a Hospital Planning Centre (HPC), changes are explored in a hospital in terms of integration (the coordination and alignment of tasks), differentiation (the extent to which tasks are segmented into subsystems), rules, coordination mechanisms and hospital performance. DESIGN/METHODOLOGY/APPROACH A case study was conducted examining the hospital's social network, rules, coordination mechanisms and performance both before and after the introduction of the HPC. All planning and execution tasks for surgery patients were studied using a naturalistic inquiry and mixed-method approach. FINDINGS After the introduction of the HPC, the overall network structure and coordination mechanisms and coordination mechanisms remained largely the same. Integration and certain rules changed for specific planning tasks. Differentiation based on medical discipline remained. The number of local rules decreased and hospital-wide rules increased, and these remained largely in people's minds. Coordination mechanisms remained largely unchanged, primarily involving mutual adjustment and standardization of work both before and after the introduction of the HPC. Overall, the hospital's performance did not change substantially. The findings suggest that integration seems to "emerge" instead of being designed. Hospitals could benefit, we argue, from a more conscious system-wide approach that includes collective learning and information sharing. ORIGINALITY/VALUE This exploratory study provides in-depth insight into how a hospital works, yielding important knowledge for further research and the enhancement of hospital performance.
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Affiliation(s)
- Annelies van der Ham
- Department of Health Services Research, Faculty of Health,
Medicine and Life Sciences, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Centre +
, Maastricht,
The Netherlands
| | - Arno Van Raak
- Department of Health Services Research, Faculty of Health,
Medicine and Life Sciences, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Centre +
, Maastricht,
The Netherlands
| | - Dirk Ruwaard
- Department of Health Services Research, Faculty of Health,
Medicine and Life Sciences, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Centre +
, Maastricht,
The Netherlands
| | - Frits van Merode
- Department of Health Services Research, Faculty of Health,
Medicine and Life Sciences, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Centre +
, Maastricht,
The Netherlands
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Harrington A, Malone D, Doucette W, Vaffis S, Bhattacharjee S, Chan C, Warholak T. A conceptual framework for evaluation of community pharmacy pay-for-performance programs. J Am Pharm Assoc (2003) 2021; 61:804-812. [PMID: 34413002 DOI: 10.1016/j.japh.2021.06.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 06/28/2021] [Accepted: 06/28/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Recent interest in initiating pay-for-performance (P4P) programs indicates an underlying belief that economic incentives will have a direct impact on health care quality and efficiency. Evaluations of the impact of P4P programs on health care organizations and providers have been presented in the literature; however, none have focused on the impact of an incentive targeting community pharmacies. OBJECTIVE To propose a theory-derived conceptual framework of how a financial incentive might work in a community pharmacy. METHODS Studies from the fields of economics (agency theory), psychology (intrinsic and extrinsic motivators; expectancy theory), and organizational theory (ownership, institutional layers, organizational culture, and change management; quality improvement) were reviewed to inform the framework's components. This proposed conceptual framework also integrated and expanded on previous health care-related P4P models. RESULTS P4P programs inherently use financial incentives to catalyze change; however, elements from psychology and organizational theories along with economic theory were identified as important considerations in how a financial incentive may operate when targeting a community pharmacy. Through the incorporation of these theories along with other P4P frameworks in health care, a conceptual framework was derived comprising 4 domains: incentive, pharmacy, other influencing factors, and P4P program measures. Hypothesized relationships among these domains were depicted. CONCLUSION As focus on improving the quality of health care provision develops, opportunities for pharmacists to provide patient care services beyond dispensing will continue to advance, along with expanded reimbursement mechanisms extending beyond traditional product dispensing. The proposed theory-derived conceptual framework serves to depict how the integration of P4P and other factors may affect the pharmacy environment and subsequently affect a pharmacy's capability to perform well on medication-related quality measures. This framework may be used as a foundation on which to design studies to investigate the association between community pharmacy factors and performance in a P4P program.
