How to become a strategic purchaser of rehabilitation services.

Rehabilitative care is often overlooked and underfunded despite being a key component of universal health coverage, and now faces further neglect due to indirect impacts of the coronavirus disease 2019 pandemic. Policy-makers can leverage strategic purchasing approaches to make the most of available funds and maximize health gains. To implement more strategic purchasing of rehabilitation, health planners must: (i) develop and prioritize evidence-based rehabilitation service packages; (ii) use fit-for-purpose contracting and provider payment mechanisms to incentivize quality and efficient service delivery; and (iii) strengthen stewardship. This paper examines these three policy priorities by analysing their associated processes, actors and resources based on country experiences. Policy-makers will likely face several obstacles in operationalizing these policy priorities, including: inadequate accountability and coordination among sectors; limited data and research; undefined and non-standardized rehabilitation services, costs and outcomes; and inadequate availability of rehabilitative care. To overcome challenges and institute optimal strategic purchasing practices for rehabilitation, we recommend that policy-makers strengthen health sector stewardship and establish a framework for multisectoral collaboration, invest in data and research and make use of available experience from high-income settings, while creating a body of evidence from low- and middle-income settings.

Les soins de réadaptation sont souvent négligés et sous-financés malgré la place essentielle qu'ils occupent dans la couverture sanitaire universelle. Aujourd'hui, ils risquent même d'être relégués au second plan à la suite des conséquences indirectes de la pandémie de maladie à coronavirus 2019. Les responsables politiques peuvent néanmoins adopter des méthodes d'achat stratégiques afin de tirer le meilleur parti des fonds disponibles et de maximiser les bénéfices pour la santé. Pour ce faire, les planificateurs sanitaires doivent: (i) développer et privilégier les programmes de réadaptation étayés par des faits; (ii) utiliser des contrats adéquats et des mécanismes de paiement des fournisseurs qui mettent en valeur la qualité et l'efficacité des prestations de services; et enfin, (iii) renforcer les activités de gestion. Le présent document se penche sur ces trois priorités politiques en analysant les processus, acteurs et ressources qui y sont associés dans différents pays. Les décideurs seront probablement confrontés à de nombreux obstacles lors de la mise en œuvre de telles politiques: un manque de responsabilisation et de coordination entre secteurs; des recherches et données limitées; une absence de normalisation et de définition claire des services, coûts et résultats; et des soins de réadaptation en pénurie. Pour relever ces défis et instaurer des pratiques d'achat stratégiques optimales en matière de réadaptation, nous leur conseillons de renforcer la gestion du secteur de la santé et d'établir un cadre de collaboration multisectorielle, d'investir dans la recherche et la collecte de données, et de s'inspirer des expériences vécues dans les régions à revenu élevé tout en récoltant un ensemble de preuves dans les régions à revenu faible et intermédiaire.

La atención de rehabilitación suele pasar desapercibida y carecer de fondos a pesar de ser un componente clave de la cobertura sanitaria universal, y ahora se enfrenta a una mayor desatención debido a las repercusiones indirectas de la pandemia de la enfermedad por coronavirus de 2019. Los responsables de formular las políticas pueden aprovechar los enfoques de adquisición estratégica para sacar el máximo provecho de los fondos disponibles y maximizar los beneficios para la salud. Para aplicar una adquisición más estratégica en materia de rehabilitación, los planificadores sanitarios deben (i) desarrollar y priorizar paquetes de servicios de rehabilitación a partir de la evidencia; (ii) utilizar mecanismos de contratación y pago a proveedores adecuados para incentivar la calidad y la prestación eficiente de los servicios; y (iii) fortalecer la administración. El presente documento estudia estas tres prioridades políticas mediante el análisis de sus procesos, actores y recursos asociados, basándose en las experiencias de los países. Es probable que los responsables de formular las políticas se enfrenten a varios obstáculos a la hora de poner en práctica estas prioridades políticas, entre los que se incluyen: una responsabilidad y coordinación inadecuadas entre sectores; la limitación de los datos y la investigación; la falta de definición y estandarización de los servicios, los costes y los resultados de la rehabilitación; y la insuficiente disponibilidad de la atención de rehabilitación. Para superar los desafíos e instituir prácticas estratégicas óptimas de adquisición en materia de rehabilitación, se recomienda que los responsables de formular las políticas fortalezcan la administración del sector sanitario y establezcan un marco de colaboración multisectorial, inviertan en datos e investigación y aprovechen la experiencia disponible en entornos de ingresos altos, al tiempo que crean un conjunto de evidencias procedentes de entornos de ingresos bajos y medios.

