Journal of the Society for Health Systems最新文献

This article reports an analysis of the effectiveness of Total Quality Management (TQM) programs. The objective of the study was gain a better understanding of how hospitals implement TQM and quality improvement initiatives. Results show that some hospital staffs have not realized that they are implementing TQM, even though they report to be using the strategies for quality improvement. On the other hand, some hospitals said that they were involved in quality programs, though not practically implementing TQM strategies. These results suggest two major conclusions about the implementation of TQM programs. First, data indicate that TQM programs may not be as effective as promised, due to a lack of understanding about TQM by the people within the organization. Second, implementation strategies that are statistically correlated are identified. These conclusions may be helpful for successful TQM implementation in from healthcare organizations as well as other service industries.

Health care executives across the country, faced with intense competition, are being forced to consider drastic cost cutting measures as a matter of survival. The entire health care industry is under siege from boards of directors, management and others who encourage health care systems to take actions ranging from strategic acquisitions and mergers to simple "downsizing" or "rightsizing," to improve their perceived competitive positions in terms of costs, revenues and market share. In some cases, management is poorly prepared to work within this new competitive paradigm and turns to consultants who promise that following their methodologies can result in competitive advantage. One favored methodology is reengineering. Frequently, cost cutting attention is focused on the materials management budget because it is relatively large and is viewed as being comprised mostly of controllable expenses. Also, materials management is seldom considered a core competency for the health care system and the organization performing these activities does not occupy a strongly defensible position. This paper focuses on the application of a reengineering methodology to healthcare materials management.

This paper presents the development and application of a Markov model that simulates the onset and progression of insulin dependent diabetes mellitus (IDDM) and its sequelae. The model estimates direct medical costs resulting from different patterns of health states during the course of the disease. The model is user-friendly and allows for changes in the input variables to be specified, thereby providing a frame-work for sensitivity analysis. The Markov process moves a cohort of individuals through six different health states: Healthy, IDDM without chronic microvascular complications, IDDM with retinopathy alone, IDDM with neuropathy alone or with retinopathy, IDDM with nephropathy, and death. Epidemiologic data were obtained from governmental sources as well as the medical literature. Transition probabilities were estimated using data from the Wisconsin Epidemiologic Study of Diabetic Retinopathy (WESDR). Direct medical costs were estimated from actual charges from a local health maintenance organization in Wisconsin. The validity of the model was tested in several ways including a comparison with an independent cost estimate made by the Wisconsin Department of Health and Family Services. The model appears to be useful in estimating the progression and associated costs of IDDM for any large population over any period of time and in allowing changes in the inputs to evaluate their impact thus providing pertinent information to healthcare decision-makers and health planners.

Integrated healthcare material management begins with manufactures of medical/surgical supplies, uses distributors and ends at the point of use at hospitals. Recent material management philosophies in the healthcare industry, such as just-in-time and stockless systems, are yet to be fully evaluated. In order to evaluate the cost effectiveness of each type of material management technique, a cost model for hospital materials management has been designed. Several case scenarios are analyzed and results are reported.

Hospital ancillary units face difficult staffing problems due to demand variability by time of day and day of week. For such problems, tour scheduling models play an important role in minimizing labor cost while meeting the staffing needs and personnel scheduling constraints of the unit. We describe an approach called tactical scheduling analysis for addressing such problems. The components of such an analysis are detailed and several actual scheduling analysis projects are presented in order to give a sense of the different types of problems faced by ancillary units and how we as engineers try to solve these problems.

This study explores influences on nursing care volume per case in four DRGs and five hospitals. After accounting for the effects of length of stay, patient characteristics, and severity of illness, the direct effect of factors describing the nursing staff and hospital was assessed. Skill mix and standing orders each were significant in one or more DRGs, but there was no significant association between the volume of nursing care and occupancy or staff availability. The management and research implications of the findings are discussed.

This paper presents a case study where the efforts to improve clinical guidelines resulted in significant savings in material costs through the standardization of the supplies and negotiation of contracts with the suppliers. It also presents an approach that is now being used to standardize material and reduce supply costs in other areas of the health system.

A growing number of hospitals are using health care-specific simulation technology to help identify process improvements, particularly when there are a number of alternatives under consideration. New software is now available which specifically meets the unique needs of health care. This paper describes how a team at one Emergency Services department in a SunHealth alliance hospital used simulation technology to test alternatives and choose a solution to significantly reduce the length of stay for patients in the Emergency Department.

There is no generally accepted definition of surgical process scheduling available in the literature; nursing researchers, physicians, administrators, and management scientists each view scheduling differently. To overcome this communication problem, a number of authors have proposed conceptual frameworks for surgical process scheduling. These frameworks have unfortunately been either unsatisfactory or incomplete. In this paper, we describe a conceptual framework for surgical process scheduling and use it to classify the existing literature. Results from the review indicate that while operational aspects of advance and allocation scheduling are well understood, further research should be directed towards resolving scheduling issues at strategic and administrative levels. In addition, techniques for integrating operating room (OR) scheduling with other hospital operations are required.