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Most of the current literature on healthcare operations management is focused on importing principles and methods from manufacturing. The evidence of success is scattered and nowhere near what has been achieved in other industries. This book develops the idea that the logic of production, and production systems in healthcare is significantly different. A line of thing that acknowledges the ingenious characteristics of health service production is developed. This book builds on a managerial segmentation of healthcare based on fundamental demand-supply constellations. Demand can be classified with the variables urgency, severity, and randomness. Supply is constrained by medical technology (accuracy of diagnostics, efficacy of therapies), patient health behavior (co-creation of health), and resource availability. Out of this emerge seven demand-supply-based operational types (DSO): prevention, emergencies, one-visit, electives, cure, care, and projects. Each of these have distinct managerial characteristics, such as time-perspective, level of co-creation, value proposition, revenue structure, productivity and other key performance indicators (KPI). The DSOs can be envisioned as platforms upon which clinical modules are attached. For example, any Emergency Department (ED) must be managed to deal with prioritization, time-windows, agitated patients, the necessity to save and stabilize, and variability in demand. Specific clinical assets and skill-sets are required for, say, massive trauma, strokes, cardiac events, or poisoning. While representing different specialties of clinical medicine they, when applied in the emergency – context, must conform to the demand-supply-based operating logic. A basic assumption in this book is that the perceived complexity of healthcare arises from the conflicting demands of the DSO and the clinical realms. The seven DSOs can neatly be juxtaposed on the much-used Business Model Canvas (BMC), which postulates the business model elements as value proposition; customer segments, channels and relations; key activities, resources and partners; the cost structure; and the revenue model.
What is ‘good care’ and does more choice lead to better care? This innovative and compelling work investigates good care and argues that the often touted ideal of ‘patient choice’ will not improve healthcare in the ways hoped for by its advocates.
This book offers an overview of service design practices for healthcare and hospital management. It explores how these practices can help to generate innovations in healthcare and contribute to the improvement of patient-centered care. Respected experts, including scholars from various disciplines and practitioners from healthcare institutions, share essential insights into established research areas, fields of work and work structures, and discuss successful approaches, methods and tools. By illustrating innovative services, products, processes, systems, and technologies, as well as their application in practice, the authors highlight the role of participating stakeholders in service design projects and the added value that comes from sharing, communicating, networking and collaborating. This book is a must-read for scholars and practitioners in the hospital and healthcare sector. It will also appeal to anyone interested in organizational development, service business model innovation, customer involvement and perceptions, and service experience.
Winner of the 1983 Pulitzer Prize and the Bancroft Prize in American History, this is a landmark history of how the entire American health care system of doctors, hospitals, health plans, and government programs has evolved over the last two centuries. "The definitive social history of the medical profession in America....A monumental achievement."—H. Jack Geiger, M.D., New York Times Book Review
Universal, comprehensive health care, equally available to all and disconnected from income and the ability to pay, was the goal of the founders of the National Health Service. This book, by one of the NHS's most eloquent and passionate defenders, tells the story of how that ideal has been progressively eroded, and how the clock is being turned back to pre-NHS days, when health care was a commodity, fully available only to those with money. How this has come about-to the point where even the shrinking core of free NHS hospital services is being handed over to private providers at the taxpayers' expense-is still not widely understood, hidden behind slogans like "care in the community," "diversity" and "local ownership." Allyson Pollock demystifies these terms, and in doing so presents a clear and powerful analysis of the transition from a comprehensive and universal service to New Labour's "mixed economy of health care," in which hospitals with foundation status, loosely supervised by an independent regulator, will be run on largely market principles. The NHS remains popular, Pollock argues, precisely because it created the "freedom from fear" that its founders promised, and because its integrated, non-commercial character meant low costs and good medical practice. Restoring these values in today's health service has become an urgent necessity, and this book will be a key resource for everyone wishing to to bring this about.
The evidence is undeniable. By any measure, the US spends more on healthcare than any other country in the world, yet its health outcomes as measure by longevity are in the bottom half among developed countries, and its health-related quality of life has remained constant or declined since 1998. In addition to high costs and lower than expected outcomes, the healthcare delivery system is plagues by treatment delays as it can take weeks to see a specialist, and many people have limited or no access to care. Part of the challenge is that the healthcare delivery system is a large, complex, and sophisticated value creation chain. Successfully changing this highly interconnected system is difficult and time consuming because the underlying problems are hard to comprehend, the root causes are many, the solution is unclear, and the relationships among problems, causes, and solution are multifaceted. To address these issues, the book carefully explains the underlying problems, examines their root causes using information, data, and logic, and presents a comprehensive and integrated solution that addresses these causes. These three steps are the methodological backbone of this book. A solution depends on understanding and applying the principles of patient-centered care (PCC) and resource management. PCC puts patients, supported by their primary care physicians, back in the role as decision makers and depends on patients being responsible for their health including making good life-style choices. After all, the best way to reduce healthcare costs and increase quality of life is to improve our health and wellness and as a result need less care. In addition, health insurance must be rethought and redesigned so it is less likely to lead to overuse. For many people with health insurance, the out-of-pocket cost of healthcare are small, so healthcare decision making is often biased toward consumption. Effective resource management means that healthcare providers must do a better job of acquiring and using resources in order to provide care quickly, productively, and correctly. This means improving healthcare strategy and management, accelerating the use of information technology, making drug costs affordable and fair, reducing the incidence of malpractice, and rebuilding the provider network. In addition, implementation is difficult because there are many participants in the healthcare delivery value chain, such as physicians, nurses, and medical technicians, as well as many provider organizations, such as hospitals, clinics, physician offices, and labs. Further up the value chain there are pharmaceutical companies, equipment providers, and other suppliers. These participants have diverse and sometimes conflicting goals, but each must be willing to accept change and work in a coordinated manner to improve healthcare. To overcome these problems, strong national leadership is needed to get the attention and support from the people and organizations involved in healthcare and to make the comprehensive changes that will lower healthcare costs, improve healthcare quality, eliminate delays, increase access, and enhance patient satisfaction.