[Procurement strategy for a dose management system]. / Einführungsstrategie für ein Dosismanagementsystem.

We present the different steps for procurement of a dose management system for a university hospital, starting from the Europe-wide request for proposals, the product presentations by the suppliers and the final decision. For a project of this size, it is advisable to involve external consultants, especially for preparation of the system specifications and the calculation of the total cost of ownership (TCO). Use cases were of special interest in assessing the functionality of the different systems. Following the product presentations some changes were made concerning the system specifications and minimum requirements. Qualified users like medical physics experts, radiologists and technicians as well as users from generic quality management should form the team for evaluation and final product decision.

Manual para otimização da aquisição de medicamentos no âmbito hospitalar / Manual for optimizing the acquisition of medicines in the hospital environment

Introdução: a falta de um medicamento durante a internação hospitalar, põe em risco o correto cumprimento dos planos terapêuticos traçados para os pacientes, o que pode vir a gerar a recidiva de um quadro clínico, o prolongamento do tempo de internação e o consequente aumento de custos para a instituição, seja ela pública ou privada. Dentro da cadeia logística do medicamento, diversas são as etapas que podem contribuir para o desabastecimento. No âmbito hospitalar essa logística se dá por meio do ciclo da assistência farmacêutica que compreende as etapas de seleção, programação, aquisição, armazenamento, distribuição e dispensação de medicamentos. Os estoques da farmácia hospitalar são caracterizados por ciclos de demandas e de ressuprimentos, com flutuações significativas, o que dificulta a disponibilidade na mesma proporção da utilização do medicamento. Tendo em vista esta complexidade torna-se necessário o uso de indicadores, que avaliem os processos de trabalho. Objetivos: o objetivo deste estudo foi identificar as principais causas de desabastecimento de medicamentos em uma unidade de saúde e desenvolver um manual para otimização da aquisição de medicamentos. Materiais e método: Inicialmente foi realizado um mapeamento do fluxo de valor a fim de compreender a movimentação de materiais e informações envolvidos no processo de aquisição de medicamentos. Posteriormente, confeccionou-se uma planilha para registrar o fluxo logístico dos produtos, que resultou na obtenção dos pontos críticos do processo. A coleta dos dados de aquisição de medicamentos foi realizada durante o ano de 2019. Os critérios avaliados foram definidos com base nas ocorrências que mais contribuíram para o desabastecimento, seja pela relevância, ou pela frequência. Por fim foi elaborado um manual contendo critérios, normas, e procedimentos, a serem seguidos a fim de se evitar o desabastecimento. Resultados: Elaboração de um manual para otimização da aquisição de medicamentos composto por: mapa do fluxo de valor logístico de medicamentos, planilha para registro da logística de aquisição de medicamentos, procedimentos operacionais padrão para a gestão da aquisição de medicamentos. Conclusão: com o manual espera-se otimizar a gestão logística de medicamentos e reduzir a incidência de problemas com desabastecimento, gerando um impacto positivo na assistência ao paciente

Introduction: the lack of a drug during hospitalization puts at risk the correct compliance with the therapeutic plans outlined for the patients, which can lead to the recurrence of a clinical condition, the extension of the hospital stay and the consequent increase in costs for the institution, whether public or private. Within the drug's logistics chain, there are several steps that can contribute to shortages. In the hospital context, this logistics takes place through the pharmaceutical care cycle, which comprises the stages of selection, programming, acquisition, storage, distribution and dispensing of medicines. Hospital pharmacy stocks are characterized by cycles of demand and resupply, with significant fluctuations, which makes availability in the same proportion as the use of the medication difficult. Due to this complexity, it is necessary to use indicators that assess work processes. Objectives: The aim of this study was to identify the main causes of drug shortages in a health unit and to develop a manual for optimizing drug acquisition. Materials and method: Initially, a mapping of the value stream was carried out in order to understand the flow of materials and information involved in the drug procurement process. Subsequently, a spreadsheet was made to record the logistical flow of the products, which resulted in the critical points of the process being obtained. Logistic data for drug acquisition during 2019 were collected and the criteria evaluated were defined based on the occurrences that most contributed to the shortage, either by relevance or by the frequency with which they occurred. Finally, a manual was created containing criteria, norms, and procedures to be followed in order to avoid shortages. Results: Preparation of a manual for optimizing drug procurement, comprising: a map of the logistical value flow of drugs, a spreadsheet for recording the logistics of drug procurement, standard operating procedures for managing drug procurement. Conclusion: the manual is expected to optimize the logistical management of medicines and reduce the incidence of problems with shortages, generating a positive impact on patient care

[Research on the Risk Prevention and Quality Control of Public Hospital Procurement].

