Readiness for improving safe care delivery through web-based hospital nurse scheduling & staffing technology: A multi-hospital approach

Hospital scheduling and staffing practices are linked to patient safety, nurse satisfaction, and cost outcomes (Steege & Rainbow, 2017). Staffing, while complex, is ultimately central to the overall success of the hospital. Demands to eliminate events that cause death or serious harm, produce high patient satisfaction scores while maximizing workforce productivity, test any administrator’s skillset. Providing qualified staff in the right place at the right time can be challenged by restrictive union contracts, variable patient acuities, staff attendance, and mandated staffing ratios. These demands may lead to overtime utilization. There is a growing understanding of the negative effects of healthcare worker fatigue on patient outcomes (IOM, 2004; Stimpfel & Aiken, 2013). The impending nursing shortage has the potential to exacerbate the problem of high quality care delivery and could lead to devastating impacts to the profession as well as patients. Though Kaiser Permanente (KP) is generally known for being a healthcare trailblazer, staffing technology was lagging. The purpose of this project is to prepare KP nursing for transformative change with web-based hospital scheduling and staffing. This work addresses the readiness for deployment across the KP system. Complexity and change theories frame this project. Hospital staffing epitomizes complexity. This planned change provides a road map for other nurse leaders to navigate the lessons learned. Satisfaction surveys from 222 nursing staff receiving training in the new technology reveal a favorable intent for technology adoption. Future work will focus on the impact realization of nurse-sensitive outcome indicators and registered nurse overtime

The Interactive Medical Emergency Department (iMED): Architectural Integration of Digital Systems into the Emergency Care Environment

In healthcare, the architectural response to the development of information technologies has largely been relegated to a reactive role, essentially waiting for systems to develop and simply accommodating them with appropriately sized spaces. Designing IT systems independently from, rather than integrally with, their environment impedes them from reaching their full potential as vital components in the delivery of care by creating a lack of flexibility, decelerating performance, and degrading the healing environment. The flexibility of the environment is compromised by fixed position, single user data systems which prevent it from actively adapting to changing conditions, especially during volumetric surges associated with mass casualty events. Additionally, the delivery of care is hindered by traditional data entry points which minimize the caregiver\u27s ability to utilize information effectively by increasing distances to, and wait times for, available platforms. Furthermore, the overall quality of the healing environment is degraded by the increasing amount of technological clutter which can be difficult to sanitize, intimidating to patients, and unsafe by frustrating care. Dissolving the disconnect between architectural environments and information technology can be achieved by devising architectural elements and treatment protocols which would fuse both entities together, creating a more holistic, digitally integrated setting in which to deliver care. Utilizing advances such as integrated wall interfaces and environmental sensor systems would improve the delivery of care by empowering users and architectural settings with the ability to effectively adapt to changing conditions, increase accessibility to information, and streamline care for improved patient outcomes. Replacing fixed position, single user data entry systems with environmentally integrated surface interfaces would improve flexibility and performance by creating a multitude of localized points to access data, as well as streamline and simplify the environment by eliminating technological clutter. The process in which to derive an architectural response to the thesis statement was initiated by performing a series of interviews with nationally prominent professionals in the fields of healthcare architecture and information technology, attending international design conferences, interning in health facilities, assembling a cross-disciplinary thesis committee, and conducting a thorough literature review. The thesis research phase began by studying the historical progression and significance of information technology in healthcare environments in order to discern the architectural role in the implementation of these systems. The research focus was then shifted to all areas of architecture, identifying applicable precedent studies in which the environmental integration of information technology had enhanced the quality of the setting, highlighting characteristics that would improve flexibility, performance, and outcomes in the field of healthcare. From this exploration, a series of typological selection criteria were developed in order to determine which area within the healthcare spectrum would best demonstrate the potentials of this union. The emergency care environment was selected as an appropriate vessel to implement the thesis, due to its need for flexibility in order to accommodate ever changing demographic needs, significant volumetric shifts, fast paced care delivery which is dependent on the rapid utilization of information, and high patient turnover rate requiring an efficient throughput processes. Specific problems relevant to contemporary emergency departments were then identified, including overcrowding, staffing issues, and inability to accommodate for volumetric surges, all of which stem from inadequate throughput methodologies. The thesis then explored how the fusion of digital modalities with architectural elements in the emergency care environment would remediate these problems by improving the throughput of the facility. To ensure the final design holistically satisfies the goal of improving the quality and effectiveness of emergency care through the environmental integration of information technology, a series of design principles were developed to serve as its basis. In order to optimize data flow, access to input areas must be maximized by conceiving the building as an interface, where spatial boundaries become digital connections. If integrated data systems are to be accessible from a universal architectural interface and respond in a safe and controlled manner, digital scanning technologies such as biometrics and RFID tagging must be fused with physical threshold conditions in order to enable the digital system\u27s recognition of its inhabitants. In an additional effort to maintain safety, maximize workability, and ensure a level of sterility in sensitive environments, the facility needs to be designed into layers of penetration, regulating access to only those users who meet proper security clearances. Furthermore, the facility needs to act like a sponge, easily expanding and contracting the layers of penetration in an effort to accommodate unpredictable volumetric increases during mass casualty events. In addition to increasing its capacity, the facility should also be prepared to appropriate adjacent, existing infrastructure for overflow shelter and staging operations during such events. The programmatic typology of a freestanding medical emergency department, in which there is no connection to an existing facility, was selected with the intention of deriving a pure condition which eliminated extraneous influences from diluting the focus of this thesis on the relationship between information technology and architecture. Although rare in the US, freestanding emergency care facilities are a viable option for expanding healthcare provider\u27s coverage, capturing areas with growing populations, and improving the regional capability to respond effectively during mass casualty events. The base program was derived from the Swedish Medical Issaquah Campus Freestanding Emergency Department in Seattle, Washington, and then modified to function as a Point of Distribution (POD) site during mass casualty events. A series of potential mass casualty event scenarios were then developed in order to effectively prepare conceptual simulations to test possible responses from the facility\u27s program. The thesis proposal consists of a freestanding, 40,000+ square foot Interactive Medical Emergency Department (iMED) located in Charleston, SC. The proposal is guided by an established set of design principles, aiming to improve the delivery of emergency care during daily operations and mass casualty surge events through the architectural integration of information technology. In order to provide a range of possible disaster response situations, the building was located in the densely populated peninsula area of Charleston, South Carolina, within a region which is susceptible to an assortment of mass casualty events (including hurricanes, earthquakes, and terrorist attacks). The final site within the urban context adheres to a set of established criteria, including placement on open, stable, elevated land adjacent to the major access arterials of I-26, Hwy 17, and Meeting Street. Additionally, the site was located within a rapidly expanding, non-historical sector of the city which is not part of an existing healthcare complex. By meeting regional and urban conditions defined in the criteria, the site\u27s location strengthens the facility\u27s ability to deliver care during both daily and surge conditions substantially