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Sielskas A. Determinants of hospital inefficiency. The case of Polish county hospitals. PLoS One 2021; 16:e0256267. [PMID: 34403449 PMCID: PMC8660014 DOI: 10.1371/journal.pone.0256267] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 08/03/2021] [Indexed: 11/18/2022] Open
Abstract
Local hospitals play a crucial role in the healthcare system. In this study, the efficiency of Polish county hospitals is assessed by considering characteristics of hospitals that may determine their performance, such as the form of ownership, size, and staff structure. The main goal was to analyze the effect of three possible determinants on efficiency: ownership, the presence of an Emergency Department, and the presence of an Intensive Care Unit. The study covered different subgroups of hospitals and different approaches of inputs and outputs. An input-oriented radial super-efficiency DEA model under variable returns to scale was used for the efficiency analysis, and then differences between distributions of efficient and inefficient units were evaluated using a Chi-square test. A Kruskal-Wallis test was also used to analyze differences in mean efficiency. Inefficiency scores were regressed with hospital characteristics to test for other determinants. These results did not confirm differences in efficiency concerning ownership. However, in some subgroups of hospitals, running an Emergency Department or an Intensive Care Unit had a significant effect. Tobit regression results provided additional insight into how an Emergency Department or Intensive Care Unit can affect efficiency. Both cases had an effect of increasing inefficiency, and the data suggested that the department/unit size plays an important role.
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Affiliation(s)
- Agata Sielskas
- Department of Applied Economics, Collegium of Finance and
Management, Warsaw School of Economics SGH, Warsaw, Poland
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8
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van der Ham A, van Raak A, Ruwaard D, van Merode F. Explaining integration and differentiation by identifying the rules and coordination mechanisms in a hospital's logistical system. J Health Organ Manag 2021; 35:66-84. [PMID: 33645173 PMCID: PMC9251638 DOI: 10.1108/jhom-06-2020-0236] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 11/26/2020] [Accepted: 01/06/2021] [Indexed: 11/18/2022]
Abstract
PURPOSE Integration, that is, the coordination and alignment of tasks, is widely promoted as a means to improve hospital performance. A previous study examined integration and differentiation, that is, the extent to which tasks are segmented into subsystems, in a hospital's social network. The current study carries this research further, aiming to explain integration and differentiation by studying the rules and coordination mechanisms that agents in a hospital network use. DESIGN/METHODOLOGY/APPROACH The current case study deepens the analysis of the social network in a hospital. All planning tasks and tasks for surgery performance were studied, using a naturalistic inquiry approach and a mixed method. FINDINGS Of the 314 rules found, 85% predominantly exist in people's minds, 31% are in documents and 7% are in the information system. In the early planning stages for a surgery procedure, mutual adjustment based on hospital-wide rules is dominant. Closer to the day of surgery, local rules are used and open loops are closed through mutual adjustment, thus achieving integration. On the day of surgery, there is mainly standardization of work and output, based on hospital-wide rules. The authors propose topics for future research, focusing on increasing the hospital's robustness and stability. ORIGINALITY/VALUE This exploratory case study provides an overview of the rules and coordination mechanisms that are used for organizing hospital-wide logistics for surgery patients. The findings are important for future research on how integration and differentiation are effectively achieved in hospitals.
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Affiliation(s)
- Annelies van der Ham
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences,
Maastricht University Medical Centre+
, Maastricht,
The Netherlands
| | - Arno van Raak
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences,
Maastricht University Medical Centre+
, Maastricht,
The Netherlands
| | - Dirk Ruwaard
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences,
Maastricht University Medical Centre+
, Maastricht,
The Netherlands
| | - Frits van Merode
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences,
Maastricht University Medical Centre+
, Maastricht,
The Netherlands
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van der Ham A, van Merode F, Ruwaard D, van Raak A. Identifying integration and differentiation in a Hospital's logistical system: a social network analysis of a case study. BMC Health Serv Res 2020; 20:857. [PMID: 32917198 PMCID: PMC7488445 DOI: 10.1186/s12913-020-05514-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 07/06/2020] [Indexed: 11/10/2022] Open
Abstract
Background Integration, the coordination and alignment of tasks, has been promoted widely in order to improve the performance of hospitals. Both organization theory and social network analysis offer perspectives on integration. This exploratory study research aims to understand how a hospital’s logistical system works, and in particular to what extent there is integration and differentiation. More specifically, it first describes how a hospital organizes logistical processes; second, it identifies the agents and the interactions for organizing logistical processes, and, third, it establishes the extent to which tasks are segmented into subsystems, which is referred to as differentiation, and whether these tasks are coordinated and aligned, thus achieving integration. Methods The study is based on case study research carried out in a hospital in the Netherlands. All logistical tasks that are executed for surgery patients were studied. Using a mixed method, data were collected from the Hospital Information System (HIS), documentation, observations and interviews. These data were used to perform a social network analysis and calculate the network metrics of the hospital network. Results This paper shows that 23 tasks are executed by 635 different agents who interact through 31,499 interaction links. The social network of the hospital demonstrates both integration and differentiation. The network appears to function differently from what is assumed in literature, as the network does not reflect the formal organizational structure of the hospital, and tasks are mainly executed across functional silos. Nurses and physicians perform integrative tasks and two agents who mainly coordinate the tasks in the network, have no hierarchical position towards other agents. The HIS does not seem to fulfill the interactional needs of agents. Conclusions This exploratory study reveals the network structure of a hospital. The cross-functional collaboration, the integration found, and position of managers, coordinators, nurses and doctors suggests a possible gap between organizational perspectives on hospitals and reality. This research sets a basis for further research that should focus on the relation between network structure and performance, on how integration is achieved and in what way organization theory concepts and social network analysis could be used in conjunction with one another.