Through the functional combination of relevant departments involved in hospital procurement, to simplify and unify the work process, we establish a standardized procurement system, to realize the pre-procurement budget and approval, power balance, strengthen the fairness and openness of procurement process. By introducing the closed-loop process of in-process supervision to ensure the impartiality of review and post-evaluation control, it comprehensively strengthens the internal control of procurement management, and finally realizes the purpose of strengthening procurement risk prevention and procurement quality management.

Environmental and Organizational Factors Associated with Hospital Use of GPO Services.

Given the potential benefits of Group Purchasing Organizations in cost-containment efforts for hospitals on supplies and purchased services, an important question that remains unanswered is what conditions support or hinder the utilization of GPOs by hospitals. Therefore, this study explores the relationship between GPO use by hospitals and their market and organizational characteristics. Data on hospital GPO utilization and other organizational characteristics were combined with secondary hospital market characteristics. Panel logistic regression with random effects and state and year fixed effects analysis was used to examine the relationship between hospitals' utilization of GPO services and hospitals' organizational and market characteristics. Overall, the majority of hospitals utilized the services of GPOs. Specifically, the number of hospitals utilizing the services of GPOs increased slightly from 3290 (72.2%) in 2004 to 3337 (74.4%) in 2013. In regression analyses, hospitals utilizing the services of GPOs operated in an external environment with mixed levels of munificence, more dynamism, and less competition. Specifically, hospitals operating in a less munificent environment are more likely to utilize the services of GPOs. The study findings provide organizational decision-makers and policymakers' insights into how certain market and organizational factors influence hospital strategy choice, in this case, the use of GPOs.

Purchase data: a proxy for safety status.

This study demonstrated the use of purchase data to determine the incidence of sharps injuries in a major tertiary referral hospital in Australia. The incidence rates of injuries per 100,000 items purchased were 2.65 and 12.60 for syringe needles and scalpel blades, respectively. These figures were lower than those reported previously using this method. The incidence rate for injuries with suture needles, which had not been reported previously, was 31.89/100,000 items purchased. Incidence data calculated in this manner may be used in conjunction with purchase cost estimates to inform policy and practices on institutional staff safety measures.

Medicine shortages and challenges with the procurement process among public sector hospitals in South Africa; findings and implications.

BACKGROUND: Medicine shortages are a complex global challenge affecting all countries. This includes South Africa where ongoing medicine shortages are a concern among public sector hospitals as South Africa strives for universal access to healthcare. The objectives of this research were to highlight challenges in the current pharmaceutical procurement process for public sector hospitals. Subsequently, suggest potential ways forward based on the findings as the authorities in South Africa seek to improve the procurement process. METHOD: Qualitative in-depth interviews were conducted with 10 pharmacy managers in public sector hospitals in the Gauteng Province, South Africa. A thematic content analysis was performed, with transcripts coded by two of the authors. Coding was discussed until consensus was reached. Categories were developed and grouped into themes. RESULTS: The 'Procurement process' emerged from the data as the overarching theme, rooted in three main themes: (i) The buy-out process that was used to procure medicines from suppliers other than the contracted ones; (ii) Suppliers not performing thereby contributing to medicine shortages in the hospitals; and (iii) Challenges such as the inaccuracy of the electronic inventory management system used in the hospitals. CONCLUSIONS: Effective management of contracts of suppliers by the Provincial Department of Health is crucial to ensure accessibility and availability of essential medicines to all citizens of South Africa. Ongoing monitoring and support for the future use of computerised inventory management systems is important to reduce medicine shortages, and this is being followed up.

Is "free" really free? Ethical implications of short-term discounts and giveaways to hospitals.

Canadian hospitals participate in provincial and national procurement processes to help reduce healthcare costs. This allows for redirection of funds to direct patient care, along with creating networks, integrating services, and improving innovative solutions. To be competitive, vendors offer creative solutions and provide free or low-cost supplies to hospitals with the hope that patients will continue to purchase those items when discharged. What is not always factored into the procurement decision-making processes is the potential financial impact of the supplies required for patients when discharged from hospital services and other ethical implications of accepting free/reduced-cost supplies. This column provides some guidance for health leaders in this respect.

Hospital purchasing alliances: Ten years after.

