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PubMed2003

Evaluation of primary health care reform in Estonia.

Estonia began to reform its health care system by reorganizing primary health care (PHC). Ten years ago, the health care system was inefficient, supply was biased towards institutional care, and PHC was almost non-existent in the western understanding: it was provided by different specialists in policlinics, and the financial basis of the system was in crisis. The reform had the following aims: to develop PHC by introducing family medicine, to guarantee the whole population access to family doctors' services, and to secure stable funding for these services. In 1998, a new phase in the reform was introduced through the creation of a new funding system for primary care services. The aim of this paper is to present a practically applicable set of indicators to evaluate PHC reform in terms of health economics criteria and then to apply these indicators in evaluation of the Estonian PHC reform.

Efficiency, Organizational↗
PubMed1998

Health care management modelling: a process perspective.

Modelling-based health care management ought to become just as popular as evidence based medicine. Making managerial decisions based on evidence by modelling efforts is certainly a step forward. Examples can be given of many successful applications in different areas of decision making: disease process modelling, screening and prevention policy development, resource allocation, waiting lists and waiting times, patient scheduling. Also examples can be given which would have benefited by prior modelling, for example adverse effects of health care system reform decisions. This contribution aims at giving an overview of health care management modelling areas, and observations from a European perspective on developing successful health care management models. The overview is created by presenting different reference frameworks for mapping health care management modelling applications. We report a development from an almost arbitrary list of applications used for bibliographic purposes (scheduling, simulation, queueing, etc.) towards frameworks that focus on the process of delivery. The advantage of mapping modelling applications in this way is that we are able to position contributions within a reference framework with a focus on processes, with the patient process at the top. The acceptance of process-orientation as a basis for modelling has consequences for the way models are developed. Close cooperation between modeller and manager and a profound insight into the dynamics of the modelling area concerned are important requirements for developing successful models. This is illustrated for waiting lists as an area of modelling.

Decision Making, Organizational↗
PubMed1998

Performance indicators in NHS libraries.

Performance indicators (PIs), workload statistics and accreditation are different ways to assess the quality of a library information service (LIS), and can be used together to give an overall picture of how well a LIS is performing its functions. PIs point out how something has been done. They are comparative values, often expressed partly as ratios or percentages, which indicate the quality or level of services and can be used to compare similar services, or the same service across time. PIs, performance ratios or performance standards are derived from performance measures, which show how much of it has been done. This paper looks at some aspects of performance measurement and suggests other areas for statistics collection in order to make better use of existing data, and considers the usefulness and derivation of PIs in NHS LIS.

Consumer Behavior↗
PubMed1998

An interdisciplinary approach to process performance improvement.

Today quality care is not driven solely by the professional integrity of health care providers. Quality is demanded and defined by health care consumers. To survive within the competitive health care market, quality is a priority initiative for most health care organizations. The Joint Commission on Accreditation of Healthcare Organizations (Joint Commission) requires interdisciplinary performance improvement activities to ensure continuous quality improvement. Johns Hopkins Bayview Medical Center has a Quality Management Structure that ensures performance improvement initiatives are interdisciplinary and directed toward the organizational mission and vision. The Clinical Value Compass and FOCUS-PDCA provide clear direction for performance improvement initiatives and foster agreement on the clinical outcomes, functional needs, satisfaction, and cost.

Academic Medical Centers↗
PubMed2002

An interdisciplinary approach to addressing patient activity and mobility in the medical-surgical patient.

Patient functional activity and mobility are essential to recovery and minimization of the risks associated with immobility in hospitalized patients. In practice, there is inconsistency in attending to this aspect of patient care and limited information in the literature to guide clinicians caring for medical-surgical patients. An interdisciplinary quality improvement team of nurses, physical therapists, occupational therapists, and patient care assistants developed a programmatic approach to the assessment, planning, and implementation of patient activity criteria in this patient population. Increased awareness and application of the patient activity criteria have improved the consistency with which patient activity is addressed and reduced the incidence of immobility-associated complications.

Activities of Daily Living↗
PubMed2001

Performance implications of Porter's generic strategies in Slovak hospitals.

The aim of the study was to examine the use of Porter's generic strategies and their effect on performance in the context of the Slovak hospital industry. Using mail survey the study first identified the natural taxonomy of four strategic types of Slovak hospitals, based on their use of Porter's generic strategies in pure form and in combination. Next the study examined whether different strategic types were associated with different levels of organisational performance, while controlling for such variables as size and location, which have been argued to influence the hospital performance. The findings indicate that hospitals which follow a "stuck-in-the-middle" strategy, in general, have superior performance on all used performance measures, while hospitals that place only low emphasis on cost leadership, differentiation and focus, labelled "wait and see" in this study, perform the poorest. The study concludes that the research provided body of knowledge relevant for the Slovak hospital industry, that may be used by hospital managers in the strategy formulation process as well as by the researches in exploring the influence of different contingencies on hospitals' strategic orientation.

Cluster Analysis↗
PubMed1998

Organisational effectiveness within National Health Service (NHS) Trusts.