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Affiliation(s)
- Annelies van der Ham
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University/Maastricht University Medical Centre+, P.O. Box 616, 6200, Maastricht, MD, The Netherlands.
| | - Frits van Merode
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University/Maastricht University Medical Centre+, P.O. Box 616, 6200, Maastricht, MD, The Netherlands
| | - Dirk Ruwaard
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University/Maastricht University Medical Centre+, P.O. Box 616, 6200, Maastricht, MD, The Netherlands
| | - Arno van Raak
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University/Maastricht University Medical Centre+, P.O. Box 616, 6200, Maastricht, MD, The Netherlands
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Alhaider AA, Lau N, Davenport PB, Morris MK. Distributed situation awareness: a health-system approach to assessing and designing patient flow management. ERGONOMICS 2020; 63:682-709. [PMID: 32279607 DOI: 10.1080/00140139.2020.1755061] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 04/06/2020] [Indexed: 06/11/2023]
Abstract
Patient flow management is a system-wide process but many healthcare providers do not integrate multiple departments into the process to minimise the time between treatments or medical services for maximum patient throughput. This paper presents a case study of applying Distributed Situation Awareness (DSA) to characterise system-wide patient flow management and identify opportunities for improvements in a healthcare system. This case study employed a three-part method of data elicitation, extraction, and representation to investigate DSA. Social, task, and knowledge networks were developed and then combined to characterise patient flow management and identify deficiencies of the command and control centre of a healthcare facility. Social network analysis provided centrality metrics to further characterise patient flow management. The DSA model helped identify design principles and deficiencies in managing patient flow. These findings indicate that DSA is promising for analysing patient flow management from a system-wide perspective. Practitioner summary: This article examines Distribution Situation Awareness (DSA) as an analysis framework to study system-wide patient flow management. The DSA yields social, task, and knowledge networks that can be combined to characterise patient flow and identify deficiencies in the system. DSA appears promising for analysing communication and coordination of complex systems. Abbreviations: CDM: critical decision method; CTaC: carilion transfer and communications center; EAST: event analysis systematic teamwork; ED: emergency department; DES: discrete event simulation; DSA: distributed situation awareness; SA: situation awareness; SNA: social network analysis.
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Affiliation(s)
- Abdulrahman A Alhaider
- Grado Department of Industrial and Systems Engineering, Virginia Tech, Blacksburg, VA, USA
- Department of Mechanical and Industrial Engineering, College of Engineering, Prince Sattam Bin Abdulaziz University, Alkharj, Saudi Arabia
| | - Nathan Lau
- Grado Department of Industrial and Systems Engineering, Virginia Tech, Blacksburg, VA, USA
| | - Paul B Davenport
- Carilion Transfer and Communications Centre, Carilion Clinic, Roanoke, VA, USA
| | - Melanie K Morris
- Carilion Transfer and Communications Centre, Carilion Clinic, Roanoke, VA, USA
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Distribution of monetary incentives in health insurance scheme influences acupuncture treatment choices: An experimental study. PLoS One 2019; 14:e0218154. [PMID: 31181131 PMCID: PMC6557502 DOI: 10.1371/journal.pone.0218154] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 05/27/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Understanding how doctors respond to occupational and monetary incentives in health care payment systems is important for determining the effectiveness of such systems. This study examined changes in doctors' behaviors in response to monetary incentives within health care payment systems in a ceteris paribus setting. METHODS An online experiment was developed to analyze the effect of monetary incentives similar to fee-for-service (FFS) and capitation (CAP) on doctors' prescription patterns. In the first session, no monetary values were presented. In the second session conducted 1 week later, doctors were randomly assigned to one of two monetary incentive groups (FFS group: n = 25, CAP group: n = 25). In all sessions, doctors were presented with 10 cases and asked to determine the type and number of treatments. RESULTS In the first session with no monetary incentives, there was no significant difference between the FFS and CAP groups in the number of treatments. When monetary incentives were provided, doctors in the CAP group prescribed fewer treatments than the FFS group. The perceived severity of the cases did not change significantly between sessions and between groups. linear mixed-effects regression model indicated the treatment choices were influenced by monetary incentives, but not by the perceived severity of the patient's symptoms. CONCLUSION The monetary values incentivized the doctors' treatment choices, but not their professional evaluation of patients. Monetary values designed within health care systems influence the doctor's decisions in the form of external rewards, in addition to occupational values, and can thus be adjusted by more effective incentives.
