Constructive tension: hospital/medical staff relations.

The missions of the hospital and its medical staff are not the same. The only reason for a hospital to exist is to provide a support system for physicians. It is in the best interests of patients and the public for physicians not to become "organization men." In turn, however, it is incumbent on physicians to show restraint in the provision of costly services. The guiding principle must be the selection of what is most relevant to the improvement of services to patients.     

Prioritized reconstruction of healthcare facilities after earthquakes based on recovery of emergency services

Earthquakes can disrupt the healthcare system heavily, leading to long wait times and many untreated patients for years after the event. Emergency services, in particular, must return to preearthquake functionality as soon as possible such that patients, especially critically injured ones, can be treated promptly. However, reconstruction and restoration of emergency services can take years. Due to limited reconstruction resources, decision-makers cannot reconstruct all hospitals simultaneously. They are typically forced to prioritize the reconstruction order, and this process is often poorly planned. This article models emergency services as an M/M/s queuing system that accounts for prioritized treatment of critical patients and formulates a greedy algorithm to plan for an effective healthcare system reconstruction. The algorithm finds the reconstruction ordering of hospital buildings such that emergency patients have the shortest time to receiving medical care possible. We show our greedy algorithm's good performance for small problem instances, with average deviations from the optimal solution below 16%. Further, we apply our methodology to a case study of Lima, Peru, under a hypothetical M8.0 earthquake. The application demonstrates that compared to typically implemented policies, a policy guided by our formulation results in shorter time to treatment and reduces the number of untreated patients over the course of the reconstruction period by more than a factor of 3 in a worst-case scenario with 70% hospital capacity disruption. Finally, we demonstrate that our formulation can be integrated into risk analysis through Monte Carlo simulations to inform decision-makers of reconstruction plans after future earthquakes.     

Hospital-physician relations: overcoming barriers to cooperation.

In the September-October 1986 issue of Physician Executive, we discussed the application of strategic business units (SBUs) to health care. SBUs are those corporate entities that market similar products to one or more target populations with similar characteristics. Examples of SBUs in health care are obstetrics, cardiology, orthopedics, etc. When the services within each SBU are linked together, they might resemble a vertically integrated health care system. In the case of obstetrics, a woman may have contact with physicians, a hospital, home care nurses, house-cleaning services, birthing teachers, and maternity clothing boutiques. Each of these are products/services within the SBU of obstetrics. Strategy development by SBU implies an external focus on the marketplace in terms of the specific mission of the SBU (clinical specialty). It also implies responding to the needs of consumers for whom the historical and present divisiveness between hospitals and physicians is immaterial and irrelevant. In this article, we will focus on ways to stabilize the relationship between hospitals and physicians within an SBU context in order to compete more successfully as a team in today's health care environment.     

Planning health services with explicit geographical considerations: a stochastic location–allocation approach

This paper is concerned with modeling for planning health services when geographical considerations in the location of services and in the locations of patients who need services are important. Examples of geographical distribution and organization of health services are the location of hospital outpatient departments within a city, and the provision of hospital-based specialist services, such as cardiac and dental surgery, across a region. Important issues in the provision of services include the location of the service centers, service capacities, geographical distribution of patients, and ease of access to the health services. This paper describes the development of a discrete-event geographical location–allocation simulation model for evaluating various options for the provision of services. Real-life case studies will illustrate the practical importance of the modeling approach.     

The Role of Clinical and Process Quality in Achieving Patient Satisfaction in Hospitals

Managers constantly struggle with where to allocate their resources and efforts in managing the complex service delivery system called a hospital. In the broadest sense, their decisions and actions focus on two important aspects of health care—clinical or technical medical care that emphasizes “what” the patient receives and process performance that emphasizes “how” health care services are delivered to patients. Here, we investigate the role of leadership, clinical quality, and process quality on patient satisfaction. A causal model is hypothesized and evaluated using structural equation modeling for a sample of 202 U.S. hospitals. Statistical results support the idea that leadership is a good exogenous construct and that clinical and process quality are good intermediate outcomes in determining patient satisfaction. Statistical results also suggest that hospital leadership has more influence on process quality than on clinical quality, which is predominantly the doctors' domain. Other results are discussed, such as that hospital managers must be mindful of the fact that process quality is at least as important as clinical quality in predicting patient satisfaction. The article concludes by proposing areas for future research.     

