Dienstleistungscontrolling und -performance in Gesundheitsorganisationen : begleitende Erfolgsmessung im Rahmen von Lean-Prozessoptimierungen

Gesundheitsdienstleister sind mit steigendem Kostendruck konfrontiert. Diesem Kostendruck kann durch eine Analyse und Optimierung bestehender Prozesse begegnet werden. Viele Leistungserbringer haben dabei das Konzept des Lean Managements als Methode ihrer Wahl bestimmt und bereits mit der Optimierung einzelner Bereiche begonnen. Entscheidungsträger wünschen sich eine Erfolgsquantifizierung solcher Optimierungsprojekte, um die investierten Ressourcen zu rechtfertigen. Leider zeigt der aktuelle Stand der Forschung, dass der Einfluss von Lean Management bei Gesundheitsdienstleistern auf Prozess- und Finanzkennzahlen kaum untersucht ist. Um diese Forschungslücke zu schließen erläutert der Beitrag, wie das Lean Management in einem Krankenhaus mittels Kennzahlen gezielt validiert werden kann. Er beschreibt das Vorgehen bei der Konzeptualisierung und Durchführung einer begleitenden Evaluation im Rahmen einer Prozessoptimierung, wobei ein Fokus auf der Erstellung eines Kennzahlen-Cockpits sowie verschiedenen Erhebungsmethoden liegt

The challenge of interprofessional collaboration in emergency department team triage - An interpretive description

To explore emergency nurses' and physicians' experience of collaboration and collective decision-making when triaging older Emergency Department patients within the interprofessional team triage system.; Qualitative.; Semi-structured interviews were conducted with seven nurses and five physicians. Transcripts were analysed via Interpretive Description between September 2016-May 2017.; 'Negotiating collaboration' was developed as the main theme. Three subthemes influenced the negotiation process: Participants described divergent opinions on how an optimal triage system should work ('preferences for triage systems'); they had conflicting perceptions of each profession's role ('role perceptions'); and they expressed different coping strategies regarding 'perceived time pressure'. The compatibility of participants' views on these sub-themes determined whether the nurse and physician were able to successfully negotiate their collaboration. These themes became more evident when the team triaged older ED patients.; Improving interprofessional team triage requires working with the involved nurses' and physicians' values and beliefs. The strengths of both professions need to be considered and a flexible approach to collaboration established according to the patients' situations.; Emergency Department leaders need to consider nurses' and physicians' values and beliefs to promote interprofessional collaboration in team triage

Investigating Therapeutic Protein Structure with Diethylpyrocarbonate Labeling and Mass Spectrometry

Protein therapeutics are rapidly transforming the pharmaceutical industry. Unlike for small molecule therapeutics, current technologies are challenged to provide the rapid, high-resolution analyses of protein higher order structures needed to ensure drug efficacy and safety. Consequently, significant attention has turned to developing new methods that can quickly, accurately, and reproducibly characterize the three-dimensional structure of protein therapeutics. In this work, we describe a method that uses diethylpyrocarbonate (DEPC) labeling and mass spectrometry to detect three-dimensional structural changes in therapeutic proteins that have been exposed to degrading conditions. Using β2-microglobulin, immunoglobulin G1, and human growth hormone as model systems, we demonstrate that DEPC labeling can identify both specific protein regions that mediate aggregation and those regions that undergo more subtle structural changes upon mishandling of these proteins. Importantly, DEPC labeling is able to provide information for up to 30% of the surface residues in a given protein, thereby providing excellent structural resolution. Given the simplicity of the DEPC labeling chemistry and the relatively straightforward mass spectral analysis of DEPC-labeled proteins, we expect this method should be amenable to a wide range of protein therapeutics and their different formulations

A Lean Laboratory: Operational Simplicity and Cost Effectiveness of the Luminex xTAG™ Respiratory Viral Panel

During certain months of the year, viral respiratory infections lead to a dramatic increase in pediatric emergency room visits and hospital admissions. Rapid identification of the infectious organism results in timely treatment and reductions in hospital cost and length of stay. Before the introduction of molecular testing to the virology laboratory, diagnosis relied on the standard methods of immunofluorescence and culture. These tests can be labor-intensive and costly. Recent studies have demonstrated the higher sensitivity, faster turnaround, and broader diagnostic spectrum provided by multiplexed RT-PCR assays. Data comparing the laboratory cost and labor efficiency of the tests are lacking. To address this issue, we chose to implement the principles of operational workflow analysis using lean methodology to critically evaluate the potential advantages of a multiplexed RT-PCR assay both in terms of workflow and cost effectiveness. Our results indicated that the implementation of the Luminex xTAG Respiratory Viral Panel (RVP) resulted in a standardized workflow with decreased requirements in laboratory cost as well as improvement in efficiency. In summary, we demonstrate that, in our laboratory, the Luminex xTAG RVP is more operationally streamlined and cost-effective than standard viral direct fluorescent antibody and culture. Further studies are needed to highlight additional benefits of the test, including shortened hospital stay and improved patient outcome