Releasing revenue cycle potential. IT managers have a critical role in organizational efficiency.
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Administrative Personnel↗
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Results for “Efficiency, Organizational”
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Organizational efficiency and quality in Texas nursing facilities.
Profit-seeking nursing facilities have been found to be overwhelmingly more cost efficient than nonprofit facilities. However, the question remains as to whether these organizational-efficiency differences are the result of operating structural differences (i.e., agency relationship costs) or differences in the quality of care rendered. Using traditional cost- and profit-function regression analyses which include a new index measure for quality, we conclude that quality influences costs and profits marginally, efficiency differences reflect agency costs and differences in organizational goals, and the belief that increases in quality require increases in cost does not hold when facility capacity is significantly underutilized.
Consumer Behavior↗
[The observation unit and patients with chest pain--an efficient organizational model?].
BACKGROUND: Patients with chest pain make up 5-8% of all acute admissions to a department of internal medicine. Many of these patients could be discharged safely after a limited period of observation. Aker University Hospital opened an observation unit in the autumn of 2000, but for organizational reasons closed the ward on weekends for 4 months in the autumn of 2001. METHOD: This study assessed the effect of this observation unit on the average admission time (in days) for patients who presented with chest pain. This was a retrospective cohort study which compared the average admission time for patients admitted on Fridays and Saturdays in the autumn of 2001 (n = 75), compared with those admitted in the autumn of 2000 and 2002 (n = 100). RESULTS: The two groups are directly comparable with regards to age, gender, general risk factors, pre-morbid hospitalization and co-morbidity. The average hospital stay was 3.84 days when the unit was closed, as opposed to 2.59 days when it was in operation. Corrected for age and previous cardiac illness, the closing of the observation ward led to an increase in hospital stay by 1.11 days, p = 0,001. This corresponded to an increase in average admission time of 43%. Most of this difference was accounted for by a higher discharge rate within 24 hours when the unit was in operation. There was no increase in the number of readmissions within 30 days. CONCLUSION: The observation unit leads to a meaningful shortening of admission time for patients with chest pain. This has not previously been shown in a Norwegian hospital.
Adult↗
Management information requirements for organizational efficiency.
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Australia↗
Medical innovation, unmet medical needs, and the drug pipeline.
This paper outlines and illustrates the working of a theoretical approach from the social sciences for analyzing medical innovation, unmet medical need, and the drug pipeline. Using the social history of three drugs made from recombinant DNA (insulin, human growth hormone, and tissue-plasminogen activator) the paper shows how drugs can be both technically and organizationally efficient while the needs they satisfy can be created or identified. The paper posits that drugs that require more organizational efficiency tend to satisfy identified, rather then created needs. Key words: Recombinant DNA, technical efficiency, organizational efficiency, anthropology.
DNA, Recombinant↗
Assessing the level of healthcare information technology adoption in the United States: a snapshot.
BACKGROUND: Comprehensive knowledge about the level of healthcare information technology (HIT) adoption in the United States remains limited. We therefore performed a baseline assessment to address this knowledge gap. METHODS: We segmented HIT into eight major stakeholder groups and identified major functionalities that should ideally exist for each, focusing on applications most likely to improve patient safety, quality of care and organizational efficiency. We then conducted a multi-site qualitative study in Boston and Denver by interviewing key informants from each stakeholder group. Interview transcripts were analyzed to assess the level of adoption and to document the major barriers to further adoption. Findings for Boston and Denver were then presented to an expert panel, which was then asked to estimate the national level of adoption using the modified Delphi approach. We measured adoption level in Boston and Denver was graded on Rogers' technology adoption curve by co-investigators. National estimates from our expert panel were expressed as percentages. RESULTS: Adoption of functionalities with financial benefits far exceeds adoption of those with safety and quality benefits. Despite growing interest to adopt HIT to improve safety and quality, adoption remains limited, especially in the area of ambulatory electronic health records and physician-patient communication. Organizations, particularly physicians' practices, face enormous financial challenges in adopting HIT, and concerns remain about its impact on productivity. CONCLUSION: Adoption of HIT is limited and will likely remain slow unless significant financial resources are made available. Policy changes, such as financial incentivesto clinicians to use HIT or pay-for-performance reimbursement, may help health care providers defray upfront investment costs and initial productivity loss.
