264 research outputs found
Post-project evaluation of IT business cases: The case of an energy supply company
This research describes the design of a post-project evaluation model for business cases of IT projects. Structured post-project evaluation is hardly common practice in industry (Gwillim et al., 1995; Kumar, 1990). Consequently, many improvement opportunities are missed out on, including improving future business cases and system development practices. On basis of a literature study a post-project evaluation design matrix was developed to illustrate the most important design issues. This matrix includes six post-project evaluation aspects and for all these aspects, the following five issues: evaluation questions, required information, time frame, roles and possible actions. On the basis of this post-project evaluation design matrix and 30 business case documents a post-project evaluation method was developed for an energy supply company. Various information and communication problems were identified, such as, too little commitment of the business case owner and incomplete initial information. Several quick wins could be established by suggesting improved calculation methods and assigning cost and benefits to responsible owners. Additional benefits could be obtained of post-project evaluation, if the business case should receive significantly more managerial attention and would play a central role in the evaluation of each mile stone. This would considerably improve organizational learning
Healthcare professionals' views on patient-centered care in hospitals
Background: Patient-centered care (PCC) is a main determinant of care quality. Research has shown that PCC is a multi-dimensional concept, and organizations that provide PCC well report better patient and organizational outcomes. However, little is known about the relative importance of PCC dimensions. The aim of this study was therefore to investigate the relative importance of the eight dimensions of PCC according to hospital-based healthcare professionals, and examine whether their viewpoints are determined by context. Methods: Thirty-four healthcare professionals (16 from the geriatrics department, 15 from a surgical intensive care unit, 3 quality employees) working at a large teaching hospital in New York City were interviewed using Q methodology. Participants were asked to rank 35 statements representing eight dimensions of PCC extracted from the literature: patient preferences, physical comfort, coordination of care, emotional support, acce
Ischaemic heart disease in Turkish migrants with type 2 diabetes mellitus in The Netherlands: wait for the next generation?
OBJECTIVE: To study the prevalence of ischaemic heart disease in Turkish
and Surinam-Asian migrants with type 2 diabetes mellitus in the
Netherlands as compared with Europeans. METHODS: In a consecutive
case-control study, 59 Turkish and 62 Surinam-Asian patients were compared
with 185 Europeans referred to a diabetes clinic for treatment of type 2
diabetes in the period 1992 to 1998. Main outcome measures were ischaemic
heart disease and its associated risk factors. RESULTS: The prevalence of
ischaemic heart disease was lower (9%) in the Turks (p < 0.02), but higher
(29%) in the Surinam-Asians compared with the Europeans (23%). The Turks
(52 +/- 10 years) and Surinam-Asians (46 +/- 12 years) were younger than
the Europeans (64 +/- 11 years, p < 0.001). Body mass index was 32 +/- 5
(p < 0.001) in the Turks, 27 +/- 5 in the Surinam-Asians (p < 0.05) and 29
+/- 5 in the Europeans. Turkish patients smoked less (23%, p < 0.05) and
used less alcohol (4%, p < 0.05) than the Europeans. Proteinuria was found
in 24% of the Turks (p < 0.05), 37% of the Surinam-Asians (NS) and 46% of
the Europeans. In univariate analysis ischaemic heart disease was related
to Turkish origin, OR 0.34 (0.14-0.83) p < 0.02, to Surinam-Asian origin,
OR 1.84 (1.00-3.38) p = 0.05, and smoking, OR 1.78 (1.18-2.68) p < 0.01.
Other variables were not related to ischaemic heart disease. Multivariate
analysis in a model with ethnicity and smoking showed significant
relations between ischaemic heart disease and Turkish ethnicity, OR 0.19
(0.06-0.65) p = 0.007, Surinam-Asian origin, OR 2.77 (1.45-5.28) p =
0.002, and smoking, OR 1.79 (1.20-2.66) p = 0.004. CONCLUSION: Type 2
diabetes mellitus in different ethnic groups results in a significant
difference in incidence of ischaemic heart disease. The most remarkable
finding is a low incidence of ischaemic heart disease in the Turkish
patients with type 2 diabetes, independent of smoking. The high prevalence
of ischaemic heart disease in young migrant Asians with diabetes is
confirmed
What makes an ideal hospital-based medical leader? Three views of healthcare professionals and managers: A case study
Medical leadership is an increasingly important aspect of hospital management. By engaging physicians in leadership roles, hospitals aim to improve their clinical and financial performances. Research has revealed numerous factors that are regarded as necessary for
âmedical leadersâ to master, however we lack insights into their relative importance. This
study investigates the views of healthcare professionals and managers on what they consider the most important factors for medical leadership. Physicians (n = 11), nurses (n = 10),
laboratory technicians (n = 4) and managers (n = 14) were interviewed using Q methodology. Participants ranked 34 statements on factors elicited from the scientific literature,
including personal features, context-specific features, activities and roles. By-person factor
analysis revealed three distinct views of medical leadership. The first view represents a strategic leader who prioritizes the interests of the hospital by participating in hospital strategy
and decision making. The second view describes a social leader with strong collaboration
and communication skills. The third view reflects an accepted leader among peers that is
guided by a clear job description. Despite these differences, all respondents agreed upon
the importance of personal skills in collaboration and communication, and having integrity
and a clear vision. We find no differences in views related to particular healthcare professionals, managers, or departments as all views were defined by a mixture of departments
