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PubMed1998

The redistricting of Columbia.

Thomas Frist worked up a familiar formula for ailing Columbia/HCA, opting to spin off one-third of its hospitals. The change promises Columbia and its offspring more capital and management scrutiny, but the recovery isn't complete.

Employment↗
PubMedDate not supplied

The new concept of hospital--the strategic plan of the "Policlinico A. Gemelli" and positioning of the reengineering project.

The innovations introduced in the Italian Health Care System by the legislative decrees No. 502/92 and 517/93 are remarkable, drawing on managerial methods and organizational structure of hospitals. To face this kind of change, in 1995 the "Policlinico A. Gemelli" prepared a five-year Strategic Plan that gave strategical lines and targets to be pursued. This plan has isolated 3 main strategical projects to be implemented with the participation of all medical and managerial professionals operating in the "Policlinico". The most complex project is that of the reengineering of management processes, we expect to end during 1998. The main target is to check the fundamental factors involved with the aim of achieving patient satisfaction as well as a cost-effective management.

Accounting↗
PubMedDate not supplied

Hospital Reengineering Project at the "Policlinico A. Gemelli".

The "Policlinico A. Gemelli" in the context of ongoing change in the Italian Health Care Service, has developed a Strategic Plan for 1996-2000. In this context a major role is played by the reengineering project, divided into there sequential phases of implementation. The natural evolution of this project results in a department-oriented organization in order to complete and implement change.

Cost Control↗
PubMedDate not supplied

Phase 1: identifying critical success factors.

Health care processes and services of the "Policlinico" are analyzed with respect to their performance. Possible improvement is identified in reducing the process overall time at the process-service interface.

Centralized Hospital Services↗
PubMedDate not supplied

Phase 2. Testing of solutions.

Phase 2 of reengineering project, the testing of solutions, was based on the definition of a Prototype, and the implementation of the Pilot phase. This gradual process has facilitated the organizational change and laid the foundations of subsequent extension phase. Ongoing initiatives concern the introduction of two new centers (wards and outpatient service) and the reorganization of ward and operating room activities.

Appointments and Schedules↗
PubMedDate not supplied

Management process reengineering of the "Policlinico A. Gemelli": outcomes of testing.

Monitoring and outcomes of experimental solutions adopted in management process reengineering of a teaching hospital ("Policlinico A. Gemelli") of approximately 1550 beds are reported. All monitored processes are considered. For each process, information flows are analyzed, specifying indicators used for monitoring of adopted organizational solutions. Different testing outcomes have shown that pre-established objectives have been attained, while corrections required for their improvement, are indicated.

Appointments and Schedules↗
PubMedDate not supplied

Radiology room productivity.

Radiology has a significant impact on all health care processes at the "Policlinico A. Gemelli". The performance of Radiology rooms was thus analyzed within the overall performance of health care processes (e.g. medical wards, emergency service, day hospital). In this context, in the assessment phase of the reengineering project the Radiology room productivity has been analyzed. From outcomes of this analysis it appears that there is a high potential for increasing the Radiology room productivity (except for TC and MRI rooms). It has been observed that a better ward/service communication, together with a better use and planning of Radiology rooms and resources would allow a more efficient performance of the service. The reengineering project has led to a reorganization of the communication between Radiology rooms and wards/day hospital, a better inpatient transfer system from wards to Radiology rooms and the planning of the requests for exams. At present, a team is working in order to introduce a medium term budget of exams for all the wards associated to the provision of care for those diseases for which patient admission can be planned based on available Radiology rooms.

Appointments and Schedules↗
PubMed1998

Re-engineering the elective surgical service of a tertiary hospital: a historical controlled trial.

OBJECTIVE: To study the clinical effects of re-engineering the processes associated with elective surgery. DESIGN: A prospective, historical controlled trial. Control patients were enrolled from March 1995 to January 1996, and postintervention patients from February 1996 to October 1996. SETTING: A major teaching, tertiary care hospital (Prince of Wales Hospital, Sydney). PATIENTS: 224 patients (123 before and 101 after the intervention) undergoing elective herniorrhaphy of laparoscopic cholecystectomy who lived in the local area. INTERVENTION: Introduction of a re-engineered surgical service consisting of preadmission assessment and education, admission on day of surgery, and postacute care after discharge. There were no changes to the operative methods or infection control procedures. MAIN OUTCOME MEASURES: Length of stay, operative complications, pain scores and patient satisfaction. RESULTS: The risk of a patient suffering one or more complications was reduced in the postintervention group (postintervention v. control patients: 25.7% v. 38.2%; relative risk [RR], 0.66; 95% confidence interval [CI], 0.44-0.98; P = 0.035) because of a reduced risk of wound infections (5.0% v. 16.3%; RR, 0.30; 95% CI, 0.12-0.78; P = 0.0075). Other complications (perioperative or postoperative) and pain scores were unchanged. Patients treated by the re-engineered service had a significantly shorter length of stay, reported a higher level of satisfaction with the preoperative and postdischarge care, and were more likely to say that they would have the same treatment again (92.9% v 82.6%; P = 0.037). CONCLUSIONS: Re-engineering surgical services, with an associated reduction in length of stay, does not lead to a deterioration in care and may decrease postoperative complications and increase patient satisfaction.

Australia↗
PubMed1998

How to build teams in the midst of change.

In the process of reengineering, nurse managers were shifted to unit coordinator positions. Former managers now share responsibility for some bedside decisions with staff who previously turned to them for problem-solving. Some staff nurses interpreted the role change as an increased workload for them that included doing their manager's jobs. Managers were challenged to empower staff members who resisted this shift in roles.

Hospital Restructuring↗
PubMed1998

The incidence of IDDM in Singapore children.

OBJECTIVE: To determine the incidence of insulin dependent diabetes mellitus (IDDM) in children 0-12 years of age in Singapore, which has a population of 2.9 million. METHODS: The primary source was a 2-year phone and mail survey of doctors in the government and government restructured hospitals and the private sector. The secondary source was the membership records of the Diabetes Society of Singapore. RESULTS: Using the capture-recapture method, ascertainment was assessed to be 92.2% complete. The age standardised incidence rate was 2.46 per 100,000 children 0-12 years old, for the period 1992-1994 (95% confidence interval: 2.16-2.75). The data seemed to indicate a rising incidence of IDDM in this population, being 1.4/100,000 in 1992, 2.4/100,000 in 1993 and 3.8/100,000 in 1994. The male: female ratio is 1:1.85. There was seasonal variation with fewer cases from July to October and more from November to May. Five percent of patients had a first degree relative with IDDM. Malays appeared to have a lower incidence (1.23/100,000) compared to the Chinese (2.25/100,000) and the Indians (5.78/100,000). CONCLUSIONS: The incidence of IDDM in Singapore children is similar to that reported for Hong Kong and Japan, but higher than that for Shanghai. The female preponderance is similar to that seen in other Asian population. The data suggests a rising incidence of IDDM in Singapore and differences in incidence between the Malays, Chinese and Indians, but further observations are needed.

Child↗