Consultancy to progress hospital in the home care provision: Final report, CHERE Project Report No 13

In July 1998, the Commonwealth Department of Health and Family Services commissioned the Centre for Health Economics Research and Evaluation (CHERE) to identify and document Hospital in the Home (HITH) care models nationally and internationally. The purpose of this consultancy was to examine the appropriateness of this form of care for acutely ill patients and to make recommendations about how to increase the utilisation and cost effectiveness of services. Hospital in the Home is emerging internationally and within Australia as a viable alternative form of provision of acute care. The benefits of HITH have generally been seen in terms of its capacity to provide a cost-effective and acceptable alternative to hospital inpatient care, which reduces pressure on hospital beds. However, so far there has only been limited evaluation to lend support to these claims. Over the past decade a wide range of hospital in the home programs have been introduced across the Australian health care system. These programs have often emerged in response to local factors and have a range of different purposes, funding and organisational arrangements, and varying levels of success. In some states hospital in the home has been formalised into a program, whereas in other parts of Australia the introduction of HITH has been left to local decision makers. Thus, the experience of HITH has been extremely variable. It is appropriate at this stage to draw together information about what services are available, how acceptable these services are and what they have achieved. This information is important for determining the future directions of HITH in Australia, as well as providing a valuable resource for service providers and policy makers.Hospital in the home, Australia

Let's Count and Manage - and Forget the Rest: Understanding Numeric Rationalization in Human Service Provision

In recent times, the development of Western welfare states has been strongly influenced by regulatory and managerial approaches that embody what this special issue refers to as ‘governing by numbers’. This article delineates this development by using the example of the human service industry in Germany. The analysis is embedded in a macrosociological perspective on blurring boundaries between the capitalistic (market) economy and the welfare state, arguing that a certain kind of (instrumentalist) numeric rationalization has spilled over from the former to the latter and sets limits to what is named ‘human development rationality’ within the operational core of involved organizations. Drawing on case study evidence from four different areas, it is shown in which dimensions this movement takes shape and how it fosters the crowding-out of elements inherent to this rationality. However, due to the proliferation of ever more ‘perfectionist’ expectations concerning quality issues, this crowding out provokes various provisional organizational and institutional responses. While the latter make production processes more volatile overall, there is no end of history regarding the struggle between instrumental rationality and countervailing forces within contemporary welfare states

Exploring the Process of Lean Training in the Healthcare Industry

Organizational leaders use lean training as a process improvement strategy to eliminate waste and inefficiencies in processes. Of the 91% of company leaders who believed lean training was important, 64% of those leaders expressed the perception that workers do not comprehend lean training and methodology. The purpose of this qualitative single case study was to explore how healthcare managers successfully implemented lean training strategies to combat escalating costs. The target population consisted of healthcare managers in a single rural care hospital located in Tennessee who had implemented lean training strategies to train staff in lean principles and lean tools. The conceptual framework for this study was the general systems theory. Data were collected through semistructured interviews with healthcare managers, document review of public hospital data, and public quality reports. Member checking of interview data was used to strengthen the credibility of the findings. Yin\u27s 5-phase qualitative data analysis process was used consisting of compiling the data, disassembling the data, reassembling the data, interpreting the data, and concluding the data. Themes emerged resulting from the use of methodological triangulation of collected data to include improving quality of patient care, teamwork and collaboration, hands-on learning, and training the trainers. The application of the findings may contribute to social change by identifying strategies related to lean training to address inefficiencies, improve quality patient care, and provide a safer healthcare environment

Research in Supply Chain Management: Issue and Area Development

Today the study of supply chain management (SCM) is growing rapidly and provides a great opportunity to do research both empirical and theoretical development. Research opportunities in SCM has been reviewed by many researchers and grouped into many categories. This paper contains a review of research SCM and classify into 7 categories, namely (1) SCM Operational Management & Strategy, (2) knowledge management, (3) Relationship Management, (4) Information Technology in SCM, (5) Supply Chain Design, Logistics & Infrastructure, (6) Global Issues, (7) Environment, Legal & Regulations. The issue in each category and research opportunities will be discussed in this paper. Keywords: Supply Chain Management, Research Opportunities in SCM, Issue in SC

Evaluating information flow in medication management process in Australian acute care facilities: A multi-professional perspective

Over the years, various interventions have been introduced to improve the medication management process. While these interventions have addressed some aspects predisposing the process to inefficiencies, significant gaps are still prevalent across the process. Studies have suggested that the goal of optimal medication therapy is achievable when information flow integrates across the various medication management process phases, stakeholders and departments involved as the patient moves through the process. To provide a cross-sectional view of the process, this study utilised a systemic philosophy to evaluate the information flow integration across the process. The research approach adopted for this study takes a positivist paradigm, which is guided by the cause and effect (causality) belief. It explored numeric measures to evaluate the relationship between constructs that assessed information flow principles (accessibility, timeliness, granularity and transparency) within the medication process and the information integration. The research design was cross-sectional and analytical, and this ensures that findings are relevant to current situations across the Australian healthcare system. Data for this research was collected using an online self-administered survey and the data assessed information flow principles and technologies used in the medication management process. There were 88 participants in this study, including doctors, nurses and pharmacists. The questions and responses were coded for analysis and data analysis techniques used were frequency analysis, Pearson’s chi-square test and multivariate analysis. Findings from this study indicates that the constructs evaluating accessibility, transparency and granularity had moderate associations with the information integration in the medication management process. Further analysis highlighted accessibility as a significant principle in explaining an increase or decrease in information integration in the medication management process. The accessibility construct referring to information retrieval was significant across the two tests conducted. Accessibility is directly related to information sharing and the assessment and monitoring and evaluation phases in the medication management process were identified as having the highest challenges with information sharing. Furthermore, the hybrid (electronic and paper) channel was preferred to support information integration in the medication management process by the participants. Among the technologies evaluated for the medication process, computer-provider-order-entry was found to be statistically significant in explaining an increase in information integration. Overall, results from this study suggest that interventions for the medication management process in Australian acute care facilities should be directed towards improving accessibility, specifically information retrieval and the sharing of information with emphasis on the assessment and monitoring phases. Implementing strategies to address the gaps identified from this research can improve information integration across the process and thereby reducing medication errors, and improving patient care management. Furthermore, the technology adoption across the process highlights that technology adoption across participants’ facilities remains a challenge in Australia