and participants. The findings contribute to increased calls from both practice and literature
to increase conceptual clarity by eliciting the relative importance of medical leadershiprelated factors. Hospitals that wish to increase the engagement of physicians in improving
clinical and financial performances through medical leadership should focus on selecting
and developing leaders who are strong strategists, socially skilled and accepted by clinical
peers
Exploring views on what is important for patient-centred care in end-stage renal disease using Q methodology
Background: This study aimed to explore views on what is considered important for Patient-Centred Care (PCC) among patients and the healthcare professionals treating them in a haemodialysis department. Methods: Interviews were conducted among 14 patients with end-stage renal disease receiving dialysis and 12 healthcare professionals (i.e. 2 doctors, 4 staff members, and 6 nurses) working at a haemodialysis department. Participants were asked to rank-order 35 statements representing eight dimensions of PCC previously discussed in the literature. Views on PCC, and communalities and differences between them, were explored using by-person factor analysis. Results: Four views on what is important for PCC in end-stage renal disease were identified. In viewpoint 1, listening to patients
Preschool Mathematics Performance and Executive Function: Rural-Urban Comparisons across Time
This longitudinal study examined the relationship between executive function (EF) and mathematics with rural and urban preschool children. A panel of direct and indirect EF measures were used to compare how well individual measures, as well as analytic approaches, predicted both numeracy and geometry skill. One hundred eighteen children, ages 39 to 68 months, were given EF and mathematics assessments twice, approximately six months apart, concurrent to their teachers completing an indirect assessment of EF for each child. Results suggest: (1) the childâs age determines if a panel of direct EF measures is a better predictor of numeracy and geometry skills than a single EF measure, (2) geometry and numeracy skill are influenced differently by contextual factors, and (3) the EF-geometry link may develop about six months later than the EF-numeracy connection. As the relationship between preschool age EF and mathematics is better understood, efforts can be made to improve the aspects of EF connected to mathematics skill, which may aid in performance
Does the pulmonary autograft in the aortic position in adults increase in diameter? An echocardiographic study
Discursively framing physicians as leaders: Institutional work to reconfigure medical professionalism
Physicians are well-known for safeguarding medical professionalism by performing institutional work in their daily practices. However, this study shows how opinion-making physicians in strategic arenas (i.e. national professional bodies, conferences and high-impact journals) advocate to reform medical professionalism by discursively framing physicians as leaders. The aim of this article is to critically investigate the use of leadership discourse by these opinion-making physicians. By performing a discursive analysis of key documents produced in these strategic arenas and additional observations of national conferences, this article investigates how leadership discourse is used and to what purpose. The following key uses of medical leadership discourses were identified: (1) regaining the lead in medical professionalism, (2) disrupting âoldâ professional values, and (3) constructing the âmodernâ physician. The analysis reveals that physicians as âleadersâ are expected to become team-players that work across disciplinary and organizational boundaries to improve the quality and affordability of care. In comparison to management that is negatively associated with NPM reform, leadership discourse is linked to positive institutional change, such as decentralization and integration of care. Yet, it is unclear to what extent leadership discourses are actually incorporated on the work floor and to what effect. Future studies could therefore investigate the uptake of l
A cost minimisation analysis in teledermatology: model-based approach
<p>Abstract</p> <p>Background</p> <p>Although store-and-forward teledermatology is increasingly becoming popular, evidence on its effects on efficiency and costs is lacking. The aim of this study, performed in addition to a clustered randomised trial, was to investigate to what extent and under which conditions store-and-forward teledermatology can reduce costs from a societal perspective.</p> <p>Methods</p> <p>A cost minimisation study design (a model based approach) was applied to compare teledermatology and conventional process costs per dermatology patient care episode. Regarding the societal perspective, total mean costs of investment, general practitioner, dermatologists, out-of-pocket expenses and employer costs were calculated. Uncertainty analysis was performed using Monte Carlo simulation with 31 distributions in the used cost model. Scenario analysis was performed using one-way and two-way sensitivity analyses with the following variables: the patient travel distance to physician and dermatologist, the duration of teleconsultation activities, and the proportion of preventable consultations.</p> <p>Results</p> <p>Total mean costs of teledermatology process were âŹ387 (95%CI, 281 to 502.5), while the total mean costs of conventional process costs were âŹ354.0 (95%CI, 228.0 to 484.0). The total mean difference between the processes was âŹ32.5 (95%CI, -29.0 to 74.7). Savings by teledermatology can be achieved if the distance to a dermatologist is larger (> = 75 km) or when more consultations (> = 37%) can be prevented due to teledermatology.</p> <p>Conclusions</p> <p>Teledermatology, when applied to all dermatology referrals, has a probability of 0.11 of being cost saving to society.</p> <p>In order to achieve cost savings by teledermatology, teledermatology should be applied in only those cases with a reasonable probability that a live consultation can be prevented.</p> <p>Trail Registration</p> <p>This study is performed partially based on PERFECT D Trial (Current Controlled Trials No.ISRCTN57478950).</p
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