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Munavalli JR, Rao SV, Srinivasan A, van Merode GG. Integral patient scheduling in outpatient clinics under demand uncertainty to minimize patient waiting times. Health Informatics J 2019; 26:435-448. [DOI: 10.1177/1460458219832044] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study addressed the problem of scheduling walk-in patients in real time. Outpatient clinics encounter uncertainty in patient demand. In addition, the disparate departments are locally (department-centric) organized, leading to prolonged waiting times for patients. The proposed integral patient scheduling model incorporates the status and information of all departments in the outpatient clinic along with all possible pathways to direct patients, on their arrival, to the optimal path. The developed hybrid ant agent algorithm identifies the optimal path to reduce the patient waiting time and cycle time (time from registration to exit). An outpatient clinic in Aravind Eye Hospital, Madurai, has a huge volume of walk-in patients and was selected for this study. The simulation study was performed for diverse scenarios followed by implementation study. The results indicate that integral patient scheduling reduced waiting time significantly. The path optimization in real time makes scheduling effective and efficient as it captures the changes in the outpatient clinic instantly.
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Affiliation(s)
| | - Shyam Vasudeva Rao
- Forus Health, India; Maastricht University Medical Centre, The Netherlands
| | | | - GG van Merode
- Maastricht University Medical Centre, The Netherlands
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van der Ham A, Boersma H, van Raak A, Ruwaard D, van Merode F. Identifying logistical parameters in hospitals: Does literature reflect integration in hospitals? A scoping study. Health Serv Manage Res 2018; 32:158-165. [PMID: 30463453 PMCID: PMC7324119 DOI: 10.1177/0951484818813488] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In order to improve the quality and efficiency of hospitals, they can be viewed as a logistical system in which integration is a critical factor for performance. This paper describes the results of a scoping study that identifies the logistical parameters mentioned in international research on hospitals and indicates whether literature reflects system integration. When subsystems collaborate in order to accomplish the task of the entire organization, there is integration. A total number of 106 logistical parameters are identified in our study. In addition, the flow type – patients, materials and staff – and hospital subsystems were registered. The results presented in international literature show that logistics is highly fragmented in hospitals. Studies also show integration, although this takes place mainly within the subsystems of hospitals. A multi-agent perspective on hospitals is proposed, following the view that both integration and differentiation are essential for effective organizational performance. Given the widely recognised importance of controlling hospital costs and the potential of logistics to help in this process, it is important to gain more knowledge of hospitals as network organizations, as well as knowledge regarding the degree of integration and the logistical parameters that are required for better hospital performance.
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Affiliation(s)
- Annelies van der Ham
- CAPHRI School for Public Health and Primary Care, Maastricht University Maastricht, Netherlands
| | - Henri Boersma
- CAPHRI School for Public Health and Primary Care, Maastricht University Maastricht, Netherlands
| | - Arno van Raak
- CAPHRI School for Public Health and Primary Care, Maastricht University Maastricht, Netherlands
| | - Dirk Ruwaard
- CAPHRI School for Public Health and Primary Care, Maastricht University Maastricht, Netherlands
| | - Frits van Merode
- CAPHRI School for Public Health and Primary Care, Maastricht University Maastricht, Netherlands
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Munavalli JR, Rao SV, Srinivasan A, Manjunath U, van Merode GG. A Robust Predictive Resource Planning under Demand Uncertainty to Improve Waiting Times in Outpatient Clinics. JOURNAL OF HEALTH MANAGEMENT 2017; 19:563-583. [PMID: 30166799 PMCID: PMC6097127 DOI: 10.1177/0972063417727627] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Jyoti R Munavalli
- Research Associate, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Shyam Vasudeva Rao
- Cofounder, President and CTO, Forus Health, Bangalore, Technical Director, Maastricht University Medical Centre, Maastricht, The Netherlands
| | | | - Usha Manjunath
- Professor, Institute of Health Management Research, Bangalore, Karnataka, India
| | - G G van Merode
- Professor of Logistics and Operations Management in Health Care, Maastricht University Medical Centre, Maastricht, The Netherlands
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Edelman ER, Hamaekers AEW, Buhre WF, van Merode GG. The Use of Operational Excellence Principles in a University Hospital. Front Med (Lausanne) 2017; 4:107. [PMID: 28752089 PMCID: PMC5507955 DOI: 10.3389/fmed.2017.00107] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2016] [Accepted: 06/29/2017] [Indexed: 11/13/2022] Open
