Major regulatory shifts as a driver of organizational change in health care: A macro and a micro perspective

In this dissertation, I explore how major shifts in the regulatory environment of actors involved in the delivery of health service trigger and shape organizational change. To do so, I conceptualize different types of policy intervention as exogenous shocks and use a range of qualitative and quantitative research methods. Chapter 1 portrays the general framework of this dissertation. Adopting a macro and a micro perspective respectively, I explore two distinct types of regulatory shift: First, in Chapters 2 and 3, I focus on regulation of market entry, whereas, in Chapter 4, I focus on reimbursement regulation by analyzing how the introduction of a system based on diagnosis-related groups (DRG) affects health care provision. To do so, I analyze how two acute care hospitals that had implemented kaizen—a management technique that aims to improve business processes—in a preparatory attempt to deliver their services in a more cost-efficient way. Chapter 5 concludes and suggests an agenda for future research. In Chapter 2, I analyze how the regulatory shift induced by the new European Union Medical Device Regulation (MDR) affects the main stakeholders of the medical device industry. The theoretical framework of this review draws on the main objectives that the MDR asserts to pursue in its preamble: to facilitate free trade and enhance public health. Taking a descriptive approach based on both theoretical considerations and empirical evidence, I assess whether the new regulation is likely to achieve these two objectives. To my knowledge, this analysis represents the most comprehensive scholarly review of the MDR so far. In Chapter 3, I conceptualize the new European Union Medical Device Regulation (MDR) as an exogenous shock that elicits a major shift in the regulatory environment of the medical device industry. To make sense of this new environment, firms are forced to reorient and recreate their working practices. Using Switzerland as ground for the subject of this study, I aim to determine the preliminary economic impact of the MDR on the European medical device industry. In this study, top executives and business leaders of medical device firms based in Switzerland completed an online survey with a Likert-scale-design. I used structural equation modeling (1) to determine whether some firms are more capable of change than others when faced with a major shift in their regulatory environment, and, (2) to outline ways in which firms may seek to improve their capacity to react to such a shift. My results suggest that higher levels of organizational capacity for change (OCC) are generally positively associated with financial performance (p < 0.01) but that small and medium-sized firms show higher levels of OCC (p < 0.01) and lower levels of performance than their larger competitors (p < 0.01). Furthermore, I outlined (1) strategies business leaders may wish to consider if they were to make their organizations more capable of change, and (2) measures policy makers could take to ensure that medical devices with no close substitutes are withdrawn from the market, especially in times of a global pandemic. In Chapter 4, I examine how providers of inpatient care respond to shifts in the reimbursement regulation of their services. I move forward towards an analysis from a micro perspective by examining organizational change on the example of individual providers. Additionally, I contrast examples of positive and negative implementation of kaizen—an approach thus far missing in the literature on health management research. By examining how two acute care hospitals had recently implemented the continuous improvement technique, I aim to (1) explore and understand the experiences of nurses, and (2) identify factors affecting the implementation of the technique. By means of purposeful sampling, I selected 30 nurses from different units in two private acute care hospitals in Switzerland in May 2018. I used the Organizational Transformation Model developed by Lukas, et al. (2007) to conduct semi-structured interviews and perform qualitative content analysis. Lastly, originating from the two-factor motivation theory (Herzberg et al., 1959), I suggested two types of factor influencing the implementation of kaizen—hygiene factors that may prevent nurses from getting demotivated, and motivational factors that may boost their motivation. Overall, nurses experienced kaizen as a positive practice that enabled them to discuss work-related activities in a more comprehensive manner. In some cases, however, a lack of visible