Quantitative methods of physician scheduling at hospitals

Masteroppgave i industriell økonomi og informasjonsledelse 2010 – Universitetet i Agder, GrimstadStaff scheduling at hospitals is a widely studied area within the fields of operation research and management science because of the cost pressure on hospitals. There is an interest to find procedures on how to run a hospital more economically and efficient. Many of the studies about staff scheduling at hospital have been done about nurses, which work under common labor law restrictions. The goal of nurse scheduling is to minimize the staffing cost and maximizing their preferences. While the operation rooms are the engine of the hospitals, the physicians are the fueling for the hospitals. Without the physicians the patients would not be treated well and the hospital would not earn money. This thesis studies the physician scheduling problem, which has not been studied so widely as the nurse scheduling problem. A limited number of literatures about this theme have been studied to answer the main research question: How can we categorize physician scheduling at hospitals? Studying the physician rostering problem on the search for efficiency and cost savings is an intricate process. One can read a lot about this theme develop a lot of models; and shape and test different hypotheses. However, to increase efficiency it is wise to make a plan of information to consider. The categories searched for within this literature review are the level of experience, the planning period, the field of specialty, the type of shifts, whether cyclic or acyclic schedules are used and also which models and methods are used to solve this problem. Level of experience was first divided between residents - that are still under education, and physicians - which are fully licensed. Physicians are medical trained doctors that provide medical treatment rather than surgical treatment in hospitals. After medical school, they have accomplished between three to seven years of residential internship before they obtain their license. The residents are still under education and must therefore participate in a number of assorted activities and patient treatments during their resident period to acquire their license. This situation for resident makes scheduling unique as they are in a learning period and staffing the hospital at the same time. The planning period is a category that is divided in three levels; short-term which lasts up to a month, midterm which lasts from one month up to six months and a long-term that lasts from six months up to one year. The field of specialty is divided between the specialties of the physicians. In the numerous departments at a hospital, the work is distinctive from one another. A normal workday in a department that is only open during the day can be quite different from a workday in an emergency department. Working in a hospital is unlike other type of jobs. A hospital or at least different departments in a hospital are open all day long, every day of the year. As a result, the hospital must be staffed all the time. The need for staffing varies during the day, the day of week; and during the different seasons, due to the fluctuation of the demands. An example for a solution is a variety of broad types of shifts. Scheduling these shift types can be made cyclic or acyclic. Qualitative method has been used in this master’s thesis. The research question is a typically quantitative method starting with “how”. And to answer it, this thesis builds on a definite number of case studies. These case studies are limited to concern only about physician and resident scheduling problem written in English. These cases are primarily scientific articles and conference handouts. The cases are read - and interesting information is registered in a case study database. The findings have shown different use of planning period after the level of experience. Few studies have been done with short-term planning period; physicians are mostly scheduled for a midterm planning period, whereas residents are mostly scheduled with a long-term planning period. Most studies have scheduled physicians and residents for a day, evening and night shift, often in a combination with some kind of on-call shift. The field of specialty that is most studied is within emergency medicine. As the work in an emergency department is stressful, it is a complex task to make good schedules that satisfies the physicians and residents working there. Exact approaches are the most used modeling technique used for physician scheduling

Emergency Room Utilization of Participants with Mental Health Conditions Enrolled in Health Home Services

Large numbers of individuals utilize the ER each year for mental health reasons. The health home agency in this study was designed under the Affordable Care Act with the intention of increasing patient self-management thus decreasing high-cost service utilization. The effectiveness of health homes in reducing mental health-related ER visits has remained unexplored. In this study, the relationship between participation in this program and ER utilization was examined, using the theoretical framework of the Health Belief Model. The sample of 128 health home participants with documented mental health conditions was selected using systematic random sampling. A one-way, repeated-measures t-test and a one-way, repeated-measures ANCOVA were used to analyze hospital records for ER visits with a primary or secondary mental health diagnosis. The results indicated that health home participation did not have a statistically significant impact on ER utilization when comparing overall 12-month means or at quarterly anniversary dates when controlling for age, race, and gender. These findings suggested opportunities for improvement in professional practice, identified areas that require further research, and will be used to initiate discussion into the existing and potential value that health homes offer to the mental health clientele being served. Those discussions have the potential to create social change through infrastructure changes that lead to improved service coordination, increased resources for improving access and quality of care, and overall enhancement of outcomes for individuals with mental health conditions

