Six Sigma to reduce claims processing errors in a healthcare payer firm

Abstract

As a continuous improvement practice, Six Sigma has been accepted globally across the service industry. In the past decade, the application and success of Six Sigma in healthcare services has been remarkable. Despite the fact that several papers on Six Sigma have appeared in the erstwhile literature related to healthcare operations, there is a dearth of field studies highlighting the application of Six Sigma in healthcare outsourced firms, in specific to healthcare payers that engage in a non-clinical setup. The aim of this paper is to explore the role of Six Sigma within the healthcare payer outsourced firms, where error-free delivery becomes critical. The article contributes to the literature of Six Sigma in healthcare outsourcing highlighting how ‘Six Sigma as a methodology’ could help reduce claims adjudication errors in a healthcare payer firm. The Six Sigma DMAIC project case study presented as part of the paper delivered a saving of USD 0.53 million and is a classic example of how Six Sigma can bring bottom-line impact to healthcare outsourced organizations. Managerial implications and lessons learned are discussed alongside the concluding notes.     

Trust‐Level Risk Evaluation and Risk Control Guidance in the NHS East of England

In recent years, the healthcare sector has adopted the use of operational risk assessment tools to help understand the systems issues that lead to patient safety incidents. But although these problem‐focused tools have improved the ability of healthcare organizations to identify hazards, they have not translated into measurable improvements in patient safety. One possible reason for this is a lack of support for the solution‐focused process of risk control. This article describes a content analysis of the risk management strategies, policies, and procedures at all acute (i.e., hospital), mental health, and ambulance trusts (health service organizations) in the East of England area of the British National Health Service. The primary goal was to determine what organizational‐level guidance exists to support risk control practice. A secondary goal was to examine the risk evaluation guidance provided by these trusts. With regard to risk control, we found an almost complete lack of useful guidance to promote good practice. With regard to risk evaluation, the trusts relied exclusively on risk matrices. A number of weaknesses were found in the use of this tool, especially related to the guidance for scoring an event's likelihood. We make a number of recommendations to address these concerns. The guidance assessed provides insufficient support for risk control and risk evaluation. This may present a significant barrier to the success of risk management approaches in improving patient safety.     

购买机制如何影响医疗服务价格？--以美国医疗保险为例

从分析价格形成的三种基本机制入手,对美国不同的医保项目的支付方式进行分类研究,特别是对其定价机制进行了研究,得出了两点结论：美国以支付方式为纽带,通过服务购买谈判方式进行医疗服务定价;医院则依据购买者议价能力,采用不同定价策略,从而形成了支付价格。因而得出：协商谈判在未来是中国医疗服务价格形成的一个重要机制,同时,应改进支付标准的形成机制和建立适合价格谈判的政策环境。     

Prioritizing lean supply chain management initiatives in healthcare service operations: a fuzzy AHP approach

The objective of this study is to investigate the perceptions of practitioners/experts about the prioritisation of healthcare performance measures and their relationship with lean supply chain management (LSCM) practices. The study will also prioritise the drivers and resources required to implement LSCM in a healthcare operations context. The prioritisation is based on the relative weights of various initiatives on a range of performance measures. Twenty-four LSCM initiatives were identified using a comprehensive literature review. Q-sort method was used to divide those initiatives into four categories. Fuzzy AHP was then used to prioritise the four categories based on relative weight of importance of each category on three different performance dimensions. The result shows that continuous improvement is a dominating LSCM initiative in increasing operational and financial performance, while enterprise alignment/integration is a dominating initiative in enhancing organisational image and operational performance. However, lack of homogeneity among LSCM initiatives suggests that there is a need for careful consideration when implementing them in healthcare organisations. Furthermore, customer needs and the influence of competitor’s actions are the most important drivers to encourage hospitals to adopt an LSCM strategy. This is one of the first studies to examine the prioritisation and ranking of LSCM constructs on performance within the context of the healthcare industry.     

