Using technology to promote the development of health science libraries in China.

From the point of view of the development of libraries, technology has made possible the emergence and development of library automation; digital libraries; mobile libraries; and smart libraries. This article briefly describes the impact of technological developments and application in Health Science Libraries in China in relation to collections development, service provision and the role of library associations.

Using data envelopment analysis to perform benchmarking in intensive care units.

BACKGROUND: Studies using Data Envelopment Analysis to benchmark Intensive Care Units (ICUs) are scarce. Previous studies have focused on comparing efficiency using only performance metrics, without accounting for resources. Hence, we aimed to perform a benchmarking analysis of ICUs using data envelopment analysis. METHODS: We performed a retrospective analysis on observational data of patients admitted to ICUs in Brazil (ORCHESTRA Study). The outputs in our data envelopment analysis model were the performance metrics: Standardized Mortality Ratio (SMR) and Standardized Resource Use (SRU); whereas the inputs consisted of three groups of variables that represented staffing patterns, structure, and strain, thus resulting in three models. We compared efficient and non-efficient units for each model. In addition, we compared our results to the efficiency matrix method and presented targets to each non-efficient unit. RESULTS: We performed benchmarking in 93 ICUs and 129,680 patients. The median age was 64 years old, and mortality was 12%. Median SMR was 1.00 [interquartile range (IQR): 0.79-1.21] and SRU was 1.15 [IQR: 0.95-1.56]. Efficient units presented lower median physicians per bed ratio (1.44 [IQR: 1.18-1.88] vs. 1.7 [IQR: 1.36-2.00]) and nursing workload (168 hours [IQR: 168-291] vs 396 hours [IQR: 336-672]) but higher nurses per bed ratio (2.02 [1.16-2.48] vs. 1.71 [1.43-2.36]) compared to non-efficient units. Units from for-profit hospitals and specialized ICUs presented the best efficiency scores. Our results were mostly in line with the efficiency matrix method: the efficiency units in our models were mostly in the "most efficient" quadrant. CONCLUSION: Data envelopment analysis provides managers the information needed to identify not only the outcomes to be achieved but what are the levels of resources needed to provide efficient care. Different perspectives can be achieved depending on the chosen variables. Its use jointly with the efficiency matrix can provide deeper understanding of ICU performance and efficiency.

FASStR: a framework for ensuring high-quality operational metrics in health care.

OBJECTIVES: Poorly defined measurement impairs interinstitutional comparison, interpretation of results, and process improvement in health care operations. We sought to develop a unifying framework that could be used by administrators, practitioners, and investigators to help define and document operational performance measures that are comparable and reproducible. STUDY DESIGN: Retrospective analysis. METHODS: Health care operations and clinical investigators used an iterative process consisting of (1) literature review, (2) expert assessment and collaborative design, and (3) end-user feedback. We sampled the literature from the medical, health systems research, and health care operations (business and engineering) disciplines to assemble a representative sample of studies in which outpatient health care performance metrics were used to describe the primary or secondary outcome of the research. RESULTS: We identified 2 primary deficiencies in outpatient performance metric definitions: incompletion and inconsistency. From our review of performance metrics, we propose the FASStR framework for the Focus, Activity, Statistic, Scale type, and Reference dimensions of a performance metric. The FASStR framework is a method by which performance metrics can be developed and examined from a multidimensional perspective to evaluate their comprehensiveness and clarity. The framework was tested and revised in an iterative process with both practitioners and investigators. CONCLUSIONS: The FASStR framework can guide the design, development, and implementation of operational metrics in outpatient health care settings. Further, this framework can assist investigators in the evaluation of the metrics that they are using. Overall, the FASStR framework can result in clearer, more consistent use and evaluation of outpatient performance metrics.

Stop Doing Needless Things! Saving Healthcare Resources During COVID-19 and Beyond.

The COVID-19 outbreak is putting tremendous strain on the US healthcare system, with a direct impact on medical professionals, hospital systems, and physical resources. While comprehensive public health and regulatory efforts are essential to overcome this crisis, it is important to recognize this moment as an opportunity to provide more intelligent and more efficient care in spite of increasing patient volumes and fewer resources. Specifically, we must limit unnecessary and wasteful medical practices and improve the delivery of those services which enhance the quality of patient care. In doing so, we will increase availability of the critical resources required for the provision of high-quality care to those in greatest need both now and in the future.

Trends in the 10-year history of the vascular integrated residency match: More work, higher cost, same result.

