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Biomedical subjects

B Bigelow

Publications and source records attributed to B Bigelow.

At least 19 recordsLinked to original sources
PubMed2000

The more things change, the more they stay the same.

For decades, the hospital environment has been described as turbulent and hostile. At the same time, the transfer of business practices into hospitals has been advocated, accompanied by the largely untested assumption that these practices are crucial to performance and even survival. As this pattern became entrenched, the accumulated knowledge gained within the industry of managing in a hostile and turbulent environment has been overlooked. We argue that it is time to question the pattern.

Commerce↗
PubMed1998

Reengineering: deja vu all over again.

There is growing interest among hospitals in reengineering. It promises dramatic improvements in performance: Costs will be reduced while work processes, productivity, and patient care will all improve. A review of the health care literature on reengineering shows that little evidence exists to support its claims. This article critiques the existing literature on reengineering and addresses the conundrum hospital executives encounter when faced with the decision to adopt a new management technique--such as reengineering--in the absence of proof of its efficacy.

Cost-Benefit Analysis↗
PubMed1996

Benefits and disadvantages of corporate restructuring--the hospital view.

Many hospitals have adopted a corporate structure to improve management and gain economic benefits. Our study of Massachusetts hospitals found that for only a few had these anticipated advantages materialized, while many found that the new structure entailed added bureaucracy and other disadvantages. The findings suggest that hospitals adopt or keep the structure not only for possible economic reasons but also to sustain their legitimacy in the eyes of important stakeholders.

Annual Reports as Topic↗
PubMed1995

Total quality management: field of dreams?

Total quality management promises to reconcile cost/quality conflicts, increase customer satisfaction, and improve hospitals' competitiveness as well as operational and financial performance. This article reviews the hospital literature on TQM and concludes that there is little evidence to substantiate these claims. The article concludes with implications for research and management.

Economic Competition↗
PubMed1995

The adoption of corporate restructuring by hospitals.

This study investigates factors associated with the adoption of corporate restructuring by hospitals in Massachusetts, where restructuring occurred much more rapidly than it did nationally. Drawing on studies of management innovation in hospitals, this article hypothesizes that early adopters will differ from those that adopt later on the basis of individual and organizational factors, and that institutional forces will explain later adoption. The findings show no differences between early and later adopters but do show that after an intense period of restructuring, hospitals became less likely to adopt the innovation. The article concludes with a discussion of the impact of reimbursement laws on the adoption pattern and the implications for the diffusion of management innovation, particularly under health care reform.

American Hospital Association↗
PubMed1995

The implementation of total quality management in hospitals: how good is the fit?

Total quality management has become popular among hospitals because of its promise to reconcile trade-offs between cost and quality. However, assumptions inherent in TQM may not translate to the hospital environment: hierarchical management control over the technical core and the dominance of rational decision making. This article considers these two assumptions and suggests that the application of TQM to hospitals take them into account because they may compromise its success.

Health Services Research↗
PubMed1991

Ambulatory care centers: are they a competitive advantage?

A common assumption found in literature about hospital-sponsored ambulatory care centers is that they increase inpatient admissions and market share. However, little empirical evidence exists to substantiate these assumptions, and it is reasonable to question their accuracy given the nonemergency, routine nature of many of the visits to ambulatory care centers. This study of hospitals in four Massachusetts markets in which at least one hospital sponsored an ambulatory care center questions whether inpatient admissions and market share are affected. The findings indicate that at least in these four markets, ambulatory care centers do not have the desired effects, relative either to past performance or to competing hospitals.

Ambulatory Care Facilities↗
PubMed1987

lambda N antitermination system: functional analysis of phage interactions with the host NusA protein.

Coliphage lambda gene expression is regulated temporally by systems of termination and antitermination of transcription. The lambda-encoded N protein (pN) acting with host factors (Nus) at sites (nut) located downstream from early promoters is the first of these systems to operate during phage development. We report observations on some of the components of this complex system that, in part, address the way in which these elements interact to render RNA polymerase termination-resistant. (1) The isolation of a conditionally lethal cold-sensitive nusA mutation demonstrates that NusA is essential for bacterial growth. (2) The effect on lambda growth in a host in which the Salmonella NusA protein is overproduced suggests that NusA is essential for N-mediated antitermination in phage lambda. (3) A truncated NusA product, representing only the amino two-thirds of the native protein, is active for both bacterial growth and pN action, indicating that the carboxy end of the molecule may not be a functionally important region. (4) lambda pN can function with the heterologous nut region from Salmonella typhimurium phage P22 when lambda pN is overproduced, demonstrating that lambda pN can function with the nut regions of other lambdoid phages. (5) A single base-pair change in the lambda nutR boxA sequence that was selected to permit a lambda derivative to utilize the Salmonella NusA protein restores lambda growth in the Escherichia coli nusA1 host.

Bacterial Proteins↗
PubMed1986

The evaluation of the omentum in ovarian cancer.

Little published data exists on omental evaluation in ovarian cancer. In a retrospective study we reviewed 334 consecutive operations for adnexal masses; 159 had ovarian cancer, and 119 omentectomies were performed, with complete information available on 109. Mean omentectomy was 203.5 cm2 (normal omentum = 792 cm2) and 190 g, with a significant correlation of weight to size. Secondary ovarian cancer was present in 66 omenta (61%). All 32 omenta examined in the pathology laboratories and described as grossly involved with tumor had ovarian cancer histologically. Of the 55 grossly negative omenta, 12 had histologically proven tumor (22%). Slide review of the grossly negative, histologically positive omenta revealed the mean tumor diameter to measure 6.7 mm. Lymph node dissection occurred in 16 patients and was positive in 10, with simultaneous absence of tumor in the omenta of 3 of these patients. Conversely, 2 patients with positive omenta had negative lymph nodes. The optimal extent of omental resection and histological examination remains undetermined.

Diagnostic Errors↗