A system dynamics-based simulation study for managing clinical governance and pathways in a hospital

This paper examines the development of clinical pathways in a hospital in Australia based on empirical clinical data of patient episodes. A system dynamics (SD)-based decision support system (DSS) is developed and analyzed for this purpose. System dynamics was used as the simulation modeling tool because of its rigorous approach in capturing interrelationships among variables and in handling dynamic aspects of the system behavior in managing healthcare. The study highlights the scenarios that will help hospital administrators to redistribute caseloads amongst admitting clinicians with a focus on multiple Diagnostic Related Groups (DRG’s) as the means to improve the patient turnaround and hospital throughput without compromising quality patient care. DRG’s are the best known classification system used in a casemix funding model. The classification system groups inpatient stays into clinically meaningful categories of similar levels of complexity that consume similar amounts of resources. Policy explorations reveal various combinations of the dominant policies that hospital management can adopt. The analyses act as a scratch pad for the executives as they understand what can be feasibly achieved by the implementation of clinical pathways given a number of constraints. With the use of visual interfaces, executives can manipulate the DSS to test various scenarios. Experimental evidence based on focus groups demonstrated that the DSS can enhance group learning processes and improve decision making. The simulation model findings support recent studies of CP implementation on various DRG’s published in the medical literature. These studies showed substantial reductions in length of stay, costs and resource utilization

Practitioner Perceptions of the A3 Method for Process Improvement in Health Care

The focus of this article is to present students’ perceptions of the recently developed A3 method, a structured problem-solving approach based on lean concepts and tools that have been adapted to the health care environment. The students were all employees of a large health care provider and were enrolled in a customized health care executive MBA Program. Each student was required to complete an individual A3 Project in order to improve a process at the department for which they worked. At the end of the semester the students presented their A3 projects to their peers who voted on the best projects. A survey measuring perceptions of the A3 method for problem solving in health care was administered and from it we present propositions for A3 implementation. These propositions are applicable both to health care practitioners and to academic researchers

Il costo dell’intervento chirurgico in laparoscopia con l’Activity Based Costing

The purpose of this research is to analyze the role of the Management Control System (MCS) and of the Management Accounting System (MAS) in healthcare (HC) organizations. It aims at studying if and how managerial considerations affect the clinical culture. Results are based on the findings of a research developed within 12 Local Health Authorities (Aziende Sanitarie Locali LHAs) and 4 Teaching Hospital (Aziende Ospedaliere Universitarie THs) in Italian Tuscany Region and address the possibility to develop an alternative model from those of accountingization or legitimation proposed in literature to understand the role of these systems in healthcare. Results highlight that the economic language may assume a great importance in clinicians’ decision making and penetrates into clinical culture. Most important factor affecting results is the development of an alliance between controllers and clinicians, based trust and collaboration. The paper is a contribution to the literature about the role of MCS and MAS in healthcare and it is developed within the schemes traced by Habermas and refined by Laughlin and by Broadbent and Laughlin. The original value stands on the individuation of a model where the “integrative interactive” management model is able to penetrate clinical discourse and the conditions at which it can be developed.Management Accounting Change, Management Control Change, Healthcare Accounting, Professional organization, accountinization, legitimation, Habermas

Annotated Bibliography: Understanding Ambulatory Care Practices in the Context of Patient Safety and Quality Improvement.

The ambulatory care setting is an increasingly important component of the patient safety conversation. Inpatient safety is the primary focus of the vast majority of safety research and interventions, but the ambulatory setting is actually where most medical care is administered. Recent attention has shifted toward examining ambulatory care in order to implement better health care quality and safety practices. This annotated bibliography was created to analyze and augment the current literature on ambulatory care practices with regard to patient safety and quality improvement. By providing a thorough examination of current practices, potential improvement strategies in ambulatory care health care settings can be suggested. A better understanding of the myriad factors that influence delivery of patient care will catalyze future health care system development and implementation in the ambulatory setting

Addendum to Informatics for Health 2017: Advancing both science and practice

This article presents presentation and poster abstracts that were mistakenly omitted from the original publication

Mapping Health Care Innovation: Tracing Walls & Ceilings

Health care is in need of innovation on many strands. Patient-centered care appears to be the key to the realization of the main objectives: service quality, cost reduction, access, patient satisfaction and the quality of working life. Innovation, and more precisely, the diffusion and implementation of new methods, new techniques and new processes and systems appears to be a difficult task. Consequently, there is a strong need for knowledge about innovation processes in health care and the drivers and barriers affecting these efforts. This paper presents a framework for mapping innovation processes in health care services. The framework consists of two axes: (1) the horizontal axis of the health care process and the inter-functional walls which can complicate innovation efforts, and (2) the vertical axis of the echelons of power, which often create ceilings too impermeable to permit effective learning and decision making. The study is based on the experiences gathered in Publin, a running research network supported by the Fifth Framework Program and Innoflex, which ended in 2003.economics of technology ;