Outsourcing the Management of Reusable Medical Devices in a Chain-Wide Care Setting: Mixed Methods Feasibility Study

BACKGROUND

Managing reusable medical devices incurs substantial health care costs and complexity, particularly in integrated care settings. This complexity hampers care quality, safety, and costs. Studying logistical innovations within integrated care can provide insights to medical devices use among staff effectively.

OBJECTIVE

This study aimed to establish the feasibility of a logistical intervention through outsourcing and a web portal. The goal was to provide insights into users' acceptability of the intervention, on whether the intervention was successfully implemented, and on the intervention's preliminary efficacy, thus benefiting practitioners and researchers.

METHODS

This paper presents a mixed methods feasibility study at a large chain-wide health care provider in the Netherlands. The intervention entailed outsourcing noncritical reusable medical devices and introducing a web portal for device management. A questionnaire gauged perceived ordering and delivery times, satisfaction with the ordering and delivery process, compliance with safety and hygiene certification, and effects on the care delivery process. Qualitative data in the form of observations, documentation, and interviews were used to identify implementing challenges. Using on-site stocktaking and data from information systems, we analyzed the utilization, costs, and rental time of medical devices before and after the intervention for wheelchairs and anti-pressure ulcer mattresses.

RESULTS

Looking at the acceptability of the intervention, a high user satisfaction with the ordering and delivery process was reported (rated on a 5-point Likert scale). With respect to preliminary efficacy, we noted a reduction in the utilization of wheelchairs (on average, 1106, SD 106 fewer utilization d/mo), and a halted increase in the utilization of anti-pressure ulcer mattresses. In addition, nurses who used the web portal reported shorter ordering times for wheelchairs (-2.7 min) and anti-pressure ulcer mattresses (-3.1 min), as well as shorter delivery times for wheelchairs (-0.5 d). Moreover, an increase in device certification was reported (average score of 1.9, SD 1.0), indicating higher levels of safety and hygiene standards. In theory, these improvements should translate into better outcomes in terms of costs and the quality of care. However, we were unable to establish a reduction in total care costs or a reduced rental time per device. Furthermore, respondents did not identify improvements in safety or the quality of care. Although implementation challenges related to the diverse supply base and complexities with different care financers were observed, the overall implementation of the intervention was considered successful.

CONCLUSIONS

This study confirms the feasibility of our intervention, in terms of acceptability, implementation success, and preliminary efficacy. The integrated management of medical devices should enable a reduction in costs, required devices, and material waste, as well as higher quality care. However, several challenges remain related to the implementation of such interventions.

Are "outsiders" in? Exploring the impact of outsourced workers' perceived insider status and job value status on job performance

Introduction

Outsourcing, one of the nonstandard employment forms, has been increasingly popular with a wide variety of industries and employers. However, much less is known about its consequences at the employee level, especially relative to standard-employed colleagues. Drawing on social categorization theory and the human resource architecture model, the study was to investigate how outsourced (vs. standard) employment form impacts employees' perceived insider status and then job performance, as well as the moderating role of job value status.

Methods

To examine these effects, we collected two-wave and multi-source questionnaires from a sample of 147 outsourced employees, 279 standard employees, and their immediate supervisors. And interviews with 31 employees, their supervisors, and human resources personnel provided further support for our findings.

Results

The results showed that relative to standard employees, outsourced employees were lower in perceived insider status and indirectly worse in job performance. Furthermore, both the comparative effects were stronger among core-status than peripheral-status employees.

Discussion

Our study contributes to outsourcing and widely nonstandard employment literature, bringing the research focus from employers to outsourced employees' psychological and behavioral consequences. Also, we extended literature on the human resource architecture, through a deeper investigation on the issue of employment form-job value status (mis)matching as well as its impacts on employees.

[Management Practice of Outsourcing Hospital Tests to Independent Clinical Laboratories]

With the development of medical technology and the deepening of medical reform, hospital laboratory test continues to expand. Affected by factors such as technology and cost, the business of outsourcing laboratory test to independent clinical laboratories develops rapidly. However, this cooperation mode has not been carried out for a long time and lacks systematic management experience. Through the analysis of the motivation of hospital delivery, this study expounds the classification, judgment basis and requirements for suppliers of third-party clinical laboratory delivery, as well as the operation practice of laboratory test delivery, so as to provide reference for more standardized and effective testing delivery for hospitals.

Analysis of human resources for health in Afghanistan

Background

Despite large-scale investment in health service delivery outsourcing, few studies have examined human resources for health (HRH) in Afghanistan.

Aims

To review the HRH situation of outsourced healthcare services in Afghanistan and evaluate nongovernment organization (NGO) investments in the health workforce.

Methods

Two questionnaires were used for data collection. One gathered information about the characteristics of HRH in 2020 and the other collected budgetary data for 2017-2020 to analyse budget allocation and expenditure by NGOs on the health workforce.

Results

A total of 25 262 (65% male, 35% female) individuals were employed by NGOs in 31 provinces of Afghanistan. There was a critical shortage of personnel and a prevalence of gender imbalance across all provinces. Healthcare workers were mostly aged 26 to 30 years. Services were mostly provided by local NGOs and their scopes were not limited to outsourced projects. More than 75% of the budget of NGOs was allocated to the health workforce in 2017-2020, and more than 70% of allocations was spent on staff salaries, followed by other health workforce expenditure. Less than 5% was spent on capacity building.

Conclusion

There is a gross shortage and large gender imbalance in the Afghanistan health workforce. It is essential to maintain and increase current financial and technical investments to ensure sustainability and enhance the fragile health system in Afghanistan.

Efficiency of Outsourcing Reporting in Thorax Computed Tomography Evaluation: Retrospective Analysis of 350 Thoracic Surgery Cases

OBJECTIVE

External reporting is frequently used due to the significant increase in computed tomography examinations in recent years and the insufficient number of personnel in internal reporting. We aimed to evaluate the adequacy of outsourcing reporting.

