An Exploratory Study of Patient Falls

Debate continues between the contribution of education level and clinical expertise in the nursing practice environment. Research suggests a link between Baccalaureate of Science in Nursing (BSN) nurses and positive patient outcomes such as lower mortality, decreased falls, and fewer medication errors. Purpose: To examine if there a negative correlation between patient falls and the level of nurse education at an urban hospital located in Midwest Illinois during the years 2010-2014? Methods: A retrospective crosssectional cohort analysis was conducted using data from the National Database of Nursing Quality Indicators (NDNQI) from the years 2010-2014. Sample: Inpatients aged ≥ 18 years who experienced a unintentional sudden descent, with or without injury that resulted in the patient striking the floor or object and occurred on inpatient nursing units. Results: The regression model was constructed with annual patient falls as the dependent variable and formal education and a log transformed variable for percentage of certified nurses as the independent variables. The model overall is a good fit, F (2,22) = 9.014, p = .001, adj. R2 = .40. Conclusion: Annual patient falls will decrease by increasing the number of nurses with baccalaureate degrees and/or certifications from a professional nursing board-governing body

Time-Driven Activity-Based Costing for Healthcare Provider Supply Chain Processes

In a time when healthcare costs continue to rise, nearly a third of hospital operating expenses are related to supplies, and the healthcare supply chain is complex, it is pertinent for healthcare providers to have a clear understanding of their healthcare supply chain process costs. Having a clear picture into how these costs are driven and where opportunities for cost reductions exist can support supply chain efficiencies. In this research, we develop a Time-Driven Activity-Based Costing (TDABC) supply chain cost management tool for healthcare providers. A TDABC management system can provide healthcare providers with valuable product and process supply chain cost information by investigating logistics activities, resource consumption, and time drivers. Based on prior expertise, existing literature, and a field study conducted with a 200-bed, not-for-profit hospital, a healthcare provider supply chain (HPSC) TDABC approach and supporting spreadsheet-based tool were developed to support cost measurement and management within the HPSC

Role of Time-Driven Resource-Consumption Accounting in Strategic Cost Reduction and Support of Supply Chain Management

The study aims to developResource-Consumption Accounting (RCA) by transforming the activities embodied in this approach fromtherigid multiple driversto aflexible unique time-driven driver by support pf supply chain management (SCM). This developmentis intended to overcome the criticisms directed at RCA,activating its role firstly in real cost reduction according to the production capacity mechanism and, secondly, in supply chain management support. The study adopts a theoretical descriptive approach,conceivingthe positives of RCA, Time-Driven Activity-Based Costing in an attempt to create a new approach that integrates the advantages of both approaches in order to reduce cost. It is concluded that Time-Driven Resource-Consumption Accounting (TDRCA) can lead to a real cost reduction and at the same timesupport supply chain management

Resources and Tools:A Step-by-Step Methodological Guide for Costing HIV/AIDS Activities

Many developing countries have recognized the need for comprehensive national reforms and comprehensive prevention, treatment, and care and support initiatives to reduce future transmission of and to meet the growing demand for HIV/AIDS services. As a part of these national health reform initiatives, governments are exploring ways to allocate resources in the most efficient and effective way to mitigate the HIV/AIDS epidemic. However, many countries lack information on the level and nature of the costs of HIV/AIDS programs. This document provides an introduction to the procedure for calculating and analyzing the costs of HIV/AIDS programs and describes how to measure directly the actual costs of a program that is up and running. The step-by-step guide is intended to provide project managers in the field with a framework for how to do measure costs for a single, recent year in the life of an HIV/AIDS program. An illustrative activities list in the report annex will assist the user to develop an activities-based framework. The information gleaned from the costing framework will enable policymakers and program managers to make informed resource allocation decisions

Can procurement affect design performance?