Leadership in Healthcare opens up the world of leadership studies to all healthcare professionals. Physicians, nurses, and other healthcare professionals spend thousands of hours studying the science and technology of healthcare, and years or even decades putting into practice recent findings in molecular biology, clinical diagnostics, and therapeutics. By contrast, the topic of leadership and the traits of effective leaders tend to receive remarkably little attention. Yet no less vital than an understanding of how to interpret diagnostic tests and design care plans is a grasp of healthcare's organizational side, including the operation of multidisciplinary care teams, academic departments, and hospitals. If patient care, education, research, and professional service are to thrive in years to come, we must do a better job of preparing healthcare professionals to lead effectively. Composed of insightful and thought-provoking essays on the key facets of leadership, this book is designed to meet the needs of several important constituencies, including educators of health professionals who wish to incorporate leadership into their educational programs; health professional organizations seeking to enhance their members' leadership effectiveness, and individual health professionals who wish to embrace leadership in their personal and professional lives. This book represents a vital resource for health professionals who wish to enhance the quality of leadership in health professions education, practice, and professional development. In addition to regularly caring for patients, Richard Gunderman, MD PhD MPH brings to this discussion a wealth of personal experience in professional and organizational leadership.
Looks at the USA, Britain and Canada to offer an international comparative study of public policy systems, as well as a recent history of the evolution of each national health care system. The book explores what drives change and why certain changes occur in some nations and not in others.
"What is going to happen to me?" Most patients ask this question during a clinical encounter with a health professional. As well as learning what problem they have (diagnosis) and what needs to be done about it (treatment), patients want to know about their future health and wellbeing (prognosis). Prognosis research can provide answers to this question and satisfy the need for individuals to understand the possible outcomes of their condition, with and without treatment. Central to modern medical practise, the topic of prognosis is the basis of decision making in healthcare and policy development. It translates basic and clinical science into practical care for patients and populations. Prognosis Research in Healthcare: Concepts, Methods and Impact provides a comprehensive overview of the field of prognosis and prognosis research and gives a global perspective on how prognosis research and prognostic information can improve the outcomes of healthcare. It details how to design, carry out, analyse and report prognosis studies, and how prognostic information can be the basis for tailored, personalised healthcare. In particular, the book discusses how information about the characteristics of people, their health, and environment can be used to predict an individual's future health. Prognosis Research in Healthcare: Concepts, Methods and Impact, addresses all types of prognosis research and provides a practical step-by-step guide to undertaking and interpreting prognosis research studies, ideal for medical students, health researchers, healthcare professionals and methodologists, as well as for guideline and policy makers in healthcare wishing to learn more about the field of prognosis.
This insightful study examines the deeply personal and heart-wrenching tensions among financial considerations, emotional attachments, and moral arguments that motivate end-of-life decisions. America’s health care system was built on the principle that life should be prolonged whenever possible, regardless of the costs. This commitment has often meant that patients spend their last days suffering from heroic interventions that extend their life by only weeks or months. Increasingly, this approach to end-of-life care is coming under scrutiny, from a moral as well as a financial perspective. Sociologist Roi Livne documents the rise and effectiveness of hospice and palliative care, and growing acceptance of the idea that a life consumed by suffering may not be worth living. Values at the End of Life combines an in-depth historical analysis with an extensive study conducted in three hospitals, where Livne observed terminally ill patients, their families, and caregivers negotiating treatment. Livne describes the ambivalent, conflicted moments when people articulate and act on their moral intuitions about dying. Interviews with medical staff allowed him to isolate the strategies clinicians use to help families understand their options. As Livne discovered, clinicians are advancing the idea that invasive, expensive hospital procedures often compound a patient’s suffering. Affluent, educated families were more readily persuaded by this moral calculus than those of less means. Once defiant of death—or even in denial—many American families and professionals in the health care system are beginning to embrace the notion that less treatment in the end may be better treatment.