MATERIAL AND METHODS

Patients who were seen or hospitalized as a consultation by thoracic surgeons with thoracic computed tomography between January 2021 and January 2022 were included in the study retrospectively. Computed tomography results reported by radiologists working in our hospital were grouped as "internal reports," and the results reported externally by a company were grouped as "outsourcing reports." The total number of computed tomography examinations taken during the same period and the number of examinations reported by a daily average radiologist were also determined. False-negative findings in internal and outsourcing reports were evaluated and statistically compared between groups.

RESULTS

A total of 84 702 computed tomography scans were taken in 2021. In external reporting, 1 physician reported an average of 202.83 computed tomography scans per day (74 033 per year). A total of 350 thorax computed tomography reports were evaluated. A total of 304 (86.9%) thorax computed tomography examinations were reported with external reporting and 46 (13.1%) with internal reporting. False-negative findings other than those reported were found in 81 reports (23.1%). A significantly higher deficiency was observed in external reporting (77/304) compared to internal reporting (4/46). (P = .013).

CONCLUSION

The effectiveness of external reporting was found to be lower than internal reporting due to a possible lack of communication and audit problems. In order to minimize the errors and related liability arising from external reporting, primarily a legal standardization is required with realistic reporting numbers of external reporting.

Is it feasible to outsource the remote monitoring of implantable cardiac defibrillators in a large tertiary hospital?

AIM

To provide a detailed description of the workflow at our telecardiology centre and to analyse the workload of real-world remote monitoring with the aim to assess the feasibility to outsource this service.

METHODS

A retrospective analysis was conducted on the telecardiology service provided at the University Hospitals of Leuven by extracting patient demographic data, general time usage and detailed information about the type of remote contacts. 10,869 contacts in 948 patients have been included. A 2-week prospective study was conducted on the same service by documenting and monitoring every action performed by specialised nurses when analysing and solving remote monitoring transmissions. 337 contacts in 262 patients were collected during this period.

RESULTS

Both analyses indicated similar numbers of events and interventions. Unplanned transmissions were more challenging and required more interventions than planned transmissions. Relatively little time (retrospective median: 1.83 min; prospective median: 1.56 min, per event) was spent on incoming non-actionable 'normal' transmissions (retrospective: 46%; prospective: 40% of all events). Retrospectively 54% and prospectively 60% of transmissions showed abnormalities and were responsible for most of the time expended. Disease-related issues were the most frequent cause for these 'abnormal' alerts. Contacting patients and physicians were key interventions undertaken. Interaction initiated by patients mainly involved the installation process (42%) and bedside monitoring problems (32%).

CONCLUSION

External data centres could deal with 40% of the transmissions, but the decline in workload would be negligible for the in-hospital remote monitoring team, because very little time is spent dealing with the many 'non-event' transmissions whereas most of the time is spent solving clinical problems. Providing sufficient resources and optimising communication protocols is necessary to aid in managing the workload of the remote monitoring team.

Implications for practiceContacting patients and physicians are key interventions for specialist nurses in remote monitoring centres.Detailed timing confirmed that most time was spent on relevant disease-related clinical problems.Despite dealing with ∼40% of transmissions, outsourcing to external data centres would decrease the workload only by 15-25%.Patient initiated contacts with questions concerning remote monitoring form a high burden and should be countered by scaling the service and creating communication protocols.

Customer Prioritization Integrated Supply Chain Optimization Model with Outsourcing Strategies

Pre-COVID-19, most of the supply chains functioned with more capacity than demand. However, COVID-19 changed traditional supply chains' dynamics, resulting in more demand than their production capacity. This article presents a multiobjective and multiperiod supply chain network design along with customer prioritization, keeping in view price discounts and outsourcing strategies to deal with the situation when demand exceeds the production capacity. Initially, a multiperiod, multiobjective supply chain network is designed that incorporates prices discounts, customer prioritization, and outsourcing strategies. The main objectives are profit and prioritization maximization and time minimization. The introduction of the prioritization objective function having customer ranking as a parameter and considering less capacity than demand and outsourcing differentiates this model from the literature. A four-valued neutrosophic multiobjective optimization method is introduced to solve the model developed. To validate the model, a case study of the supply chain of a surgical mask is presented as the real-life application of research. The research findings are useful for the managers to make price discounts and preferred customer prioritization decisions under uncertainty and imbalance between supply and demand. In future, the logic in the proposed model can be used to create web application for optimal decision-making in supply chains.

Drug development process and COVID-19 pandemic: Flourishing era of outsourcing

Traditional drug development is a tedious process with involvement of enormous cost and a high attrition rate. Outsourcing drug development services to contract research organizations (CROs) has become an important strategy for cost and risk reduction, capacity building, and data generation. The therapeutic and operational expertise of these CROs has allowed pharmaceutical industry to reduce in-house infrastructure as well as research capacity. Working with specialized CROs has not only increased the rate of success but also the speed of drug discovery process. Small firms with promising molecules but limited resources and large firms interested in diversifying their dimensions are utilizing the services of efficient CROs. Globally, approximately one-third of the drug development processes are now being outsourced and the data generated by the independent third party are well appreciated during regulatory submissions. In this article, we discuss the international and national trends, outsourcing services and models, key considerations while selecting CRO, and benefits and challenges of outsourcing. Further, we discuss how the technical expertise of competent CROs was utilized when traditional ways of conducting clinical trials were disrupted by the COVID-19 pandemic. Taken together, the increasing health-care demands, COVID-19 pandemic or any other such upcoming health crisis, and recent advances in advanced technologies (machine learning and artificial intelligence, etc.) are likely to fuel global CRO market in the coming years.

National guidelines for sanitation services: Addressing the unmet need of standardizing cleaning practices in tertiary care public health facilities of a developing country

BACKGROUND

Cleanliness is one of the main reasons for poor satisfaction among the patients and their attendants visiting healthcare facilities.

OBJECTIVE

To elevate and transform the sanitation in public sector facilities, a committee was constituted by Ministry of Health and Family Welfare, Government of India to study the existing system of Housekeeping in Central Government Hospitals and draft the Guidelines for house-keeping services, since no such literature is available in context of the healthcare facilities in India.