OBJECTIVE: The purpose of this study was to examine trends in application submission, rank lists, and applicant quality for vascular surgery integrated residency. METHODS: The National Resident Matching Program Results and Data reports and the Electronic Residency Application Service Statistics from 2007 to 2017 were compiled and mined for trends in terms of application submission and the number of applicants a program needed to rank to fill all residency positions. Applicant pool depth and percentage of programs applied to were calculated. Outcome data from the National Resident Matching Program were reviewed for 2014 and 2016 for United States Medical Licensing Examination Step scores and experiences. RESULTS: During the last 10 years, the number of vascular surgery integrated residency spots rose from 9 to 60 per year. Most programs offer one spot per year; none offer more than two. The average number of applications received by programs rose from 17 applications in 2008 to 63.8 in 2017. The average rank list depth needed by programs to fill the spots has not increased (range, 2.5-5.1; standard deviation, 0.73). The proportional depth of the applicant pool decreased from 4.6 U.S. and Canadian applicants for every one residency spot in 2008 to 1.7 applicants for every one residency spot in 2017. Applicant quality metrics were available for 2 years (2014 and 2016). Step 1 scores (237/239), Step 2 scores (250/250), research experiences (3.7/4.2), and volunteer experiences (5.9/5.5) remained nearly unchanged. The number of contiguous ranks for matched applicants remained stable (12.3/12.8). CONCLUSIONS: The current system promotes multiple inefficiencies, resulting in application glut. Fewer applicants are flooding programs with an increasing number of applications. More money is being spent on Electronic Residency Application Service applications without changes in the number needed to rank by applicants or programs to achieve a match. There is no improvement in the quality of the applicant. Should these trends continue, they represent an unsustainable model for resident selection.

Artificial Intelligence and Nursing: The Future Is Now.

As systems evolve over time, their natural tendency is to become increasingly more complex. Studies in the field of complex systems have generated new perspectives on the application of management strategies in health systems. Much of this research appears as a natural extension of the cross-disciplinary field of systems theory. Since writing my 1st article for Managing Organizational Complexity in 2004, much has happened to further our understanding of complexity in healthcare systems. The growth of new computational methods in the fields of data science and data analytics has allowed scientists to identify signals or patterns in large complex data sets (big data) that in the past were seemingly hidden. Rather than relying on historical statistical methods to infer outcomes, these advanced methods combined with increased computer processing power allow machines to learn the structure of data and create artificial intelligence (AI). In our ongoing efforts to find solutions for complex healthcare problems, AI is becoming more and more an accepted method. The purpose of this edition of Managing Organizational Complexity is to define AI and machine learning, discuss the recent resurgence of AI, and then provide examples of how AI can provide value to healthcare with an emphasis on nursing.

Identifying the contribution to hospital performance among Chinese regions by an aggregate directional distance function.

In this paper, we examine efficiency and total factor productivity for hospitals operating in China between the years of 2009-2016. Given reforms in China focusing on the hospital sector, it has been demonstrated that efficiency and productivity are important in meeting the overall objective of meeting more accessibility to hospital care for the population. Measuring an aggregate directional distance function is in itself a non-parametric approach, we report on the decomposition of hospital performance and found that between 2009 and 2010, technical inefficiency (using resources inefficiently) dominated overall inefficiency but beyond 2011-2016, mix inefficiency (misallocation of resources) was higher. Furthermore, an additive total factor productivity (TFP) indicator is proposed to capture contributions of individual provincial (or group) hospital performance to the total productivity gain. We also report that mix inefficiency had growth throughout this time period indicating a catching up in the correct mix of inputs. This finding is worth following as hospital reform in China also focuses on utilizing the right labor and capital mix in producing efficient care.

Changing Anesthesia Block Allocations Improves Endoscopy Suite Efficiency.

Non-operating room anesthesia (NORA) has grown and continues to expand as a proportion of all anesthesia practice in the United States [1, 2]. While many management processes have been adapted for NORA from the traditional operating room, it is still unclear what scheduling paradigm will maximize efficiency of resource utilization in this arena. In this study, we investigate the impact of tactical a shift from a shared group to individual, provider-specific block allocations for available anesthesia time in an endoscopy suite for adult patients undergoing elective endoscopy procedures at an academic hospital. Using a retrospective and prospective analysis, we measured elective time-in-block; elective time out-of-block; under-utilized (opportunity and non-opportunity unused) time; over-utilized time; and case tardiness to determine operational efficiency and clinical productivity. Over the study period, the monthly caseload remained constant. Elective time in block increased by 156% (p < 0.0001) and elective time out of block decreased by 38% (p < 0.0001). Opportunity unused time decreased by 28% (p < 0.0001) and productivity increased by 51% (p < 0.0001). Neither over-utilized time nor case tardiness showed a significant change after the intervention. Despite the evidence base supporting traditional approaches to anesthesia block allocation involving group block allocation and non-sequential case scheduling, we have demonstrated an advantage to individual block allocation in a GI endoscopy setting. This sequential case scheduling highlights how tactical decisions in NORA environments may require a rethinking of many practices that anesthesiologists have brought with them from the traditional OR. Using these efficiency and productivity metrics, further adjustments to scheduling practices should be investigated, and connecting these metrics to other systems outcomes, such as financial productivity, is an important next step as NORA services expand into the future.