In view of the dearth of information relating to organisational effectiveness of NHS Trusts in comparison with clinical effectiveness, a complex study was undertaken to determine whether overall effectiveness was a result of management processes, people, or a combination of both. The study incorporated two phases involving the distribution of a comprehensive questionnaire to identify the "whats" of organisational effectiveness, and a bench-marking exercise aimed at identifying the "hows". In the main, the better performing trusts were found to be subscribing to the concepts of "keeping it simple", innovation and attainment of highly efficient processes. A number of examples of better/best practices were observed which included visible leadership, a commitment towards stakeholder involvement and the practice of teamworking. Given the complexity of the study area, the findings were deemed valuable to managers practising within all areas of healthcare. However, a need for further research was identified in order to substantiate the results.

Data Collection↗
PubMed1998

Dental practice and the environment.

This paper summarises issues pertaining to the environmental effects of clinical practice. Using examples of environmental awareness, the concept of environmental auditing is introduced by way of a pointer to actions to limit the environmental impact of dentistry. It is concluded that environmental management and auditing would be advantageous to dentistry.

Dental Waste↗
PubMed1990

Hospital-physician joint ventures: a strategic approach for both dimensions of success.

Joint ventures between hospitals and the physicians on their medical staffs have produced successes and failures. Each joint venture has two very different dimensions of success--financial and collaborative. The most successful ventures are able to accomplish both of these often conflicting goals. To enhance hospital executives' success in joint ventures with physicians, a strategic approach with a series of six steps and their corresponding models or maps is proposed. The steps in this strategic approach are: (1) identify key stakeholders and linkages among them; (2) surface stakeholder conflict using problem-oriented maps; (3) diagnose the venture on both dimensions of success; (4) classify the venture using both dimensions of success; (5) select a strategy to optimize the venture's current potential for success; and (6) select an approach to transform the venture with limited potential for success.

Conflict, Psychological↗
PubMed1994

Total quality management in health care.

Studying 'the best way of doing things' does expedite performance improvement. Using cost as the only measure of health care has provided a one dimensional view of 'the best'. Now there is an urgency to improve the value of clinical outcomes, the real product of health care. For this to be achieved by any method, more effective and comparable measures of quality are needed to focus improvement efforts. This paper comments on the application of the best practice principles, developed for other Australian industries, to health care.

Australia↗
PubMed1998

Ongoing data monitoring, accountability as important as reengineering itself.

After your reengineering success: Don't just sit there! What happens after a process redesign program ends can be just as important as the reengineering effort itself. Just ask officials at this New Jersey facility. Despite a whopping $4 million in savings derived from a major redesign of patient care service delivery, administrators and managers are working just as hard at keeping everyone on their toes with an ongoing monitoring and accountability process. Learn how important those efforts can be to ensuring continued success long after the formal reengineering process is completed.

Data Collection↗
PubMedDate not supplied

The balanced scorecard: a potent tool for energizing and focusing healthcare organization management.

The current environment for healthcare organizations contains many forces demanding unprecedented levels of change. These forces include changing demographics, increased customer expectations, increased competition, and intensified governmental pressure. Meeting these challenges will require healthcare organizations to undergo fundamental changes and to continuously seek new ways to create future value. This article provides explanation of a potent new management tool-the balanced scorecard-that can be used by healthcare organizations to meet these challenges. The article also presents the opinions of many high-level healthcare administrators that the balanced scorecard can be highly beneficial to healthcare organizations. It also summarizes these administrators' suggestions regarding the goals and measures that can make up an effective scorecard for a hospital as a whole, as well as for a specific subunit of a hospital. Interestingly, while no published report of balanced scorecard implementations in healthcare organizations exists, a number of administrators stated that they had fully implemented systems similar to the scorecard. These actions can be considered support for the scorecard's potential usefulness; at the same time, they suggest that some sharing of experiences will likely be available in the future. As all administrators are well aware, moving from concept to practice is often difficult. While the article includes some suggestions for scorecard development and implementation, each organization must engage in the full range of activities, from defining its mission to the selection of goals and strategies, and develop its own unique scorecard to assist progress toward the selected goals. As a starting point, Table 3 provides a timeline of some general events that may be common to all organizations during this process.

Benchmarking↗
PubMed1998

Process improvement program evolves into compliance program at an integrated delivery system.

An integrated delivery system discovered questionable practices when it undertook a process-improvement initiative for its revenue-to-cash cycle. These discoveries served as a wake-up call to the organization that it needed to develop a comprehensive corporate compliance program. The organization engaged legal counsel to help it establish such a program. A corporate compliance officer was hired, and a compliance committee was set up. They worked with counsel to develop the structure and substance of the program and establish a corporate code of conduct that became a part of the organization's policies and procedures. Teams were formed in various areas of the organization to review compliance-related activities and suggest improvements. Clinical and nonclinical staff attended mandatory educational sessions about the program. By approaching compliance systematically, the organization has put itself in an excellent position to avoid fraudulent and abusive activities- and the government scrutiny they invite.

Accounts Payable and Receivable↗