Computerization of a medium-sized hospital without an internal DP department

The conventional approach to computerization in a large hospital is to establish an internal data processing (DP) department and DP professionals then begin to develop computer-based information systems (CBIS). For medium-sized hospitals, however, this approach is doubtful. The limitation of financial resources and the lack of skilled systems professionals force the medium-sized hospital to consider different approaches. In this paper, we present a conceptual framework for the computerization of a medium-sized hospital based upon the viewpoint of top management. Based on the conceptual framework presented, a PC-based application software package has been developed, tested, and implemented at Cheng-Ching Hospital in Taiwan. Our study shows that a medium-sized hospital can initiate and conduct computerization in very short time with low cost and without an internal DP department.     

From knowledge to decision – a case study of sales and operations planning in health care

One of the most important challenges in health care management is balancing resources with fluctuating and uncertain demand. This study examines whether introducing a standardised process for sales and operations planning at a large university hospital improved specialty department managers’ knowledge of planning conditions and if so, whether decisions were made based on this knowledge. Using responses from a survey of 30 specialty department managers at Sahlgrenska University Hospital in Sweden, the analyses indicate that operational knowledge strengthens insights about the needs for strategic decisions, and vice versa. Moreover, knowledge is a necessary, but not sufficient, condition for making decisions at the department level. An overall planning and decision structure is required and should be implemented first at the hospital level to effectively allocate resources.     

Work satisfaction, health, and stress: A study of Dutch nurses

A study was conducted to compare nurses' work satisfaction and feelings of health and stress in five different nursing departments: a cardiac care unit and a general surgical ward in a general hospital; and an admissions department, a short-stay department, and a long-stay department in a psychiatric hospital. One hundred nurses took part in the study: the instruments used were questionnaires and structured interviews. The main results showed that:

(1) nurses in the cardiac care unit had the most positive satisfaction scores

(2) nurses in the general surgical ward had the most positive scores on the health and stress variables

(3) feelings of dissatisfaction and stress were most prominent in the short-stay department and, to a lesser extent, in the long-stay department.

The findings are interpreted in terms of the different work situations and die implications for hospital management are discussed.

Dr J. A. Landeweerd graduated in industrial and organizational psychology in 1968 (PhD in 1978). He has worked at Eindhoven University of Technology (Department of Industrial Engineering) and now holds a position as senior lecturer at Limburg University (Department of Health Sciences), where he is project-leader for a number of research projects on the relationships between work and health.

Nicolle Boumans, MA, graduated in health sciences in 1985 (specialization: nursing science) and is now a research assistant. She is working on a PhD thesis concerned with the relationship between task characteristics of nurses and their reaction in terms of job satisfaction, health and stress.     

Work satisfaction,health, and stress: A study of Dutch nurses

Abstract

A study was conducted to compare nurses' work satisfaction and feelings of health and stress in five different nursing departments: a cardiac care unit and a general surgical ward in a general hospital; and an admissions department, a short-stay department, and a long-stay department in a psychiatric hospital. One hundred nurses took part in the study: the instruments used were questionnaires and structured interviews. The main results showed that:

(1) nurses in the cardiac care unit had the most positive satisfaction scores

(2) nurses in the general surgical ward had the most positive scores on the health and stress variables

(3) feelings of dissatisfaction and stress were most prominent in the short-stay department and, to a lesser extent, in the long-stay department.

The findings are interpreted in terms of the different work situations and die implications for hospital management are discussed.

Dr J. A. Landeweerd graduated in industrial and organizational psychology in 1968 (PhD in 1978). He has worked at Eindhoven University of Technology (Department of Industrial Engineering) and now holds a position as senior lecturer at Limburg University (Department of Health Sciences), where he is project-leader for a number of research projects on the relationships between work and health.

Nicolle Boumans, MA, graduated in health sciences in 1985 (specialization: nursing science) and is now a research assistant. She is working on a PhD thesis concerned with the relationship between task characteristics of nurses and their reaction in terms of job satisfaction, health and stress.     

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.     

Coaching für die Chefärztin der Chirurgischen Abteilung eines Kreiskrankenhauses

Coaching the head physician of a surgical department The author presents an individual coaching of a female head physician, who is leading the surgical department of a hospital for half a year. The motive were conflicts in the relationship to the colleagues, mainly an interactional conflict with the assistant medical director, caused by dysfunctional patterns of understanding and behaviour. Together with the coach objectives were developed to find a more planning, structuring and communicative leading style. Further more, interventions were prepared and the interactions with the assistant analyzed. Finally, as a first conflict intervention a team discussion is prepared and successfully supported.     

