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PubMed2003

Identification and verification of critical performance dimensions. Phase 1 of the systematic process redesign of drug distribution.

BACKGROUND: Worldwide patient safety has become a major social policy problem for healthcare organisations. As in other organisations, the patients in our hospital also suffer from an inadequate distribution process, as becomes clear from incident reports involving medication errors. Medisch Spectrum Twente is a top primary-care, clinical, teaching hospital. The hospital pharmacy takes care of 1070 internal beds and 1120 beds in an affiliated psychiatric hospital and nursing homes. OBJECTIVE: In the beginning of 1999, our pharmacy group started a large interdisciplinary research project to develop a safe, effective and efficient drug distribution system by using systematic process redesign. The process redesign includes both organisational and technological components. This article describes the identification and verification of critical performance dimensions for the design of drug distribution processes in hospitals (phase 1 of the systematic process redesign of drug distribution). METHODS: Based on reported errors and related causes, we suggested six generic performance domains. To assess the role of the performance dimensions, we used three approaches: flowcharts, interviews with stakeholders and review of the existing performance using time studies and medication error studies. CONCLUSIONS: We were able to set targets for costs, quality of information, responsiveness, employee satisfaction, and degree of innovation. We still have to establish what drug distribution system, in respect of quality and cost-effectiveness, represents the best and most cost-effective way of preventing medication errors. We intend to develop an evaluation model, using the critical performance dimensions as a starting point. This model can be used as a simulation template to compare different drug distribution concepts in order to define the differences in quality and cost-effectiveness.

Attitude of Health Personnel↗
PubMed1987

The distributional implications of using relative prices in DRG payment systems.

Decisions by state Medicaid programs and other third-party payers to use DRGs as the basis of hospital payment require the resolution of numerous technical design issues, including determining relative price schedules, that are likely to have important distributional implications for payers and hospitals. At issue is the development of price schedules that reflect average resource use in the populations using DRG reimbursement. An examination of differences between the Medicare relative prices and other relative prices based on different populations in New York State revealed that significant cross-subsidies among payers and hospitals would occur if Medicare relative prices were used as the basis of payment for patients outside the Medicare program. Such unintended cross-subsidies would compromise a major goal of DRG payment: to reduce "inequitable" charge and cost differentials among third-party payers.

Blue Cross Blue Shield Insurance Plans↗
PubMed1999

Use of a control chart to monitor diarrhoea admissions: a quality improvement exercise in West Kalimantan Provincial Hospital, Pontianak, Indonesia.

Data on the number of admissions for diarrhoea each week to the West Kalimantan Provincial Hospital, Pontianak, Indonesia over a 5 year period, 1992-1996, were collected. After cleaning and exclusion of extreme values, transformation was then performed to ensure that the data were free of special cause variation and normally distributed. A control chart was then constructed to provide an 'early warning' system for hospital authorities in order to facilitate the management of the epidemic and to improve patient care.

Adult↗
PubMed1988

Marketing-oriented organizations: an integrated approach.

Organizations can be oriented toward marketing from a production, product, sales, or marketing perspective. Strategies, structures, and cultures, which reflect a company's basic orientation, must be integrated to ensure that marketing efforts communicate a clear corporate position. In a study of 31 hospitals, the Center for Health Services Education Research, St. Louis University, found that no hospital's organization fit neatly into a single category. For example, a hospital may have some service lines that were marketing oriented while other lines were production oriented. The majority of hospitals, however, were product oriented, focusing on productivity and financial performance rather than on market factors. The most effective sales orientation was observed in the for-profits. Their selling efforts, however, tended to be internally focused, with product development activities divorced from the planning and marketing functions. Only the for-profit hospitals showed the beginning of a marketing orientation. Developing a marketing orientation, especially in line divisions, requires a careful, well-orchestrated effort and the presence of several key factors: Access to capital and an emphasis on long-range planning and strategic spending The availability of hospital-specific market research. Key distribution channels. Talented middle managers. Up-to-date systems and structures equipped to serve new values and strategies. Leaders capable of communicating to the organization a vision of its role in the community.

Hospital Administration↗
PubMed2004

Dealing with organizational change when implementing EHR systems.

Over the past years researchers at Aalborg University have been developing a method for examining change readiness of hospital staff during the implementation of new IT-systems. (CRR; Change readiness-research). The aim is to provide the hospital-management with a tool that will lead to an optimal implementation of new IT-systems. The method has recently been used in department Y at Skejby Hospital, Skejby, Denmark. 81% out of 241 employees answered the distributed questionnaire, and the results showed, that the employees have some expectations to the new EHR-system, which are important to either confirm or reject; on the other hand a great part of the employees lack basic computer skills. Thus the CRR-method has provided the Organization with important information before the implementation of the new EHR-system.

Attitude of Health Personnel↗
PubMed1991

[Distribution of admission costs].

This article is based on a system of information at hospital and departmental level (clinical-economical method of analysis). The method and its employment in planning adjustments to the increasing requirements have been reviewed in previous articles. The analysis may also be employed for description of the expenses involved in admission of various patients groups, one of the objects being review of the employment of resources in departments and hospitals and their relationships to the composition of the patients populations involved. Some of the results of description of the expenses from Ringkøbing Hospital in 1988 are demonstrated.

