61,288 research outputs found

    A multi-faceted approach to optimising a complex unplanned healthcare system

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    Unscheduled and urgent health care represents the largest area of activity and cost for the UK’s National Health Service (NHS). Like typical complex systems unplanned care has the features of interdependence and having structures at different scales which requires modelling at different levels. The aim of this paper is to discuss the development of a multifaceted approach to study and optimise this complex system. We aim to integrate four different methodologies to gain better understanding of the nature of the system and to develop ways to enhance its performance. These methodologies are: (a) Lean/ Flow theory to look at the process and patients and other flows; (b) Simulation/ System Dynamics to undertake analytical analysis and multi-level modelling; (c) stakeholder consultation and use of system thinking to analyse the system and identify options, barriers and good practice; and (d) visual analytic modelling to facilitate effective decision making in this complex environment. Of particular concern are the boundary issues i.e. how changes in unplanned care will impact on the adjacent facilities and ultimately on the whole Healthcare system

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

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    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

    Modelling and simulating unplanned and urgent healthcare: the contribution of scenarios of future healthcare systems.

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    The current financial challenges being faced by the UK economy have meant that the NHS will have to make £20 billion of savings between 2010 and 2014 requiring it to be innovative about how it delivers healthcare. This paper presents the methodology of a research project that is simulating the whole healthcare system with the aim of reducing waste within urgent unscheduled care streams whilst understanding the impact of such changes on the whole system. The research is aimed at care commissioners who could use such simulation in their decision-making practice, and the paper presents the findings from early stakeholder discussions about the scope and focus of the research and the relevance of stakeholder consultation and scenarios in the development of a valid decision-support tool that is fit for purpose

    The Impact of Lean Six Sigma on the Overall Results of Companies

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    Lean Six Sigma represents a management approach for driving innovating processes inside a company in order to achieve superior results. It involves a practical analysis based on facts, aiming the innovation and growth, not only the efficiency of processes. It is a long term process of gradual and continuous improvement. The application of Lean Six Sigma in companies led to attaining superior financial performance by addressing new needs, by differentiating the products and services or by adjusting the business lines to new processes. Quality is more than making things without errors. It is about making a product or service meet the individual perception of a customer about the quality or value. Therefore, in what regards Lean Six Sigma, the concern is not only to "do the things right" but also to "do the right things right". We focus on the impact of implementing the Lean Six Sigma approach on companies, seeking for what changes and benefits it brings. The key elements it aims at are achieving the best quality, the lowest cost, getting the shortest lead-time, stressing on waste elimination. The requirements of a company for its implementation and the strategy to obtain the maximum practical outcome are investigated. Furthermore, we conduct a comparison analysis with the other methods of the total quality management and see why Lean Six Sigma is a more desirable approach.Lean Six Sigma, fact-based analysis, innovation, strategy, quality, gradual and continuous process.

    How can frontline expertise and new models of care best contribute to safely reducing avoidable acute admissions? A mixed-methods study of four acute hospitals

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    Background: Hospital emergency admissions have risen annually, exacerbating pressures on emergency departments (EDs) and acute medical units. These pressures have an adverse impact on patient experience and potentially lead to suboptimal clinical decision-making. In response, a variety of innovations have been developed, but whether or not these reduce inappropriate admissions or improve patient and clinician experience is largely unknown. Aims: To investigate the interplay of service factors influencing decision-making about emergency admissions, and to understand how the medical assessment process is experienced by patients, carers and practitioners. Methods: The project used a multiple case study design for a mixed-methods analysis of decision-making about admissions in four acute hospitals. The primary research comprised two parts: value stream mapping to measure time spent by practitioners on key activities in 108 patient pathways, including an embedded study of cost; and an ethnographic study incorporating data from 65 patients, 30 carers and 282 practitioners of different specialties and levels. Additional data were collected through a clinical panel, learning sets, stakeholder workshops, reading groups and review of site data and documentation. We used a realist synthesis approach to integrate findings from all sources. Findings: Patients’ experiences of emergency care were positive and they often did not raise concerns, whereas carers were more vocal. Staff’s focus on patient flow sometimes limited time for basic care, optimal communication and shared decision-making. Practitioners admitted or discharged few patients during the first hour, but decision-making increased rapidly towards the 4-hour target. Overall, patients’ journey times were similar, although waiting before being seen, for tests or after admission decisions, varied considerably. The meaning of what constituted an ‘admission’ varied across sites and sometimes within a site. Medical and social complexity, targets and ‘bed pressure’, patient safety and risk, each influenced admission/discharge decision-making. Each site responded to these pressures with different initiatives designed to expedite appropriate decision-making. New ways of using hospital ‘space’ were identified. Clinical decision units and observation wards allow potentially dischargeable patients with medical and/or social complexity to be ‘off the clock’, allowing time for tests, observation or safe discharge. New teams supported admission avoidance: an acute general practitioner service filtered patients prior to arrival; discharge teams linked with community services; specialist teams for the elderly facilitated outpatient treatment. Senior doctors had a range of roles: evaluating complex patients, advising and training juniors, and overseeing ED activity. Conclusions: This research shows how hospitals under pressure manage complexity, safety and risk in emergency care by developing ‘ground-up’ initiatives that facilitate timely, appropriate and safe decision-making, and alternative care pathways for lower-risk, ambulatory patients. New teams and ‘off the clock’ spaces contribute to safely reducing avoidable admissions; frontline expertise brings value not only by placing senior experienced practitioners at the front door of EDs, but also by using seniors in advisory roles. Although the principal limitation of this research is its observational design, so that causation cannot be inferred, its strength is hypothesis generation. Further research should test whether or not the service and care innovations identified here can improve patient experience of acute care and safely reduce avoidable admissions. Funding: The National Institute for Health Research (NIHR) Health Services and Delivery Research programme (project number 10/1010/06). This research was supported by the NIHR Collaboration for Leadership in Applied Health Research and Care South West Peninsula

