Physician-owned specialized facilities: focused factories or destructive competition?: a systematic review.

Multiple studies have investigated the business case of physician-owned specialized facilities (specialized hospitals and ambulatory surgery centers). However literature lacks integration. Building on the theoretical insights of disruptive innovation, a systematic review was conducted to assess the evidence base of these innovative delivery models. The Institute of Medicine’s quality framework (safe, effective, equitable, efficient, patient-centered and accessible care) was applied in order to evaluate the performance of such facilities. In addition the corresponding impact on full-service general hospitals was assessed. Database searches yielded 6,108 candidate articles of which 47 studies fulfilled the inclusion criteria. Overall the quality of the included studies was satisfactory. Our results show that little evidence exists in support of competitive advantages in favor of specialized facilities. Moreover even if competitive advantages exist, it is equally important to reflect on the corresponding impact on full service-general hospitals. The development of specialized facilities should therefore be monitored carefully

The gaps between healthcare service and building design : a state of the art review

Healthcare buildings are designed to achieve diverse objectives, ranging from providing appropriate environments where care can be delivered to communities to increasing operational efficiency and improving patient flows and the patient experience. Improvements in operational efficiency should result from state-of-the-art buildings, more appropriate layouts, departmental adjacencies, efficient clinical and business processes and enhanced information systems. However, complexities around requirements and stakeholders management may prevent the achievement of such objectives. The aim of this article is to identify and understand how healthcare services (re)design and building design can be integrated to facilitate increased performance both in terms of service delivery and future changes. Findings indicate that current approaches and innovation are restricted due to functional barriers in the design process, and that there is a need to support the development of operations driven design through time (e.g. flexible and durable) that satisfies diverse needs

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To Reform Medicare, Reform Incentives and Organization

Alain C. Enthoven's paper, To Reform Medicare, Reform Incentives And Organization, explains how the principles of cost-responsible consumer choice among competing health-insurance plans, sometimes called "managed competition," can both improve quality and reduce cost in the federal government's Medicare program