考虑信息平台优化的医疗服务系统决策研究

微信、支付宝等手机应用上预约挂号和智能分诊的实现,实质上是信息平台优化。而信息平台优化投入对患者就医偏好的影响具有不确定性。通过分析信息平台优化投入对患者就诊选择影响,本文构建了考虑信息平台优化的医疗服务系统。与以往研究不同的是,系统中的期望等待时间为更精确的等待队列等待时间。另外,服务提供者的最优化决策变量创新地由医疗服务能力转为信息平台优化的投入,同时资金提供者的决策目标为最小化社会医疗成本。本文研究了医疗服务系统的均衡策略与均衡状态的性质。其次,对不同医疗服务规模的医疗服务系统的均衡状态进行了对比。研究发现,对于公共医疗系统,信息平台优化的最优投入与患者自付率无关,而这有助于实现基本医疗服务均等化。本文从数理上证明了,在均衡状态下,当患者的医疗需要增加时,划拨到公立医院的预算会减少。患者自付率与医疗服务的复杂度无关,即患者负担的医疗费用与医疗服务的复杂度无关。     

Service Architecture and Modularity*

An understanding of the nature of service architecture and modularity is crucial to service design and innovation. Two sets of approaches are developed that further our understanding and support decision making. First is a systematic decomposition approach to architecture modeling that allows organizations to understand their current architecture, evaluate alternative architectures, and identify key interfaces between different parts of the service. Second, the article develops a service modularity function (SMF), a mathematical model indicating the degree of modularity deriving from unique services and the degree to which the modules can be replicated across a variety of services. Three areas are identified that can contribute to competitiveness: the possession of unique service modules or elements not easily copied in the short term by competitors; the ability to exploit these through replication across multiple services and/or multiple sites; and the presence of a degree of modularity, which in turn supports both customization and rapid new product development. The SMF can support decision making in the design of services and the exploitation of service innovation. In particular, the relationship between architecture and modularity and the roles of service contact personnel in the customization of services is shown to be complementary. It is proposed that service customization can be either combinatorial (the combination of a set of service processes and products to create a unique service) or menu driven (the selection of one or more services from a set of existing services/products to meet customer needs).     

An information system model for negotiating capitation contracts

Capitation contracts require health care organizations to negotiate on a much more sophisticated and risky level. Understanding whether a capitation contract will allow a hospital to remain financially viable while providing quality care requires estimating the number of patients to be served, the amount and types of services to be offered, and the cost to provide them. This article presents an information system model designed to assist a large hospital, not only in determining true patient cost, but also in aggregating the cost information in different ways, such as conducting a case-mix analysis, to perform a more informed quote analysis for capitated contracts.     

推荐系统对消费者网购支出的影响研究

推荐系统能在电子商务中利用信息过滤技术为消费者推荐感兴趣的商品和服务。本文通过收集大量消费者网购调查问卷，问卷的信度和效度均符合数据分析的要求。首先分析了消费者的产品偏好、忠诚度等网购行为与其年龄、性别、地域等个人属性的相互关系，之后运用倾向得分匹配法（Propensity Score Matching，PSM）研究推荐系统对消费者网购支出的影响，同时使用工具变量法（（Instrumental Variable，IV）对PSM研究结果进行稳健性检验。结果显示使用推荐系统的消费者网购支出比未使用的消费者高出14.7%，网购支出与受教育程度和收入水平呈正相关、与年龄呈负相关，城市消费者和女性更愿意使用推荐系统；同时统计分析表明推荐效果受电子商务平台中社交关系、互补产品、店铺声誉等因素影响。研究结果对评估推荐系统的经济效益、增强消费者忠诚度和提高商家营销的精准性等方面起到了重要作用。     