Abstract
The introduction of Operational Excellence in the Maastricht University Medical Center (MUMC+) has been the first of its kind and scale for a university hospital. The policy makers of the MUMC+ have combined different elements from various other business, management, and healthcare philosophies and frameworks into a unique mix. This paper summarizes the journey of developing this system and its most important aspects. Special attention is paid to the role of the operating rooms and the improvements that have taken place there, because of their central role in the working of the hospital. The MUMC+ is the leading tertiary healthcare center for the South-East region of The Netherlands and beyond. Regional, national, and international developments encouraged the MUMC+ to start significantly reorganizing its care processes from 2009 onward. First experiments with Lean Six Sigma and Business Modeling were combined with lessons learned from other centers around the world to form the MUMC+’s own type of Operational Excellence. At the time of writing, many improvement projects of different types have been successfully completed. Every single department in the hospital now uses Operational Excellence and design thinking in general as a method to develop new models of care. An evaluation in 2014 revealed several opportunities for improvement. A large number of projects were in progress, but 75% of all projects had not been completed, despite the first projects being initiated back in 2012. This led to a number of policy changes, mainly focusing on more intensive monitoring of projects and trying to do more improvement projects directly under the responsibility of the line manager. Focusing on patient value, continuous improvement, and the reduction of waste have proven to be very fitting principles for healthcare in general and specifically for application in a university hospital. Approaching improvement at a systems level while directly involving the people on the work floor in observing opportunities for improvement and realizing these has shown itself to be essential.
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Affiliation(s)
- Eric R Edelman
- Faculty of Health, Medicine and Life Sciences, Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, Netherlands
| | - Ankie E W Hamaekers
- Department of Anesthesiology, Maastricht University Medical Center+, Maastricht, Netherlands
| | - Wolfgang F Buhre
- Department of Anesthesiology, Maastricht University Medical Center+, Maastricht, Netherlands
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Blank JLT, van Hulst BL. Balancing the health workforce: breaking down overall technical change into factor technical change for labour-an empirical application to the Dutch hospital industry. HUMAN RESOURCES FOR HEALTH 2017; 15:15. [PMID: 28212687 PMCID: PMC5316228 DOI: 10.1186/s12960-017-0184-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2016] [Accepted: 01/14/2017] [Indexed: 05/12/2023]
Abstract
BACKGROUND Well-trained, well-distributed and productive health workers are crucial for access to high-quality, cost-effective healthcare. Because neither a shortage nor a surplus of health workers is wanted, policymakers use workforce planning models to get information on future labour markets and adjust policies accordingly. A neglected topic of workforce planning models is productivity growth, which has an effect on future demand for labour. However, calculating productivity growth for specific types of input is not as straightforward as it seems. This study shows how to calculate factor technical change (FTC) for specific types of input. METHODS The paper first theoretically derives FTCs from technical change in a consistent manner. FTC differs from a ratio of output and input, in that it deals with the multi-input, multi-output character of the production process in the health sector. Furthermore, it takes into account substitution effects between different inputs. An application of the calculation of FTCs is given for the Dutch hospital industry for the period 2003-2011. A translog cost function is estimated and used to calculate technical change and FTC for individual inputs, especially specific labour inputs. RESULTS The results show that technical change increased by 2.8% per year in Dutch hospitals during 2003-2011. FTC differs amongst the various inputs. The FTC of nursing personnel increased by 3.2% per year, implying that fewer nurses were needed to let demand meet supply on the labour market. Sensitivity analyses show consistent results for the FTC of nurses. CONCLUSIONS Productivity growth, especially of individual outputs, is a neglected topic in workforce planning models. FTC is a productivity measure that is consistent with technical change and accounts for substitution effects. An application to the Dutch hospital industry shows that the FTC of nursing personnel outpaced technical change during 2003-2011. The optimal input mix changed, resulting in fewer nurses being needed to let demand meet supply on the labour market. Policymakers should consider using more detailed and specific data on the nature of technical change when forecasting the future demand for health workers.
