Strategically integrating hospital/home care services for improved profitability

Because hospitals and home health agencies have been predominantly separate organizations, coordination of their efforts has not been optimized. However, with the recent proliferation of hospital-based home health agencies, opportunities to integrate these health care service delivery systems have increased. Bethesda Memorial Hospital, Boynton Beach, Fla., is a 362-bed not-for-profit community hospital with a Medicare-certified home health agency organized as a department of the hospital. Until recently, the home health agency was generally perceived as a separate entity whose services were distinct from hospital services. Progress toward integration of hospital and home care services was given impetus through collaboration of the home health agency administrator and a newly appointed director of medical affairs who was given the responsibility as medical director of the home health agency. A prime responsibility of the director of medical affairs was to reduce length of stay and hospital costs through appropriate resource management.     

Medically necessary?

Coverage decisions can ultimately be traced back to three words in the original health policy contract: medically necessary and investigational. Investigational as a coverage exclusion applies to the minority of cases, in which there is inadequate data to validate the effectiveness of the intervention. In contrast, the majority of coverage decisions are based on medical necessity. Over the years the concept of medical necessity has evolved to encompass a multitude of medical management strategies. This discussion highlights the variable uses of the concept of medical necessity in terms of: (1) Determining the most appropriate intensity of service and place of service; (2) determining whether the proposed therapy is medically appropriate for the patient's condition; (3) distinguishing between medically necessary services and those that are performance enhancing or discretionary in nature; (4) making a distinction between medically necessary, cosmetic, and reconstructive services; and (5) defining medical necessity in accordance with generally accepted principles of good medical practice.     

面向客户的项目管理过程

客户关系作为项目管理过程中的重要方面需要引起项目实施团队的高度重视,面向客户的项目管理过程是在项目实施中管理客户关系的有效方法。本文探讨了客户关系在项目过程中的重要性,根据客户在项目实施过程中的角色及项目过程中项目团队与客户间的常见冲突,结合项目实施的五大管理过程提出在项目实施过程中进行客户关系管理的主要工作。     

The SERVICE Framework: A Public‐service‐dominant Approach to Sustainable Public Services

In this paper we argue that the new public management has been a flawed paradigm for public services delivery that has produced very internally efficient but externally ineffective public service organizations. Subsequently we develop the SERVICE framework for sustainable public services and public service organizations. This framework is rooted within the public‐service‐dominant business logic and emphasizes the need for a focus on external value creation rather than internal efficiency alone.     

Using a benchmarking system to improve patient care and assist in technology assessment

Clinical benchmarking is a tool of CQI that can be used to improve outcomes in areas of strategic importance. While it is a simple tool, benchmarking requires a long-term commitment from the entire organization involved in its use to be successful. Benchmarking is a means of setting goals or targets. As a tool used for continuous quality management, benchmarking is an ongoing activity of comparing an organization's service, product, or process with similar ones outside the organization that are known to be the best. In attempting to emulate or surpass "best practice," an organization must set challenging but attainable goals and reach them with a plan of realistic and efficient actions.     

Finding and Implementing Energy Efficiency Projects in Industrial Facilities

This study addresses the challenges of finding and implementing profitable energy efficiency (EE) projects, a critical foundation for sustainable operations. We focus on manufacturing enterprises, but many of our findings apply also to the back office of service operations. Our starting point is that, in nearly every industrial enterprise, there are many profitable EE projects that could be implemented but are not. An oft‐cited hindrance to implementation is the lack of an internal management framework in which to find, value, and execute these projects. Using a conceptual approach, we rely on proven sustainable operations tools to develop such a framework. We identify three major value drivers of EE projects: savings intensity, “green” image, and project complexity. We then describe a framework for understanding the context of EE projects in industry, with an underlying analytic foundation in optimal portfolio analysis. A case study of a large manufacturing site is used to illustrate emerging best practices—based on Kaizen management principles—for integrating EE project management with operations, engineering, and strategy.     

Part-time medical director: way station or end of the line?

This article is mostly directed to physicians who are contemplating a career change into management. You may be one of those persons who is contemplating taking a part-time position and continuing part-time clinical practice to see if you might enjoy management. It is important to understand that a part time medical director is there primarily because management perceives a need for a physician's skills and license. When a physician is hired on a part-time basis, it is unlikely that management realizes the larger benefits that can accrue to the organization from the physician manager's knowledge of health care and unique approach to the problems and opportunities in the delivery of that health care. Part-time medical directors seldom have an opportunity to be exposed to real management issues and activities and are usually sequestered and limited to functions that a naive management team thinks are most appropriate to a physician's skills and temperament. Be cautious in extrapolating a part-time experience to a full-time role. Consider taking the plunge to full-time management without a part-time transition phase.     

Physician-centered management guidelines.