METHODS

The committee ascertained the housekeeping services in three tertiary care hospitals of Central Government and simultaneously conducted the literature review of the best practices in hospital sanitation and housekeeping.

RESULTS

Formulated national guidelines focus on various aspects of sanitation services in health facilities, i.e., hospital infrastructure; organization of sanitation services; human resource requirements; qualification, experience and training needs of sanitation staff; roles and responsibilities of different personnel; risk categorization of hospital areas; mechanized cleaning; cleaning agents; cleaning standards and standard operating procedures; effective supervision and monitoring; procurement of these services, etc.

CONCLUSION

Formulated guidelines can be adopted by developing countries aiming for standardizing cleaning practices in public health facilities.

Mycorrhizal associations change root functionality: a 3D modelling study on competitive interactions between plants for light and nutrients

Recent studies show that the variation in root functional traits can be explained by a two-dimensional trait framework, containing a 'collaboration' axis in addition to the classical fast-slow 'conservation' axis. This collaboration axis spans from thin and highly branched roots that employ a 'do-it-yourself' strategy to thick and sparsely branched roots that 'outsource' nutrient uptake to symbiotic arbuscular mycorrhizal fungi (AMF). Here, we explore the functionality of this collaboration axis by quantifying how interactions with AMF change the impact of root traits on plant performance. To this end, we developed a novel functional-structural plant (FSP) modelling approach that simulates plants competing for light and nutrients in the presence or absence of AMF. Our simulation results support the notion that in the absence of AMF, plants rely on thin, highly branched roots for their nutrient uptake. The presence of AMF, however, promotes thick, unbranched roots as an alternative strategy for uptake of immobile phosphorus, but not for mobile nitrogen. This provides further support for a root trait framework that accommodates for the interactive effect of roots and AMF. Our modelling study offers unique opportunities to incorporate soil microbial interactions into root functionality as it integrates consequences of belowground trait expression.

A Crisis of Governance - Or an Opportunity?

The National Health Service Track and Trace Programme has been one of the most pivotal and controversial tools the UK government has deployed to combat the COVID-19 pandemic. This article reviews the challenges of the development and implementation of the NHS COVID-19 mobile application, and reviews these in the context of the following 3 key areas: outsourcing of public sector, organisational structure and leadership, digital framework and governance. The paper argues that the current pandemic has demonstrated weaknesses in each of the above-mentioned areas, and that is an urgent need to strategically address these in order to prepare for the next public health crisis.

An integrated outsourcing practice of nonclinical LC-MS bioanalysis and toxicokinetics at Novartis small molecule drug development

With decommissioning of internal regulated bioanalytical (BA) and toxicokinetic (TK) capabilities, Novartis has relied on external service providers (ESPs) for all nonclinical LC-MS BA and majority of the associated TK work since 2017. This paper outlines an integrated outsourcing practice of the Novartis nonclinical LC-MS BA/TK group, which covers the roles and responsibilities of Novartis nonclinical LC-MS BA/TK expert scientific monitors, selection of ESPs for Novartis nonclinical LC-MS BA/TK studies, qualification of BA/TK ESPs, study conduct and completion, ESP oversight and evaluation, issue mitigation, and future perspectives.

Is it worth outsourcing essential public health services in China?-Evidence from Beilin District of Xi'an

BACKGROUND

Essential public health services (EPHS) is general welfare public health interventions led by the Chinese government and provided by the primary medical institutions to all residents. In Beilin District, Xi'an, EPHS producers can be divided into outsourced institutions and public institutions.

OBJECTIVE

Can outsourcing EPHS reduce costs and improve efficiency and quality? There is still no definite answer to this question. This paper compares the performance of outsourced institutions and public institutions in terms of efficiency and quality, explains the reasons for this phenomenon.

METHODS

This paper uses a theoretical and two-stage DEA model Based on a "triple subject" research framework.

RESULTS

The results show that the difference between public institutions and outsourced institutions is mainly reflected in service quality. When the quality is not measured, outsourced institutions' production efficiency is higher than that of public institutions. When there are quality measurements, the production efficiency of outsourced institutions is lower than that of public institutions.

CONCLUSIONS

Outsourced institutions perform worse than public institutions. The reason is that a bilateral monopolistic market structure has formed between local governments and outsourced institutions. This situation makes it difficult for the government to replace poor quality outsourced institutions under the constraints of a limited budget.

Data driven CRO benchmarking for biomarker analysis

Outsourcing is a common strategy across the pharmaceutical industry and clinical research. CROs offer many choices for selecting outsourcing partners for bioanalytical and biomarker support. We aimed this paper to provide critical insights into CRO benchmarking and selection using a bioanalytical challenge approach performing fit-for-purpose ligand-binding assay. Bioanalytical challenge (method validation and sample analysis) offer Pharma sponsors a great opportunity to stress test CRO technical and scientific competency, quality systems and operational capabilities. In addition, CROs demonstrated their real-life performance in communication, time management and cost - key contributors to a successful sponsor-CRO partnership. Benchmarking CROs based on objective assay data and real-life experiences will help sponsors to make better-informed decisions in vendor selection.

Outsourcing Microbiology Services in Medical Centers: Is It Worth It?

BACKGROUND

Outsourcing of microbiology laboratory services is a growing trend in US medical centers. Data on the actual impact of outsourcing on patient care, safety, and medical education, including costs, are limited. The objective of this study was to examine the published literature on the potential benefits and harms when medical centers outsource common microbiology services.

METHODS

We conducted a 16-step literature search of PubMed and Embase. Articles were selected for full-text review if their content matched our key questions: (1) What are the potential benefits of outsourcing core microbiology laboratory testing? (2) What are the potential harms to patient care and medical education when medical centers outsource essential microbiology services?

RESULTS

The initial search yielded 6111 unique published articles; 36 were selected for full-text review, which resulted in the identification of 8 articles that addressed our key questions (2 editorials, 3 editorials with observational data, 1 survey, 1 case series, and 1 study of blood culture transport). These articles described a variety of issues, including longer turnaround times for blood cultures that resulted in delays in diagnosis and treatment, errors that resulted in patient morbidity, limited cost savings, and communication barriers.

