Simulating health systems:modelling problems and software solutions

Discrete event simulation is well suited to modelling health systems, providing valuable information for operational or strategic purposes. Simulation packages provide facilities for creating models in which individuals pass through a series of queues and activities. Modelling problems arise in health systems because patients renege from queues, take part in multiple activities, prematurely terminate activities, and change activities midstream. Simulation structures have been developed in Pascal to facilitate the description of these modelling complexities. Illustrations of the software's use are taken from an example of a simulation of patients with renal failure.</p

Performance Measurement and Management of Healthcare Professionals: Some Topical Issues

Healthcare professionals are increasingly held accountable for the standards of care that they provide. The focus of control for this accountability can be either internal or external activity to the professional body and can use implicit or explicit quality assessment techniques. The science of performance measurement and performance management of professional activity is a new and rapidly expanding one. Advocates of an actively managed approach to quality improvement often underestimate the tensions associated with promoting change amongst traditionally autonomous professionals who work in complex organisations. This tension has tended to result in polarised opinions about complex issues rather than legitimate debate. There is considerable uncertainty about the most effective ways of measuring professional performance and the relationship between measurement and quality improvement. This article examines some of the important issues in measuring clinical performance and using such measures to manage healthcare activity and promote quality improvement. This article is intended to shed light on the rapidly changing, data-rich environment within which healthcare systems now operate, and it highlights a number of questions that need to be addressed before the full potential of performance management in healthcare can be realised.Pharmacoeconomics, Quality of care

Using evidence: how research can inform public services.

There is widespread commitment across public service agencies in the UK and elsewhere to ensuring that the best available evidence is used to improve public services. The challenge is not only making research evidence accessible and available, but also getting it used. This book provides a timely and novel contribution to understanding and enhancing evidence use. It builds on and complements the popular and best-selling What Works?: Evidence-Based Policy and Practice in Public Services by drawing together current knowledge from the education, health care, social care, and criminal justice fields

Budgeting and performance management in the Italian National Health System (INHS):Assessment and constructive criticism

Purpose The aim of the paper is to trace the history and development of performance measurement and management systems in the Italian National Health System (INHS), to identify their key characteristics, and to provide a critical assessment of their implementation. Design/methodology/approach A combination of literature review, action-research and fieldwork conducted over a ten-year period in several Italian health care organizations. Findings Performance management has grown considerably in the INHS over the last 15 years. Explanations for this growth include normative, coercive and mimetic isomorphism, the introduction of quasi-markets, the adoption of DRGs, an increased focus on clinical governance and innovative practices in human resource management. Research limitations/implications The paper shows how performance management has been implemented in the INHS and why it can still be considered a “work in progress”. Practical implications The introduction of performance management systems has stimulated greater accountability and promoted a more cost conscious culture in healthcare organizations. Nevertheless, there are many problems that remain to be solved if performance management arrangements are to deliver the desired improvements in performance. Originality/value The paper advocates the need for reduced isolationism and increased international comparison with concomitant evaluative effort.</p

A Creative Approach to the Development of an Agenda for Knowledge Utilization:Outputs from the 11th International Knowledge Utilization Colloquium (KU 11)

A group of researchers and practitioners interested in advancing knowledge utilization met as a colloquium in Belfast (KU 11) and used a "world café" approach to exploit the social capital and shared understanding built up over previous events to consider the research and practice agenda. We considered three key areas of relevance to knowledge use: (1) understanding the nature of research use, influence and impact; (2) blended and collaborative approaches to knowledge production and use; and (3) supporting sustainability and spread of evidence-informed innovations. The approach enabled the development of artifacts that reflected the three areas and these were analyzed using a creative hermeneutic approach. The themes that emerged and which are outlined in this commentary are not mutually exclusive. There was much overlap in the discussions and therefore of the themes, reflecting the complex nature of knowledge translation work. The agenda that has emerged from KU 11 also reflects the participatory and creative approach in which the meeting was structured and focused, and therefore emphasizes the processual, relational and contingent nature of some of the challenges we face. The past 20 years has seen an explosion in activity around understanding KU, and we have learned much about the difficulties. Whilst the agenda for the next decade may be becoming clearer, colloquia such as KU 11, using creative and engaging approaches, have a key role to play in dissecting, articulating and sharing that agenda. In this way, we also build an ever-expanding international community that is dedicated to working towards increasing the chances of success for better patient care