PubMed · 10166821
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J Nunnelly. 1997. Managing with decision support tools.. https://pubmed.ncbi.nlm.nih.gov/10166821/
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While administrative information systems can assist nurse managers to improve cost containment and resource management of their units, such effects cannot be known without rigorous evaluations. This article presents evaluation results of CLASSICA, an information system designed to provide decision support for nurse managers in financial management, resource allocation, and activity planning. CLASSICA demonstrated a 41% reduction in expenditures for overtime and extra hours during the evaluation period as compared with a 1.8% reduction in control units that did not use the system. Nurse managers reported a substantial improvement in management information and stated that they had gained control over costs. The system helped them analyse the relationships between patient activity, staffing and costs of nursing care. Nurse managers also reported high satisfaction with the system, the information and decision support provided, and its ease of use. These results suggest that CLASSICA is a decision support system that can successfully assist nurse managers in effectively managing their units.
OBJECTIVES: To make preliminary comparisons of Veterans Health Administration (VA) Decision Support System (DSS) patient-level cost information with Medicare allowable reimbursements. METHODS: For six VA facilities in the Evaluating VA Costs study for federal fiscal year 1999, DSS cost estimates for outpatient inguinal hernia and cataract operations and inpatient stays for chronic obstructive pulmonary disease, simple pneumonia, diabetes, and detoxification were compared with Medicare allowable reimbursement amounts for the same procedures and diagnosis-related groups. Medicare average base payments were adjusted for disproportionate share, capital, and indirect medical education costs. The amounts include Medicare's geographic adjustments for wages and capital. Medicare professional fees were a weighted average of site-specific fees paid for the indicated procedure. RESULTS: For the chosen types of care in fiscal year 1999, average DSS cost estimates were generally higher than estimated Medicare allowable reimbursement amounts, but included different amounts of professional services per discharge or outpatient procedure. The difference was greatest for inguinal hernia repair ($3253 US dollars compared with $1506 US dollars). Two diagnosis-related groups for detoxification (434 and 435) were least comparable between the systems because some VA discharges undoubtedly included both acute and nonacute portions of the hospitalizations, whereas the Medicare rates are for acute stays only. CONCLUSIONS: Researchers and managers need DSS detail records to make any meaningful comparisons of the VA's DSS costs and non-VA reimbursement amounts such as those of Medicare. Non-VA reimbursement estimates should include an average of all professional services, including those of anesthesiologists and consultants. Separating acute and nonacute bedsections in DSS data would improve the VA's capability for comparison. Current information is insufficient for make or buy decisions.
Scrutinising recent systematic reviews both on action research and on the management of change in organisations, we have made two observations which, we believe, clarify a rather amorphous literature. First, by comparing formal descriptions of each, action research cannot be clearly distinguished from many other change methodologies. This applies particularly to total quality management (TQM). Both action research and TQM are cyclical activities involving examination of existing processes, change, monitoring the apparent effects of the change and further change. Both emphasise active participation of stakeholders. The examples used to illustrate action research would serve equally well as examples of TQM and vice versa. Second, the methods used in action research are neither specific to action research nor are they of any particular kind. It therefore follows that action research, in so far as it purports to describe a unique or discrete form of research rather than a change process, is a misnomer. Based on these observations, we make two suggestions. Organisational change should be described in terms of the steps actually taken to effect change rather than in 'terms of art' which, like the various brands of post-Freudian psychotherapy, obscure what they have in common rather than illuminate substantive differences. And the research embedded in any cyclical managerial process can have two broad (non-exclusive) aims: to help local service managers to take the next step or to assist managers in other places and in future years to make decisions. These can be described as limited (formative) and general (summative) aims. Whether, or to what extent, a research finding is generalisable across place and time is a matter of judgement and turns on the form of the research and on its context; it is completely independent of whether or not the research was carried out within a cycle of managerial action currently described by terms such as action research or TQM.