CONCLUSIONS

In this study, with the exception of the blood culture transport study, we found no published prospective studies that quantified the effects of outsourcing microbiology services on patient care, patient safety, or medical education. However, these largely anecdotal reports suggest that outsourcing microbiology services may have a detrimental impact on medical education, especially infectious disease training programs.

Assessing Outsourcing Oversight Practices and Performance

BACKGROUND

The Tufts Center for the Study of Drug Development conducted a study updating benchmarks on outsourcing model adoption and assessing oversight practices and experience.

METHODS

An online survey examining organizational use of clinical development outsourcing was distributed between February and April 2018. Responses from a total of 88 individuals were included in the final analysis.

RESULTS

More than half of individuals responding reported using 3 or more models simultaneously, mixing and matching approaches to meet individual project needs. Outsourcing practices among small, medium, and large sponsor companies remain inconsistent and deliver mixed levels of satisfaction and performance. Full-service models are the most commonly used. Biopharmaceutical companies report that the primary purpose of their oversight mechanisms is to minimize risks and regulatory missteps. Oversight mechanisms are generally supported by middle management personnel focusing on more reactive and tactical issues. Executive-level involvement in outsourcing oversight is minimal and highly variable.

CONCLUSION

Several opportunities to improve oversight practices were identified in the study, including increasing executive-level involvement and leveraging technologies to monitor performance, enhance communication, and expand collaboration capabilities.

A fuzzy multi-criteria decision analysis approach for risk evaluation in healthcare logistics outsourcing: Case of Morocco

Public-private partnerships in emerging countries are gradually considered a tool for growth development. One particular public-private partnership is that of outsourcing logistics in the healthcare sector. These partnerships provide several benefits for both private and public sectors but are generally associated with numerous risks that must be evaluated and subsequently managed. The aim in this paper is to develop a risk evaluation approach to rank risks when decision makers' judgment is taken into consideration and where traditional risk evaluation techniques become less applicable. The proposed approach makes use of fuzzy multi-criteria decision analysis methods since they are efficient techniques to rank alternatives based on selected evaluation criteria and can accommodate human judgment and preferences. The approach treats predetermined risks like alternatives, and evaluation criteria are represented by areas of impact of the risks. To validate the approach, we applied it to a real case of logistics outsourcing to private service providers in a Moroccan public pharmaceutical supply chain. The ranking results obtained show that the two methods lead to some differences in ranking but are highly correlated. The obtained results support healthcare policy makers in setting priorities to effectively deploy preventive and mitigation efforts.

Exploring perceptions, motivations, and practices regarding outsourcing support services by general hospitals in Uganda: A mixed methods study

Research on outsourcing in a developing country using a mixed methods approach can provide insights on outsourcing decisions and practices. This study investigated motivations, practices, perceived benefits, and barriers to outsourcing by general hospitals in Uganda. An explanatory sequential mixed methods design was used. Quantitative data were collected using a self-administered questionnaire from managers in 32 randomly selected hospitals. Qualitative data were latter collected from eight purposively selected managers using an interview guide. Quantitative data were statistically analyzed using SAS 9.3. Qualitative data were managed using ATLAS ti 7 and coded manually, and content analysis was conducted. Quantitative findings indicate that outsourcing of support services was prevalent (72% of hospitals). The key motivation for outsourcing was to gain access to quality service (68%). Limited availability of service providers was a key challenge during outsourcing (57%). Managers perceive improved productivity and better services as key benefits of outsourcing (90%). The main barrier to outsourcing is limited financing. These findings were confirmed and explained by the qualitative data. Findings and recommendations from this study are critical in developing interventions to encourage effective outsourcing by hospitals in Uganda and other developing countries.

Outsourcing in Iranian hospitals: Findings from a qualitative study

Outsourcing is used as a strategy to improve efficiency, quality, and satisfaction of beneficiaries in hospitals. This study aimed to determine the reasons for outsourcing, outsourced services, achieved objectives, and outsourcing challenges. This qualitative study was conducted through 58 face-to-face semi-structured interviews with chief executive officers (CEOs), chief financial officers (CFOs), and contracting experts (CEs) in 42 public hospitals in Tehran, Iran. Purposive and snowball sampling techniques were used. Interviews were recorded digitally and transcribed verbatim. Data analysis was performed based on an inductive-deductive approach via MAXQDA-10. The Participants included 26 CEOs, 15 CFOs, and 17 CEs. The most important reasons for outsourcing were divided into four main categories including financial resources and funding, customers, management, and factors related to the hospitals. Accessing to up-to-date knowledge and technology, improving service quality and accountability, focusing on strategic points, reducing workload, and increasing patient satisfaction turned out to be the positive outcomes of outsourcing. Weakness in laws and regulations, monitoring and assessment of an outsourced unit, creating dependency and changing organizational culture, as well as human resource issues were introduced as the main pitfalls and challenges of outsourcing. Based on the results, it was suggested that the hospital managers must attempt to outsource services by realistic analysis of the organization's current status. They should specify the reasons and objectives of outsourcing and make decisions based on outsourcing potentials. By taking the current challenges of outsourcing in Iranian hospitals into account, the authorities can make the most efficient decisions with regard to outsourcing.

Radiation Oncology-Where to from Here? A Global Inquiry into the Perspectives of Radiation Oncology Professionals in Light of the Growing Cancer Epidemic

INTRODUCTION

Radiation oncology is a vital tool in resisting the cancer epidemic affecting millions worldwide. This study queried the perspectives of radiation oncology professionals and sought their solutions in regard to current practice, future practice, outsourcing, and common values.

METHODS

A mass consumer survey was distributed globally that collected quantitative and qualitative data from 245 radiation oncology professionals based in 47 countries.

RESULTS

Participants scored the sector highly on the quality of current practice. The United States was identified as the perceived global leader in the practice of radiation oncology. The sector was considered moderately open to reform with suggestions of better training, greater resources, and incorporation of data informatics. A preference for paradigms involving private enterprise emerged. Appropriate outsourcing tasks and companies were identified and industry leaders evaluated. Remarkable accord was observed in values and priorities across professional groups and examined subsets.