ACUTA Journal of Telecommunications in Higher Education

In This Issue Classroom Technology: Practical Approaches Synchronous Blended Learning Using Videoconferencing over lP Planning for Classroom Audiovisual Technologies Optimization Tools lmprove Bandwidth Bottom Line New Technologies Redefine the Classroom WiMax Facing the WMAN Challenge Mobility and the New Student lntegrating lnstructional and Network Technologies for Distance Education lnstitutional Excellence Award Honorable Mention Interview President\u27s Message From the Executive Director Here\u27s My Advic

Culture in a nutshell

Reiseführer sind ein wichtiger Bestandteil der modernen Tourismusindustrie und ein treuer Begleiter vieler Reisender. Sie ermöglichen einen schnellen Ein- und Überblick in eine fremde Kultur und versorgen Touristen mit allerhand praktischen und interessanten Information über Sehenswürdigkeiten, Land und Leute. In diesem Sinne wird in Reiseführern nun gewissermaßen Kultur auf den Punkt gebracht, d.h. sie präsentieren somit a culture in a nutshell. Nicht zuletzt stehen sie aus diesem Grund seit jeher auch unter der Kritik einen (durch die Autoren) vorselektierten Blick auf eine Region und Kultur zu präsentieren und somit die Erwartungshaltung und/oder das Erlebnis der Reisenden zu prägen und zu beeinflussen. Ein solches Bild oder Image kann zwar mit dem Selbstbild bzw. der Identität der Einwohner einer Region übereinstimmen, es könnte aber jedoch auch (stark) davon abweichen und ein falsches oder negatives Bild transportieren. Gerade deshalb scheint die Untersuchung und Auseinandersetzung mit den in Reiseführern dargestellten Bildern essentiell. Im Rahmen dieser Diplomarbeit werden vier englischsprachige Reiseführer (Lonely Planet, Rough Guide, Fodor’s, DK Eyewitness Travel) der Region Neuengland im Hinblick auf die Repräsentation dieser Region untersucht. Dabei geht es jedoch nicht um interdifferenzielle Unterschiede zwischen den jeweiligen Reiseführern, sondern um das Gesamtbild welches in Summe von den Reiseführern transportiert wird. Die Analyse der Reiseführer beschränkt sich auf vorher genau definierte Kapitel bzw. Bereiche und bedient sich sowohl quantitativer als auch qualitativer Methoden. Ziel der Untersuchung ist es folgende vier Forschungsfragen zu beantworten: 1. Wie wird die nordostamerikanische Region Neuengland in den ausgewählten Reiseführen dargestellt? 2. Welche Aspekte werden besonders hervorgehoben? 3. Welche Aspekte werden kaum oder gar nicht berücksichtigt? 4. Werden Stereotypen in Bezug auf die Menschen dieser Region erzeugt oder unterstützt? Die Untersuchung hat ergeben, dass die Region in den Reiseführern – bestimmt auch aufgrund des speziellen Genres – sehr positiv repräsentiert ist. Es stellte sich heraus, dass Neuengland zwar in vielerlei Hinsicht als eine Einheit wahrgenommen wird, zwischenstaatliche Differenzen jedoch eine große Rolle spielen. Obwohl die gemeinsame Bezeichnung („Neuengland“) der sechs Staaten ein gewisses Maß an Homogenität suggeriert, so hat die Analyse gezeigt, dass die Reiseführer die Heterogenität der Region, die Differenzen zwischen den Staaten sowie die Diversität der einzelnen Staaten besonders hervorheben und als positiven Aspekt der Region unterstreichen. Die quantitative Analyse hat gezeigt, dass die Kategorien ‘Aktivitäten‘, ‘Geschichte, ‘Natur, ‘Kultur‘ (inklusive Literatur), und ‘Essen/Küche’ die mit Abstand meist genannten Bereiche sind und somit zentrale Charakteristika der Region darstellen welche das Bild maßgeblich prägen. Es stellte sich auch heraus, dass einige Bereiche, wie beispielsweise Religion, Politik, Sklaverei als auch die aktuelle Situation der amerikanischen Ureinwohner nur bedingt Beachtung geschenkt wird. Bezüglich der Stereotypen ist zu sagen, dass es – obwohl die Attribute welche den Einwohnern zugeschrieben werden oft staatenspezifisch sind – aber dennoch einige Eigenschaften gibt, welche dem Neuengländer an sich zugeschrieben werden wobei diese überwiegend positiv sind. Ein typischer Neuendländer wird als stolz, robust/zäh, unabhängig, intelligent und gebildet, patriotisch, einfallsreich und erfinderisch, herzlich, (gast-) freundlich, sportfanatisch und gleichzeitig vielleicht auch etwas reserviert dargestellt.This thesis aims to make a contribution to the better understanding of guidebooks and the images they convey. Therefore, it investigates the representation of the American region of New England as it is portrayed in four selected guidebooks: Lonely Planet, Rough Guide, Fodor’s and DK Eyewitness Travel. In order to do so, a content analysis is undertaken in which both quantitative and qualitative methods are employed to show the distribution of 20 categories (e.g. history, nature, culture, etc.) and to interpret more closely particular instances. Besides revealing the overall image which is promoted by the guidebooks, an emphasis is also put on aspects which are either particularly highlighted or only hardly covered or even completely left out by the authors. Moreover, special focus is set on the investigation of the support, enforcement or creation of stereotypes regarding the inhabitants of the region. Overall, the results of the empirical study showed that the image of the region is a distinct and yet very positive one. Though the shared name “New England” connotes a certain degree of homogeneity, the analysis revealed that the heterogeneity, the differences between the states, as well as the diversity of the individual states are emphasized and highlighted as a positive and unique feature of the region. The quantitative analysis disclosed that the categories ‘activities’, ‘history’, ‘nature’, ‘culture’ (including literature), and ‘food’ turned out to be the most frequently occurring. Moreover, the results also showed that less emphasis is, for instance, put on religion, politics, the institution and the effects of slavery and the contemporary situation of Native Americans. As regards the creation or reinforcement of stereotypes, it can be said that despite many attributes being state-specific, some characteristics seem to apply to a typical inhabitant of the region. Hence, it can be concluded that the guidebooks do indeed support the stereotypical image of the proud, tough, independent, intelligent and well-educated, patriotic, inventive, hearty, friendly, and yet reserved New Englander