There is an emerging view in the construction industry that better performance or better value for money can be achieved by integrating teamwork for planning, design and construction of building projects. There are though, two opposing perspectives regarding how changes in traditional design practices should occur. Advocates of sustainable construction in North America posit that it is a matter of evolving processes, moving from a sequential to an iterative approach to design, whereas the British government supports the view that a change in how projects are procured is required to transform the context that dictates relationships among the members of the team. The objective of the research is to study the influence of procurement on the performance of integrated design teams. It analyses, through case studies representing these two perspectives, the influence of procurement on the performance of integrated teams. The research is conclusive in that it is the context created by contractual relationship, and not the process set up for conducting integrated design, that most influence team efficiency. It demonstrates that traditional procurement processes reinforce socio-cognitive barriers that hinder team efficiency. It also illustrates how new procurement modes can transform the dynamics of relationships between the client and the members of the supply chain, and have a positive impact on team performance

Understanding the UK hospital supply chain in an era of patient choice

Author Posting © Westburn Publishers Ltd, 2011. This is a post-peer-review, pre-copy-edit version of an article which has been published in its definitive form in the Journal of Marketing Management, and has been posted by permission of Westburn Publishers Ltd for personal use, not for redistribution. The article was published in Journal of Marketing Management, 27(3-4), 401 - 423, doi:10.1080/0267257X.2011.547084 http://dx.doi.org/10.1080/0267257X.2011.547084The purpose of this paper is to investigate the UK hospital supply chain in light of recent government policy reform where patients will have, inter alia, greater choice of hospital for elective surgery. Subsequently, the hospital system should become far more competitive with supply chains having to react to these changes as patient demand becomes less predictable. Using a qualitative case study methodology, hospital managers are interviewed on a range of issues. Views on the development of the hospital supply chain in different phases are derived, and are used to develop a map of the current hospital chain. The findings show hospital managers anticipating some significant changes to the hospital supply chain and its workings as Patient Choice expands. The research also maps the various aspects of the hospital supply chain as it moves through different operational phases and highlights underlying challenges and complexities. The hospital supply chain, as discussed and mapped in this research, is original work given there are no examples in the literature that provide holistic representations of hospital activity. At the end, specific recommendations are provided that will be of interest to service to managers, researchers, and policymakers

Cost measurement in laparoscopic surgery: results from an activity-based costing application

Activity Based Costing (ABC) techniques are designed to support advanced cost analysis in different organizations. Centred on organization activities and processes, it provides more accurate cost information on cost objects using appropriate cost drivers and constitutes a powerful costing model to improve efficiency and effectiveness in delivering products and services. ABC can be successfully applied also in Health Care organizations, where the patient is the main “object” of the activities performed. In addition, in can be fruitfully used in costing the resource consumption of new medical technology devices or surgery processes to assess their economic impact on health care costs. The purpose of this paper is to describe an Activity based costing model designed to measure and control resources consumption and cost when a new technology is applied in health care processes. An ABC model has been defined in relation to laparoscopic technologies applied to surgical cases, designing a health care “activity hierarchy” based on the processes of a specific local unit organization. The output of the application has been a full cost of laparoscopic surgery to be compared with the correspondent DRG current value. As a further result, the paper shows how the ABC model is able to generate different cost figures referred to activity levels or aggregations able to support decision making especially when the introduction of a new surgical technology has to be economically assessed. Propositions are finally made to generate discussion about the effectiveness of the existing cost accounting systems in the health care organizations and on the need for the wider diffusion of ABC techniques in this service sector.Activity-Based Costing, Economic assessment of surgery techniques

Using abm in managing territorial health services: the “home-care”.