CONCLUSIONS

There is an opportunity to realize value through the application of successful global paradigms. Our research generated a unique performance evaluation of the sector by identifying the current situation and areas open to reform. The required shift in the role of government from provider to regulator implied a mandate for a reorientation of policy settings with greater emphasis on free enterprise solutions that maximize value and ultimately advance patient care.

Outsourcing within the Nordic context: Care services for older people in Finland

The early 1990s economic setback brought significant reforms favoring the outsourcing of care in Finnish municipalities. Here, outsourcing refers to the practice of municipalities employing private organizations through different means (e.g., open tendering) to deliver public care services. In this context, this study examines the growth in the outsourcing of service housing and home-help services in 311 municipalities from 2001 to 2015 and investigates the municipal factors associated with outsourcing using four dimensions: care needs, population size, economic situation, and political ideology of the municipality. The findings reveal a steep increase in the outsourcing of home-help and service housing. Care needs of older people are the most influential factor for outsourcing, particularly for service housing. Overall, the findings show a growing trend in private care provision in Finnish municipalities.

Outsourcing of Academic Clinical Laboratories: Experiences and Lessons From the Association of Pathology Chairs Laboratory Outsourcing Survey

American hospitals are increasingly turning to service outsourcing to reduce costs, including laboratory services. Studies of this practice have largely focused on nonacademic medical centers. In contrast, academic medical centers have unique practice environments and unique mission considerations. We sought to elucidate and analyze clinical laboratory outsourcing experiences in US academic medical centers. Seventeen chairs of pathology with relevant experience were willing to participate in in-depth interviews about their experiences. Anticipated financial benefits from joint venture arrangements often eroded after the initial years of the agreement, due to increased test pricing, management fees, duplication of services in support of inpatients, and lack of incentive for utilization control on the part of the for-profit partner. Outsourcing can preclude development of lucrative outreach programs; such programs were successfully launched in several cases after joint ventures were either avoided or terminated. Common complaints included poor test turnaround time and problems with test quality (especially in molecular pathology, microbiology, and flow cytometry), leading to clinician dissatisfaction. Joint ventures adversely affected retention of academically oriented clinical pathology faculty, with adverse effects on research and education, which further exacerbated clinician dissatisfaction due to lack of available consultative expertise. Resident education in pathology and in other disciplines (especially infectious disease) suffered both from lack of on-site laboratory capabilities and from lack of teaching faculty. Most joint ventures were initiated with little or no input from pathology leadership, and input from pathology leadership was seen to have been critical in those cases where such arrangements were declined or terminated.

Preliminary hazard analysis applied to outsourcing sterile chemotherapy preparations

Background Our hospital organization raised the possibilities of outsourcing their sterile pediatric chemotherapy preparations to another hospital conditional on analyzing the potential hazardous events that need to be anticipated. Methods The study was conducted by a multidisciplinary working group from September 2015 to January 2016 with the support of a risk manager. A list of hazardous situations that could occur during outsourcing process was assessed. First, a map of hazardous situations was developed by crossing outsourcing processes divided into phases classified as critical or not. Second, a map of risk was established by crossing potential consequences of these hazardous situations and elaborating corrective actions to reduce the initial risks. Results The map of hazardous situations identified 183 relevant hazardous situations, 78 of which were considered high priority and 154 scenarios were developed. Slightly more than half of these hazardous situations concerned information system (30%), human resources (14%), and management (11%). The generic hazards of information system and human generated 37 (24%) and 41 (27%) scenarios, respectively. To reduce critical risks, 33 corrective actions were proposed. Working time required was estimated at 35 days. The subcontractor personnel for this new organization included an estimated extra time of 0.7-pharmacist working day and 1.4-pharmacy dispenser working day. Conclusions The preliminary hazard analysis method appeared to apply to our system of outsourcing sterile cytotoxic preparations in another hospital. Regardless, this analysis is complex and requires time and expertise.

Benefits of Outsourcing Strategy and IT Technology in Clinical Trials

Introduction:

Aim of this paper is to describe some of models of outsourcing (numerous and response to different types of risks and increment of quality is based on individual problem and situation). Defining whether to outsource or not and whether to build or buy new information technology (IT) is question for contract research organization (CRO) and Pharma companies dealing with clinical trials, so the aim of this paper is to show business model that could make process of decision making less time consuming, less segmented and more efficient.

Material and methods:

This paper has a descriptive character, and represents a review of the literature that deals with the described issues.

Results:

Outsourcing should enable optimal capacity flexibility (technology that is outsourced should be done only optimally not entirely). The goal with CRO partners is to establish equivalent levels of global quality, as extensions of other research and development activities (by unification of standards of performance of alliance partners with best standards of industry). IT is gaining greater significance at each stage of clinical study and represent an inevitable element of the quality of a clinical study (for the purpose of monitoring of clinical site activities, data collection and management, medical monitoring, statistical programming, statistical analysis, clinical study reporting).

Conclusion:

CROs are able to maximize work within the CRO global development, to support the notion of a fully integrated outsourced company; facilitate the use of similar business processes and norms, reusing established CRO standards and improve CRO operational decision making within outsourced studies by providing consistent and current information across outsourced and in-house activities.

The psychodynamics of recognition in informatics outsourced work at a public institution

Background

Outsourced work has considerably increased in Brazil, being currently seen as one of the main approaches to reduce the expenses of companies. However, the recognition given to outsourced workers does not match their relevance for the organizations that employ them. According to "work psychodynamics" theory, recognition is a symbolic reward for physical, cognitive and affective investment; personal identity is shaped through the mediation of recognition.

Objective

The aim of the present study was to analyze employee recognition among IT outsourced workers at a public institution.

Methods

Three sessions of collective interviews were conducted, lasting two hours each. The data were analyzed by means of discourse interpretation and were categorized according to the following criteria: work organization, experiences of pleasure and suffering and dynamics of recognition.

Results

Outsourced workers feel they are recognized by their peers and system users as a function of the visibility and usefulness of their activity. However, they do not feel appreciated by formally employed colleagues, namely, their bosses. These results corroborate some studies on socioeconomic fragility and precariousness conducted with outsourced workers.