智联产品服务供应链研发运维多阶段联合优化与协调

在智联化和服务化背景下,智能产品服务系统成为制造企业转型升级的重要方向。产品的“智能”和“互联”特性给供应链中的产品和服务都带来了新的变化。考虑产品的“智能”和“互联”对产品、服务的需求和成本的影响,构建了供应链两阶段动态博弈模型。刻画了分散决策和集中决策下供应链的最优运作行为,基于产品收益和服务收益提出了“双元收益共享”的供应链协调机制。通过算例分析,探讨了“服务化”、“智能互联”与“双元收益共享”契约对供应链利润的影响。研究表明,智联产品供应链中融入智能服务,不总是能增加供应链利润,存在“服务化悖论”;当产品智联化后,智能互联特性加强了产品与服务的融合,使供应链各方的利润都有较大提高;“双元收益共享”契约不仅能实现供应链Pareto改进,还能提高消费者剩余。     

Legal issues in accepting capitation

The effort to reduce the cost of medical, hospital, and ancillary services increasingly focuses on shifting the financial risk for the cost of these services to those who provide them. Shifting arrangements include capitation for physicians classified as "primary care" physicians; capitation arrangements that include primary and specialty services; risk shifting to medical groups, IPAs, and other physician organizations; as well as the packaging of physician and hospital services on a "full risk," "per case," or other basis. Accepting financial risk for the cost of medical and other health care services, as well as the responsibility for managing the provision of services, may very well be the only remaining opportunity for providers to maximize reimbursement and maintain administrative and clinical self-direction. However, physicians must work with managed care organizations (MCOs) through negotiation of contracts and throughout the relationship to make sure: Unnecessary financial and legal risks to the MCO and physicians are eliminated. Risks that cannot be eliminated are apportioned between the MCO and physicians. All risks are managed in a coordinated fashion between the MCO and physicians.     

Standardisierte Qualitätsinformationen und ihr Einfluss auf die Wahl von Leistungsanbietern – Ergebnisse einer empirischen Studie am Beispiel der Qualitätsberichte von Krankenhäusern

This study analyses the impact of standardized quality information of complex services on decisions, exemplified for Germany’s hospital quality reports. The presumed impact of quality information on decisions is based on theoretical considerations and hypotheses are developed accordingly. Though results of two experiments show that simplified quality indicators used in the quality reports for hospitals basically lead to consistent decisions, results also show that the impact of standardized quality information on decisions is not stable. It is disturbed and superimposed by the effects of additionally presented quality information. Implications for competition on hospital markets and for the effectiveness of standardized quality information as they are used in the hospitals’ quality reports are discussed as well as general conclusions about standardized information of complex services are drawn.     

Models for investment in electronic commerce—financial perspectives with empirical evidence

Electronic Commerce (“eCommerce”) is a concept for trade based upon products and services that are being marketed, contracted, and paid for over the Internet. Consequently, electronic commerce demands for the investment in computer systems, marketing, logistics and payments.This paper will develop conditions for profitable investments in eCommerce with a special focus on outlays for information technology systems and sales management. If the services are made more standardized, if they do not change that often, or if they are well known to the customers so that there is little need for supplementary information, then the less costly will the information technology system become. The investment in marketing depends on how well known the brand name is to the customer. eCommerce firms “Born on the Net” have to spend substantially more resources on marketing than firms that “Move to the Net”.These investments may be seen as parts of a process, which aims to generate larger revenues to the firm, better services to the customers, a more efficient logistic system, and lower payment costs. A financial perspective is taken, where investment outlays for web services and marketing are balanced to cost savings when serving existing customers and net revenues from the generation of new customers. This financial approach is applied to five case studies from the sectors of capital goods, financial services, food, ornamental horticulture, and books and stationeries, where the given background from practice and conditions for success are developed in terms of a customer-base, margins, and sales growth. It is demonstrated that an existing customer base offline reduces the need for a marketing that is costly. It is also shown that a combination of services online and offline improves customer services and increases the extension of repeat purchases.     