In recent years in Italy, as in other European countries, profound changes have been introduced in health care at both the central and the regional levels. Most of them were oriented towards a shift from “hospital-centred” healthcare to healthcare based more on territorial services. This transition pursues two objectives: giving more effective responses to citizens’ needs and reducing public health expenditure. Changes that involve organizational structure must also be carried out with the introduction of measurement tools that can help in planning and can control the changes. Starting from the experiences of the healthcare system of the Tuscan Region of Italy, the paper aims to provide an experience of the ABM approach to measure both output and efficiency of territorial health services. Activity Based Management provides an appropriate method to examine territorial activities and to meet the fact-finding needs of national and regional policy, by considering the issues indicated by the territorial managers of the Tuscan healthcare system and the regional and national experiences in recent years. ABM focuses on managing activities as the route to improving value for users and for the local healthcare unit; this is accomplished by the measurement of activities and resources that determine the costs and performance of territorial services. This approach requires organization and integration of sets of data belonging to different systems such as financial and operational systems. The ABM model is complex but it can be used by policy makers for strategic perspective and for continuous improvement. Moreover, ABM meets managers’ demands, as the Tuscan territorial managers have confirmed in interviews. On the basis of experience obtained in territorial long term homecare , the paper underscores the principal issues arising from the process of conducting an ABM project in territorial health services through strong involvement of healthcare workers. The paper also presents the main outputs achieved.Home care, performance measurement, ABM.

Integration of mahalanobis-taguchi system and activity based costing in decision making for remanufacturing

Classifying components at the end of life (EOL) into remanufacture, repair or dispose is still a major concern to automotive industries. Prior to this study, no specific approach is reported as a guide line to determine critical crankpins that justifying economical remanufacturing process. Traditional cost accounting (TCA) has been used widely by remanufacturing industries but this is not a good measure of estimating the actual manufacturing costs per unit as compared to activity based costing (ABC). However, the application of ABC method in estimating remanufactured cost is rarely reported. These issues were handled separately without a proper integration to make remanufacturing decision which frequently results into uneconomical operating cost and finally the decision becomes less accurate. The aim of this work is to develop a suitable pattern recognition method for classifying crankshaft into three different EOL groups and subsequently evaluates the critical and non-critical crankpins of the used crankshaft using Mahalanobis-Taguchi System (MTS). A remanufacturability assessment technique was developed using Microsoft Excel spreadsheet on pattern recognition and critical crankpins evaluation, and finally integrates these information into a similar spreadsheet with ABC to make decision whether the crankshaft is to be remanufactured, repaired or disposed. The developed scatter diagram was able to recognize group pattern of EOL crankshaft which later was successfully used to determine critical crankpins required for remanufacturing process. The proposed method can serve as a useful approach to the remanufacturing industries for systematically evaluate and decide EOL components for further processing. Case study on six engine models, the result shows that three engines can be securely remanufactured at above 40% profit margin while another two engines are still viable to remanufacture but with less profit margin. In contrast, only two engines can be securely remanufactured due overcharge when using TCA. This inaccuracy affects significantly the overall remanufacturing activities and revenue of the industry. In conclusion, the proposed integration on pattern recognition, parameter evaluation and costing assists the decision making process to effectively remanufacture EOL automotive components as confirmed by Head of workshop of Motor Teknologi Industri Sdn. Bhd

The extent to which businesses in New Zealand are willing to pay carbon tax and other related mechanisms of carbon pricing.

Global climate change is the most critical environmental and economic problem that must be addressed. Failure to address the issue of climate change will result in catastrophic and irreversible damage to natural resources. Issues around climate change have been created by problems caused by industrial pollution and reckless deforestation for commercial gains. Therefore, corporations and businesses should be held accountable for damage they cause. The release of greenhouse gasses should be eliminated or reduced and one way to achieve this is by introducing carbon tax. The aim of this research is to determine the awareness and acceptance of carbon tax and carbon related pricing for businesses in New Zealand. This research included different businesses from different sectors to obtain generalisable results. Quantitative data was gathered from 15 businesses using a closed questionnaire. The data gathered by the survey were than analysed using a percentage approach. The research found that the businesses were aware of carbon tax and its importance. The majority of the businesses were prepared to incur extra carbon tax cost however, preferring the upstream method of taxation as they will be taxed based on quantum of emission. The literature and survey agree that revenue collected from carbon tax and related pricing should be used to fund research to reduce carbon emission and present carbon levels to the desired levels to protect the environment and ensure human existence