The Quest for National Digital Agility: Digital Responses to Covid-19 in Five Countries

Countries worldwide have employed different digital solutions to contain and cope with the Covid-19 pandemic. In this explorative case research, we examine national-level digital responses to the pandemic in four specific areas—tracking and tracing, health data reporting, teleconsultation, and vaccination mobilization—across five countries: China, Denmark, Germany, South Korea, and the U.S. Drawing on the notion of agility and digital infrastructures, our cross-case analysis unveils how the countries’ digital responses to the pandemic have been shaped by their national health system characteristics. In addition, we highlight how existing digital health infrastructures, regulatory adaptations, and industry collaborations fostered the alacrity with which nations responded to the pandemic. We define national-level digital agility as the ability of a nation to leverage digital infrastructure capabilities to address urgent societal challenges in a contextually appropriate way. Our key contribution is a model of this complex, but urgently needed concept containing five building blocks, each of which is a critical prerequisite to building such agility. Despite focusing on addressing the existing challenges of the ongoing Covid-19 pandemic, we believe that researchers and policymakers can also take pointers away from our framework to tackle other socio-environmental challenges

A Metaheuristic-Based Simulation Optimization Framework For Supply Chain Inventory Management Under Uncertainty

The need for inventory control models for practical real-world applications is growing with the global expansion of supply chains. The widely used traditional optimization procedures usually require an explicit mathematical model formulated based on some assumptions. The validity of such models and approaches for real world applications depend greatly upon whether the assumptions made match closely with the reality. The use of meta-heuristics, as opposed to a traditional method, does not require such assumptions and has allowed more realistic modeling of the inventory control system and its solution. In this dissertation, a metaheuristic-based simulation optimization framework is developed for supply chain inventory management under uncertainty. In the proposed framework, any effective metaheuristic can be employed to serve as the optimizer to intelligently search the solution space, using an appropriate simulation inventory model as the evaluation module. To be realistic and practical, the proposed framework supports inventory decision-making under supply-side and demand-side uncertainty in a supply chain. The supply-side uncertainty specifically considered includes quality imperfection. As far as demand-side uncertainty is concerned, the new framework does not make any assumption on demand distribution and can process any demand time series. This salient feature enables users to have the flexibility to evaluate data of practical relevance. In addition, other realistic factors, such as capacity constraints, limited shelf life of products and type-compatible substitutions are also considered and studied by the new framework. The proposed framework has been applied to single-vendor multi-buyer supply chains with the single vendor facing the direct impact of quality deviation and capacity constraint from its supplier and the buyers facing demand uncertainty. In addition, it has been extended to the supply chain inventory management of highly perishable products. Blood products with limited shelf life and ABO compatibility have been examined in detail. It is expected that the proposed framework can be easily adapted to different supply chain systems, including healthcare organizations. Computational results have shown that the proposed framework can effectively assess the impacts of different realistic factors on the performance of a supply chain from different angles, and to determine the optimal inventory policies accordingly