improvement in the workplace lowered nurses’ motivation to make suggestions. Nurses’ attitudes towards kaizen differed across both hospitals depending on the available managerial support, resources such as infrastructure and staffing levels. To reap the benefits of kaizen, hospital managers should promote the exchange of opinions across hierarchy levels, allocate the necessary resources in terms of personnel and infrastructure, and show nurses how the technique can help them improve their workplace.In dieser Dissertation untersuche ich, wie drastische regulatorische Veränderungen im Gesundheitswesen Organisationswandel auslösen und gestalten. Dazu betrachte ich unterschiedliche Arten von Regulierungen als exogene Schocks und wende dabei eine Reihe von qualitativen und quantitativen Forschungsmethoden an. Kapitel 1 beschreibt den konzeptionellen Rahmen der Dissertation. Zunächst aus einer Makro- und darauf aus einer Mikro-Perspektive untersuche ich zwei verschiedene Arten von regulatorischen Veränderungen: In den Kapiteln 2 und 3 konzentriere ich mich auf Marktzugangsregulierung am Beispiel der Medizinprodukteindustrie, während ich in Kapitel 4 die Rückerstattungsregulierung als Forschungshintergrund nehme und analysiere, wie die bevorstehende Einführung eines auf diagnosebezogenen Fallgruppen basierenden Abrechnungssystems die stationäre Gesundheitsversorgung beeinflusst. Kapitel 5 hält die wichtigsten Schlussfolgerungen sowie Handlungsempfehlungen für Politik, Praxis und Wissenschaft fest und schliesst mit Vorschlägen für künftige Forschung. In Kapitel 2 untersuche ich, wie sich der regulatorische Wandel, der durch die neue Verordnung der Europäischen Union über Medizinprodukte (MDR) ausgelöst wurde, auf die zentralen Akteure der Medizinprodukteindustrie auswirkt. Meines Wissens stellt diese Studie die bisher umfassendste wissenschaftliche Analyse der MDR dar. Zusammenfassend zeigt meine Analyse, dass die MDR höchstwahrscheinlich den europäischen Binnenmarkt stärken wird, da sie regulatorische Vorgaben über die Grenzen der Mitgliedsstaaten hinweg weiter spezifiziert und harmonisiert. Die endgültigen Auswirkungen der Verordnung auf die Patientensicherheit bleiben jedoch unklar, da bis dato keine belastbaren Längsschnittstudien zu diesem Thema vorhanden sind. In Kapitel 3 stelle ich die neue MDR als einen exogenen Schock dar, der die regulatorischen Rahmenbedingungen der Medizinprodukteindustrie erheblich verändert. Um sich in diesem neuen Umfeld zurechtzufinden, sind Unternehmen gezwungen, ihre bestehenden Geschäftspraktiken anzupassen und neue einzuführen. Das Ziel dieser Studie ist, am Beispiel der Schweiz die vorläufigen wirtschaftlichen Folgen der MDR auf die europäische Medizinprodukteindustrie zu untersuchen. Abschliessend skizziere ich (1) Strategien, die Führungskräfte in Betracht ziehen könnten, um die OCC ihres Unternehmens zu erhöhen, und zeige (2) Massnahmen auf, die politische Entscheidungsträgerinnen und -träger ergreifen könnten, um sicherzustellen, dass Unternehmen in finanzieller Notlage Medizinprodukte nicht vom Markt nehmen, für die es keine Substitute gibt und deren Rückzug die gesundheitliche Versorgung von Patientinnen und Patienten beeinträchtigen kann. In Kapitel 4 untersuche ich, wie die Anpassung der Rückerstattungsregulierung stationärer Behandlungen Organisationswandel auslösen kann. Vor diesem Hintergrund betrachte ich, wie zwei private Akutspitäler Kaizen-Management im Hinblick auf die zum damaligen Zeitpunkt bevorstehende Einführung eines Fallpauschalensystems für die Abrechnung von gesundheitlichen Leistungen im stationären Bereich (DRG-System) implementiert haben. Kaizen stellt eine niederschwellige Managementtechnik dar, die die kontinuierliche Verbesserung einer Organisation durch kleine aber ständige Anpassungen von Unternehmensstrukturen und -prozessen bezweckt. In dieser Studie stelle ich Beispiele positiver und negativer Implementierung von Kaizen gegenüber – ein Ansatz, der in der Fachliteratur bislang fehlt. Mein Ziel ist, (1) die Erfahrungen der Pflegefachkräfte zu untersuchen und (2) Faktoren zu identifizieren, die die Implementierung der Managementtechnik beeinflussen können. Aus meinen Erkenntnissen leite ich mehrere Bewältigungsstrategien ab, die Führungskräften helfen sollen, Kaizen zum Nutzen ihrer Organisation und ihrer Angestellten zu implementieren: Um die Vorteile des Managementansatzes zu nutzen, sollten Führungskräfte den Meinungsaustausch über Hierarchieebenen hinweg fördern, die notwendigen Ressourcen in Form von Personal und Infrastruktur bereitstellen und den Pflegefachkräften zeigen, wie die Technik ihnen helfen kann, ihren Arbeitsplatz zu verbessern

