Implementation by simulation; strategies for ultrasound screening for hip dysplasia in the Netherlands

Background: Implementation of medical interventions may vary with organization and available capacity. The influence of this source of variability on the cost-effectiveness can be evaluated by computer simulation following a carefully designed experimental design. We used this approach as part of a national implementation study of ultrasonographic infant screening for developmental dysplasia of the hip (DDH). Methods: First, workflow and performance of the current screening program (physical examination) was analyzed. Then, experimental variables, i.e., relevant entities in the workflow of screening, were defined with varying levels to describe alternative implementation models. To determine the relevant levels literature and interviews among professional stakeholders are used. Finally, cost-effectiveness ratios (inclusive of sensitivity analyses) for the range of implementation scenarios were calculated. Results: The four experimental variables for implementation were: 1) location of the consultation, 2) integrated with regular consultation or not, 3) number of ultrasound machines and 4) discipline of the screener. With respective numbers of levels of 3,2,3,4 in total 72 possible scenarios were identified. In our model experimental variables related to the number of available ultrasound machines and the necessity of an extra consultation influenced the cost-effectiveness most. Conclusions: Better information comes available for choosing optimised implementation strategies where organizational and capacity variables are important using the combination of simulation models and an experimental design. Information to determine the levels of experimental variables can be extracted from the literature or directly from experts

A critical evaluation and framework of business process improvement methods

The redesign of business processes has a huge potential in terms of reducing costs and throughput times, as well as improving customer satisfaction. Despite rapid developments in the business process management discipline during the last decade, a comprehensive overview of the options to methodologically support a team to move from as-is process insights to to-be process alternatives is lacking. As such, no safeguard exists that a systematic exploration of the full range of redesign possibilities takes place by practitioners. Consequently, many attractive redesign possibilities remain unidentified and the improvement potential of redesign initiatives is not fulfilled. This systematic literature review establishes a comprehensive methodological framework, which serves as a catalog for process improvement use cases. The framework contains an overview of all the method options regarding the generation of process improvement ideas. This is established by identifying six key methodological decision areas, e.g. the human actors who can be invited to generate these ideas or the information that can be collected prior to this act. This framework enables practitioners to compose a well-considered method to generate process improvement ideas themselves. Based on a critical evaluation of the framework, the authors also offer recommendations that support academic researchers in grounding and improving methods for generating process improvement ideas. Next to the framework and its critical evaluation, this review investigates the research procedures of the studies that were used to create the framework. Related to this investigation, academic researchers can find additional guidance regarding procedures for building and evaluating new methods