Conclusions

Despite the lack of visibility of their work for a part of their colleagues, outsourced workers feel they are appreciated. The present study contributes to the advancement of research on work psychodynamics, as well as to overall considerations on management models and attitudes relative to the status of outsourcing within the public service setting.

The evolution of the Pharma-CRO working relationship: AstraZeneca and Covance

Christopher Bailey (AstraZeneca) and Lee Goodwin (Covance) speak to Sankeetha Nadarajah (Managing Commissioning Editor, Bioanalysis) about the evolution of the Pharma-CRO working relationship between AstraZeneca and Covance.

Current status of bioanalytical outsourcing: a pharma perspective

Eric Woolf, Ajai Chaudhary and Sheila Breidinger from Merck, spoke to Sankeetha Nadarajah (Managing Commissioning Editor, Bioanalysis) about outsourcing strategy implementation.

The Landscape of Contract Manufacturing of Sterile Injectable Drugs: Who Is Making What, Where, and for Whom

BACKGROUND

Contract manufacturing of prescription drugs is perceived to be on the rise, as companies look to optimize manufacturing capacity by either outsourcing or manufacturing for others. The lack of transparency into these proprietary arrangements has led to concerns that outsourcing may result in an overly concentrated manufacturing base, making the system more vulnerable to drug shortages.

METHODS

Using nonpublic, internal FDA data, we link 374 sterile injectable new drug applications (NDAs) and 797 abbreviated new drug applications (ANDAs, otherwise known as generics) with finished dosage form manufacturing facilities in which the drugs were made as of November 2014. We then examine which kinds of firms were outsourcing which products and for whom.

RESULTS

We find that NDAs were twice as likely to be outsourced as ANDAs: 39% versus 19%. Outsourced NDAs were just as likely to be made in the US as in Western Europe (45%), but outsourced ANDAs were mostly made in Asia (57%). Large application holders outsourced 10% of their application portfolio. They also manufactured for others-about 14% of applications they made were for others. Sixty-one percent of contract manufacturing firms were small and of those, 76% owned no applications. Because so much contract manufacturing of sterile injectables was being done by small players, there were no discernable differences in market concentration measures between application holders and drug manufacturers.

CONCLUSION

The landscape of sterile injectable contract manufacturing in 2014 was diverse, with small and large companies participating. This diversity resulted in a market similar in its concentration on the ownership and manufacturing sides.

Digital labour and development: impacts of global digital labour platforms and the gig economy on worker livelihoods

As ever more policy-makers, governments and organisations turn to the gig economy and digital labour as an economic development strategy to bring jobs to places that need them, it becomes important to understand better how this might influence the livelihoods of workers. Drawing on a multi-year study with digital workers in Sub-Saharan Africa and South-east Asia, this article highlights four key concerns for workers: bargaining power, economic inclusion, intermediated value chains, and upgrading. The article shows that although there are important and tangible benefits for a range of workers, there are also a range of risks and costs that unduly affect the livelihoods of digital workers. Building on those concerns, it then concludes with a reflection on four broad strategies - certification schemes, organising digital workers, regulatory strategies and democratic control of online labour platforms - that could be employed to improve conditions and livelihoods for digital workers.

Development of medical writing in India: Past, present and future

Pharmaceutical medical writing has grown significantly in India in the last couple of decades. It includes preparing regulatory, safety, and publication documents as well as educational and communication material related to health and health-care products. Medical writing requires medical understanding, knowledge of drug development and the regulatory and safety domains, understanding of research methodologies, and awareness of relevant regulations and guidelines. It also requires the ability to analyze, interpret, and present biomedical scientific data in the required format and good writing skills. Medical writing is the fourth most commonly outsourced clinical development activity, and its global demand has steadily increased due to rising cost pressures on the pharmaceutical industry. India has the unique advantages of a large workforce of science graduates and medical professionals trained in English and lower costs, which make it a suitable destination for outsourcing medical writing services. However, the current share of India in global medical writing business is very small. This industry in India faces some real challenges, such as the lack of depth and breadth in domain expertise, inadequate technical writing skills, high attrition rates, and paucity of standardized training programs as well as quality assessment tools. Focusing our time, attention, and resources to address these challenges will help the Indian medical writing industry gain its rightful share in the global medical writing business.

Current practice and perspectives in CRO oversight based on a survey performed among members of the German Association of Research-Based Pharmaceutical Companies (vfa)

In recent years, the number and scope of outsourced activities in the pharmaceutical industry have increased heavily. In addition, also the type of outsourcing has changed significantly in that time.

This raises the question of whether and how sponsors retain the capability to select and to control the contract research organizations (CROs) involved and what expertise still has to be present in the development department as well as other relevant departments to ensure adequate oversight, also in line with the expectations of regulators and health authorities. In order to answer these questions, a survey was conducted among the German vfa member companies. The survey describes the latest developments and experiences in outsourcing by 18 German vfa member companies. It concentrates on measures how to implement Quality Assurance (QA) when performing outsourced clinical studies.

This study shows that the majority of companies apply a full-outsourcing, preferred-provider model of clinical trial services, with the clinical research department playing the major role in this process. A large amount of guiding documents, processes and tools are used to ensure an adequate oversight of the services performed by the CRO(s).

Finally the guiding principles for all oversight processes should be transparent communication, a clearly established expectation for quality, a precise definition of accountability and responsibility while avoiding silo mentality, and a comprehensive documentation of the oversight’s evidence. For globally acting and outsourcing sponsors, oversight processes need to be aligned with regards to local and global perspectives.

This survey shows that the current implementation of oversight processes in the participating companies covers all relevant areas to ensure highest quality and integrity of the data produced by the outsourced clinical trial.

Can Pharmacovigilance Learn From the Oil and Gas Industry, Which Has Been Outsourcing for Over a Century?

