Operationalising lean in healthcare: the impact of professionalism

Abstract

Lean is endorsed as policy in practice in the UK but the challenges and complexities affecting Lean in healthcare are still to be adequately assessed. Through a qualitative single case study of an NHS organisation implementing Lean, 43 interviews with multi-disciplinary team members involved in Lean were conducted. The progress of Lean is found to be inhibited as medical professionals have failed to engage or provide clinical leadership in supporting the trajectory of Lean. This resulted in limited outcomes, sustainability implications, and failed projects. Lean is challenged by complexity and this is evident in conflicts between professional identity, corresponding status and clinical/managerial relationships. Medical professionals as a group have received a limited focus in papers assessing the progress of Lean in Healthcare from an operational perspective. Going forward, strategies for mitigating the negative impact of this can be developed to support operational managers in the healthcare domain.     

Dynamic DEA: A slacks-based measure approach

In data envelopment analysis, there are several methods for measuring efficiency changes over time, e.g. the window analysis and the Malmquist index. However, they usually neglect carry-over activities between two consecutive terms and only focus on the separate time period independently aiming local optimization in a single period, even if these models can take into account the time change effect. In the actual business world, a long time planning and investment is a subject of great concern. For these cases, single period optimization model is not suitable for performance evaluation. To cope with long time point of view, the dynamic DEA model incorporates carry-over activities into the model and enables us to measure period specific efficiency based on the long time optimization during the whole period. Dynamic DEA model proposed by Färe and Grosskopf is the first innovative contribution for such purpose. In this paper we develop their model in the slacks-based measure (SBM) framework, called dynamic SBM (DSBM). The SBM model is non-radial and can deal with inputs/outputs individually, contrary to the radial approaches that assume proportional changes in inputs/outputs. Furthermore, according to the characteristics of carry-overs, we classify them into four categories, i.e. desirable, undesirable, free and fixed. Desirable carry-overs correspond, for example, to profit carried forward and net earned surplus carried to the next term, while undesirable carry-overs include, for example, loss carried forward, bad debt and dead stock. Free and fixed carry-overs indicate, respectively, discretionary and non-discretionary ones. We develop dynamic SBM models that can evaluate the overall efficiency of decision making units for the whole terms as well as the term efficiencies.     

Services culture: A matrix to measure diversity

Services culture differs from goods manufacturing in that customer and employee subcultures are more relevant inputs. The cultural model appears to be structurationist and bottoms-up rather than monolithic and corporate. Analogies with international business suggest adaptation of the Farmer-Richman matrix as a “culture scale” for services. The paper discusses organizational culture, services “differentness,” and the matrix. A hypothetical example drawn from the Citibank case illustrates application of the matrix to a services firm.     

A slack-based measure of efficiency in context-dependent data envelopment analysis

Data envelopment analysis (DEA) has been proven as an excellent data-oriented performance evaluation method when multiple inputs and outputs are present in a set of peer decision-making units (DMUs). In the DEA literature, a context-dependent DEA is developed to provide finer evaluation results by examining the efficiency of DMUs in specific performance levels based upon radial DEA efficiency scores. In DEA, non-zero input and output slacks are very likely to present after the radial efficiency score improvement. Often, these non-zero slack values represent a substantial amount of inefficiency. Therefore, in order to fully measure the inefficiency in DMU's performance, it is very important to also consider the inefficiency represented by the non-zero slacks in the context-dependent DEA. This study proposes a slack-based context-dependent DEA which allows a full evaluation of inefficiency in a DMUs performance. By using slack-based efficiency measure, we obtain different frontier levels and more appropriate performance benchmarks for inefficient DMUs.     

A slacks-based inefficiency measure for a two-stage system with bad outputs

We model the performance of DMUs (decision-making units) using a two-stage network model. In the first stage of production DMUs use inputs to produce an intermediate output that becomes an input to a second stage where final outputs are produced. Previous black box DEA models allowed for non-radial scaling of outputs and inputs and accounted for slacks in the constraints that define the technology. We extend these models and build a performance measure that accounts for a network structure of production. We use our method to estimate the performance of Japanese banks, which use labor, physical capital, and financial equity capital in a first stage to produce an intermediate output of deposits. In the second stage, those deposits become an input in the production of loans and securities investments. The network estimates reveal greater bank inefficiency than do the estimates that treat the bank production process as a black box with all production taking place in a single stage.     

