The Grass Is Not Always Greener: A Look at National Health Care Systems Around the World

Critics of the U.S. health care system frequently point to other countries as models for reform. They point out that many countries spend far less on health care than the United States yet seem to enjoy better health outcomes. The United States should follow the lead of those countries, the critics say, and adopt a government- run, national health care system. However, a closer look shows that nearly all health care systems worldwide are wrestling with problems of rising costs and lack of access to care. There is no single international model for national health care, of course. Countries vary dramatically in the degree of central control, regulation, and cost sharing they impose, and in the role of private insurance. Still, overall trends from national health care systems around the world suggest the following: Health insurance does not mean universal access to health care. In practice, many countries promise universal coverage but ration care or have long waiting lists for treatment. Rising health care costs are not a uniquely American phenomenon. Although other countries spend considerably less than the United States on health care, both as a percentage of GDP and per capita, costs are rising almost everywhere, leading to budget deficits, tax increases, and benefit reductions. In countries weighted heavily toward government control, people are most likely to face waiting lists, rationing, restrictions on physician choice, and other obstacles to care. Countries with more effective national health care systems are successful to the degree that they incorporate market mechanisms such as competition, cost sharing, market prices, and consumer choice, and eschew centralized government control. Although no country with a national health care system is contemplating abandoning universal coverage, the broad and growing trend is to move away from centralized government control and to introduce more market-oriented features. The answer then to America's health care problems lies not in heading down the road to national health care but in learning from the experiences of other countries, which demonstrate the failure of centralized command and control and the benefits of increasing consumer incentives and choice

The Impact of Work Environment on Successful Implementation of Lean Six Sigma in Emergency Department

Continuous improvement (CI) is an initiative to improve the performance of processes in alignment with the customer needs and organizational strategy. Lean Six Sigma (LSS) is one of the most successful CI techniques in redesigning and improving significant processes to improve quality and eliminate waste. The healthcare sector has benefited from applying LSS due to its complicated work practices that face many challenges including increased expenditures and difficulties related to individual or community access to appropriate care. In particular, Emergency Departments (ED) have an important unit within healthcare organizations due to their essential role in providing urgent medical care services to patients. The aim of this doctoral research study is to develop a theoretical model using grounded theory to investigate the factors for successful LSS implementation in ED including how ED work environment affects the reduction of patient length of stay, which is one of the biggest issues that ED face. Therefore, the main objectives of this research are to: (1) investigate trends in the research area using systematic literature review, (2) develop an Initial Conceptual Framework including identifying the relationships between the variables of LSS implementation, (3) use an expert study where a group of experts will provide additional evidence regarding LSS implementation, and (4) test the model using survey questionnaire that examines the behavior of the variables. This research will be documented as a manuscript-style dissertation including four peer-reviewed academic journal articles each summarizing the results from a phase of this research. The results of this research will provide a conceptual model to guide the implementation of LSS in ED bringing the potential benefits of this approach to a critical department in healthcare organizations. Further, this research will inform future research by investigating the work environment effects on application of LSS

International Profiles of Health Care Systems, 2011

This publication presents overviews of the health care systems of Australia, Canada, Denmark, England, France, Germany, Japan, Italy, the Netherlands, New Zealand, Norway, Sweden, Switzerland, and the United States. Each overview covers health insurance, public and private financing, health system organization, quality of care, health disparities, efficiency and integration, use of health information technology, use of evidence-based practice, cost containment, and recent reforms and innovations. In addition, summary tables provide data on a number of key health system characteristics and performance indicators, including overall health care spending, hospital spending and utilization, health care access, patient safety, care coordination, chronic care management, disease prevention, capacity for quality improvement, and public views

Improvement of outpatient service processes based on BRP theory and information technology: a case study of the University of Hong Kong-Shenzhen Hospital