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Affiliation(s)
- Jos L. T. Blank
- Delft University of Technology, Delft, The Netherlands
- Erasmus University Rotterdam, Rotterdam, The Netherlands
- PO Box 5015, 2600 GA Delft, The Netherlands
| | - Bart L. van Hulst
- Delft University of Technology, Delft, The Netherlands
- PO Box 5015, 2600 GA Delft, The Netherlands
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Costa CKF, Balbinotto G, Sampaio LMB. [Analysis of contractual incentives for kidney transplants in Brazil using the principal-agent model]. CAD SAUDE PUBLICA 2016; 32:e00022915. [PMID: 27626647 DOI: 10.1590/0102-311x00022915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 11/26/2015] [Indexed: 11/22/2022] Open
Abstract
The aim of this article was to analyze contractual incentives for kidney transplants in Brazil based on the principal-agent model. The approach assumes that the Brazilian Ministry of Health is the principal and the public hospitals accredited by the National Transplant System are the agent. The Ministry of Health's welfare depends on measures taken by hospitals in kidney uptake. Hospitals allocate administrative, financial, and management efforts to conduct measures in kidney donation, removal, uptake, and transplantation. Hospitals may choose the levels of effort that are consistent with the payments and incentives received in relation to transplantation costs. The solution to this type of problem lies in structuring an optimal incentives contract, which requires aligning the interests of both parties involved in the transplantation system.
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Affiliation(s)
| | - Giácomo Balbinotto
- Programa de Pós-graduação em Economia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brasil.,Instituto de Avaliações de Tecnologias em Saúde, Porto Alegre, Brasil
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Using nonparametric conditional approach to integrate quality into efficiency analysis: empirical evidence from cardiology departments. Health Care Manag Sci 2016; 20:565-576. [DOI: 10.1007/s10729-016-9372-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Accepted: 07/05/2016] [Indexed: 10/21/2022]
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Productivity and quality of Dutch hospitals during system reform. Health Care Manag Sci 2015; 19:279-90. [PMID: 25774011 PMCID: PMC4971046 DOI: 10.1007/s10729-015-9321-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Accepted: 02/23/2015] [Indexed: 10/26/2022]
Abstract
This study addresses the productivity of Dutch hospitals since the start of the health systems reform in 2005. We consider DEA based measures, which include efficiency and quality for the complete set of Dutch hospitals and present cross-sectional and longitudinal analysis. In particular, we consider how hospital efficiency has developed. As the reform created an environment of regulated competition, we pay special attention to relative efficiency. Our results suggest that the differences in efficiency among hospitals have become larger. In the years 2009-2010, the number of hospitals identified as (close to) efficient by DEA analysis decreased.
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Mateus C, Joaquim I, Nunes C. Measuring hospital efficiency—comparing four European countries. Eur J Public Health 2015; 25 Suppl 1:52-8. [DOI: 10.1093/eurpub/cku222] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Heimeshoff M, Schreyögg J, Tiemann O. Employment effects of hospital privatization in Germany. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2014; 15:747-757. [PMID: 23880885 DOI: 10.1007/s10198-013-0520-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2012] [Accepted: 07/08/2013] [Indexed: 06/02/2023]
Abstract
The main argument for the ongoing privatization process is that privatization will lead to an increase in efficiency, which has been confirmed by a large number of studies. An important argument against privatization is that privatization may lead to employment reductions. In the hospital sector, potential employment reductions might also lead to a decrease in the quality of care. This is the first study to investigate the employment effects of different types of hospital privatization (i.e., for-profit vs non-profit privatization) on different categories of staff. A combination of propensity score matching and difference-in-difference methods was used to identify the causal effect. We found large employment reductions after for-profit privatization, while there were no permanent reductions after non-profit privatization. Moreover, even for-profit privatization does not affect all types of staff. While there are large reductions in non-clinical staff, we could not detect any reduction in the number of physicians. The consequences of the detected employment effects of privatization have to be addressed in greater detail in future research.