A patient agent controlled customized blockchain based framework for internet of things

Although Blockchain implementations have emerged as revolutionary technologies for various industrial applications including cryptocurrencies, they have not been widely deployed to store data streaming from sensors to remote servers in architectures known as Internet of Things. New Blockchain for the Internet of Things models promise secure solutions for eHealth, smart cities, and other applications. These models pave the way for continuous monitoring of patient’s physiological signs with wearable sensors to augment traditional medical practice without recourse to storing data with a trusted authority. However, existing Blockchain algorithms cannot accommodate the huge volumes, security, and privacy requirements of health data. In this thesis, our first contribution is an End-to-End secure eHealth architecture that introduces an intelligent Patient Centric Agent. The Patient Centric Agent executing on dedicated hardware manages the storage and access of streams of sensors generated health data, into a customized Blockchain and other less secure repositories. As IoT devices cannot host Blockchain technology due to their limited memory, power, and computational resources, the Patient Centric Agent coordinates and communicates with a private customized Blockchain on behalf of the wearable devices. While the adoption of a Patient Centric Agent offers solutions for addressing continuous monitoring of patients’ health, dealing with storage, data privacy and network security issues, the architecture is vulnerable to Denial of Services(DoS) and single point of failure attacks. To address this issue, we advance a second contribution; a decentralised eHealth system in which the Patient Centric Agent is replicated at three levels: Sensing Layer, NEAR Processing Layer and FAR Processing Layer. The functionalities of the Patient Centric Agent are customized to manage the tasks of the three levels. Simulations confirm protection of the architecture against DoS attacks. Few patients require all their health data to be stored in Blockchain repositories but instead need to select an appropriate storage medium for each chunk of data by matching their personal needs and preferences with features of candidate storage mediums. Motivated by this context, we advance third contribution; a recommendation model for health data storage that can accommodate patient preferences and make storage decisions rapidly, in real-time, even with streamed data. The mapping between health data features and characteristics of each repository is learned using machine learning. The Blockchain’s capacity to make transactions and store records without central oversight enables its application for IoT networks outside health such as underwater IoT networks where the unattended nature of the nodes threatens their security and privacy. However, underwater IoT differs from ground IoT as acoustics signals are the communication media leading to high propagation delays, high error rates exacerbated by turbulent water currents. Our fourth contribution is a customized Blockchain leveraged framework with the model of Patient-Centric Agent renamed as Smart Agent for securely monitoring underwater IoT. Finally, the smart Agent has been investigated in developing an IoT smart home or cities monitoring framework. The key algorithms underpinning to each contribution have been implemented and analysed using simulators.Doctor of Philosoph

science of delivery case studies

Thesis(Master) --KDI School:Master of Public Management,2018.1 Implementing Government Reforms: Science of Delivery Case Studies 2 How Ghana’s National Health Insurance Scheme (NHIS) Used the Electronic Claims Management System to Streamline and Boost Efficiency in Claims Management 3 Community-based Disaster Risk Reduction and Management in the Philippines: A Science of Delivery Case Study 4 Indian Railway’s Civic Engagement Mechanism for Enhancing Customer Service and Responsiveness 5 Development of Integrated Security for Public Safety in EcuadormasterpublishedGustavo Adolfo, BENITEZ

An Exploration in Accountable Care Organization Structure, Contingency and Performance, 2015-2017

