Business Process Redesign in the Perioperative Process: A Case Perspective for Digital Transformation

This case study investigates business process redesign within the perioperative process as a method to achieve digital transformation. Specific perioperative sub-processes are targeted for re-design and digitalization, which yield improvement. Based on a 184-month longitudinal study of a large 1,157 registered-bed academic medical center, the observed effects are viewed through a lens of information technology (IT) impact on core capabilities and core strategy to yield a digital transformation framework that supports patient-centric improvement across perioperative sub-processes. This research identifies existing limitations, potential capabilities, and subsequent contextual understanding to minimize perioperative process complexity, target opportunity for improvement, and ultimately yield improved capabilities. Dynamic technological activities of analysis, evaluation, and synthesis applied to specific perioperative patient-centric data collected within integrated hospital information systems yield the organizational resource for process management and control. Conclusions include theoretical and practical implications as well as study limitations

Introduction

The Trotter Review, which has been published for over fifteen years, is entering a new phase. That is what the current issue represents, a marriage of old and new, a branching out into expanded territory that does not betray, we hope, the ideals or principles of the past. What we have put together is historical and cultural and political. We raise questions. We draw connections and provide context as we focus on the local, the national, the international, and the diasporic. In addition, we give cognizance to the literary, as an expression of the urge to order the real, to give it utterance, or, as Chuck D would say, to bow to the power of the pad. We wanted to sample the range of work that the Trotter has produced, and for that reason, many of the articles and essays are drawn from papers that the Trotter Institute has published as monographs over the years. There is a theme here, and it is the resistance of the African-inflected spirit, generation after generation, community after community, and country after country in an internecine war that has not yet come to an end

Introduction

What is the political valence of blackness at the beginning of the second decade of the twenty-first century; has it waxed or waned? Is it headed to greater potency or back into the dark days of the past when complexion determined the worth of character? Major political advances have been achieved nationally in the last ten years, most significantly in the election of the nation’s first African American president. Yet a resistant status quo remains. The push to unseat President Obama is virulent, and it is hard to imagine that all of the motivation to do so is tied only to his performance. A vanguard state in some respects, Massachusetts made history this century by granting a black governor a second term for the first time ever. In the twentieth century, the state also distinguished itself as an out-front player in black politics when Edward Brooke, a Republican, became the first black U.S. senator to enjoy reelection in a place with the best and worst of racial history. Boston, where Martin Luther King earned his doctorate and developed his theory of non-violence, is identified with liberalism but also reactionary racial attitudes, exemplified most prominently in the busing crisis of the 1970s, when an angry young man of Irish background from South Boston whacked an ambitious young black lawyer of African descent. Boston, the symbolic navel of the nation, is one of the last large cities in the country to tarry in electing a black mayor. Will the city look out from its vaunted hill and rise above the quagmire of its racial past or will it slip and fall like Jack and Jill, tumbling down and losing its capacity to hold water

Introduction: Appreciating Difference

Are we a narrative nation, imagined and connected mentally, tied by a common history of disruption if not by contiguous geography? Lorick-Wilmot suggests that the stories we tell offer the basis of mutual understanding across distance and cultures and generations. In a reconfigured mental Diasporic cartography, where is our citadel, our castle (not to be confused with what Europeans named as slave castles of Africa)? The remains and monuments built in this hemisphere by iron will and the drive to change yesterday, uprooting it from the ground of inequality, still stand on the highest hill in northern Haiti, reminding us that the challenge legacy is long and tall but incomplete. And suggesting, through the lessons of history that undid the men (and women) who took part in that long-ago revolution, that the way forward cannot be through divide and conquer but with the rubric of unite and win, which requires appreciating difference in full measure

Introduction: Lynching, Incarceration’s Cousin: From Till to Trayvon

The wholesale criminalizing of the black male has been much in the news, put there by the Trayvon Martin case and the Florida verdict. (Incidentally, even though we don’t often think of it, Florida was where the first African slaves were installed in America, back in the 1500s in the city of St. Augustine.) As an academic, which, loosely translated means that I often bury my head between the covers of a book trying to figure out one thing or another, I am thought of as someone who is cautious and circumspect in what I think and write, but I cannot be at this time. When I heard the news late on a Saturday night that the jury deliberations in Florida ended with exoneration, I was speechless. I simply could not believe that a young man going to his father’s house after buying Skittles and a soft drink could be killed, shot in the street, and no one would be accountable and, on the contrary, he would be the one who was suspect. So the label of criminal, ever at the ready, was put to work, and the person who pulled the trigger that blasted a teen off the planet was acting in self defense

Introduction: The Gentrification Game

In real estate talk, there are only three things that matter, and they are location, location, location. The same is true in dispossession, which translates into the freeing up of location so that it can be possessed by others. Another term that has cropped up fairly recently, much in use in the crossover between the twentieth and twenty-first centuries, is gentrification, which has a benign face as well as one that is not so kindly, like the paired tragic and comic masks of classic drama. In this issue of the Trotter Review, we explore gentrification and its alternate, dispossession, through the lens of housing policy focused on increasing opportunity; as a strategy of neighborhood displacement; as possible collusion between developers, politicians, and members of an African heritage leadership class eager to keep their pockets jingling with gold; and as local examples of ouster and remake of a neighborhood to suit the tastes of a more moneyed population with a creamier complexion

Introduction

A day or two after Barack Obama was elected president, a colleague with an international reputation for political savvy commented that George W. Bush had made it possible for Obama to be president.“No,” I responded. “You can’t give that to Bush single-handedly. There is a whole history, a backlog of effort, not to mention Obama’s strategic genius, to explain the outcome of the election. Bush may have weakened the gate, but Obama pushed it open, and he had a whole group of folks, much bigger and more diverse than the Verizon network, behind him.”The idea that white folks are the ones who make things happen, that they are the motive force fueling any black accomplishment, persists as a misconception. White folks have agency, black folks do not; white folks are doers, black folks are takers. Of course, not everyone thinks or feels that way, but some still do, and not necessarily through individual fault alone. The media often subscribe to the notion that accomplishment is an exception for blacks, not a given. Rather, criminality is their constant, and so too disadvantage

Nosocomial Transmission of Trichophyton tonsurans Tinea Corporis in a Rehabilitation Hospital

Abstract Objective: Investigate the nosocomial transmission of Trichophyton tonsurans tinea corporis. Design: Descriptive study of a nosocomial epidemic of tinea corporis. Setting: A free-standing inpatient rehabilitation facility. Participants: Patients and healthcare workers present on an inpatient rehabilitation ward at the time of transmission of tinea corporis. Results: T tonsurans tinea corporis was transmitted from one patient to four healthcare workers despite early diagnosis and treatment. Infection rates for healthcare workers having major, moderate, and minor contact with the index case were 30%, 17%, and 0%, respectively (overall rate, 25%). Conclusions: This study identifies rehabilitation inpatients as another population in which nosocomial transmission of T tonsurans tinea corporis can occur. The high attack rate and transmission, despite early diagnosis and treatment, emphasizes the need for isolation precaution