The productivity development of total hip arthroplasty in Sweden: a multiple registry-based longitudinal study using the Malmquist Productivity Index.

OBJECTIVE: The increasing demand for total hip arthroplasty (THA) combined with limited resources in healthcare puts pressure on decision-makers in orthopaedics to provide the procedure at minimum costs and with good outcomes while maintaining or increasing access. The objective of this study was to analyse the development in productivity between 2005 and 2012 in the provision of THA. DESIGN: The study was a multiple registry-based longitudinal study. SETTING AND PARTICIPANTS: The study was conducted among 65 orthopaedic departments providing THA in Sweden from 2005 to 2012. OUTCOME MEASURES: The development in productivity was measured by Malmquist Productivity Index by relating department level total costs of THA to the number of non-cemented, hybrid and cemented THAs. We also break down the productivity change into changes in efficiency and technology. RESULTS: Productivity increased significantly in three periods (between 1.6% and 27.0%) and declined significantly in four periods (between 0.8% and 12.1%). Technology improved significantly in three periods (between 3.2% and 16.9%) and deteriorated significantly in two periods (between 10.2% and 12.6%). Significant progress in efficiency was achieved in two periods (ranging from 2.6% to 8.7%), whereas a significant regress was attained in one period (3.9%). For the time span as a whole, an average increase in productivity of 1.4% per year was found, where changes in efficiency contributed more to the improvement (1.1%) than did technical change (0.2%). CONCLUSIONS: We found a slight improvement of productivity over time in the provision of THA, which was mainly driven by changes in efficiency. Further research is, however, needed where differences in quality of care and patient case mix between departments are taken into account.

Evaluation of an Enhanced Peer Mentoring Program on Scholarly Productivity and Promotion in Academic Emergency Medicine: A Five-Year Review.

OBJECTIVE: To design, implement, and evaluate the effectiveness of an enhanced peer mentoring program (EPMP) for faculty in emergency medicine aimed at overcoming traditional mentoring challenges. METHODS: Full time faculty (Clinical Instructor, Assistant, and Associate levels) were placed into peer groups (based upon their primary academic roles) led by senior faculty advisors at the Professor level. Peer groups met at least quarterly from 2012 to 2017. In lieu of a structured curriculum, session topics were informed by individual faculty surveys and peer group consensus. Areas of focus included work-life balance, prioritizing academic commitments, identification of mentors (both within and external to the department and university), networking opportunities, promotions goals, and career satisfaction. RESULTS: Effectiveness of the EPMP was evaluated by academic productivity and advancement over a 5- year period. A total of 22 faculty members participated in the program. There was an increase in promotions to the next academic level, from 3 promotions in the five years before the program to 7 promotions in the five years of the program. Total grant funding increased 3-fold from $500,000 to $1,706,479 from the first year to the last year of the evaluation period. CONCLUSIONS: This enhanced peer mentoring program was effective in mitigating many of the traditional mentoring challenges faced by faculty in academia and was successful in improving both academic productivity and advancement.

Efficiency of medical service systems in the rural areas of Mainland China: a comparative study from 2013 to 2017.

OBJECTIVES: Inefficient rural medical service systems are one of major obstacles to the Deepening Healthcare Reform. The objectives of this work are to analyze the efficiency of China's rural medical service systems and explore the key related factors. STUDY DESIGN: Two-stage study including measuring efficiency and identifying factors. METHODS: An output-oriented slacks-based data envelopment analysis model was used to measure the efficiency, and a Spearman rank correlation analysis and a multiple linear regression model were used to explore the factors. RESULTS: For the village-level medical service system, 20 out of 27 provinces were inefficient in 2013-2017, 12 out of 27 provinces had the efficiency lower than the average scores in 2013-2017 (0.633, 0.659, 0.638, 0.603, and 0.589), Guangdong had the highest scores of 1 in 2014-2017, whereas Tibet had the lowest scores (0.064-0.083) in 2013-2017, and the west region performed worst. For the township-level medical service system, 11 out of 27 provinces were inefficient in 2013-2017, 10 out of 27 provinces had the efficiency lower than the average scores in 2013-2017 (0.819, 0.791, 0.757, 0.787, and 0.811), Ningxia had the highest efficiency of 1 in 2013-2017, whereas Jilin had the lowest efficiency (0.313-0.370), and the central region performed worst. Additionally, rural residents' income was positively associated with the efficiency of village-level medical services, while the proportion of the vulnerable population was positively associated with the efficiency of township-level medical services. CONCLUSIONS: Most provinces had inefficient rural medical service systems in 2013-2017. The efficiency scores varied greatly across provinces, and most scores changed a little over time. Imbalances in the development of rural medical service systems existed across regions, and the efficiency of village-level medical services and township-level medical services was associated with different factors.

