Horizontal Collaborative e-Purchasing for Hospitals: IT for Addressing Collaborative Purchasing Impediments

Horizontal collaborative purchasing (HCP) has often been cited as a way for hospitals to address the challenges of the rising healthcare costs. However, hospitals do not seem to utilize horizontal collaborative purchasing on any large scale, and recent initiatives have had mixed results. Focusing on Dutch hospitals, in this paper we present major impediments for collaborative purchasing, resulting in a first component of our proposed electronic horizontal collaborative purchasing model for hospitals; as a second component it contains a collaborative purchasing typology. A first validation round with hospital purchasing professionals, described separately in Kusters and Versendaal (2011), confirmed four applicable purchasing types and fourteen salient collaborative purchasing impediments. The model is operationalized by including possible information technology (IT) solutions that address the specific fourteen impediments. This model is validated through methodological triangulation of four different validation techniques. We conclude that IT has the potential to support, or overcome, the impediments of HCP. The validation also reveals the need to distinguish between more process-related, as opposed to social-related, obstacles; the immediate potential for IT solutions is greater for the process-related impediments. Ultimately, we conclude that the collaborative e-purchasing model (e-HCP) and implementation roadmap can be used by healthcare consortia, branche organizations, partnering healthcare institutes and multi-site healthcare institutes as a means to help identifying strategies to initiate, manage and evaluate collaborative purchasing practices

Customer knowledge transfer challenges in a co-creation value network:Toward a reference model

In today’s interconnected global marketplace, where customers have become increasingly knowledgeable and empowered, a customer-centric view is becoming a prominent differentiating strategy for firms. Accordingly, firms with the aim of delivering a seamless customer experience strive to offer integrated solutions. This quite often relies on inter-organizational collaboration in the context of a value network In this context, customer-related knowledge is regarded as one of the primary sources in the provisioning process of integrated solutions. This, in turn, implies the importance of effective sharing of customer knowledge among actors of a value network. Customer knowledge transfer is difficult due to some recognizable challenges such as a lack of trust. Because of the added complexity of a value network, achieving a shared understanding among actors about customer knowledge transfer challenges in a value network setting (VN-CKTC) might be more difficult. A systematic and comprehensive overview of the VN-CKTC (in the form of a reference model) might support this by providing additional structure. Although scholars have long studied knowledge transfer challenges within business network settings, they are usually limited in scope and their resulting challenges differ widely. Therefore, they provide insufficient coverage of the possible challenges. A more comprehensive view is thus needed. Our research aims at designing and validating a reference model that provides a systematic and wider spectrum of possible VN-CKTC. To this end, a design science research approach is followed. In the design phase, by conducting a systematic literature review followed by a structured classification, a reference model of VN-CKTC is designed. In the evaluation phase, the validation of this designed artifact is evaluated in a value network setting by conducting multiple case studies. The results of this study give us both theoretically and context-specific descriptions of the significant relevant of these challenges. The proposed reference model provides a rich picture of VN-CKTC. Decision makers of value networks can use this reference model as a means to achieve a shared understanding about customer knowledge transfer challenges and to come to an agreement on these challenges. They can also apply it to be aware of which challenges to focus on, so they are provided with a much stronger basis to make better-informed decisions to address and mitigate these challenges

Data from configuration management tools as sources for software process mining

Process mining has proven to be a valuable approach that provides new and objective insights into processes within organizations. Based on sets of well-structured data, the underlying ‘actual’ processes can be extracted and process models can be constructed automatically, i.e., the process model can be ‘mined’. Successful process mining depends on the availability of well-structured and suitable data. This paper investigates the potential of software configuration management (SCM) and SCM- tools for software process mining. In a validation section, data collected by a SCM tool in practice are used to apply process-mining techniques on a particular software process, i.e., a Change Control Board (CCB) process in a large industrial company. Application of process mining techniques revealed that although people tend to believe that formally specified and well-documented processes are followed, the ‘actual’ process in practice is different. Control-flow discovery revealed that in the CCB process in most of the cases, i.e., 70%, an important CCB task ‘Analysis’ was skipped

A PCT algorithm for discontinuation of antibiotic therapy is a cost-effective way to reduce antibiotic exposure in adult intensive care patients with sepsis

Objective: Procalcitonin (PCT) is a specific marker for differentiating bacterial from non-infective causes of inflammation. It can be used to guide initiation and duration of antibiotic therapy in intensive care unit (ICU) patients with suspected sepsis, and might reduce the duration of hospital stay. Limiting antibiotic treatment duration is highly important because antibiotic over-use may cause patient harm, prolonged hospital stay, and resistance development. Several systematic reviews show that a PCT algorithm for antibiotic discontinuation is safe, but upfront investment required for PCT remains an important barrier against implementation. The current study investigates to what extent this PCT algorithm is a cost-effective use of scarce healthcare resources in ICU patients with sepsis compared to current practice. Methods: A decision tree was developed to estimate the health economic consequences of the PCT algorithm for antibiotic discontinuation from a Dutch hospital perspective. Input data were obtained from a systematic literature review. When necessary, additional information was gathered from open interviews with clinical chemists and intensivists. The primary effectiveness measure is defined as the number of antibiotic days, and cost-effectiveness is expressed as incremental costs per antibiotic day avoided. Results: The PCT algorithm for antibiotic discontinuation is expected to reduce hospital spending by circa €3503 per patient, indicating savings of 9.2%. Savings are mainly due to reductions in length of hospital stay, number of blood cultures performed, and, importantly, days on antibiotic therapy. Probabilistic and one-way sensitivity analyses showed the model outcome to be robust against changes in model inputs. Conclusion: Proven safe, a PCT algorithm for antibiotic discontinuation is a cost-effective means of reducing antibiotic exposure in adult ICU patients with sepsis, compared to current practice. Additional resources required for PCT are more than offset by downstream cost savings. This finding is highly important given the aim of preventing widespread antibiotic resistanc

Hysteresis and bi-stability by an interplay of calcium oscillations and action potential firing

Many cell types exhibit oscillatory activity, such as repetitive action potential firing due to the Hodgkin-Huxley dynamics of ion channels in the cell membrane or reveal intracellular inositol triphosphate (IP$_3$) mediated calcium oscillations (CaOs) by calcium-induced calcium release channels (IP$_3$-receptor) in the membrane of the endoplasmic reticulum (ER). The dynamics of the excitable membrane and that of the IP$_3$-mediated CaOs have been the subject of many studies. However, the interaction between the excitable cell membrane and IP$_3$-mediated CaOs, which are coupled by cytosolic calcium which affects the dynamics of both, has not been studied. This study for the first time applied stability analysis to investigate the dynamic behavior of a model, which includes both an excitable membrane and an intracellular IP$_3$-mediated calcium oscillator. Taking the IP$_3$ concentration as a control parameter, the model exhibits a novel rich spectrum of stable and unstable states with hysteresis. The four stable states of the model correspond in detail to previously reported growth-state dependent states of the membrane potential of normal rat kidney fibroblasts in cell culture. The hysteresis is most pronounced for experimentally observed parameter values of the model, suggesting a functional importance of hysteresis. This study shows that the four growth-dependent cell states may not reflect the behavior of cells that have differentiated into different cell types with different properties, but simply reflect four different states of a single cell type, that is characterized by a single model.Comment: 29 pages, 6 figure