An emergency department perspective--Part one

High patient volumes requiring rapid turn around times, critical decision making processes, and a necessity for establishing an accurate working diagnosis are a few of the many challenges in hospital emergency departments. Quality management, rather than quality assurance, most accurately describes how activities in the emergency department should be monitored to meet these challenges. Already an important factor in manufacturing and service industries across the United States, quality management will become the essential driving force in the health care industry. To survive in the '90s, the emergency department must include in its goals the development of plans and processes that meet the challenge of the ED environment and that focus on customer satisfaction.     

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.     

Design and Analysis of Hospital Admission Control for Operational Effectiveness

Variability in hospital occupancy negatively impacts the cost and quality of patient care delivery through increased emergency department (ED) congestion, emergency blockages and diversions, elective cancelations, backlogs in ancillary services, overstaffing, and understaffing. Controlling inpatient admissions can effectively reduce variability in hospital occupancy to mitigate these problems. Currently there are two major gateways for admission to a hospital: the ED and scheduled elective admission. Unfortunately, in highly utilized hospitals, excessive wait times make the scheduled gateway undesirable or infeasible for a subset of patients and doctors. As a result, this group often uses the ED gateway as a means to gain admission to the hospital. To better serve these patients and improve overall hospital functioning, we propose creating a third gateway: an expedited patient care queue. We first characterize an optimal admission threshold policy using controls on the scheduled and expedited gateways for a new Markov decision process model. We then present a practical policy based on insight from the analytical model that yields reduced emergency blockages, cancelations, and off‐unit census via simulation based on historical hospital data.     

Bundling services saves everybody time

From a practical viewpoint, the close relationships among utilization review, quality assurance/improvement, infection control, discharge planning, social services, and medical records makes it impossible to separate them. Case management combines these traditionally isolated hospital functions into one department in order to perform many related functions simultaneously. It provides a much more effective and efficient method than can be accomplished by the traditional institutional approach.     

Chief of staff and medical director: conflict or cooperation?

Inevitably as the role of the medical director expands, it will directly affect power structures already existing in the hospital hierarchy, including department chiefs, other administrators, and the chief of staff. This article will attempt to define the roles of the medical director and the chief of staff, explore possible conflicts, and provide suggestions to help avoid confrontation. Finally, an attempt will be made to look into the future direction of the medical director's position.     

Risk Assessment for Hospital-Acquired Diseases: A Risk-Theory Approach

We introduce a new approach to hospital-acquired disease risk assessment from public health databases. In a spirit similar to actuarial risk theory, we define an adjustment coefficient that can quantify the risk associated with a hospital department, allowing comparisons of similar departments. The adjustment coefficient characterizes the tail of the distribution of the total patient length of stay in a department before the first disease event occurs. We show that this coefficient is the solution of a Lundberg-like equation, and we provide a nonparametric estimation procedure for this measure, based on a Cramér-Lundberg approximation for the tail of the distribution. Using simulations, we provide evidence of the robustness of the approximation to various individual risk models. In addition, we illustrate the relevance of this approach by evaluating the risk associated with a standard patient safety indicator in 20 hospitals of southeastern France.     

How to fight the regulator glut: the role of the HCFA-type survey

More and more hospitals in this country are being threatened by the removal of their Health Care Financing Authority (HCFA) Medicare Certification. A perception of competitiveness among HCFA, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), and other organizations has heightened this concern. This unpleasant situation has provoked many hospitals to prevent any type of regulator decertification. One of the practical methods of prevention is the use of a HCFA-type survey. These surveys prepare institutions for unexpected, unarmored review by regulators and should be part of the quality improvement (QI) process even in institutions with limited resources. This article discusses the means to accomplish the HCFA-type survey. The development of the survey process involves institutional commitment, hospital policy and procedures, a department review schedule, selection of review personnel, preparation of review personnel, record keeping, and department education.     

Managing health care quality.

Using the cited principles of professional staff credentialing and quality assurance, a department chairman, medical director, or other health care executive will be in an excellent position to assess quality of care against established standards and manage problems in the routine provision of medically appropriate care. He or she will also be able to assure the hospital's board that the hospital and its medical staff are well positioned to meet future challenges to provide effective quality, utilization, and risk management.     