A slacks-based measure of super-efficiency in data envelopment analysis: An alternative approach

The current paper proposes a slack-based version of the Super SBM, which is an alternative super-efficiency model for the SBM proposed by Tone. Our two-stage approach provides the same super-efficiency score as that obtained by the Super SBM model when the evaluated DMU is efficient and yields the same efficiency score as that obtained by the SBM model when the evaluated DMU is inefficient. The projection identified by the Super SBM model may not be strongly Pareto efficient; however, the projection identified from our approach is strongly Pareto efficient.     

A generalisation of the Farrell cost efficiency measure applicable to non-fully competitive settings

This paper enhances cost efficiency measurement methods to account for situations where the input prices can depend on negotiation or tend to qualitatively differentiate the resources available at each decision making unit. In these circumstances, there are some shortcomings in the cost efficiency measure described in the data envelopment analysis (DEA) literature. This paper proposes new models and measures for cost efficiency evaluation that overcome the limitations of the existing DEA models. The applicability of the measures developed is illustrated in the context of the analysis of bank branch performance.     

Efficiency evaluation of banks in China: A dynamic two-stage slacks-based measure approach

Operational processes of banks in China can be divided into productivity and profitability stages. Within this, non-performing loans can be treated as a carry-over variable, an undesirable output of the profitability stage in the previous period but an input to the profitability stage in the current period. Using this framework, this paper proposes a dynamic two-stage slacks-based measure model to evaluate the efficiencies of Chinese banks. Based on the proposed model, the measures of stage, period and period stage efficiencies are defined. The proposed approach is applied to evaluate the operational efficiency of banks in China during 2008–2012. Key findings are that banks in China show both technical and scale inefficiency during 2008–2012, which results from the inefficiencies of both the productivity stage and profitability stage; city-owned commercial banks are more overall technically efficient than state-owned commercial banks and joint-stock commercial banks although state-owned commercial banks show best practice for pure technical efficiency, and city-owned commercial banks perform better than joint-stock commercial banks for pure technical efficiency.     

A slacks-based measure model for calculating cross efficiency in data envelopment analysis

Cross efficiency is a concept for solving the problem of incomparability among the efficiencies of a set of decision making units (DMUs) calculated from different weights in data envelopment analysis, and is helpful for ranking. Conventional cross efficiency is a radial measure, and the radial measure has some weaknesses. First, it is not able to provide appropriate efficiency scores for weakly efficient DMUs. Second, the efficiencies measured from the input and output sides under variable returns to scale are different which may cause difficulties in subsequent analyses. Third, negative values may appear when the efficiency is measured from the input side. To solve these problems, this paper proposes a slacks-based measure to calculate efficiency. The basic idea is the same as that of the radial measure using the frontier corresponding to a DMU to measure the efficiency of all DMUs, except that the efficiency measure is slacks-based instead of radial. Due to the nature of the slacks-based efficiency measure, the problems caused by weak efficiency and difference in input and output radial measures do not exist. More importantly, negative efficiencies are not produced. The proposed method is applied to a real case involving the selection of the most efficient robot to use for production. The results help identify the top-ranked robot.     

基金管理者报酬的线性模型研究与实证分析

探讨了四种跟踪组合回报率与目标回报率间偏差的线性模型 ,线性偏差比传统的二次型偏差更能准确描述投资者的风险态度 ,用线性规划给出了明确的优化方案 ,并对上海证券 A股各分类资产组合作出了实证分析和比较 ,得出为达不同的投资目标投资者确定投资组合及基金管理者报酬的各种优化模型 .     