接收机自主完好性监测算法研究

卫星导航接收机自主完好性监测RAIM是利用接收机自身的冗余观测值进行卫星故障的检测和识别,根据现有RAIM算法进行故障检测,有较大的漏警率。该文通过研究基于最小二乘残差的故障检测和识别方法,提出了一种改进的RAIM算法,有效地降低了漏警率。该算法在某型号接收机的相关实验中取得了较好的效果。     

Short‐Term Ethnography: Intense Routes to Knowing

In this article, we explore how short‐term theoretically informed ethnography is emerging as an approach to doing research that is contemporary in both its subject matter and in its use for applied research projects designed to lead to informed interventions in the world. We argue that far from being a ‘quick and dirty’ route to doing qualitative research, short‐term ethnography is characterized by forms of intensity that lead to deep and valid ways of knowing.     

The chain is never stronger than its weakest link: implementing a model of collaboration among agencies serving vulnerable children and adolescents

This article analyses agency collaboration to help vulnerable children and adolescents with complex social and psychological problems, examining the implementation of a formal collaboration model for these groups. This model, implemented in Västra Götaland, Sweden, involves five municipal agencies and five county council agencies in 49 different municipalities. Data were collected using two questionnaires sent to 355 lower managers and 424 professional representatives in the concerned organizations. The analysis demonstrates that there are differences in implementation results between the agencies, and that the differences are largely explainable by organizational self-interest and top management prioritization of collaboration model implementation. The main barriers to collaboration are factors modifiable by the agencies themselves, and perceived barriers decreased when the policy was working. The study suggests that managers of human service organizations must assume responsibility when implementing collaboratively, and that accountable professional and political leaders must rise above organizational interests to protect vulnerable citizens.     

人参花苹果汁保健饮料的研制

利用人参花丰富的营养和保健价值。通过去苦技术对人参花提取液进行处理，使人参花微苦的口味和独特的气味得到保持和改良。同时配以苹果汁和木糖醇，通过正交试验确定最佳配比，研制成良好风味且营养丰富的保健饮料。     

Cocaine use among the College Age Group: Biological and Psychological Effects—Clinical and Laboratory Research Findings

Abstract

Though cocaine has been used by man for centuries for both medical and nonmedical reasons, a knowledge of its effect on the human mind and body remains limited and not yet clearly documented. Sources of information consist of myth, street knowledge, animal studies, and clinical and laboratory studies of man. This paper focuses on findings from the latter two sources.

The biological effects of cocaine include the local effects of producing anesthesia and constriction of blood vessels in areas where it is applied topically. Solutions of the drug applied directly to the eye cause the pupils to dilate. Systemic effects include an increase in heart rate and blood pressure. In some individuals, an increase in alertness occurs, and in others a state of drowsiness. The drug also decreases total sleep, REM sleep, and appetite.

The psychological effects of the drug vary with dosage, chronicity, and a host of other variables. Increasing doses over long periods of time appear to cause increasingly severe impairment of affective and cognitive functioning. These effects include a strong psychological craving, making cocaine one of the most powerfully reinforcing of all known substances. In addition, cocaine may induce symptoms ranging from mild euphoria to hyperalertness, hyperactivity, anorexia, insomnia, hypersexuality, and proneness to violence. In others, cocaine may produce sadness, melancholia, apathy, and various symptoms of dysphoria. Depression has been reported to occur in people who stop taking the drug, especially those who have taken the drug intravenously. At high doses taken over a long period of time, cocaine may produce symptoms that mimic acute paranoid psychosis with hallucinations, stereotyped behavior, paranoid delusions, insomnia, and proneness to violence. Finally, cocaine may cause delirium, convulsions, and death from cardiorespiratory failure. With over 30 million individuals in the college age group reported to have taken cocaine, college health personnel must be prepared to diagnose and treat symptoms resulting from cocaine toxicity.