Resources for Action: A Resource-Based View of Service Systems

This paper presents a new, operational view of service activities and service systems in the form of an extension of the resources-for-action (RA) section of an existing service system metamodel. The original metamodel represented the fact that service activities need resources in order to occur and also produce products/services that are resources for subsequent service activities and/or the service system\u27s customers. The new RA section clarifies the different types of resources that are created or used by service activities within service systems.This paper addresses an area of service science that is not well-developed. The literature related to service science tends to treat resources in a general and nonspecific manner that provides relatively little insight about how to identify specific resources that are needed or used in specific service systems. This paper combines ideas from two streams of research, one related to a service system metamodel and the other related to a new tool for systems analysis and design. After summarizing a new extension of the RA section of the service system metamodel, it uses an example related to service activities in a medical clinic to illustrate how the new RA section leads to a tabular documentation, analysis, and design tool. That tool can be used for examining the design or operation of a service system with emphasis on the timely availability of necessary resources

Understanding Workplace Conditions Contributing to Physician Burnout Prevalence in Maryland State

Physician burnout is a three-dimensional work-related response to prolonged and unresolved stress. The prevalence of up to 50 percent is higher among primary care providers in the U.S. and is a significant healthcare problem. This qualitative multiple-case study explored workplace conditions contributing to physician burnout in Maryland State. In a purposive sample, the researcher interviewed twenty-one (21) physicians comprised of Medical Doctors (M.D.), Doctors of Nursing Practitioners (DNPs), and Nurse Practitioners (NP). The Shanafelt\u27s well-being framework was applied to understand physician burnout, workplace conditions, and attrition. Data was collected and analyzed using semi-structured interviews and literature. Five themes analyzed are: Excessive workload, healthcare financing and insurance, limited workplace resources, systemic issues, and the COVID-19 pandemic. The implications include sub-optimal care quality and physician shortages, which continue to define the U.S. healthcare system despite high healthcare expenditure

DO RISK PERCEPTIONS INFLUENCE PHYSICIAN\u27S RESISTANCE TO USE ELECTRONIC MEDICAL RECORDS? AN EXPLORATORY RESEARCH IN GERMAN HOSPITALS

IT in health care can lower the cost of health care delivery, improve the quality of care for patients and reduce medical errors.Given these strong advantages, it is interesting that technology diffusion for process support in hospitals is somewhat slow.The major process of a hospital -delivering patient care- is still supported by traditional paper files in the vast majority ofGerman hospitals.In this paper, we ask what the barriers towards implementing and using an electronic medical record (EMR) -the electronicpatient file- might be. Technology resistance theories indicate that perceived risks are a major inhibitor towards systemsacceptance. In the absence of thorough empirical studies, we start our investigation by conducting exploratory research intothe risks hospital-based physicians associate with using an EMR. A list of possible risks was derived from the literature and10 physicians were interviewed to gather their assessment. Our findings show that, indeed, physicians associate several riskswith adopting EMRs, thereby suggesting these risks will need to be mitigated to enable proper user acceptance

Arduous implementation: Does the Normalisation Process Model explain why it's so difficult to embed decision support technologies for patients in routine clinical practice

Background: decision support technologies (DSTs, also known as decision aids) help patients and professionals take part in collaborative decision-making processes. Trials have shown favorable impacts on patient knowledge, satisfaction, decisional conflict and confidence. However, they have not become routinely embedded in health care settings. Few studies have approached this issue using a theoretical framework. We explained problems of implementing DSTs using the Normalization Process Model, a conceptual model that focuses attention on how complex interventions become routinely embedded in practice.Methods: the Normalization Process Model was used as the basis of conceptual analysis of the outcomes of previous primary research and reviews. Using a virtual working environment we applied the model and its main concepts to examine: the 'workability' of DSTs in professional-patient interactions; how DSTs affect knowledge relations between their users; how DSTs impact on users' skills and performance; and the impact of DSTs on the allocation of organizational resources.Results: conceptual analysis using the Normalization Process Model provided insight on implementation problems for DSTs in routine settings. Current research focuses mainly on the interactional workability of these technologies, but factors related to divisions of labor and health care, and the organizational contexts in which DSTs are used, are poorly described and understood.Conclusion: the model successfully provided a framework for helping to identify factors that promote and inhibit the implementation of DSTs in healthcare and gave us insights into factors influencing the introduction of new technologies into contexts where negotiations are characterized by asymmetries of power and knowledge. Future research and development on the deployment of DSTs needs to take a more holistic approach and give emphasis to the structural conditions and social norms in which these technologies are enacte

The Managerial and Technological Innovation in Health System

The invention is the first incidence of an impression for a new creation, service and process, whereas the innovation signifies placing somewhat into practice, a new way of doing things, a new value and a new application of an old concept. To be able to turn invention into innovation organizations normally need to combine several different types of knowledge, capabilities, skills and resources. For example, the introduction of a fresh technology will have need of new equipment, new skills and knowledge through learning, training and improvement along with an entire system approach to make sure a joined-up service. Innovation is the thoughtful overview and application within the products or procedures, processes, planned to benefit the individual, new to the related adoption of role, the group, society and organization. Public  sector  innovation  correspond  creativity,  novelty  and  the  intention  of  affecting improvement in something, for example through new or improved services and processes

Ariel - Volume () Number 1

Copyright 1986 Arie

Notes on the Sociology of Medical Discourse: The Language of Case Presentation

Also CSST Working Paper #19.http://deepblue.lib.umich.edu/bitstream/2027.42/51147/1/379.pd

Modelling medical diagnostic processes

The thesis investigates the development of medical reasoning processes and how student modelling of such processes can be achieved in intelligent tutoring systems. The domain of orthopaedics was chosen for the research. Literature has shown that medical reasoning has been modelled mainly from an expert point of view. The research problem addressed is to model explicitly various levels of medical expertise in terms of reasoning strategies. The thesis reports on a system, DEMEREST (DEvelopment of MEdical REasoning STrategies), a developmental user model component which describes successive stages of medical reasoning and which could ultimately be part of a medical tutor. The system diagnoses physicians' reasoning strategies, determines the level of expertise and produces a plan corresponding to the application of these strategies. As a basis of doing so, a set of seven reasoning strategies was identified in the medical problem solving literature. These strategies are based on generalisation, specialisation, confirmation, elimination, problem refinement, hypothesis generation and anatomy. An empirical study was carried out to examine the development of these strategies. Protocols of ten physicians at various levels of expertise were collected and analysed. A number of interactions of strategies at different levels of expertise was identified in half of these protocols and this information was used to construct a model of changes of strategies over time. Planning in· artificial intelligence was used as a means of decomposing medical problem solving into a set of goals; the goals being associated with the reasoning strategies. By taking this approach, medical reasoning is viewed as a planning process. The remaining protocols from the empirical study were used to evaluate DEMEREST. The system was tested for its ability to determine a level of expertise for each protocol, model the reasoning strategies applied and their interactions, and generate a plan for each protocol. The assessment of the overall performance of the system showed that it was successful. This assessment also helped to identify conceptual as well as implementation constraints of the prototype system. The main result of the research undertaken in this thesis is that the design of the system DEMEREST demonstrates the feasibility of modelling the development of medical reasoning strategies and its usefulness for student modelling