On qualitative multi-attribute group decision making and its consensus measure: A probability based perspective

This paper focuses on qualitative multi-attribute group decision making (MAGDM) with linguistic information in terms of single linguistic terms and/or flexible linguistic expressions. To do so, we propose a new linguistic decision rule based on the concepts of random preference and stochastic dominance, by a probability based interpretation of weight information. The importance weights and the concept of fuzzy majority are incorporated into both the multi-attribute and collective decision rule by the so-called weighted ordered weighted averaging operator with the input parameters expressed as probability distributions over a linguistic term set. Moreover, a probability based method is proposed to measure the consensus degree between individual and collective overall random preferences based on the concept of stochastic dominance, which also takes both the importance weights and the fuzzy majority into account. As such, our proposed approaches are based on the ordinal semantics of linguistic terms and voting statistics. By this, on one hand, the strict constraint of the uniform linguistic term set in linguistic decision making can be released; on the other hand, the difference and variation of individual opinions can be captured. The proposed approaches can deal with qualitative MAGDM with single linguistic terms and flexible linguistic expressions. Two application examples taken from the literature are used to illuminate the proposed techniques by comparisons with existing studies. The results show that our proposed approaches are comparable with existing studies.     

Meet the mandate to measure clinical quality

The mandate for health care organizations to be accountable for quality, as well as price, is now unavoidable. The Joint Commission's ORYX project is requiring every hospital to measure clinical outcomes of a majority of its patients within the next three years. This mandate can be met best with systems of clinical outcomes measurement that provide valid, reliable risk adjustment; yield meaningful information about many different diseases and procedures; and measure more than mortality or cost--all using primarily billing data. New outcomes measurement tools with all of these capabilities are available and have already enabled quality improvement in dozens of hospitals across the U.S.     

Masstige model and measure for brand management

The purpose of this article is to reconceptualize the term “masstige” (Mass Prestige) marketing, develop a masstige model for brand management, and extend the use of the Masstige Mean Scale (MMS). The study was conducted based on the data from 600 individuals living in the United States, France, and India using a structured questionnaire consisting of different factors/sources of brand equity, such as mass prestige, brand knowledge, and perceived quality. On the basis of the findings, we establish that the greater the brand's Masstige Mean Index (MMI) value (“MMIV”), the higher the potential customers' top-of-mind brand awareness. Low MMIVs imply that firms have a long way to go to build their brands. We argue that MMI may allow firms to measure brand equity in different regions, within a country or in foreign countries, to derive insights into the popularity of their brands. We posit three theoretical propositions and develop two theoretical models (i) a hexagon model and (ii) a three-stage model for masstige marketing to define, reconceptualize, and explain the phenomenon.     

Entrepreneurial openness: Concept development and measure validation

This study introduces entrepreneurial openness as a construct that helps understanding the impact of entrepreneur's personality on small firm's performance. We draw from the entrepreneurship and positive psychology literature to conceptualize entrepreneurial openness as an individual-level positive personal cognitive strength that has three subdimensions: engaging in learning, searching for novelty, and seeking feedback. We validated the construct's structure in three consecutive studies: Study 1 provided initial empirical evidence in support of the proposed scale with a pilot sample of Slovenian business owners; Study 2 assessed the reliability and validity of the scale with a cross-cultural study in Canada, Slovenia, and USA; and Study 3 tested the scale for its impact on business performance and job satisfaction. Findings from our empirical studies demonstrate the utility of entrepreneurial openness in explaining firm's performance by showing strong reliability, appropriate dimensionality, convergent, discriminant, and nomological validity.     

Using leadership criteria to measure and reward performance

Physicians speak of performance and outcomes. They speak of customers and patients. While many leaders nod their heads, shake hands in agreement, and establish liaisons, agreements are implemented without an appropriate understanding of how to recognize and measure leadership performance. How are physicians and other management team members measured? Are you measuring the right things? Physician executives should be measured for simplicity, for streamlining, for standardization, and for knowing the right processes. That's productivity. They should be measured for taking risks, for being creative, and for exploring and initiating new ways to use existing resources. That's entrepreneurship. And they should be measured for kindness, for empathy, for building trust, for sharing with colleagues, and for working together. That's teamwork.     

基于多标度分形理论的金融风险测度指标研究

多标度分形(multifractal)理论是一种刻画金融市场波动复杂性特征的有力工具,而金融价格时间序列的多标度分形谱(multifractal spectrum)则是对测度对象复杂性特征的一种具体和全面的描述.以上海证券交易所综合股价指数高频价格时间序列的多标度分形谱计算为例,建立了基于多标度分形谱两个主要参数的市场风险测度指标Rf,弥补了传统风险测度指标在非有效市场条件下的不足.通过对上证综指的实证研究验证了这一指标的有效性,并对其在价格波动预测方面的作用进行了初步的探讨和理论解释.