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Horizontal Collaborative e-Purchasing for Hospitals: IT for Addressing Collaborative Purchasing Impediments
Horizontal collaborative purchasing (HCP) has often been cited as a way for hospitals to address the challenges of the rising healthcare costs. However, hospitals do not seem to utilize horizontal collaborative purchasing on any large scale, and recent initiatives have had mixed results. Focusing on Dutch hospitals, in this paper we present major impediments for collaborative purchasing, resulting in a first component of our proposed electronic horizontal collaborative purchasing model for hospitals; as a second component it contains a collaborative purchasing typology. A first validation round with hospital purchasing professionals, described separately in Kusters and Versendaal (2011), confirmed four applicable purchasing types and fourteen salient collaborative purchasing impediments. The model is operationalized by including possible information technology (IT) solutions that address the specific fourteen impediments. This model is validated through methodological triangulation of four different validation techniques. We conclude that IT has the potential to support, or overcome, the impediments of HCP. The validation also reveals the need to distinguish between more process-related, as opposed to social-related, obstacles; the immediate potential for IT solutions is greater for the process-related impediments. Ultimately, we conclude that the collaborative e-purchasing model (e-HCP) and implementation roadmap can be used by healthcare consortia, branche organizations, partnering healthcare institutes and multi-site healthcare institutes as a means to help identifying strategies to initiate, manage and evaluate collaborative purchasing practices
Clinical characteristics of women captured by extending the definition of severe postpartum haemorrhage with 'refractoriness to treatment': a cohort study
Background: The absence of a uniform and clinically relevant definition of severe postpartum haemorrhage
hampers comparative studies and optimization of clinical management. The concept of persistent postpartum
haemorrhage, based on refractoriness to initial first-line treatment, was proposed as an alternative to common
definitions that are either based on estimations of blood loss or transfused units of packed red blood cells
(RBC). We compared characteristics and outcomes of women with severe postpartum haemorrhage captured
by these three types of definitions.
Methods: In this large retrospective cohort study in 61 hospitals in the Netherlands we included 1391 consecutive
women with postpartum haemorrhage who received either ≥4 units of RBC or a multicomponent transfusion. Clinical
characteristics and outcomes of women with severe postpartum haemorrhage defined as persistent postpartum
haemorrhage were compared to definitions based on estimated blood loss or transfused units of RBC within 24 h
following birth. Adverse maternal outcome was a composite of maternal mortality, hysterectomy, arterial embolisation
and intensive care unit admission.
Results: One thousand two hundred sixty out of 1391 women (90.6%) with postpartum haemorrhage fulfilled the
definition of persistent postpartum haemorrhage. The majority, 820/1260 (65.1%), fulfilled this definition within 1 h
following birth, compared to 819/1391 (58.7%) applying the definition of ≥1 L blood loss and 37/845 (4.4%) applying
the definition of ≥4 units of RBC. The definition persistent postpartum haemorrhage captured 430/471 adverse maternal
outcomes (91.3%), compared to 471/471 (100%) for ≥1 L blood loss and 383/471 (81.3%) for ≥4 units of RBC. Persistent
postpartum haemorrhage did not capture all adverse outcomes because of missing data on timing of initial, first-line
treatment.
Conclusion: The definition persistent postpartum haemo
A Balanced Evaluation Perspective: Picture Archiving and Communication System Impacts on Hospital Workflow
Around the world, hospitals are faced with both budget and regulatory pressures, forcing them to re-examine the way clinical practice is carried out. Proposed technologies that provide workflow enhancements include Picture Archiving and Communications Systems (PACS); however, is PACS really effective in improving hospital workflow and the flow onto patient care, and how should this be evaluated? An acknowledged and successful approach for organizational evaluation is the Balanced Scorecard (BSC), providing the fundamental features for assessing organizations from various perspectives. In this research, the impact of PACS on the workflow of a large public hospital in Melbourne, Australia, is examined using an adapted version of the BSC. Empirically, this model was applied as an evaluation instrument through a series of in-depth interviews with PACS users. Results show that PACS did improve hospital workflow considerably and that the organizational alignment of PACS in hospitals is an important critical success factor