Every Minute Counts: Using Process Improvement and Performance Feedback to Improve Patient Flow in an Emergency Department

Prolonged emergency department (ED) visits are associated with a number of adverse outcomes for patients as well as lower patient satisfaction scores and increased costs. Several factors that influence the length of ED visits are out of the control of hospital employees, but some opportunities exist to improve performance. For this study, the ED department of a 150-bed hospital in the southeastern United States wanted to improve door-to-discharge time. To do so, a subprocess of door-to-discharge time was targeted, door-to-order. After analyzing the process, the team created standard orders for the 10 most common presenting conditions in the ER with preapproval, allowing nurses to submit the orders without the provider first visiting the patient. Following the process change, daily feedback was added to increase utilization of the preapproved orders. Reductions in door-to-order times and door-to-discharge were observed and patient satisfaction remained stable. Implications for future research in this area are discussed.     

基于Hawkes过程中美股市大幅波动互激效应的研究

近年来，由于中美经济联系日趋紧密，中美股票市场大幅波动的互激效应明显增强。本文考虑中美股市时差和法定节假日差异等因素，运用标值Hawkes过程对2006-2017年CSI300和S&P500大幅波动收益率数据进行建模，结果表明：（1）中美股市大幅波动互激效应存在不对称性，美股市场大幅波动对中国股市的互激效应更强；（2）中美股市大幅波动的幅度对互激效应不存在显著影响；（3）中美股票市场对于大幅波动互激效应的消化速度存在差异，中国股票市场消化美股大幅波动互激效应的速度较快。本研究对金融市场监管者和投资者均有一定意义。     

The covariance of the backward and forward recurrence times in a renewal process: the stationary case and asymptotics for the ordinary case

In a Poisson process, it is well-known that the forward and backward recurrence times at a given time point t are independent random variables. In a renewal process, although the joint distribution of these quantities is known (asymptotically), it seems that very few results regarding their covariance function exist. In the present paper, we study this covariance and, in particular, we state both necessary and sufficient conditions for it to be positive, zero or negative in terms of reliability classifications and the coefficient of variation of the underlying inter-renewal and the associated equilibrium distribution. Our results apply either for an ordinary renewal process in the steady state or for a stationary process.     

Modeling spatial overdispersion via the generalized Waring point process

Modeling spatial overdispersion requires point process models with finite‐dimensional distributions that are overdisperse relative to the Poisson distribution. Fitting such models usually heavily relies on the properties of stationarity, ergodicity, and orderliness. In addition, although processes based on negative binomial finite‐dimensional distributions have been widely considered, they typically fail to simultaneously satisfy the three required properties for fitting. Indeed, it has been conjectured by Diggle and Milne that no negative binomial model can satisfy all three properties. In light of this, we change perspective and construct a new process based on a different overdisperse count model, namely, the generalized Waring (GW) distribution. While comparably tractable and flexible to negative binomial processes, the GW process is shown to possess all required properties and additionally span the negative binomial and Poisson processes as limiting cases. In this sense, the GW process provides an approximate resolution to the conundrum highlighted by Diggle and Milne.     

Control charts based on dependent count data with deflation or inflation of zeros

The process of serially dependent counts with deflation or inflation of zeros is commonly observed in many applications. This paper investigates the monitoring of such a process, the first-order zero-modified geometric integer-valued autoregressive process (ZMGINAR(1)). In particular, two control charts, the upper-sided and lower-sided CUSUM charts, are developed to detect the shifts in the mean process of the ZMGINAR(1). Both the average run length performance and the standard deviation of the run length performance of these two charts are investigated by using Markov chain approaches. Also, an extensive simulation is conducted to assess the effectiveness or performance of the charts, and the presented methods are applied to two sets of real data arising from a study on the drug use.     

A general central limit theorem and a subsampling variance estimator for α‐mixing point processes

We establish a central limit theorem for multivariate summary statistics of nonstationary α‐mixing spatial point processes and a subsampling estimator of the covariance matrix of such statistics. The central limit theorem is crucial for establishing asymptotic properties of estimators in statistics for spatial point processes. The covariance matrix subsampling estimator is flexible and model free. It is needed, for example, to construct confidence intervals and ellipsoids based on asymptotic normality of estimators. We also provide a simulation study investigating an application of our results to estimating functions.     

For an integrative theory of social behaviour: Theorising with and beyond rational choice theory

Most sociologists are not content with merely relating macrosocial phenomena to preceding macrosocial causes in their causal explanations of social phenomena. Instead they are seeking to provide (non‐reductive) microfoundations with which they can corroborate and make understandable the connection between macrosocial phenomena. In order to do so a theory (or theories) of human action is required. One such theory, rational choice theory (RCT), has long been viewed with strong suspicion in sociology. I show such suspicion to be partially justified. RCT cannot be a general theory of social behaviour. Nonetheless, there are important insights in various versions of RCT that should not be discarded. In order to improve upon RCT and move toward a more unified or integrative theory of action social‐psychological research has to be taken note of. I demonstrate how dual‐process theories and the research on heuristics can help sociologists move beyond RCT without contradicting some of its more basic insights.     

治理效能视角下公民参与公共服务的制度研究

公民参与公共服务的有序性和有效性并非直接相关,可以从有序性和有效性两个维度分析公民参与及其治理效能的关系.为提升治理效能,以程序性规则为核心的制度设计能更为充分地保障公民有序有效参与公共服务,实现公民与政府之间的良性互动与有序合作.基于全过程民主、程序性权利和共同体秩序等公民参与的程序性价值维度考量,再以环境保护领域中的公民参与为例,从公开公示机制、意见表达机制、回应吸纳机制、监督评价机制和责任追究机制等方面构建公民全过程参与制度,并探索公民参与的方法和策略.通过公民参与的程序性价值内化、方法创新与技术转型来推进治理体系和治理能力现代化.     

Strategy as engagement: What organization strategy can learn from military strategy

Strategy process and practice research has illuminated the internal dynamics of strategy work – at the cost of backgrounding processes and practices that relate to engagement with external actors. In this conceptual paper, we argue for an extension of this body of work by shifting the focus of research from internal practices and processes towards externally oriented practices of engagement. We do so by critically building on the military strategy literature and develop the concept of strategy as engagement. This concept suggests understanding the role of strategy as bridge between policy and tactics; the importance of grand strategy as the making of policy; and the need to focus attention on tactics as distributed collective action. Thus, we contribute to strategy process and practice research through 1) extending its repertoire to practices of engagement and 2) broadening its epistemic foundation through a critical reading of military strategy.