The "Fortune 500 Most Admired" companies fully understand the irreverent premise "the customer comes second" and that there is a direct correlation between a satisfied work force and productivity, service quality, and, ultimately, organizational success. If health care organizations hope to recruit and retain the quality workforce upon which their core competency depends, they must develop a vision strategic plan, organizational structure, and managerial style that acknowledges the vital and central role of physicians in the delivery of care. This article outlines a conceptual framework for effective physician management, a "critical pathway," that will enable health care organizations to add their name to the list of "most admired." The nine principles described in this article are based on a more respectful and solicitous treatment of physicians and their more central directing role in organizational change. They would permit the transformation of health care into a system that both preserves the virtues of the physician-patient relationship and meets the demand for quality and cost-effectiveness.     

全球视角下跨境医疗服务研究述评与展望

本文从跨境医疗研究现状出发,对跨境医疗新趋势进行分析。研究发现关于跨境医疗的研究成果较多基于传统的医疗管理和公共卫生理论与模式。互联网时代跨境医疗的特征和医疗服务模式发生了变革,在这一背景下的相关研究较少。本文系统分析了跨境医疗整体概况及测度研究、驱动机制与服务模式研究成果,有针对性地提炼跨境医疗研究的理论框架,探讨跨境医疗带来的全球医疗资源均等化配置问题,提出新趋势下跨境医疗研究的关键科学问题与相关研究建议。研究成果对于推动国内外学者开展跨境医疗前沿领域研究,贡献全球健康事业有着重要的理论价值和实践意义。     

Ecological stewardship in Japanese firms

As pressure develops for foreign multinationals to follow the lead of U.S. companies by providing greater accountability on environmental performance and the development of environmental management systems; author Jacob Park brings CES readers a rare insight into the nature of Japanese environmental strategy. With examples from NEC's “green innovation” plan, Mr. Park reveals the strategic initiatives Japanese companies institute to address their own unique set of internal and external pressures.     

基于公理设计和功能过剩的公共住房撮合分配方法

公共住房的合理分配是关系保障性安居工程成败及可持续发展的"生命线"。公共住房分配中缺乏科学规划和依据,既难以保障公共住房资源分配的"公平正义",也在一定程度上造成了效率缺失。本文借鉴双边匹配思想,给出了一种基于公理设计和功能过剩的公共住房撮合分配方法,构建了一个公共住房撮合分配多目标优化决策模型。文中给出的公共住房分配案例计算表明,该方法有利于提高公共住房撮合分配的科学性、合理性及正确性,具有一定的可行性和适用性。基于相关系数权重的数值模拟试验,研究进一步探讨了住房保障的发展阶段、住房保障策略与最优撮合分配结果的关系,为公共住房分配提供了一些策略:在住房保障起步和发展阶段,应当优先考虑较高的保障覆盖面,同时也应避免公共住房对保障需求过剩;在住房保障发展成熟和完善阶段,则应当注重提高住房保障的保障水平,尽力满足住房保障对象更高水平的住房改善需求。     

An empirical multi-level analysis for achieving balance between incremental and radical innovations

An examination of 202 innovation projects in 42 firms revealed two approaches in how firms manage employees to explore new knowledge for radical innovations and to exploit existing knowledge for incremental innovations. The first is the system of organization-level management practices, whereby employees are recruited based primarily on prior work experience in other companies and developed interdepartmentally, and compensation is based primarily on joint performance without a specific innovation project in mind. The second is the system of team-level management practices, whereby employees are selected based mainly on overlapping knowledge with team members, and are trained and rewarded for a specific innovation project. Although both systems offer employees the necessary psychological safety for attaining radical innovations and the perspective-taking capability helpful for incremental innovations, each system is better for achieving one type of innovation than the other. The system of organization-level management practices better achieves radical innovations because it provides greater psychological safety, while the system of team-level management practices better achieves incremental innovations because it develops superior perspective-taking capability. Using both systems assists in incremental innovations but not radical innovations, because contradictory expectations are placed on the employees, diminishing psychological safety. The main implication of these findings is that companies should manage their employees differently depending on the type of innovation they wish to achieve.     

New thinking for health care leaders

What is the difference between strategic management and a typical strategic plan? It is simply not enough today to restate and refine current organizational strategy, when the environment is demanding innovation and the rules of the game are rapidly changing. What are the consequences for hospital administrators and boards that still believe that catering to medical specialists and inpatient facility improvement will suffice when the future will be driven by greater needs for outpatient and primary care provider services? Developing a plan based on outdated operations or assumptions may speed the organization's decline. Strategic management involves a process of thinking through a "vision" of what sort of organization you want and asking extremely difficult questions.     

