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.     

On the Integration of Science and Practice in College Health

Abstract

College health professionals want to assure the unique healthcare and health education needs of college students will continue to be met under national and state healthcare reform. This may be an “all or nothing” proposition. Either colleges and universities will have exclusive control of healthcare delivery for the college student population or else college health will not be a major force in healthcare reform. If college health is to play a meaningful role in future government-controlled health insurance programs, it must first demonstrate that current health services and insurance financing programs meet minimum quality standards. This proposal calls for expanding existing federal laws to create qualified student health plans and integrating the college health model into a reform package based on employer-sponsored health insurance. The concept of qualified student health plans allows for a high degree of flexibility that can be integrated into the majority of state and federal healthcare reform proposals, including the plan proposed by President Clinton, that are not based on a single-payer system. Ultimately, the authors suggest, their proposed plan would eliminate the current situation, in which large numbers of college students are uninsured or underinsured.     

The healthcare supply network: current state of the literature and research opportunities

Abstract

This literature review maps recent studies addressing supply chain management (SCM) in the healthcare sector through a systematic approach that synthesises 74 empirical studies (2006–2016). Our approach adopts a network lens to map the literature and offers key contributions to the field. First, we show that there is a lack of network level studies. Second, there is an imbalance of research attention regarding the various types of supply, namely health services, medicines, medical supplies and blood supply. Third, we underline the advantages of the network lens, indicating network actors and flows between those actors that need further research. Fourth, we show an alarming lack of theoretical lens in healthcare SCM studies and draw attention to the fact that even when explicitly adopting a theory, some studies show inconsistencies between theoretical lens and level of analysis. Ultimately, we offer a map of future research for healthcare SCM through a network lens in order to improve the understanding the complexities of the healthcare sector.     

The effect of capacity management strategies on employees' well-being: A quantitative investigation into the long-term healthcare industry

The aim of this study is to understand the effects of different capacity management strategies on the well-being of employees in long-term healthcare organizations. Such strategies may produce psychological effects in terms of job satisfaction and well-being among employees, namely frontline employees, thus affecting service quality. We collected 2158 observations from 42 nursing homes in Italy. Our results show that all capacity management strategies addressed in this study can influence the perceived degree of fatigue or of job hazard, and some of them can influence both. Moreover, a better perception of job hazard and fatigue leads to a higher degree of reported well-being from employees, although with the former, it is only through the mediation of job satisfaction. We conclude our paper by discussing theoretical contributions and policy implications.     

Amplifying accountability by benchmarking results at district and national levels

This multi‐level ethnography of the Zambian health system illustrates the importance of top‐down accountability, and how it has emerged in a historically neglected sector. Maternal healthcare indicators are prioritized when they are benchmarked, at district and national levels. The realization that Zambia was lagging behind African countries in making progress towards Millennium Development Goal (MDG) 5 (to reduce the maternal mortality ratio by three quarters) appears to have evoked reputational concerns and revealed inspirational possibilities. Growing prioritization also stems from a change in incentives, with some partner funding being conditional on the proportion of deliveries attended by skilled health personnel.     

Fairness of the national health service in Italy: a bivariate correlated random effects model

The primary purpose of this paper is to comprehensively assess households’ burden due to health payments. Starting from the fairness approach developed by the World Health Organization, we analyse the burden of healthcare payments on Italian households by modeling catastrophic payments and impoverishment due to healthcare expenditures. For this purpose, we propose to extend the analysis of fairness in financing contribution through a generalized linear mixed models by introducing a bivariate correlated random effects model, where association between the outcomes is modeled through individual- and outcome-specific latent effects which are assumed to be correlated. We discuss model parameter estimation in a finite mixture context. By using such model specification, the fairness of the Italian national health service is investigated.     

Nursing a Grievance? The Role of Healthcare Assistants in a Modernized National Health Service

The complex division of labour in health care has encouraged the analysis of occupational boundary disputes between separate professions. Less attention has been directed at the divisions in individual occupational groups but in a context of intensive health sector workforce reform there has been a growth in lower status occupations. This article extends debate about lower status occupations by exploring the manner in which nurses and healthcare assistants engage in boundary work to advance their occupational interests. The UK government's modernization agenda has encouraged a more prominent role for healthcare assistants and the findings confirm that this agenda has reinforced occupational boundary disputes between nurses and healthcare assistants. Tensions between nurses and healthcare assistants took particular forms influenced by gendered notions of caring work. The consequences of these boundary management strategies in terms of work undertaken, pay and status are also explored.     

Mobilising patients towards transnational healthcare markets – insights into the mobilising work of medical travel facilitators in Delhi

ABSTRACT

Medical travel facilitators play an important role in mobilising patients towards transnational healthcare markets. However, little is known about the actual mobilising work of medical travel facilitators located at destination sites, such as Delhi, India. The following ethnographic study suggests conceptualising medical travel facilitators as brokers who are productive of a mobility infrastructure. This allows categorising three mobilisation strategies: direct patient mobilisation, channel partner mobilisation and patient testimonial mobilisation. These strategies draw attention to practices that build trust over distance, the power of word-of-mouth and the importance of nurturing personal relationships that translate into transnational channels that direct people to particular destinations.     

C19. Bayesian oedemology

The fitting of age-dependent HIV incidence models to AIDS data is a computationally intensive task, particularly when allowance is made for non-proportional dependence of the infection rate on age. This paper presents a computational alternative to a very intensive method described by Rosenberg (1994). Our approach is to use the EM algorithm on a discretized form of the model used by Rosenberg (1994). The EM approach has certain attractive features including ease of implementation and flexibility. of model specification. It also conveniently generalizes to allow smoothed estimation and less detailed forms of age-specific AIDS data.     

Healthcare Experiences of Latinos in a Nontraditional Destination Area

The purpose of this study was to describe the health and healthcare experiences of immigrant Latinos compared to USA-born Latinos, Whites, and African Americans in Greater Cincinnati, Ohio, a nontraditional immigrant destination area. Immigrant Latinos had significantly worse physical and mental health than other groups and significantly more barriers to healthcare. Latinos rated the degree to which their town is socially accepting of Latinos. Lower social acceptance was correlated with worse mental health and more barriers to healthcare. Geographic information system (GIS) mapping techniques revealed geographic patterns in the association between social acceptance of Latinos and health outcomes.