Implementing a quality assessment program

It is difficult to imagine a more stressed organization than today's hospital. If the scope of change is not a sufficient challenge, the rate of the change is staggering, especially in quality assessment. Now we are poised for continuous quality improvement, whereby outcomes identified by quality assessment become the focus for system and process review and modification. It is imperative that a good quality assessment program be in place before implementing and integrating a continuous quality improvement process. The purpose of this article is to show how a quality assessment system can be implemented in a community hospital, regardless of size or scope of services. Key to the process is making all staff members part of the system's development and operation.     

Political Exhortation, Patient Expectation and Professional Execution: Perspectives on the Consumerization of Health Care

A central theme underpinning the reform of public-sector services in western economies since the 1980s has been the emphasis on reorienting service provision around the user. Public-sector organizations have been forced to reappraise the design of the service delivery process, in particular the service encounter, to take account of the resultant changes in service users' expectations. Such focus on the service user has fundamental implications for public-sector professionals, specifically challenging the dominance of service professionals in the design and delivery of services. Based on a survey of patient attitudes towards service provision in the National Health Service in Scotland (NHSiS) and in-depth interviews with senior hospital clinicians and managers, the paper critically examines the reaction of both patients and professionals to politically driven initiatives to reorientate the delivery of health-care services. Specifically the paper explores the emerging perspectives of both patients and professionals towards the consumerization of health care and the changing nature of the relationship between patients and professionals within a publicly funded health-care system.     

基于产品相关性及研发创新下的销售方式偏好研究

针对零售商捆绑上游多个制造商产品的现状，考察了由两个制造商和一个零售商组成的供应链系统，制造商进行研发投资降低各自产品成本，零售商进行产品销售并选择分开销售还是捆绑销售。考虑制造商研发行为下，探究供应链成员对不同相关性产品销售方式的偏好。研究发现，（1）对于独立产品，系统成员不存在共同的偏好。（2）对于互补产品，并非"一绑就灵"，分开销售会成为系统成员的共同偏好，而非捆绑销售。（3）对于替代产品，并非不能捆绑，感知价值相差处于中间范围的低成本替代产品和感知价值相差较小的高成本替代产品均在捆绑销售下更有利可图。     

A Model for Partial Product Complementarity and Strategic Production Decisions under Demand Uncertainty

This paper considers a general industrial setting where multiple manufacturers each produce a different product and sell it to the markets. These products are partially complementary in the sense that there is a common demand stream that requests all these products as complementary sets and there are streams of individual demands each requesting only one of the products. All demands are uncertain and may follow any general, joint distributions. Facing demand uncertainties, the manufacturers each choose a production quantity for its product with an objective to maximize its own expected profit. We formulate the problem as a non‐cooperative game to study the strategic interactions of such firms and their implications to supply chain performance. We show that such a game may have numerous equilibria. Among all the possible equilibria, however, we prove that there always exists a unique one that maximizes each and every manufacturer's profit, and we derive an explicit solution for this Pareto‐optimal equilibrium point. We further study the optimal solution for a centralized system and compare it with the decentralized solution. Managerial insights are drawn as to how system parameters and control mechanisms affect firms' decisions and performance.     

Determining the capacity of a transportation system—Passenger airlines

Capacity measurement is critical to the evaluation of the effectiveness with which existing output capabilities are being utilized, of the potential effects of re-allocating current facilities among the mix of products and services which the given system can provide, and of the prospective effects of investments in additional major capital goods. This paper illustrates how the multiple dimensions of capacity may be encompassed for complex transportation systems, as illustrated by passenger airlines.     

Managing provider networks through expert systems: use of patterns of treatment to address overutilization

Among the most important contributors to rising health care costs is excess utilization of services. Sophisticated clinical criteria, encoded as an expert system in software, allow identification of probable excess utilization in large claims data sets. These systems can be used to adjudicate claims, resulting in direct cost savings, or to profile physicians and other providers, facilitating creation and maintenance of networks. These systems are used by traditional payers to promote quality, control costs, and enhance competitiveness and are beginning to be used by nontraditional payers, such as physician groups and hospital-based networks.