Diffusion of the e-SUS Primary Care innovation in Family Health Teams.

OBJECTIVE: To analyze the diffusion of e-SUS Primary Care innovation in Family Health Teams. METHOD: A qualitative approach case study, based on Innovation Diffusion Theory and Technology Acceptance Model. We conducted 62 interviews and observation of professionals from Family Health Teams in six municipalities of Minas Gerais State, between March 2016 and January 2017. The data were treated through Categorical Thematic Content Analysis and, systematized, with Atlas.ti software . RESULTS: It was verified that although the e-SUS Primary Care strategy is recognized as a technological innovation, situations predominate that weaken its acceptance as: incompatibilities with the work process; sudden deployment, poor training; work overload; resistance; and negative impacts on health care. CONCLUSION: The diffusion of the e-SUS Primary Care strategy as a technological innovation has presented potential situations of its rejection, conforming as challenges to be overcome.

Diffusion of the e-SUS Primary Care innovation in Family Health Teams / Difusión de la innovación e-SUS Atención Primaria en Equipos de Salud de la Familia / Difusão da inovação e-SUS Atenção Básica em Equipes de Saúde da Família

ABSTRACT Objective: To analyze the diffusion of e-SUS Primary Care innovation in Family Health Teams. Method: A qualitative approach case study, based on Innovation Diffusion Theory and Technology Acceptance Model. We conducted 62 interviews and observation of professionals from Family Health Teams in six municipalities of Minas Gerais State, between March 2016 and January 2017. The data were treated through Categorical Thematic Content Analysis and, systematized, with Atlas.ti software . Results: It was verified that although the e-SUS Primary Care strategy is recognized as a technological innovation, situations predominate that weaken its acceptance as: incompatibilities with the work process; sudden deployment, poor training; work overload; resistance; and negative impacts on health care. Conclusion: The diffusion of the e-SUS Primary Care strategy as a technological innovation has presented potential situations of its rejection, conforming as challenges to be overcome.

RESUMEN Objetivo: Analizar la difusión de la innovación e-SUS Atención Primaria en Equipos de Salud de la Familia. Método: Estudio de caso de abordaje cualitativo, fundamentado en la Teoría de la Difusión de la Innovación y Modelo de Aceptación de Tecnologías. Se realizaron 62 entrevistas y observación de profesionales de Equipos de Salud de la Familia en seis municipios de Minas Gerais, entre marzo de 2016 y enero de 2017. Los datos fueron tratados a través del Análisis de Contenido Temático Categorial y, sistematizados, con el software Atlas.ti. Resultados: Se verificó que a pesar de que la estrategia e-SUS Atención Primaria es reconocida como una innovación tecnológica, predominan situaciones que debilitan su aceptación como: incompatibilidades con el proceso de trabajo; implantación de forma súbita, capacitación deficiente; sobrecarga de trabajo; resistencia; e impactos negativos sobre la asistencia. Conclusión: La difusión de la estrategia e-SUS Atención Primaria como una innovación tecnológica ha presentado situaciones potencializadoras de su rechazo, conformándose como desafíos a ser superados.

RESUMO Objetivo: Analisar a difusão da inovação e-SUS Atenção Básica em Equipes de Saúde da Família. Método: Estudo de caso de abordagem qualitativa, fundamentado na Teoria da Difusão da Inovação e Modelo de Aceitação de Tecnologias. Realizamos 62 entrevistas e observação de profissionais de Equipes de Saúde da Família em seis municípios de Minas Gerais, entre março de 2016 e janeiro de 2017. Os dados foram tratados através da Análise de Conteúdo Temático Categorial e, sistematizados, com o software Atlas.ti. Resultados: Verificou-se que apesar de a estratégia e-SUS Atenção Básica ser reconhecida como uma inovação tecnológica, predominam situações que fragilizam a sua aceitação como: incompatibilidades com o processo de trabalho; implantação de forma súbita, capacitação deficiente; sobrecarga de trabalho; resistências; e impactos negativos sobre a assistência. Conclusão: A difusão da estratégia e-SUS Atenção Básica como uma inovação tecnológica tem apresentado situações potencializadoras de sua rejeição, conformando-se como desafios a serem superados.