El escepticismo apasionado de Los reportajes españoles de Iliá Erenburg

El objetivo del presente trabajo consiste en darles a conocer a los rusistas del ámbito hispano la obra publicística de Iliá Erenburg en la que éste reflejó el desarrollo del régimen republicano en España y trató al detalle los acontecimientos de la Guerra Civil española. Hasta ahora sólo se ha traducido al español una veintena de sus artículos, escritos antes del inicio del conflicto armado; sin embargo, existen numerosos escritos de Erenburg-reportero de guerra que analizaremos someramente en este estudio, aportando ejemplos de nuevas traducciones.Цель данной работы ― познакомить испанских русистов с публицистическими произведениями Ильи Эренбурга, в которых он отобразил развитие республиканского режима в их стране и детально описал события гражданской войны 1936 – 1939 гг. На сегодняшний на испанский язык переведено чуть более двадцати его статей, написанных до начала вооруженного конфликта, однако существуют еще сотни репортажей, в которых Эренбург выступает как военный корреспондент. На них-то мы и остановимся подробно в нашем докладе и приведем несколько примеров новых переводов

Crítica social en El viaje de Petersburgo a Moscú de Aleksandr Radíschev y Los artículos de Mariano José de Larra

This study aims, using the comparative method, to approach for the fi rst time some key aspects through which Aleksandr Radíschev and Mariano José de Larra practiced their social criticism, and seeks to establish a correlation between the career and life of both writers. To carry out this task, it not only takes into account the fact that the works discussed may be included within the essay genre, but also special emphasis is placed on a series of significant historical and biographical factors.El presente estudio tiene como objetivo, utilizando el método comparativo, acercarse por vez primera a algunos aspectos fundamentales a través de los cuales Aleksandr Radíschev y Mariano José de Larra realizaron sus críticas sociales, y pretende establecer una serie de correspondencias entre las trayectorias artísticas y vitales de ambos escritores. Para llevar a cabo dicha tarea, no sólo se toma en consideración el hecho de que las obras examinadas puedan englobarse en el género ensayístico, sino, además, se hace especial hincapié en una serie de factores históricos y biográfi cos significativos

Dachnyi͡a grezy, Op. 5

https://scholarexchange.furman.edu/periphery-kharbintsy2/1019/thumbnail.jp

Padé Approximation to Solve the Problems of Aerodynamics and Heat Transfer in the Boundary Layer

In this chapter, we describe the applications of asymptotic methods to the problems of mathematical physics and mechanics, primarily, to the solution of nonlinear singular perturbed problems. We also discuss the applications of Padé approximations for the transformation of asymptotic expansions to rational or quasi-fractional functions. The applications of the method of matching of internal and external asymptotics in the problem of boundary layer of viscous gas by means of Padé approximation are considered

How to pay primary care physicians for SARS-CoV-2 vaccinations: An analysis of 43 EU and OECD countries.

Vaccinations are crucial to fighting SARS-CoV-2, and high coverage rates can in most countries probably only be achieved with the involvement of primary care physicians (PCPs). We aimed to explore how SARS-CoV-2 vaccination payment schemes in 43 countries differ with regard to the (i) type of payment scheme, (ii) amount paid, (iii) degree of bundling, and (iv) use of pay-for-performance elements. We collected information on payments and health system characteristics, such as PCP income and employment status, in all EU and OECD countries over time. We regressed the payment amount on the income of PCPs for countries with activity-dependent schemes using a linear regression (OLS), and we interpreted the residuals of this regression as a vaccination payment index. The majority of countries (30/43) had chosen payment schemes that reward PCPs for the activity they perform. Seventeen countries paid less per vaccination than the income-adjusted average, whereas 13 countries paid more. Twelve countries used pay-for-performance elements

Improving health care from the bottom up: Factors for the successful implementation of kaizen in acute care hospitals

Background Kaizen—a management technique increasingly employed in health care—enables employees, regardless of their hierarchy level, to contribute to the improvement of their organization. The approach puts special emphasis on frontline employees because it represents one of their main opportunities to participate directly in decision making. In this study, we aimed to (1) understand the experiences of nurses in two hospitals that had recently implemented kaizen, and (2) identify factors affecting the implementation of the technique. Methods By means of purposeful sampling, we selected 30 nurses from different units in two private acute care hospitals in Switzerland in May 2018. We used the Organizational Transformation Model to conduct semi-structured interviews and perform qualitative content analysis. Lastly, originating from Herzberg’s motivation theory, we suggest two types of factor influencing the implementation of kaizen—hygiene factors that may prevent nurses from getting demotivated, and motivational factors that may boost their motivation. Results Nurses generally experienced kaizen as a positive practice that enabled them to discuss work-related activities in a more comprehensive manner. In some cases, however, a lack of visible improvement in the workplace lowered nurses’ motivation to make suggestions. Nurses’ attitudes towards kaizen differed across both hospitals depending on the available managerial support, resources such as infrastructure and staffing levels. Conclusions From our findings, we derived several coping strategies to help health practitioners implement kaizen for the benefit of their organization and employees: Strong managerial support, appropriate use of kaizen tools, and a greater sense of team cohesion, among other factors, can influence how effectively hospital teams implement kaizen. To reap the benefits of kaizen, hospital managers should promote the exchange of opinions across hierarchy levels, allocate the necessary resources in terms of personnel and infrastructure, and show nurses how the technique can help them improve their workplace

