Healthcare Management Primer

This primer was written by students enrolled in HMP 721.01, Management of Health Care Organizations, in the Health Management & Policy Program, College of Health and Human Services, University of New Hampshire. This course was taught by Professor Mark Bonica in Fall 2017

Utilization of big data to improve management of the emergency departments. Results of a systematic review

Background. The emphasis on using big data is growing exponentially in several sectors including biomedicine, life sciences and scientific research, mainly due to advances in information technologies and data analysis techniques. Actually, medical sciences can rely on a large amount of biomedical information and Big Data can aggregate information around multiple scales, from the DNA to the ecosystems. Given these premises, we wondered if big data could be useful to analyze complex systems such as the Emergency Departments (EDs) to improve their management and eventually patient outcomes. Methods. We performed a systematic review of the literature to identify the studies that implemented the application of big data in EDs and to describe what have already been done and what are the expectations, issues and challenges in this field. Results. Globally, eight studies met our inclusion criteria concerning three main activities: the management of ED visits, the ED process and activities and, finally, the prediction of the outcome of ED patients. Although the results of the studies show good perspectives regarding the use of big data in the management of emergency departments, there are still some issues that make their use still difficult. Most of the predictive models and algorithms have been applied only in retrospective studies, not considering the challenge and the costs of a real-time use of big data. Only few studies highlight the possible usefulness of the large volume of clinical data stored into electronic health records to generate evidence in real time. Conclusion. The proper use of big data in this field still requires a better management information flow to allow real-time application

How Labor-Management Partnerships Improve Patient Care, Cost Control, and Labor Relations: Case Studies of Fletcher Allen Health Care, Kaiser Permanente, and Montefiore Medical Center’s Care Management Corporation

[Excerpt] This paper explores the ways in which healthcare unions and their members are strategically engaging with management through partnership to control costs and improve the patient experience, clinical outcomes, workplace environment, and labor relations. These initiatives depend on making use of the knowledge of front-line healthcare workers, improving communication between all staff members, and increasing transparency. In turn, these initiatives can also lead to more robust and dynamic local unions. Through participating in joint work activities, many union members note feeling more respected in their workplace and more connected to their union. Unions can benefit from these activities by offering their members the ability to inform decisions about how work gets done

Employers skill survey : case study : health and social care

"This report examines the relationship between service delivery strategies and processes, and the deployment of skills, recruitment problems and skill gaps within selected sub-sectors of health and social care. The sub-sectors within health are physiotherapy and radiography. Within social care the focus is on care of the elderly (both residential and domiciliary care). Although subject to similar drivers and associated pressures, the two sub-sectors of health and social care display markedly different characteristics, particularly in terms of service delivery strategies, qualification frameworks and utilisation of skills. In simple terms, the health and social care subsectors considered within this report may be thought of as being situated at opposite poles of the ‘skills spectrum’: with radiography and physiotherapy characterised by high level skills, while care of the elderly is traditionally associated with low level skills. Hence, the two sub-sectors are discussed separately throughout this report. The greater complexity and range of skills required in the two health sub-sectors is reflected in the comparative length of the two sections of the report" - page 9

Systemwide Clinical Ultrasound Program Development: An Expert Consensus Model.

Clinical ultrasound (CUS) is integral to the practice of an increasing number of medical specialties. Guidelines are needed to ensure effective CUS utilization across health systems. Such guidelines should address all aspects of CUS within a hospital or health system. These include leadership, training, competency, credentialing, quality assurance and improvement, documentation, archiving, workflow, equipment, and infrastructure issues relating to communication and information technology. To meet this need, a group of CUS subject matter experts, who have been involved in institution- and/or systemwide clinical ultrasound (SWCUS) program development convened. The purpose of this paper was to create a model for SWCUS development and implementation

"A manager in the minds of doctors" : a comparison of new modes of control in European hospitals

Background: Hospital governance increasingly combines management and professional self-governance. This article maps the new emergent modes of control in a comparative perspective and aims to better understand the relationship between medicine and management as hybrid and context-dependent. Theoretically, we critically review approaches into the managerialism-professionalism relationship; methodologically, we expand cross-country comparison towards the meso-level of organisations; and empirically, the focus is on processes and actors in a range of European hospitals. Methods: The research is explorative and was carried out as part of the FP7 COST action IS0903 Medicine and Management, Working Group 2. Comprising seven European countries, the focus is on doctors and public hospitals. We use a comparative case study design that primarily draws on expert information and document analysis as well as other secondary sources. Results: The findings reveal that managerial control is not simply an external force but increasingly integrated in medical professionalism. These processes of change are relevant in all countries but shaped by organisational settings, and therefore create different patterns of control: (1) ‘integrated’ control with high levels of coordination and coherent patterns for cost and quality controls; (2) ‘partly integrated’ control with diversity of coordination on hospital and department level and between cost and quality controls; and (3) ‘fragmented’ control with limited coordination and gaps between quality control more strongly dominated by medicine, and cost control by management. Conclusions: Our comparison highlights how organisations matter and brings the crucial relevance of ‘coordination’ of medicine and management across the levels (hospital/department) and the substance (cost/quality-safety) of control into perspective. Consequently, coordination may serve as a taxonomy of emergent modes of control, thus bringing new directions for cost-efficient and quality-effective hospital governance into perspective

Reducing dose for digital cranial radiography : The increased source to the image-receptor distance approach

This investigation proposes that an increased source to the image-receptor distance (SID) technique can be used to optimize occipital frontal and lateral cranial radiographs acquired with direct digital radiography. Although cranial radiography is not performed on a routine basis, it should nonetheless be optimized to keep the dose to the patient as low as reasonably achievable, particularly because it can form part of the facial bone and sinus series. Dose measurements were acquired at various SIDs, and image quality was assessed using visual grading analysis. Statistically significant reductions in the effective dose between 19.2% and 23.9% were obtained when the SID was increased from the standard 100 to 150 cm (P ≤.05), and visual grading analysis scores indicate that image quality remained diagnostically acceptable for both projections. This investigation concludes that increasing the SID effectively optimizes occipital frontal and lateral skull radiographs. Radiology departments must be advised of the benefits of this technique with the goal of introducing an updated reference SID of 150 cm into clinical practice.Peer reviewe

A survey of health care models that encompass multiple departments

In this survey we review quantitative health care models to illustrate the extent to which they encompass multiple hospital departments. The paper provides general overviews of the relationships that exists between major hospital departments and describes how these relationships are accounted for by researchers. We find the atomistic view of hospitals often taken by researchers is partially due to the ambiguity of patient care trajectories. To this end clinical pathways literature is reviewed to illustrate its potential for clarifying patient flows and for providing a holistic hospital perspective