Breaking away

While life as hospital employees was comfortable, the lure of independence won out for these two emergency department physicians. Breaking away to develop a new company was not easy, but it's paid off for the entrepreneurs of the Capital Region Emergency Medicine, P.C. Developing an emergency medicine business meant learning all aspects of business: billing services, evaluating legal services, raising capital, and becoming employers. The advantage has been an ability to use profits to improve the moral of staff, an increase in salary, and an overall sense of satisfaction.     

Job satisfaction and occupational stress in UK general hospital nursing staff

This study investigated factors associated with the perceptions of stress reported by nurses in a general hospital environment in the UK. The levels and sources of stress experienced by nursing staff were examined in relation to the type of ward or department, and nursing grade. The association between reported stress and job satisfaction was also examined. By means of a self-completion questionnaire survey, data were collected from 234 nurses from 24 wards in a single general hospital. The Brayfield and Rothe job satisfaction index was used to provide data for analysis. Factor analysis, analysis of variance, and Pearson product moment correlation procedures were performed on these data. The factor analysis identified two main factors concerned with sources of stress: interpersonal relations and resource problems, and dealing with death. Although there were no differences found across wards, the analyses of variance revealed that reported stress varied over different nursing grades. It was also found that job satisfaction was correlated with nursing experience and negatively related to stress.     

Impact of shift work and department type upon strain and attitudinal measures of hospital nurses

The effects of shift work (fixed versus rotating), type of hospital department (intensive care unit versus non-ICU), and job scope on stress and attitudes have been reported previously. The goal of the present study was to examine the interactive, as well as individual, impact of these variables on measures of perceived work stress, strain, work satisfaction and withdrawal intentions. Respondents in the study were nurses in a large general hospital in Israel. None of the two- or three-way interactions received empirical support. However, significant multivariate main effects for each of the three independent measures were found. The negative influence of rotating work shift compared to fixed work shift was supported. Nurses who thought that their job was more enriching were more satisfied and perceived their workload as being lower. Department type affected only burnout level; nurses in non-ICUs were lower in burnout. Several theoretical and practical possible interpretations and possible implications are presented.     

Research on dispatch of drugs and consumables in SPD warehouse of large scale hospital under uncertain environment: take respiratory consumables as an example

This paper studies the supply chain management of medical supply-processing-distribution (SPD) and models the logistics scheduling of drugs and consumables in SPD warehouse under uncertain environment. Firstly, the key management materials are determined, and then SPD distributors are set up for the key management materials to speed up the turnover of drugs and consumables, reduce the loss and unnecessary wastage, and reduce and control the operating costs of hospital departments. This paper establishes an optimization model for achieving the highest total efficiency of drug or consumables distribution and receipt on the premise of sending the least SPD distributors to release the nurses who plan to apply for, count and keep the materials in the second-level warehouse, and return the nursestime to patients. Through the example of SPD distribution of infusion devices consumed by respiratory consumables in a large scale A hospital, the feasibility of using this model to calculate the optimal allocation method of SPD material distributors and the establishment of SPD material distributors in each department is verified. Finally, this paper compares the effects before and after practice and verifies the correctness and effectiveness of the model.

     

Barriers to Swift,Even Flow in the Internal Supply Chain of Perioperative Surgical Services Department: A Case Study*

This research analyzes the internal service supply chain of a perioperative surgical services department of a nonacademic community hospital using the theory of swift and even flow as a theoretical lens. Performance data were gathered using an in‐depth case study and it was determined that the swift and even flow constructs did affect flow speed and variance, but did not account for all the effects observed. To understand the need for departments to coordinate their efforts with each other and how this affected flow, further analysis was conducted using insights from Pagell's (2004) theory of internal integration and Gittell's (2002) research about coordinating mechanisms. The findings suggest the need to incorporate a variable measuring supply chain coordination into the theory of swift and even flow.     

基于流程的部门与岗位职责关系模型与算法

针对职能管理中部门与岗位职责的关系进行了研究,建立了基于业务流程的部门与岗位职责关系概念模型,研究了业务及其流程、岗位与流程节点、部门及其职责的循环作用关系,建立了部门与岗位、岗位与业务流程、业务流程与部门的责任数量分布矩阵与转换算法,以A企业为例对算法的应用与相关实际问题进行了分析。