JEL Classification: M15 – IT Management, I12 – Health ProductionCurrently, due to some irrational allocation of medical and healthcare resources, a considerable proportion of state-of-the-art medical equipment and talented medical personnel are concentrated in large urban hospitals. This situation is particularly common in 3A hospitals (3A hospitals are hospitals which are equipped with more than 501 beds, can provide medical and healthcare services with high-level specialty to various regions and with scores higher than 900 according to the grading standard), which are often crowded with patients. According to the normal outpatient process, patients need to undergo a prolonged procedure from registration, treatment, laboratory test, diagnosis to drug dispensing. Often patients have to spend a long time waiting for treatment, receiving tests and paying for medical care. The congestion of patients at certain time-consuming processes allows doctors little time to check and treat patients thoroughly. As a result, doctors are often unable to make accurate and comprehensive diagnosis. Considered the window of a hospital, outpatient service is extremely important. Whether the design of its process is reasonable and whether its management is able to maximize interests for patients will directly affect the hospital’s medical level, and even its social benefits and reputation. Therefore, it has become a major issue for a hospital achieves to optimize the business process of its outpatient service. Outpatient process, as a core business process of a hospital, is critical to improving the quality of its medical service, upgrading its performance and minimizing its operating costs. Therefore, re-designing the outpatient process of a hospital can help enhance its comprehensive strength by endowing it with a core competence. In addition, the hospital will be impelled to provide patients with more convenient medical services with higher quality and lower price. This work conducts a case study on The University of Hong Kong-Shenzhen Hospital (HKU-SZH), which was the first to implement an outpatient appointment registration system. This thesis gives an anatomy of the outpatient process of the hospital through various methods and theories, such as literature review, field research, expert consultation, Business Process Reengineering Theory and Information technology, aiming to identify objectives and strategies of the case hospital in improving its outpatient process. The study consists of: - An investigation into the current situation of HKU-SZH’s outpatient registration process: through questionnaires and structured interviews, the defects and weak links in the hospital’s appointment registration model were analyzed. A structural equation model for existing outpatient processes was established and the influence of different variables on patients’ satisfaction level as well as the correlation between these variables was analyzed by means of a simulation model. - Research on outpatient process reengineering: with the needs and satisfaction of patients as a goal, this thesis reexamines the strategic goals and internal and external environment of HKU-SZH on the basis of Business Process Reengineering Theory, Queuing Theory, Six Sigma Theory and Information technology. This thesis improves HKU-SZH’s registration process, using methods of order modification, integration, simplification and automation and materializes the process by network technology and outpatient information system. - An empirical study on outpatient process: this thesis conducts a systemic and empirical analysis in a functional integration of registration and payment, process reengineering research through information technology (development of new functions of appointment system) and an empirical study on queuing theory. - Research on local adaptation of outpatient process: this thesis explores solutions and suggestions for HKU-SZH with the objective of optimize its outpatient process through the perspectives of hospital organizational structure, information technology, human resources, building of outpatient culture and optimization of waiting cost. By means of outpatient process reengineering, this thesis aim to increase the case hospital’s efficiency and raise its patients’ satisfaction so that the hospital may enhance its comprehensive competence. In addition, an effective and operable methodology will be generated, which is expected to serve as a reference for other hospitals to improve their operation and their management.Atualmente, devido a alguma atribuição irracional dos recursos médicos e de saúde, uma proporção considerável de modernos equipamentos médicos e pessoal médico talentoso estão concentrados em grandes hospitais urbanos. Esta situação é particularmente comum em hospitais 3A (hospitais 3A são os hospitais que estão equipados com mais de 501 camas, e que podem fornecer serviços médicos e de saúde com alto nível de especialidade para diversas regiões e com pontuações superiores a 900 de acordo com o padrão de classificação), que são frequentemente sobrelotados com pacientes. De acordo com o processo ambulatório normal, os pacientes precisam passar por um procedimento prolongado desde o registo, tratamento, análise laboratorial, diagnóstico, até à distribuição de medicamentos. Muitas vezes os pacientes têm de passar um longo tempo de espera para tratamento, para receber testes e para pagar por cuidados médicos. O congestionamento de pacientes em determinados processos demorados, leva a que os médicos tenham pouco tempo para verificar e tratar os pacientes completamente. Como resultado, os médicos são muitas vezes incapazes de fazer um diagnóstico preciso e abrangente. Considerado a montra de um hospital, o serviço ambulatório é extremamente importante. Se o desenho do seu processo é razoável e se a sua gestão é capaz de maximizar os interesses dos pacientes, irá afetar diretamente o nível médico do hospital, e até mesmo os seus benefícios sociais e reputação. Portanto, tornou-se um importante problema para um hospital conseguir otimizar o processo do seu serviço ambulatório. O processo ambulatório, como um processo de negócio nuclear de um hospital, é fundamental para melhorar a qualidade do seu serviço médico, aumentar o seu desempenho e minimizar seus custos operacionais. Portanto, reprojetar o processo ambulatório de um hospital pode ajudar a aumentar a sua força global dotando-o de uma competência essencial. Além disso, o hospital será impelido a oferecer aos pacientes serviços médicos mais convenientes com maior qualidade e menor preço. Este trabalho apresenta um estudo de caso sobre o Hospital da Universidade de Hong Kong-Shenzhen (HKU-SZH), que foi o primeiro a implementar um sistema de registo de consulta externa. Esta tese apresenta uma análise do processo ambulatório do hospital através de vários métodos e teorias, como a revisão de literatura, pesquisa de campo, consultas a especialistas, teoria da reengenharia de processos e tecnologias da informação, com o objetivo de identificar os objetivos e estratégias do hospital na melhoria do seu serviço ambulatório. O estudo consiste em: - Investigação sobre a situação atual do processo de registo ambulatório de HKU-SZH. Através de questionários e entrevistas estruturadas, foram analisados os defeitos e pontos fracos no modelo de registro de consultas do hospital. Um modelo de equações estruturais para os processos ambulatórios existentes foi estabelecido, e a influência de diferentes variáveis sobre o nível de satisfação dos pacientes, bem como a correlação entre essas variáveis foi analisada por meio de um modelo de simulação. - Investigação sobre a reengenharia do processo ambulatório. Tendo as necessidades e satisfação dos pacientes como objetivo, esta tese reexamina as metas estratégicas e o ambiente interno e externo de HKU-SZH com base na Teoria da Reengenharia de Processos, Teoria das Filas, Teoria Six Sigmae Tecnologias da Informação. Esta tese melhora o processo de registro de HKU-SZH, usando métodos de modificação, integração, simplificação e automação e materializa o processo através de tecnologias de rede e um sistema de informação para o processo ambulatório. - Estudo empírico sobre o processo ambulatório. Esta tese conduz uma análise sistémica e empírica sobre a integração funcional de inscrições e pagamentos, a pesquisa de reengenharia de processos através de tecnologias da informação (desenvolvimento de novas funções do sistema de consultas) e um estudo empírico sobre a teoria das filas. - Investigação sobre a adaptação local do processo ambulatório. Esta tese explora soluções e sugestões para o HKU-SZH para otimizar seu processo ambulatório através das perspetivas de estrutura hospitalar organizacional, tecnologias da informação, recursos humanos, construção da cultura do ambulatório e otimização do custo de espera. Por meio do processo de reengenharia do serviço de ambulatório, esta tese visa aumentar a eficiência do processo de internamento e aumentar a satisfação dos seus pacientes para que o hospital possa aumentar a sua capacidade global. Além disso, foi gerada uma metodologia eficiente e operacionalizavel, a qual se espera possa servir como referência para outros hospitais, para melhorar o seu funcionamento e a sua gestão