BACKGROUND: Most hospitals outsource supply procurement to purchasing alliances, or group purchasing organizations (GPOs). Despite their early 20th century origin, we lack both national and trend data on alliance utilization, services, and performance. The topic is important as alliances help hospitals control costs, enjoy tailwinds from affiliated regional/local alliances, and face headwinds from hospital self-contracting and criticism of certain business practices. PURPOSE: We compare the utilization, services, and performance of alliances in 2004 and 2014. APPROACH: We analyze alliances using two comparable surveys of hospitals. We use significance tests to assess changes in alliance utilization, services, and performance (e.g., cost savings). We also assess the use of regional/local alliances affiliated with national GPOs. RESULTS: Purchasing through national alliances has somewhat diminished. Over 10 years, hospitals have diversified GPO memberships to include regional/local alliances (many affiliated with their national GPO) and engaged in self-contracting. At the same time, hospitals have increased purchases of many categories of supplies/services through national GPOs and endorsed their value-added functions and increasingly important role. Hospitals report greater satisfaction with several GPO functions; performance on most dimensions has not changed. CONCLUSIONS: National alliances still play important roles that hospitals find valuable. PRACTICE IMPLICATIONS: Purchasing alliances continue to play an important role in helping hospitals with both cost savings and new services. Their growing complexity, along with growing use of self-contracting, poses managerial challenges for hospital purchasing staff that may require greater hospital investment.

Lessons learned from a comprehensive electronic patient record procurement process-implications for healthcare organisations.

BACKGROUND: This study describes learning from procurement of a comprehensive electronic patient record (EPR/electronic health record (EHR)), system for a specialist clinical academic institution. METHOD: Retrospective review of procurement process in addition to evaluation of peer-reviewed literature in the field. RESULTS: Main lessons learned include the importance of detailed preparation of organisational requirements/specifications and organisational 'readiness'. Early staff involvement, resulting in ownership of the selected system by the organisation was a key achievement. The scoring process used required significant resource commitment but, despite being extensive in scope, provided relatively poor distinction between suppliers, despite significant variation in supplier self-scoring. Other elements, such as demonstrations and site visits, provided superior evaluation of functional abilities, and specification requirements should be regarded as threshold evaluation. CONCLUSION: While principles should be followed, the procurement process must be modified to meet the needs of the specific organisation, in terms of its clinical activities, digital maturity, existing infrastructure and budget.

Six Sigma Application in Healthcare Logistics: A Framework and A Case Study.

Six Sigma is used heavily in various industrial sectors, yet no noticeable applications are seen in healthcare logistics. This paper reveals the special case of healthcare logistics where cost reduction is not the only factor considered in project selection; performance and criticality of each item in the logistics system are of high importance as well. This paper provides a proposed framework to apply Six Sigma in the area of healthcare logistics. It also presents a case study implementing the proposed framework at a Jordanian hospital. In the case study, the paper reveals how the modifications of the define phase to take into consideration the criticality, cost, and performance of items make typical Six Sigma methodology very beneficial for healthcare logistics. In addition, it shows how the Six Sigma project selection can be done to deal effectively with healthcare logistics issues. This paper paves the road for research to elaborate on ways to use Six Sigma in the area of improving healthcare logistics.

Observations on the Medicare Value-Based Ranking of Hospitals During Fiscal Years 2015 and 2016.

Medicare's Value-Based Purchasing Program (VBPP) compensates hospitals based on value of care provided. VBPP's total performance score (TPS) components data were evaluated by hospital groups: physician-owned surgical hospitals (POSH), Kaiser Hospitals, University HealthSystem Consortium Hospitals, Pioneer Accountable Care Organization Hospitals, US News and World Report Honor Roll Hospitals, and other hospitals. Multilevel random coefficient models estimated mean and significance of TPS differences from fiscal year (FY) 2015 and FY 2016, by hospital type. Overall mean TPS for 2985 hospitals decreased from 41.65 to 40.25. POSH and Kaiser Hospitals had significantly higher TPS in FY 2015 and FY 2016. POSH Patient Experience Domain scores exceeded all other Patient Experience Domain scores. The Efficiency Domain scores of Kaiser greatly exceeded the scores of all groups. Results suggest that POSH and Kaiser Hospitals provide significantly greater value of care with consistency from year to year when compared with other groups studied.

Needs Assessment Using a Structured Prioritization Schema: An Open Letter to PACS Vendors.

