Emergency department performance assessment using administrative data: A managerial framework

Administrative data play an important role in performance monitoring of healthcare providers. Nonetheless, little attention has been given so far to the emergency department (ED) evaluation. In addition, most of existing research focuses on a single core ED function, such as treatment or triage, thus providing a limited picture of performance. The goal of this study is to harness the value of routinely produced records proposing a framework for multidimensional performance evaluation of EDs able to support internal decision stakeholders in managing operations. Starting with the overview of administrative data, and the definition of the desired framework's characteristics from the perspective of decision stakeholders, a review of the academic literature on ED performance measures and indicators is conducted. A performance measurement framework is designed using 224 ED performance metrics (measures and indicators) satisfying established selection criteria. Real-world feedback on the framework is obtained through expert interviews. Metrics in the proposed ED performance measurement framework are arranged along three dimensions: performance (quality of care, time-efficiency, throughput), analysis unit (physician, disease etc.), and time-period (quarter, year, etc.). The framework has been judged as "clear and intuitive", "useful for planning", able to "reveal inefficiencies in care process" and "transform existing data into decision support information" by the key ED decision stakeholders of a teaching hospital. Administrative data can be a new cornerstone for health care operation management. A framework of ED-specific indicators based on administrative data enables multi-dimensional performance assessment in a timely and cost-effective manner, an essential requirement for nowadays resource-constrained hospitals. Moreover, such a framework can support different stakeholders' decision making as it allows the creation of a customized metrics sets for performance analysis with the desired granularity

Explaining the servitization paradox: a configurational theory and a performance measurement framework

Purpose Previous research reports mixed results regarding the performance impact of servitization in manufacturing firms. To resolve this, the purpose of this paper is to develop a conceptually consistent and comprehensive measurement framework for both dimensions, servitization and its performance effect, and apply in a configurational analysis to reexamine previous evidence, arriving at a configurational theory of the relationship between servitization and firm performance. Design/methodology/approach Combining systematic literature review (SLR) and inductive reasoning, the existing indicators for servitization and performance are identified and clustered into groups that adequately represent both dimensions. The dataset is reanalyzed against the resulting framework to identify the configurational patterns and to formulate the theoretical propositions. Findings Financial and nonfinancial indicators of servitization and its performance impact are organized into a comprehensive measurement framework grounded on existing research. The subsequent meta-analysis shows that the positive or negative impacts of servitization on performance depend on how firms implement servitization strategies and which performance aspects are examined. Research limitations/implications The results explain when servitization can be successful and confirm the existence of the so-called servitization paradox. The meta-analysis identified patterns that explain the previous mixed results, shaping a configurational theory of servitization. Thus, the measurement framework is conceptually robust and has sufficient detail to capture servitization and its performance outcome as it feasibly distinguished between different organizational configurations. Originality/value The framework provides a comprehensive portfolio of indicators for both managers and scholars to measure servitization intensity and performance. This supports managers of servitizing firms in leading this organizational transformation while avoiding its organizational and financial paradoxes

Materials Characterization Using Acoustic Nonlinearity Parameters and Harmonic Generation: Effects of Crystalline and Amorphous Structures

The importance of nonlinearity in the description of material behavior is gaining widespread attention. Nonlinearity plays a major, if not dominating, role in a number of material properties. For example, properties that are important in engineering design such as thermal expansion or the pressure dependence of optical refraction are inherently nonlinear [1]. New assembley techniques such as the use of ultrasonic gauges to determine the loading of critical fasteners depend upon nonlinear properties of the fasteners [2]. Areas of considerable fundamental interest in nonlinearity include lattice dynamics [3], radiation stress in solids [4,5], and nonlinear optics [6

A BPMN extension to support discrete-event simulation for healthcare applications:an explicit representation of queues, attributes and data-driven decision points

Stakeholder engagement in simulation projects is important, especially in healthcare where there is a plurality of stakeholder opinions, objectives and power. One promising approach for increasing engagement is facilitated modelling. Currently, the complexity of producing a simulation model means that the ‘model coding’ stage is performed without the involvement of stakeholders, interrupting the possibility of a fully-facilitated project. Early work demonstrated that with currently-available software tools we can represent a simple healthcare process using Business Process Model and Notation (BPMN) and generate a simulation model automatically. However, for more complex processes, BPMN currently has a number of limitations, namely the ability to represent queues and data-driven decision points. To address these limitations, we propose a conceptual design for an extension to BPMN (BPMN4SIM) using Model Driven Architecture. Application to an elderly emergency care pathway in a UK hospital shows that BPMN4SIM is able to represent a more-complex business process