Perspective on succession planning in multiple MNCs: interview with Aparna Sharma

?Organizations are often confronted with the challenges of developing a continuous flow of functional leaders who can operate effectively in different cultural contexts. To maintain a sustainable leadership structure across different functional units, organizations need to put in place an efficient succession plan to meet any unexpected leadership void. The existing scholar practitioner literature offers limited information regarding evidence-based practices adopted by organizations for creating an effective succession planning strategy. The interview presented here is an attempt to highlight different approaches and strategies of effective succession management for ensuring leadership continuity and harnessing talent from within the organizations.     

A computerized financial planning model for a health maintenance organization

The time and resource costs needed to plan and start a prepaid medical program or health maintenance organization (HMO) are extensive. It can take up to 3 years to bring one on line and another 3 to 4 years to reach financial stability. Depending on the type of prepaid medical plan designed, the cost can reach $6 to $8 million before breakeven occurs. Because the financial stakes are so high, a systematic and sound business approach must be taken to find that one ‘best’ design that will survive in the market place. Thousands of hours are required to study all of the possible HMO design configurations. This paper describes how a corporation constructed a computerized financial planning model to simulate the financial behavior of a prepaid medical program with different organizational formats, operational policies and pricing and compensation schemes in varying market, economic and cost environments. Model development and application was a corporate affair. The computerized model provided a special design team with the capability to evaluate the economic impact of many different designs by asking ‘what if’ questions dealing with several key design and operating variables concerning different health benefit options, service utilization rates, staffing patterns, inflation rates and price and premium schedules. Thousands of hours of design time were saved and the corporation was able to find the ‘best’ possible design in a reasonable time and at a reasonable cost.     

An empirical study of transformational leadership,team performance and service quality in retail banks

The discipline of operations management (OM) has long been offering differing quantitative techniques for improving the efficiency of banking operations. However, there has been a trend in recent years that operations and services of the banking industry are becoming more diverse and unstructured, rendering many traditional OM quantitative techniques less effective in performance improvement. By integrating the literature on banking operations, service quality, leadership style and work teams, we argue that leadership style and team performance are crucial concerns determining the service quality performance of today's banking operations in a team setting. Using data collected from 192 employees from 32 operational teams (a leader and five members in each team) in 15 retail banks in Macau, China, we investigated whether the five dimensions of transformational leadership have an impact on team performance with respect to team cohesion, team leader job satisfaction and team competence; and whether the dimensions of team performance have an impact on such service quality dimensions as reliability and responsiveness. We found that one of the dimensions of transformational leadership and two of the dimensions of team performance have a significant impact on service quality. We discuss the implications of the findings for research and practise.     

An Integrated Methodology for Assessment and Selection of the Project Risk Response Actions

In a systematic process of project risk management, after risk assessment is implemented, the risk analysts encounter the phase of assessment and selection of the project risk response actions (RA). As indicated by many researchers, there are less systematic and well-developed solutions in the area of risk response assessment and selection. The present article introduces a methodology including a modeling approach with the objective of selecting a set of RA that minimizes the undesirable deviation from achieving the project scope. The developed objective function comprises the three key success criteria of a project, namely, time, quality, and cost. Our model integrates overall project management into the project risk response planning (P2RP). Furthermore, the proposed model stresses on an equivalent importance for both "risk" and "response." We believe that applying the proposed model helps the project risk analyst in most effective and efficient manner dealing with his or her complicated RA selection problems. The application of the proposed model was implemented in projects in the construction industry in which it showed tremendous time, cost, and quality improvements.     

Fostering Risk Taking in Research and Development: The Importance of a Project's Terminal Value

Large firms face a conflict in managing a portfolio of high-risk projects. When an ongoing project is thought to have a low likelihood of success, project team members take risks to improve its chances of success. However, upper-level managers who allocate resources tend to withhold resources from a project with a low likelihood of success in favor of others in the portfolio that look more promising. Because this paucity of resources influences project team members to avoid risk, the total effect of success likelihood on risk taking is conflicted. The influence on risk taking of a project's terminal value—defined as the value that remains in the firm in the event of project failure—is unequivocally positive, because both senior management resource allocation and project team risk-taking propensity are encouraged by terminal value. Thus, firms can override the ambivalent effect of likelihood of success on project decision making by focusing attention on a project's terminal value.     

Clinical program renovation management

The day-to-day management of medical practice is so heavily influenced by tactical imperatives that few physicians have the time to think strategically. Traditionally, the difference between tactics and strategy is not a major concern of most physician executives. The realm of tactics is the short run, when managers must make do with the fixed resources at hand. Strategy addresses the long run, when all resources and markets are variable. A tactical focus is understandable, maybe even acceptable, in industries where nothing challenges traditional approaches to production of an established product or service. However, medical care in the 1990s is changing so fast that a physician executive must devote an incredible amount of time and effort just to stay confused about what is going on.