Outsourcing in pharmacovigilance has grown in the past decade. However, standards are lacking in this area, both for initiating as well as maintaining an outsource relationship. In this paper, the authors propose that the sector can learn from other industries that have been outsourcing activities for a much longer time, such as the oil and gas industry. The Safety Case is put forward as a body of evidence that facilitates the continuous exchange of data, especially focused on risk management of the relationship between outsourcer and vendor. Finally, the authors will make an attempt to come to a global consensus in this area through the Allliance for Clinical Research Excellence and Safety (ACRES) network.

The for-profit sector in humanitarian response: integrating ethical considerations in public policy decision making

The engagement of the for-profit private sector in health, social and humanitarian services has become a topic of keen interest. It is particularly contentious in those instances where for-profit organizations have become recipients of public funds, and where they become key decision-makers in terms of how, and to whom, services are provided. We put forward a framework for identifying and organizing the ethical questions to be considered when contracting government services to the for-profit sector, specifically in those areas that have traditionally remained in the public or not-for-profit spheres. The framework is designed to inform both academic debate and practical decision-making regarding the acceptability, feasibility and legitimacy of for-profit organizations carrying out humanitarian work. First, we outline the importance of posing ethical questions in government contracting for-profit vs. not-for-profit organizations. We then outline five key areas to be considered before then examining the extent to which ethics concerns are warranted and how they may be safeguarded.

An Eroding Social Justice Agenda: The Case of Physical Education and Health Edu-Business in Schools

In this article, we draw on current research to explore notions of socially just health and physical education (HPE) programs, in light of claims that a neoliberal globalization promotes markets over the states and a new individualism that privileges self-interest over the collective good. We also invite readers to consider the UN Educational, Scientific, and Cultural Organization's ambition for physical education in light of preliminary findings from an Australian-led research project exploring national and international patterns of outsourcing HPE curricula. Data were sourced from this international research project through a mixed-methods approach. Each external provider engaged in 4 phases of research activity: (a) Web audits, (b) interviews with external providers, (c) network diagrams, and (d) school partner interviews and observations. We then used these data to pose what we believe to be three emerging lines of inquiry and challenge for a socially just school HPE in neoliberal times. In particular, our data indicate that the marketization of school HPE is strengthening an emphasis on individual responsibility for personal health, thereby elevating expectations that schools and teachers will "fill the welfare gap" and, finally, influencing the nature and purchase of educative HPE programs in schools. The apparent proliferation of external providers of health work and HPE resources and services reflects the rise and pervasiveness of neoliberalism in education. We conclude that this global HPE landscape warrants attention to investigate the extent to which external providers' resources are compatible with schooling's educative and inclusive mandates.

Clinical operations generation next… The age of technology and outsourcing

Huge cost pressures and the need to drive faster approvals has driven a technology transformation in the clinical trial (CT) industry. The CT industry is thus leveraging mobile data, cloud computing, social media, robotic automation, and electronic source to drive efficiencies in a big way. Outsourcing of clinical operations support services to technology companies with a clinical edge is gaining tremendous importance. This paper provides an overview of current technology trends, applicable Food and Drug Administration (FDA) guidelines, basic challenges that the pharma industry is facing in trying to implement such changes and its shift towards outsourcing these services to enable it to focus on site operations.

The effect of radiology services outsourcing on patients' satisfaction in Tehran city hospitals

Background: To have a developed society we should have healthy, active, and happy individuals and present that extended healthcare services perform an essential function in increasing the society's health level. Health in a society includes the society's, and people comfort with the condition and an assuring the situation that they can live healthily. Also, considering the self-governing plan of hospitals from 1995, the hospital authorities should choose a method of presenting services, and, the hospital is ready to present those activities during its own activities from an economic viewpoint. The current study was done while trying to discover the effect of the Outsourcing of the Radiology Unit on the patients' satisfaction in hospitals of Tehran. Method: The present research was done in a case-evidence and sectional study. Considering the weight of a month's references to the Radiology Unit, which included around 1200 individuals, the volume of samples for measuring the frequency of the patients' satisfaction with the means of Morgan table was similar to 291 individuals. To decrease the error percentage in each hospital we questioned 300 individuals. (n+10) were questioned and the gathered information were examined by what means SPSS application variant 21 and were then studied by climagraph - Smirnoph, Du Whitman - Vitney K tests. Findings: the mean of the patients' satisfaction of turned over and non-turned over Radiology Unit services were 41.46 and 45, respectively (from the maximum score of 60). A meaningful variation was seen among the patients' Satisfaction in the two hospitals from the analytical viewpoint (p-value<0.001) and there was also a significant difference between the patients' waiting time (p-value<0.001). The research's findings showed that the outsourcing has a negative influence on the patients' satisfaction and the duration of their waiting time. Conclusion: Many times, managers do the outsourcing without considering individual and organizational dimensions and characteristics by just justifying it based on decreasing the expenses. Therefore, it is essential for authorities to consider not only the economic characters but also the individual and human aspects while setting the outsourcing contracts and arrangements.

A Review on influencing criteria for selecting supplier of information technology services in the hospital

Organizations try to outsource their activities as much as possible in order to prevent the problems and use organizational capabilities in Information Technology (IT) field. The purpose of this paper was first, to express the effective criteria for selecting suppliers of IT services, second, to explain the advantages and disadvantages of outsourcing IT in hospitals. This study was narrative review, which search was conducted with the help of libraries, books, conference proceedings, and databases of Science Direct, PubMed, Proquest, Springer, and SID (Scientific Information Database). In our searches, we employed the following keywords and their combinations: Outsourcing, information technology, hospital, decision making, and criteria. The preliminary search resulted in 120 articles, which were published between 2000 and 2013 during July 2013. After a careful analysis of the content of each paper, a total of 46 papers were selected based on their relevancy. The criteria and sub-criteria influencing outsourcing decisions in Iranian hospitals were identified in six major categories including administrative issues, issues related to the service/product, technology factors, environmental factors, risks, and economic factors associated with 15 sub-criteria containing business integration, dependence on suppliers, human resources, focus on core competencies, facilities and physical capital, innovation, quality, speed of service delivery, flexibility, market capabilities, geographical location, security, management control, cost, and financial capability. Identify the advantages and disadvantages of outsourcing and effective criteria in IT services supplier selection causes the managers be able to take the most appropriate decision to select supplier of IT services. This is a general review on influencing criteria for electing of supplier of information technology services in hospitals.