A New Vision for Health Care: A Leadership Role for Business

This report urges employers, along with government, not only to stay the course but to actively lead in implementing specific changes in private and public policies that could produce a health care system that works for all Americans. Since the publication of this report, CED has reversed its health care policy recommendations

Wisdom at Work: The Importance of the Older and Experienced Nurse in the Workplace

Focuses on promising strategies and opportunities for retaining experienced nurses, one of many approaches the authors recommend to alleviate the current nurse shortage crisis

ARCH 14 - International Conference on Research on Health Care Architecture - November 19-21, 2014, Espoo, Finland - Conference Proceedings

Healthcare Architecture has grown rapidly in recent years. However, there are still many questions remaining. The commission, therefore, is to share the existing research knowledge and latest results and to carry out research projects focusing more specifically on the health care situation in a variety of contexts. The ARCH14 conference was the third conference in the series of ARCH conferences on Research on Health Care Architecture initiated by Chalmers University. It was realized in collaboration with the Nordic Research Network for Healthcare Architecture .It was a joint event between Aalto University, Finnish Institute of Occupational Health (FIOH) and National Institute of Health and Welfare (THL International).The conference gathered together more than 70 researchers and practitioners from across disciplines and countries to discuss the current themes

A qualitative investigation of patient and staff experience across multiple clinical services: The case of a redevelopment programme at an English acute hospital NHS trust

This thesis was submitted for the degree of Doctor of Philosophy and awarded by Brunel University.This study was a qualitative examination of patient and staff experiences within a redeveloping acute NHS hospital Trust in England. The aim of the investigation was to examine the current direction in government policy which places considerable emphasis upon delivering healthcare services structured broadly around increased patient involvement and choice. There is a need to address the gaps in the evidence for this strategic direction, which indicate an apparent lack of appreciation for the complexities involved. The qualitative methods applied in the study included the use of patient and staff interviews, observations and some documentary review. The research location was selected as an opportunity to assess and compare the perceptions and experiences of patients and staff in the context of a hospital redevelopment programme, from within three distinct clinical services. The three clinical services studied were accident and emergency, a paediatric ambulatory care unit and an adult respiratory outpatient clinic. Thematic content analysis was applied to the data. Findings indicated that generally patients were satisfied with their care and did not expect greater control or involvement. Some issues were raised by staff around uncertainty towards the change programme. Furthermore, there was a suggestion that staff and patients had differing perceptions of what constituted satisfactory care, with respect to technical versus functional quality. The notion of a ‘model’ of patient behaviour emerged. The conclusion is that given the current political agenda focused on the role of the patient, greater sensitivity in understanding towards terms such as patient-centred care, involvement and choice is required. Additionally, there is a need for greater awareness and appreciation of the discrepancy between staff and patient perspectives of what impacts the patient experience. Further research might focus upon the understanding of the patient processes and interactions involved with respect to patient-centred care and choice

International Profiles of Health Care Systems, 2012

This publication presents overviews of the health care systems of Australia, Canada, Denmark, England, France, Germany, Japan, Iceland, Italy, the Netherlands, New Zealand, Norway, Sweden, Switzerland, and the United States. Each overview covers health insurance, public and private financing, health system organization, quality of care, health disparities, efficiency and integration, care coordination, use of health information technology, use of evidence-based practice, cost containment, and recent reforms and innovations. In addition, summary tables provide data on a number of key health system characteristics and performance indicators, including overall health care spending, hospital spending and utilization, health care access, patient safety, care coordination, chronic care management, disease prevention, capacity for quality improvement, and public views