Attitude of Health Personnel↗
Advanced practice nursing: reflections on the past, issues for the future.
PURPOSE/OBJECTIVES: To provide a comprehensive historical review of advanced practice nursing, describe the development of the professional role of oncology advanced practice nurses (APNs), and document the current status of major issues. DATA SOURCES: Published articles, research findings, position papers and statements, conference proceedings, books, newsletters, newspaper articles, executive summaries, standards and guidelines, and personal communications. DATA SYNTHESIS: The oncology APN role has evolved over the past 100 years in response to the healthcare needs of society and available educational opportunities. Trends in health care and education continue to influence the expansion of the professional APN role. CONCLUSIONS: Oncology APNs are prepared to practice in a variety of roles, providing expert clinical, educational, emotional, and supportive care to patients with cancer. Several major professional issues have been identified and addressed. Oncology APNs must document the influence of expert nursing care on patient outcomes and organizational efficiency.
Education, Nursing, Graduate↗
[The efficiency of organizational measures in improving the management of the prior appointment program].
OBJECTIVES: To estimate the organisational impact of the volume of appointments processed in the Primary Care (PC) Administration Units (AU) of Area 10, and to evaluate the effectiveness of organisational measures to correct the excess of appointments processed at particular times of day. DESIGN: Before-and-after intervention study. SETTING: AU of 16 PC teams from Madrid's Area 10. PARTICIPANTS: All the appointments made for users by 78 clerks in the 16 AU in the Area during the two weeks of the study. INTERVENTIONS: Strengthening of administrative staff dealing with the appointment system; and an information campaign for users about the system. MEASUREMENTS AND RESULTS: The percentage of appointments processed by AU was broken down for morning and afternoon, by the way the appointment was made (telephone/counter) and by the scheduling of the list. The hourly development was analysed by a graph. A mean number of appointments per clerk per day was found. The above figures were compared for before and after intervention. CONCLUSIONS: The work load caused by the appointment system was redistributed by internal organisational measures, since user habits did not alter.
Appointments and Schedules↗
Administrative burden and its implications for outpatient substance abuse treatment organizations.
OBJECTIVE: The aim of this study was to examine the extent of administrative burden on outpatient substance abuse treatment organizations and its implications for efficiency and productivity. METHODS: Using data from the 1995 and 2000 waves of the National Drug Abuse Treatment System Survey, the authors conducted multivariate analyses using generalized estimating equations. Two measures of organizational efficiency (operating expenses per therapy hour and salary and wages per therapy hour) and one measure of productivity (treatment sessions per full-time equivalent) were included. RESULTS: The average administrative burden in outpatient substance abuse treatment units increased between 1995 and 2000. The weighted and adjusted national sample data showed that one hour of substance abuse treatment therapy was associated with approximately $60 US dollars (in 1999 dollars) of nonsalary operating expenses and $124 US dollars in salaries and wages. Approximately eight treatment sessions were delivered each week by each full-time-equivalent staff member. The average weekly administrative burden consisted of about 71 hours of administrative work and almost 87 hours of clerical work. After controlling for various organizational characteristics, the authors found support for their predictions that administrative burden has negative relationships with organizational efficiency and productivity. CONCLUSIONS: This study uncovered different relationships for various types of burden and different types of organizational performance. It provided some evidence that, as treatment organizations face increased administrative burden, they may be shifting resources away from the provision of care.
Ambulatory Care↗
Job satisfaction among military prevention specialists.
The relationships between role perceptions and job satisfaction were studied. Such perceptions included perceived importance of the military prevention specialist role vis-a-vis substance abuse prevention, organizational efficiency, and supervisory interest. Perceived importance of the prevention duty for substance abuse prevention and organizational efficiency were primarily related to job satisfaction. Perception of the supervisor's emphasis upon the prevention duty was significant but secondary.