Medical Information Services: How Are We Trending?

As the pharmaceutical and biotechnology industry continues to undergo transformative changes with mergers and acquisitions, loss of patent exclusivity, increased collaborations, and health care reform, Medical Information departments have changed as well. A total of 25 companies were asked to participate in a telephone survey to better understand the trends and adaptations over the last 5 years. Of these, 21 companies participated; the response rate was 84%. The survey focused on 5 key areas: operations and demographics, outsourcing, diversity of responsibilities, value, and health care reform. Results from this survey indicate an increase in outsource activity with expanded contact center functions and continued interest in globalization. Changes over the past 5 years were noted for promotional review, sales training, medical booth convention coverage, field medical slide review, inquiry volume, and support for products approved through the 505(b)(2) pathway. The full impact of health care reform remains to be determined; however, an increase in consumer inquiries is expected. Results from this research should be considered for future surveys.

Taking the pulse of strategic outsourcing relationships

PURPOSE

Articles in peer-reviewed journals and the trade press presuppose that strategic outsourcing relationships have been formed to replace preexisting collaborative approaches with contract research organizations. They do not consider that large, fragmented pharmaceutical and biotechnology companies may be supporting competing and conflicting relationship models simultaneously. A recent Tufts Center for the Study of Drug Development study quantifies actual strategic outsourcing practices among drug development companies and sheds new light on why these relationships may be failing.

METHODS

Tufts Center for the Study of Drug Development conducted an in-depth assessment of 43 Phase II and III clinical studies completed since 2012 to examine the outsourcing relationships used by 9 major pharmaceutical and biotechnology companies to support key functional areas. Descriptive statistics were assessed and t tests were performed to characterize outsourcing practices by function and to determine differences in study performance between transactional and strategic outsourcing relationships.

FINDINGS

The results indicate that sponsor companies are using a variety of outsourcing relationship models to support their studies, mixing and matching the use of internal staff, and using traditional transactional and strategic outsourcing relationships simultaneously. Specifically, despite the fact that each sponsor company had entered into several strategic outsourcing relationships, in no instance did a single contract research organization manage all functional areas supporting an individual Phase II or III study. In addition, sponsor companies vary the types of outsourcing relationship models that they use on a study-by-study basis.

IMPLICATIONS

The inability of pharmaceutical and biotechnology companies to consistently embrace and coordinate sourcing strategies is creating internal friction and inefficiency. As a result, the expected impact of strategic outsourcing relationships on drug development performance, quality, and cost remains elusive.

Clinical SAS programming in India: A study of industry needs versus wants

BACKGROUND

The clinical SAS (www.sas.com) programming industry, in India, has seen a rapid growth in the last decade and the trend seems set to continue, for the next couple of years, due to cost advantage and the availability of skilled labor. On one side the industry needs are focused on less execution time, high margins, segmented tasks and the delivery of high quality output with minimal oversight. On the other side, due to the increased demand for skilled resources, the wants of the programmers have taken a different shift toward diversifying exposure, unsustainable wage inflation due to multiple opportunities and generally high expectations around career progression. If the industry needs are not going to match with programmers want, or vice versa, then there is the possibility that the current year on year growth may start to slow or even go into decline.

AIM

This paper is intended to identify the gap between wants and need and puts forwards some suggestions, for both sides, in ways to change the equation to benefit all.

SETTINGS AND DESIGN

Questionnaire on similar themes created to survey managers and programmers working in clinical SAS programming industry and was surveyed online to collect their perspectives. Their views are compared for each theme and presented as results.

MATERIALS AND METHODS

Two surveys were created in www.surveymonkey.com.

MANAGEMENT

https://www.surveymonkey.com/s/SAS_India_managment_needvswant_survey. Programmer: https://www.surveymonkey.com/s/SAS_India_programmer_needvswant_survey.

STATISTICAL ANALYSIS USED

Bar chart and pie chart used on data collect to show segmentation of data.

RESULTS AND CONCLUSIONS

In conclusion, it seeks to highlight the future industry direction and the skillset that existing programmers need to have, in order to sustain the momentum and remain competitive, to contribute to the future pipeline and the development of the profession in India.

Differences in the use of outsourcing in public and private institutions providing medical services

INTRODUCTION

The costs of health care in Poland are continuously increasing. Thus, almost every institution providing medical services aims at their limitation. One of the costs rationalisation methods in the health care sector is outsourcing.

MATERIAL AND METHODS

The study was conducted in 153 randomly selected institutions providing medical activities. The tool was a questionnaire, available via a web browser.

RESULTS

Over 30% of public institutions identified the need for financial savings, as the main reason for outsourcing the cleaning function. Among private institutions, the dominant reason for this is too high maintenance cost of the cleaning staff (less than 40% of responses). The huge number of medical institutions use the services of an external company for laundering. Over 30% of public institutions identified as the most common reason for separation of functions laundering lack of resources to upgrade and modernize facilities. Less than 27% of public institutions indicate too high costs of kitchen staff as the main reason for ordering function of feeding. Another reason is the need for financial savings (22% response rate). Some institutions indicate a desire to focus on key areas (20% of responses) and lack of financial resources to upgrade and modernize the kitchen (20% response rate). Public and private institutions exercise control over the quality and method performed by an external service (71% of public institutions and 59% of private institutions). Private institutions often informally exercise external control (difference confirmed - Fisher's exact test). Less than 90% of public institutions indicated satisfaction with the services provided by external companies.

CONCLUSIONS

The adaptation of outsourcing in medical facilities leads to financial efficiency improvement. Through the separation of some medical functions and entrusting their realisation to external companies, medical institutions can focus on their basic activity that is the provision of health services.

National health service in India: be aware of what it means

India welcomes international partners and businesses. Indians and Indian health care need to understand the nature and role of foreign collaborators so that appropriate use of expertise and resources can happen. India will initially need to find a balance and eventually need to 'grow its own' to achieve success in healthcare.