The New Hampshire, Vol. 86, No. 50 (May 7, 1996)

The student publication of the University of New Hampshire

The New Hampshire, Vol. 84, No. 49 (May 10, 1994)

The student publication of the University of New Hampshire

Senate journal, 13 May 1999.

Titles and imprints vary; Some volumes include miscellaneous state documents and reports; Rules of the Senat

Clemson Newsletter, 1989-1991

Information for the faculty and staff of Clemson Universityhttps://tigerprints.clemson.edu/clemson_newsletter/1021/thumbnail.jp

Supreme Court Opinion Authorship Attribution on a Case-by-Case Basis

This thesis analyzes the authorship of Supreme Court opinions and the theory that Justices on that Court might be delegating portions, if not the majority, of opinion authorship to their clerks. I test the theories that as Justices age they are more likely to delegate, and that delegation has increased across all justices over the past several decades of the Court’s history. I employ a content analysis method known as stylometry to assign authorship attributions on a case by case basis and use those attributions to inform larger trends regarding authorship. I ultimately find that there is little evidence to support the age or time-period theories but that there is significant variation across Justices in attribution, indicating that clerks are likely playing a large and measurable role in opinion drafting

Senate journal, 6 December 2000.

Titles and imprints vary; Some volumes include miscellaneous state documents and reports; Rules of the Senat