Alcoholism↗
Clinical capital equipment acquisition: decision-making at the executive level.
Capital investment in the United States health care industry is one of the components of the system that has historically fueled cost increases and complicated the quality/cost/access conundrum. This article is concerned with capital development focused on clinical equipment acquisition in acute care hospitals. The research findings suggest that decision-makers are abandoning two approaches to decision-making known as Quantitative Decision-Making and Mixed Scanning in favor of two models known as Rational Decision-Making and Political Decision-Making. While this is the case, a method of decision-making known as Idea Sets (developed and labeled by James March as Garbage Can Decision-Making) is the most widely used approach. Equipment acquisition criteria used by the decision-makers are shifting away from concerns of enhancing existing clinical programs and/or adding new clinical programs. Acquisition criteria are shifting toward procuring equipment which will decrease institutional expense, improve organizational efficiency, and galvanize operational effectiveness. In addition to the technical findings of the research, further insights about ourselves and our colleagues are gleaned. Accordingly, we understand more completely the human dynamics surrounding decisions and thus are able to dialogue more richly about issues. Meaningful dialogue such as this will have the dual benefit of advancing teamwork and facilitating decision-making.
Capital Expenditures↗
Hospital ownership, performance, and outcomes: assessing the state-of-the-science.
OBJECTIVE: This study 1) identified the research evidence; 2) assessed the state-of-the-science surrounding hospital ownership, performance, and outcomes in acute care hospitals in the United States; and 3) identified measurable components of hospital performance and outcomes for the organization, patient, and community. BACKGROUND: As the size of the nonprofit sector decreases and the size of the for-profit sector increases, hospital ownership warrants examination. Most research has focused on either ownership and performance or ownership and outcomes, rather than the potential interaction of all three variables. METHODS: A comprehensive, computerized search of the healthcare research literature yielded 69 data-based references published between 1985 and 1999. Coding sheets were developed to abstract the articles. Analysis involved synthesizing the research evidence for each of the three major variables and their components. RESULTS: Hospital ownership has an impact on hospital performance in relation to system operations; costs, prices, and financial management practices; and personnel issues. Organizational outcomes are similar among hospital ownership types in relation to increasing administrative costs and overall mediocre efficiency. Organizational outcomes differ among hospital ownership types in relation to nursing staff mix and professional satisfaction. The association of hospital ownership with patient outcomes varies depending on the dimension measured. The evidence is mixed or inconclusive regarding hospital ownership and access to care, morbidity, and mortality. The association of hospital ownership and adverse events is consistently supported. Hospital ownership status has an impact on the type and magnitude of community benefits. Differences among the three hospital ownership types are minimized in a competitive market. CONCLUSIONS: This study reinforces the position that nurse researchers need to include hospital ownership as an important structural variable in their studies of hospital-based nursing. Examining the conceptual links between ownership, performance, and outcomes requires the integration of macro-level and micro-level theory.
Community-Institutional Relations↗
Frontier efficiency measurement in health care: a review of empirical techniques and selected applications.
Health care institutions worldwide are increasingly the subject of analyses aimed at defining, measuring, and improving organizational efficiency. However, despite the importance of efficiency measurement in health care services, it is only relatively recently that the more advanced econometric and mathematical programming frontier techniques have been applied to hospitals, nursing homes, health management organizations, and physician practices, among others. This article provides a synoptic survey of the comparatively few empirical analyses of frontier efficiency measurement in health care services. Both the measurement of efficiency in a range of health care services and the posited determinants of health care efficiency are examined.
Australia↗
The paradox of the not-for-profit hospital.