Adolescent↗
PubMed1997

Emergency Health Care Information System for Bucharest-Romania.

The Emergency Health Care Information System (EHCIS) in Bucharest provides information about the whole activity of Dispatch Emergency Ambulance Service and Emergency Receiving Room of the 7 Hospitals, providing emergency health care in Bucharest over a MAN (Metropolitan Area Network). In each of these places a local network is located, containing a database server ORACLE. The link among LANs is made via switched lines. The Hospitals collect information only about emergency cases. The microstation represents station for emergency teams of Emergency Ambulance Service of Bucharest (EASB), distributed in all 6 districts of Bucharest. The system is structured accordingly with the working-groups existing in Dispatch, microstations and hospitals: registration operators (phone-operators) for administer the emergency requests/calls; a location for the medical coordinator which must to choose, in few seconds, the emergency team, accordingly with the case emergency degree; radio-operators which communicate with the teams in the field; a location for the manager of Dispatch, in order to provide a full-set of real-time medical and resources information; a registration operator at each microstation; a registration operator at each hospital. The data are registered in the ORACLE database on the central server. The client/server architecture assures the real time communication among all these locations. The system works 7 days/week, 24 hours/day.

Ambulances↗
PubMed1983

The use of Selectron afterloading equipment to simulate and extend the Manchester System for intracavitary therapy of the cervix uteri.

When Selectron afterloading machines were introduced in the Christie Hospital the first aim was to reproduce, as closely as possible, the isodose distributions achieved with the traditional Manchester Radium System. This resulted in the establishment of standard pellet loading patterns, and standard treatment times, for programming the Selectron channels. However, the availability of whole-body CT scanning facilities provides a method of accurately locating the source positions with respect to the local anatomy and hence the possibility of dosage control based on doses to specific pelvic structures. Various computer programs have been written to extract source position data from the CT images, to allow the operator to propose pellet loading patterns and treatment times, and ultimately to display the resultant isodose distribution superposed on the cross-sectional scans. The effects on the dose distribution arising from changing the number of pellets, the pellet positions within the applicators, and the treatment times, are briefly discussed.

Brachytherapy↗
PubMed1999

A diversity of blood smear examination system of Thai public hospital.

A good laboratory practice is the heart of clinical laboratory quality. One must establish a standard system in order to achieve the quality. However, standard system is not only the technical but also a state of the art. The socioeconomic and culture are the influence factors. At present, technique of reporting the blood smear examination is still a nation controversy. We surveyed the blood smear examination reporting system of the public hospital in Thailand. There were 77 hospitals participated in this study. A questionnaire comprised of 23 questions was distributed to 105 clinical laboratory staffs of the public health hospitals. Results showed that there was a diversity of blood smear examination reporting system. Generally, there were 2 ways of blood smear review. Every smeared slide and only abnormal slides were re-examined by the conventional technique. When an abnormal white blood cell blood picture was observed. The presence of either blast cell or atypical lymphocyte has clinical significance. A majority of laboratory would report in form "counting number of abnormal cell within 100% of the differential count". For other abnormalities of white blood cell; i.e. the neutrophils with toxic granules, most of laboratory reported as "presence". Interestingly, the red blood cell reporting system varied from laboratory to laboratory. There was a total of nine reporting patterns. Results indicated that pattern 4 (few or some, 1+,2+,3+,4+ are 5-10%, 11-25%, 26-50%, 51-75% and 51-100% cell/oil field, respectively) was the most popular one in reporting anisocytosis and poikilocytosis. However, the reporting pattern on red blood cell staining was difference. Pattern 4 and pattern 7 (grading by the size of central pallor) obtained a same popularity on the consideration of hypochromia. But the pattern 9 (few or some, 1+,2+,3+ are 0-1, 1-3, 4-6 and >6 cell/oil field, respectively) was the most frequently used in reporting of polychromasia. Fortunately we found that the reporting system for platelet was not complicated. A majority of laboratory chose the qualitative pattern (reporting as adequate, increased and decreased). Our study indicated that Thai clinical laboratory encounter a diversity of blood smear reporting system. Every clinical laboratory should pay a great attention to this circumstance. Since a good laboratory practice is a knot of the knot-bolt system of healthcare service, therefore, a nation standard system must be established in the near future.

Hematologic Tests↗
PubMed1994

Health care expenditures for the elderly and reforms in the health care system in Japan.

In recent times, significant reforms have been instituted in Japan's health care system, such as the introduction of hospital categorization and the clarification of hospital roles, together with the establishment of geriatric health care facilities, and the reform of the pharmaceutical distribution and pricing system. These reforms are expected to improve the efficiency and quality of the health care system in Japan and to provide better care for the aging society. The changes will also eventually affect health care costs and patterns of services. This paper describes Japan's health care system, including the recent reforms, and then examines the costs and patterns of health care services for the elderly in the light of the recent changes in the system. While more resource allocation is necessary for training of workers for nursing, rehabilitation and care-giving, drugs should be more cost-effective and fit for use at home and in non-medically oriented institutions. Health care providers, health care industries and the government need further to properly respond to the changes in demography, patterns of diseases and disabilities and patients' wishes for better quality of life.

Aged↗