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Affiliation(s)
- Mareike Heimeshoff
- Hamburg Center for Health Economics, University of Hamburg, Esplanade 36, 20354, Hamburg, Germany,
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Kounetas K, Papathanassopoulos F. How efficient are Greek hospitals? A case study using a double bootstrap DEA approach. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2013; 14:979-94. [PMID: 23229820 DOI: 10.1007/s10198-012-0446-z] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2012] [Accepted: 11/19/2012] [Indexed: 05/22/2023]
Abstract
The purpose of this study was to measure Greek hospital performance using different input-output combinations, and to identify the factors that influence their efficiency thus providing policy makers with valuable input for the decision-making process. Using a unique dataset, we estimated the productive efficiency of each hospital through a bootstrapped data envelopment analysis (DEA) approach. In a second stage, we explored, using a bootstrapped truncated regression, the impact of environmental factors on hospitals' technical and scale efficiency. Our results reveal that over 80% of the examined hospitals appear to have a technical efficiency lower than 0.8, while the majority appear to be scale efficient. Moreover, efficiency performance differed with inclusion of medical examinations as an additional variable. On the other hand, bed occupancy ratio appeared to affect both technical and scale efficiency in a rather interesting way, while the adoption of advanced medical equipment and the type of hospital improves scale and technical efficiency, correspondingly. The findings of this study on Greek hospitals' performance are not encouraging. Furthermore, our results raise questions regarding the number of hospitals that should operate, and which type of hospital is more efficient. Finally, the results indicate the role of medical equipment in performance, confirming its misallocation in healthcare expenditure.
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Affiliation(s)
- Kostas Kounetas
- Department of Economics, University of Patras, University Campus Rio, 26504, Patras, Greece,
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Bjorvatn A. Making incentives work: Hospital organisation and performance. Scand J Public Health 2012; 40:449-56. [DOI: 10.1177/1403494812454232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aims: In 1997, financing of Norwegian hospitals was changed to a combination of block grants and activity-based reimbursements. Since then, many hospitals have also reorganised their internal structures, for instance by implementing activity-based budgets at the departmental level. The purpose of this study is to investigate the impact of departmental activity-based budgets on overall hospital productivity and unit costs. Methods: The analysis is based on register data on hospital admissions and hospital input factors, along with survey data on internal organisation of hospitals. Fixed-effects regression models are applied for the analysis. Results: The main results indicate that hospitals with departmental activity-based budgets and department authority have higher productivity. The effect on unit costs is insignificant. Conclusions: The positive effect of the departmental activity-based budgets and departmental authority on productivity without increase in costs may indicate that providing incentives at lower hospital levels such as departments could be a useful tool for increasing overall hospital productivity and cost efficiency.
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Affiliation(s)
- Afsaneh Bjorvatn
- Department of Economics, University of Bergen, Bergen, Norway; Samarbeidsorganet, Haukeland University Hospital, Bergen, Norway; and SNF – Institute for Research in Economics and Business Administration, University of Bergen, Bergen, Norway
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Vos L, Chalmers SE, Dückers MLA, Groenewegen PP, Wagner C, van Merode GG. Towards an organisation-wide process-oriented organisation of care: a literature review. Implement Sci 2011; 6:8. [PMID: 21247491 PMCID: PMC3035025 DOI: 10.1186/1748-5908-6-8] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2009] [Accepted: 01/19/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Many hospitals have taken actions to make care delivery for specific patient groups more process-oriented, but struggle with the question how to deal with process orientation at hospital level. The aim of this study is to report and discuss the experiences of hospitals with implementing process-oriented organisation designs in order to derive lessons for future transitions and research. METHODS A literature review of English language articles on organisation-wide process-oriented redesigns, published between January 1998 and May 2009, was performed. RESULTS Of 329 abstracts identified, 10 articles were included in the study. These articles described process-oriented redesigns of five hospitals. Four hospitals tried to become process-oriented by the implementation of coordination measures, and one by organisational restructuring. The adoption of the coordination mechanism approach was particularly constrained by the functional structure of hospitals. Other factors that hampered the redesigns in general were the limited applicability of and unfamiliarity with process improvement techniques. CONCLUSIONS Due to the limitations of the evidence, it is not known which approach, implementation of coordination measures or organisational restructuring (with additional coordination measures), produces the best results in which situation. Therefore, more research is needed. For this research, the use of qualitative methods in addition to quantitative measures is recommended to contribute to a better understanding of preconditions and contingencies for an effective application of approaches to become process-oriented. Hospitals are advised to take the factors for failure described into account and to take suitable actions to counteract these obstacles on their way to become process-oriented organisations.