PURPOSE: The aim of this work was to prioritize in a quaternary academic environment necessary elements of a replacement PACS. METHODS: This quality improvement work was conducted at one academic medical center and was "not regulated" by the institutional review board. Three workgroups (10-15 members each) with unique resident, fellow, and attending radiologists; IT specialists; and departmental leaders convened in 2018 to prioritize elements for a PACS replacement project, including integrated IT tools. Each workgroup met two or three times and represented one of three missions (clinical, research, and education). Six elements assigned the highest priority were distilled from each workgroup. The resulting 18 elements were condensed into survey format and distributed to all department residents, fellows, and faculty members for 5-point Likert-type prioritization stratified by mission. Data were collected over 2 weeks. RESULTS: The survey response rate was 37% (71 of 192; 17 of 44 residents, 3 of 27 fellows, and 51 of 121 faculty members). Self-reported work effort was 63 ± 26% clinical, 14 ± 11% education, 15 ± 21% research, and 8 ± 14% administration. Aggregate priority ratings across all domains were highest for "stable system with predictable behavior" (mean, 4.51), "minimizes repetitive non-value-added work" (mean, 4.40), "interoperability" (mean, 4.12), and "near-instantaneous load times" (mean, 4.07). Clinical-specific ratings for these elements were even higher (means, 4.85-4.90). The lowest aggregate scores were mobile device compatibility (mean, 3.03), connectivity to nonaffiliated sites (mean, 3.01), and integrated instant messaging (mean, 2.87). CONCLUSIONS: The department prioritized a stable and interoperable system that minimized non-value-added work. In other words, participants wanted a functioning PACS. PACS vendors should prioritize a reliable experience over niche add-ons.

Hospital Supply Expenses: An Important Ingredient in Health Services Research.

The purpose of this article is to shed light on hospital supply expenses, which form the second largest expense category after payroll and hold more promise for improving cost-efficiency compared to payroll. However, limited research has rigorously scrutinized this cost category, and it is rarely given specific consideration across cost-focused studies in health services publications. After reviewing previously cited estimates, we examine and independently validate supply expense data (collected by the American Hospital Association) for over 3,500 U.S. hospitals. We find supply expenses to make up 15% of total hospital expenses, on average, but as high as 30% or 40% in hospitals with a high case-mix index, such as surgery-intensive hospitals. Future research can use supply expense data to better understand hospital strategies that aim to manage costs, such as systemization, physician-hospital arrangements, and value-based purchasing.

Strategies for Promoting the Medical Device Industry in Korea: An Analytical Hierarchy Process Analysis.

This study examines the medical device industry in the context of the Fourth Industrial Revolution and identifies the key strategies and general directions for promoting this industry through analytical hierarchy process (AHP). It is based on discussions of the key issues with specialists such as doctors, medical device companies, hospital staff, professors, and government agencies in the medical device industry. A total of 18 responses were obtained from the survey, and an analysis was conducted on the results. Among the medical device strategies identified by the surveyed specialists, clarifying the application of regulations (access strategy), increasing R&D investment for the technological development of medical devices (expansion strategy), and increasing support for global market expansion (infrastructure expansion strategy) were found to have the highest priority. Based on the above, we suggest key strategies and directions for promoting the medical device industry.

Qualitative analysis of national documents on health care services and pharmaceuticals` purchasing challenges: evidence from Iran.

BACKGROUND: Iranian health sector encountered many challenges in resource allocation and health service purchasing during the past decades, the aim of this study was to determine the main challenges of the present process of health service purchasing for national policymakers and other developing countries with the same setting. METHODS: It was a qualitative study carried out via the complete content analysis of all relevant national documents from 2007 to 2014. In order to retrieve the related documents, we searched the official websites related to the Ministry of Health and Medical Education, four main Iranian insurance organizations, the Health Committee of the Parliament Profile, strategic vice president's site and Supreme Insurance Council. After recognition of documents, their credibility and authenticity were evaluated in terms of their publication or adjustment. For the analysis of documents, the four step-Scott method was used applying MAXQDA version 10. RESULTS: Findings illustrated that health service purchase challenges in the country can be classified in 6 main themes of policy-making, executive, intersectional, natural, legal and informational challenges with 26 subthemes. Furthermore, 5 themes of Basic Benefit Package, Reimbursement,Decision making, Technology and Contract are considered as the main Challenges in pharmaceutical purchasing area containing 13 relevant subthemes. CONCLUSIONS: It seems that according to documents, Iran has faced many structural and procedural problems with the purchase of the best health interventions. So it is highly recommended to consider consequences derived from the present challenges and try to use these evidences in their policy making process to decrease the existed problems and move to better procurement of health interventions.