Технология высокопроизводительных вычислений в исследовании влияния сектора биотехнологий на макропоказатели развития экономики Кировской области

A normative balance mathematical model for regional economy contains a lot of unspecified parameters which are not defined directly by the data of economic statistics. Only confidence intervals for the unknown parameters can be computed from the statistical data. A method for estimation of the model parameters by application of parallel computations on multi-processors systems are presented here. They determine the unknown parameters of economic model by indirect way, comparing time series for macro indexes calculated by model with statistical time series for these indexes. The use of the method is illustrated by the parameter estimation of a macroeconomic model of Kirov Region of Russia for 2000-2006. Production sectors in the regional economic model are presented by three sectors: (X) the timber industry complex including forestry; (Y) a complex of new innovation industries in biotechnology and the chemistry, including science and education; (Z) combination of the remained industries. The each production sector shadow money stock grows due to sale of shadow final product to households and as intermediate product to other sectors. The simulation model of regional economy enables to receive a quantitative estimation of dynamics of macroindexes for regional economy. Calibrated model is used for estimation of the Regional Government economic politics and for research of bio-technology sector impact on Kirov Region economy. The model constructed here is an innovative product and the experience received on its parameter estimation is those "know-how" which can be used in the adaptation of the given model for concrete regional economic systems. The work is in part supported by the Russian Humanitarian Scientific Foundation (Grant 06-02-91821); by the Russian Foundation of Basic Research (Grant 08-01-00377); by the Program of State Support of Leading Scientific Schools (Grant SS- 2982.2008.1); and by the Program of Basic Research no.15 of Presidium of the Russian Academy of Sciences

Технология высокопроизводительных вычислений в исследовании влияния сектора биотехнологий на макропоказатели развития экономики Кировской области

A normative balance mathematical model for regional economy contains a lot of unspecified parameters which are not defined directly by the data of economic statistics. Only confidence intervals for the unknown parameters can be computed from the statistical data. A method for estimation of the model parameters by application of parallel computations on multi-processors systems are presented here. They determine the unknown parameters of economic model by indirect way, comparing time series for macro indexes calculated by model with statistical time series for these indexes. The use of the method is illustrated by the parameter estimation of a macroeconomic model of Kirov Region of Russia for 2000-2006. Production sectors in the regional economic model are presented by three sectors: (X) the timber industry complex including forestry; (Y) a complex of new innovation industries in biotechnology and the chemistry, including science and education; (Z) combination of the remained industries. The each production sector shadow money stock grows due to sale of shadow final product to households and as intermediate product to other sectors. The simulation model of regional economy enables to receive a quantitative estimation of dynamics of macroindexes for regional economy. Calibrated model is used for estimation of the Regional Government economic politics and for research of bio-technology sector impact on Kirov Region economy. The model constructed here is an innovative product and the experience received on its parameter estimation is those "know-how" which can be used in the adaptation of the given model for concrete regional economic systems. The work is in part supported by the Russian Humanitarian Scientific Foundation (Grant 06-02-91821); by the Russian Foundation of Basic Research (Grant 08-01-00377); by the Program of State Support of Leading Scientific Schools (Grant SS- 2982.2008.1); and by the Program of Basic Research no.15 of Presidium of the Russian Academy of Sciences

INFLUENCE OF PRESSURE OSCILLATIONS IN COMMON RAIL INJECTOR ON FUEL INJECTION RATE

Fuel injection causes considerable oscillations of fuel pressure at the injector inlet. One of the reasons is hydraulic impact when the needle valve closes. For multiple injections, the previous injections affect the following. As both the fuel pressure in rail pac and the injection rate grow, the oscillations increase. The pressure oscillation range at the common rail injector inlet at pac=1500 bar is up to 350 bar, and at the rail pressure pac=500 bar, the amplitude decreases to 80 bar. Physical properties of the fuel are also important. As the viscosity of the fuel increases, its hydraulic friction grows which results in a rapid damping of pressure oscillations. The data for an injector operating on sunflower oil is presented. As compared with diesel fuel, the oscillations range decreases from 400 to 250 bar at the same operating mode. The influence of the interval between the impulses of a double injection on the injection rate of the second fuel portion was investigated. Superposition of two waves during multiple injections may result in amplification and damping of the oscillations. Simulation was performed to estimate the influence of fuel type and time interval Δτ between control impulses of a double injection on the injection quantity of the second portion at pressures of 2000-3000 bar. When the rail pressure pac grows, the oscillations and their impact on the injection process increase. For diesel fuel at pressure of pac=2000 bar, the variation in injection rates of the second portion is 2.36-4.62 mg, and at pac=3000 bar – 1.58-6.63 mg