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Affiliation(s)
- Leti Vos
- NIVEL, Netherlands Institute for Health Services Research, P.O. Box 1568, 3500 BN Utrecht, the Netherlands
- Department of Medical Decision Making, Leiden University Medical Center, P.O. Box 9600, 2300 RC Leiden, the Netherlands
| | | | - Michel LA Dückers
- Impact, Dutch knowledge and advice center for post-disaster psychosocial care, P.O. Box 78, 1110 AB Diemen, the Netherlands
| | - Peter P Groenewegen
- NIVEL, Netherlands Institute for Health Services Research, P.O. Box 1568, 3500 BN Utrecht, the Netherlands
- Department of Sociology, Department of Human Geography, Utrecht University, P.O. Box 80140, 3508 TC Utrecht, the Netherlands
| | - Cordula Wagner
- NIVEL, Netherlands Institute for Health Services Research, P.O. Box 1568, 3500 BN Utrecht, the Netherlands
- The EMGO Institute for Health and Care Research (EMGO+), VU University Medical Centre Amsterdam, P.O. Box 7057, 1007 MB Amsterdam, the Netherlands
| | - Godefridus G van Merode
- Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Centre+, P.O. Box 5800, 6202 AZ Maastricht, the Netherlands
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Vos L, Dückers MLA, Wagner C, van Merode GG. Does case-mix based reimbursement stimulate the development of process-oriented care delivery? Health Policy 2010; 98:74-80. [PMID: 20605051 DOI: 10.1016/j.healthpol.2010.06.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2009] [Revised: 06/01/2010] [Accepted: 06/06/2010] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Reimbursement based on the total care of a patient during an acute episode of illness is believed to stimulate management and clinicians to reduce quality problems like waiting times and poor coordination of care delivery. Although many studies already show that this kind of case-mix based reimbursement leads to more efficiency, it remains unclear whether care coordination improved as well. This study aims to explore whether case-mix based reimbursement stimulates development of care coordination by the use of care programmes, and a process-oriented way of working. METHODS Data for this study were gathered during the winter of 2007/2008 in a survey involving all Dutch hospitals. Descriptive and structural equation modelling (SEM) analyses were conducted. RESULTS SEM reveals that adoption of the case-mix reimbursement within hospitals' budgeting processes stimulates hospitals to establish care programmes by the use of process-oriented performance measures. However, the implementation of care programmes is not (yet) accompanied by a change in focus from function (the delivery of independent care activities) to process (the delivery of care activities as being connected to a chain of interdependent care activities). CONCLUSION This study demonstrates that hospital management can stimulate the development of care programmes by the adoption of case-mix reimbursement within hospitals' budgeting processes. Future research is recommended to confirm this finding and to determine whether the establishment of care programmes will in time indeed lead to a more process-oriented view of professionals.
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Affiliation(s)
- Leti Vos
- NIVEL, Netherlands Institute for Health Services Research, P.O. Box 1568, 3500 BN Utrecht, The Netherlands.
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Bredenhoff E, van Lent WAM, van Harten WH. Exploring types of focused factories in hospital care: a multiple case study. BMC Health Serv Res 2010; 10:154. [PMID: 20529299 PMCID: PMC2904334 DOI: 10.1186/1472-6963-10-154] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2009] [Accepted: 06/07/2010] [Indexed: 12/02/2022] Open
Abstract
Background Focusing on specific treatments or diseases is proposed as a way to increase the efficiency of hospital care. The definition of "focus" or "focused factory", however, lacks clarity. Examples in health care literature relate to very different organizations. Our aim was to explore the application of the focused factory concept in hospital care, including an indication of its performance, resulting in a conceptual framework that can be helpful in further identifying different types of focused factories. Thus contributing to the understanding of the diversity of examples found in the literature. Methods We conducted a cross-case comparison of four multiple-case studies into hospital care. To cover a broad array of focus, different specialty fields were selected. Each study investigated the organizational context, the degree of focus, and the operational performance. Focus was measured using an instrument translated from industry. Data were collected using both qualitative and quantitative methods and included site visits. A descriptive analysis was performed at the case study and cross-case studies level. Results The operational performance per specialty field varied considerably, even when cases showed comparable degrees of focus. Cross-case comparison showed three focus domains. The product domain considered specialty based focused factories that treated patients for a single-specialty, but did not pursue a specific strategy nor adapted work-designs or layouts. The process domain considered delivery based focused factories that treated multiple groups of patients and often pursued strategies to improve efficiency and timeliness and adapted work-designs and physical layouts to minimize delays. The product-process domain considered procedure based focused factories that treated a single well-defined group of patients offering one type of treatment. The strategic focusing decisions and the design of the care delivery system appeared especially important for delivery and procedure based focused factories. Conclusions Focus in hospital care relates to limitations on the patient group treated and the range of services offered. Based on these two dimensions, we identified three types of focused factories: specialty based, delivery based, and procedure based. Focus could lead to better operational performance, but only when clear strategic focusing decisions are made.
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Affiliation(s)
- Eelco Bredenhoff
- School of Management and Governance, University of Twente, The Netherlands.
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