This quantitative research study assesses the organizational characteristics, market factors, and performance of not-for-profit hospitals in the United States. These results have managerial implications related to hospital efficiency, organizational performance, and the role of not-for-profit hospitals within local communities. The study has policy implications on access to clinical services within local communities, the availability of charity care, and the long-term viability of the not-for-profit health care industry due to potential bankruptcy and closure. This study clearly demonstrates that not-for-profit hospital managers are faced with declining profitability and are challenged to reduce hospital-operating expenses while meeting their charitable mission. Additionally, the greater size and increased clinical complexity of not-for-profit hospitals are increasing organizational overhead. In many cases, the increased clinical complexity is a commitment to the organizational mission of providing a full range of services to the community. From a policy perspective, the study suggests that not-for-profit hospitals have aging facilities and reduced cash flow due to lower profit margins. As a result, many not-for-profit hospitals face potential bankruptcy and closure. This study clearly documents a threat to the provision of charity care in local communities and the long-term viability of the not-for-profit health care industry in the United States.
Aged↗
Technological stress: psychophysiological symptoms in modern offices.
Increasingly, employees in modern office environments report suffering from psychosomatic symptoms. Studies of employees in high-technology industries suggest that psychosomatic symptoms are related in part to high perceived mental demands in combination with lack of sufficient skills. Employees with symptoms more commonly report that they are not sufficiently recognized by their employer, as compared with nonsymptomatic peers. Low perceived organizational efficiency correlates with high mental stress among employees. In a controlled stress management program, we observed lower mental stress levels among participants, as compared with controls, and lower physiological arousal, measured as circulating levels of prolactin. It is suggested that organizational reengineering and the introduction of information technologies constitute potential stressors challenging employees' cognitive resources. It is predicted that psychosomatic syndromes in the workplace will most likely increase in the foreseeable future due to the rapid changes currently transcending working life.
Computer Terminals↗
Reorganizing care and work: process and productivity gains.
A Montreal-area hospital implemented organizational changes to improve the psychosocial environment for patients and health care workers and enhance organizational efficiency. This article describes a participatory approach to improving the organization of care and work, an approach focused on productivity gains in an organization. Productivity gains were analyzed in 13 units of the Department of Nursing, which had introduced a series of organizational changes. Changes introduced in care and work organization led to productivity gains in all units overseen by the Nursing Directorate. A reorganization of care and work based on the psychosocial work environment and staff participation can have positive outcomes, both for employees and for the wider organization.
Efficiency, Organizational↗
Clinica Tibas: an experimental response to health system challenges in Costa Rica.
Several experiments in health services delivery featuring contractual arrangements between government and the private sector have been initiated in Costa Rica. This report describes a public-private partnership serving a community of 50,000. A 'cooperative' of providers stands to gain financially if it succeeds in providing clinic services in an efficacious and efficient manner. This experimental approach retains elements of the existing public system for health promotion and disease prevention while introducing innovations for increased organizational efficiency and client satisfaction. The clinic provides easier access to better care, including ambulatory surgery, pharmacy service, and home visits, and at a lower cost to government than that budgeted under pre-existing arrangements. Inappropriate usage of area hospitals has been reduced; and a commitment to community participation and organized programming permit greater responsiveness to community needs. Those served by the clinic report satisfaction. Personnel also report satisfaction and enthusiasm for their work. Issues concerning extension of this model are considered.
Community Health Services↗
PrePare: a program of enhanced prenatal services within health-maintenance organization settings.
This paper presents the conceptual framework and implementation strategies of a relationship-focused behavioral intervention for pregnant women and their families. The program, PrePare ('Prenatal Parenting'), was designed as a prenatal precursor to the pediatric health care model, Healthy Steps. PrePare includes preventive intervention elements that address parents' universal concerns about pregnancy and parenthood, as well as specific activities to support optimum pregnancy health and reduce high-risk behaviors. As described here, the program is embedded within a large not-for-profit health-maintenance organization (HMO). Delivery of the prenatal component is carried out by Healthy Steps interventionists through three home visits and telephone follow-up during mothers' second and third trimesters of pregnancy. An evaluation of program outcomes is underway. The design compares three groups of families, those who receive PrePare followed by Healthy Steps, Healthy Steps alone and a usual HMO-practice comparison. It is hypothesized that initiating expanded services during the prenatal period will lead to increases in reported patient satisfaction, provider satisfaction and organizational efficiency within the health care delivery system.
Female↗