The Patient Protection and Affordable Care Act of 2010 enacted one of the most significant reforms seen in the United States healthcare landscape. The Center for Medicare and Medicaid (CMS) led transformation efforts in regulatory reform and coverage expansion across the U.S. population. Since 2010, care delivery systems have been shifting from episodic, decentralized and fee-for-service models to value-based population health models, like accountable care organizations (ACO). ACOs have been specifically primed for local response to improve the health of their communities. ACO research has traditionally focused on performance measures like mortality, readmissions, quality outcomes and savings. ACO organizational characteristics analyzed in the literature have focused on provider composition, health information technology, leadership structures and provider access. According to CMS, readmissions account for one of the greatest contributors in healthcare spend, and studies by The Commonwealth Fund detail the top percentile of the population as high need, high cost (HNHC) patients who further contribute to the majority of healthcare spend. Opportunity exists to explore the diversity among ACO structures, their relationship to local environments and influence on top contributors to healthcare spend, like readmissions and high need, high cost populations. The objectives of this study are to better understand existing ACO structures, explore relationships among ACO organizational structures, their local environment in which they operate and directional impact on performance, with emphasis on at risk patients like high need, high cost populations. Theoretically, this study applies Structural Contingency Theory (SCT) for its empirical analyses, specifically a multiple contingency approach. In the extant literature, SCT has not been commonly applied due to its longitudinal nature and limited public access to ACO organizational data. The study sample consists of 45 ACOs that entered into the Medicare Shared Savings Program under Track 1 for the entire term from 2015 to 2017. ACO performance is represented by total shared savings, change in rate of readmissions and change in rate of inpatient psychiatric admissions. Four contingency-structure relationships are analyzed from the National Survey of Accountable Care Organizations and CMS Public Use Files, 1) ACO governance structure and strategy alignment, 2) Interdependency from complex coordination and formalized provider agreement types, 3) interdependency from complex coordination and formalized relationships with mental and behavioral health specialists, and 4) complex coordination and health IT integration and interoperability. Regression analyses were used to analyzed potential misfit and directional impact on performance and the contingency-structure pairs. Results indicate that wide variety exists among ACO structures, that conventional investments in provider agreements and fully integrated health IT do not clearly present positive performance effect. Future research opportunities exist to further examine the impact ACO programs have on meeting community needs and populations. This study offers the theoretical application of a multiple contingency approach from Structural Contingency Theory and a practical exploration of ACO structure, its contextual operations and performance on high need, high cost populations

LORIS: a web-based data management system for multi-center studies

Longitudinal Online Research and Imaging System (LORIS) is a modular and extensible web-based data management system that integrates all aspects of a multi-center study: from heterogeneous data acquisition (imaging, clinical, behavior, and genetics) to storage, processing, and ultimately dissemination. It provides a secure, user-friendly, and streamlined platform to automate the flow of clinical trials and complex multi-center studies. A subject-centric internal organization allows researchers to capture and subsequently extract all information, longitudinal or cross-sectional, from any subset of the study cohort. Extensive error-checking and quality control procedures, security, data management, data querying, and administrative functions provide LORIS with a triple capability (1) continuous project coordination and monitoring of data acquisition (2) data storage/cleaning/querying, (3) interface with arbitrary external data processing “pipelines.” LORIS is a complete solution that has been thoroughly tested through a full 10 year life cycle of a multi-center longitudinal project1 and is now supporting numerous international neurodevelopment and neurodegeneration research projects

Blockchain Application in Information Systems Research

Blockchain is a radical innovation with a core value proposition of shifting trust from institutions towards algorithms. Still, the potential of Blockchains remains vague due to the knowledge gap between computer science and socio-economic activities. Ninety percent of current Blockchain projects did not move from ideas to production-ready prototypes. Researchers and practitioners are searching for the meaningful leveraging of Blockchains for value creation. This dissertation aims to bridge the gap between technical and managerial knowledge of Blockchain that allows successful Blockchain system design and implementation. Therefore, the objective of the project is to identify the scope of Blockchain applications and introduce guidelines to make purposeful decisions of Blockchain implementations. The dissertation project covers four research questions. First, I consolidated knowledge of Blockchain technical configurations through the development of a taxonomy. Second, I considered the design patterns of smart contracts that represent the application logic of Blockchain systems. Third, I offered guidance for transforming initial conceptions of Blockchain ideas into working system prototypes by introducing a Blockchain configuration process model. Fourth, I investigated the common factors of Blockchain decisions to evaluate Blockchain implementations in the form of the framework. I employed a Design Science Research approach to developing four artefacts. The first three artefacts consider technical, application, and organizational aspects of Blockchain. The synergy reflects in the fourth, combinational artefact, which employs the high-level factors of Blockchain decisions. During the project, I have investigated the scientific and business studies, run Blockchain-based applications, conduct interviews, and evaluate the findings on Blockchain projects. The dissertation project contributes to research by bridging knowledge gaps between computer science and socio-economic research on a Blockchain that provides a fruitful ground for future conceptual and empirical studies. For practitioners, the developed artefacts are useful to identify and guide Blockchain projects that facilitate purposeful Blockchain adoption