    Mercy Medical Center: Reducing Readmissions Through Clinical Excellence, Palliative Care, and Collaboration

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    Outlines strategies and practices behind low readmissions rates for heart attack, heart failure, and pneumonia patients, such as investing in advanced practice nurses who help incorporate evidence-based standards into patient care. Lists lessons learned

    How can frontline expertise and new models of care best contribute to safely reducing avoidable acute admissions? A mixed-methods study of four acute hospitals

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    BackgroundHospital emergency admissions have risen annually, exacerbating pressures on emergency departments (EDs) and acute medical units. These pressures have an adverse impact on patient experience and potentially lead to suboptimal clinical decision-making. In response, a variety of innovations have been developed, but whether or not these reduce inappropriate admissions or improve patient and clinician experience is largely unknown.AimsTo investigate the interplay of service factors influencing decision-making about emergency admissions, and to understand how the medical assessment process is experienced by patients, carers and practitioners.MethodsThe project used a multiple case study design for a mixed-methods analysis of decision-making about admissions in four acute hospitals. The primary research comprised two parts: value stream mapping to measure time spent by practitioners on key activities in 108 patient pathways, including an embedded study of cost; and an ethnographic study incorporating data from 65 patients, 30 carers and 282 practitioners of different specialties and levels. Additional data were collected through a clinical panel, learning sets, stakeholder workshops, reading groups and review of site data and documentation. We used a realist synthesis approach to integrate findings from all sources.FindingsPatients’ experiences of emergency care were positive and they often did not raise concerns, whereas carers were more vocal. Staff’s focus on patient flow sometimes limited time for basic care, optimal communication and shared decision-making. Practitioners admitted or discharged few patients during the first hour, but decision-making increased rapidly towards the 4-hour target. Overall, patients’ journey times were similar, although waiting before being seen, for tests or after admission decisions, varied considerably. The meaning of what constituted an ‘admission’ varied across sites and sometimes within a site. Medical and social complexity, targets and ‘bed pressure’, patient safety and risk, each influenced admission/discharge decision-making. Each site responded to these pressures with different initiatives designed to expedite appropriate decision-making. New ways of using hospital ‘space’ were identified. Clinical decision units and observation wards allow potentially dischargeable patients with medical and/or social complexity to be ‘off the clock’, allowing time for tests, observation or safe discharge. New teams supported admission avoidance: an acute general practitioner service filtered patients prior to arrival; discharge teams linked with community services; specialist teams for the elderly facilitated outpatient treatment. Senior doctors had a range of roles: evaluating complex patients, advising and training juniors, and overseeing ED activity.ConclusionsThis research shows how hospitals under pressure manage complexity, safety and risk in emergency care by developing ‘ground-up’ initiatives that facilitate timely, appropriate and safe decision-making, and alternative care pathways for lower-risk, ambulatory patients. New teams and ‘off the clock’ spaces contribute to safely reducing avoidable admissions; frontline expertise brings value not only by placing senior experienced practitioners at the front door of EDs, but also by using seniors in advisory roles. Although the principal limitation of this research is its observational design, so that causation cannot be inferred, its strength is hypothesis generation. Further research should test whether or not the service and care innovations identified here can improve patient experience of acute care and safely reduce avoidable admissions.FundingThe National Institute for Health Research (NIHR) Health Services and Delivery Research programme (project number 10/1010/06). This research was supported by the NIHR Collaboration for Leadership in Applied Health Research and Care South West Peninsula

    The human bias in shipbuilding decision-making. Case study STX-OSV Søviknes

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    Confidential until 25 May 201

    Globalization and Management Education in Developing Countries

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    The globalization process is significantly affecting the economic and commercial life of nations. With increasing global competition and the rapidly advancing technologies, the business organizations and business models as well as management systems and practices are undergoing continuous change. To cope up with these changes, the management education is also being restructured and refocused. For one thing, the leading business schools in the more economically advanced countries are moving from producing ‘functionally skilled’ managers to ‘business leaders’ capable of operating in the competitive global environment. The trend is to make the management education more flexible and broad based in both content and approach. The situation in the developing countries is substantially different. Although most of the developing countries are being integrated into the Global economy to various degrees, yet the relative share of local businesses and the public sector/non-profit organizations is very significant. Judging by the market demand, the need to prepare managers for specialized jobs is still great. But, at the same time, the imperatives of globalization require the managers of the twenty-first century to cope up with the new developments, which are taking place in global business and related management techniques and practices. The purpose of this paper is to identify some of the elements of globalization, which affect business and management strategies and practices, and to examine the extent to which management education needs to be restructured in developing countries. Some suggestions are made in the context of MBA education in Malaysia.Globalization; management education; developing countries
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