Why enterprise resource planning initiatives do succeed in the long run: A case-based causal network.

Despite remarkable academic efforts, why Enterprise Resource Planning (ERP) post-implementation success occurs still remains elusive. A reason for this shortage may be the insufficient addressing of an ERP-specific interior boundary condition, i.e., the multi-stakeholder perspective, in explaining this phenomenon. This issue may entail a gap between how ERP success is supposed to occur and how ERP success may actually occur, leading to theoretical inconsistency when investigating its causal roots. Through a case-based, inductive approach, this manuscript presents an ERP success causal network that embeds the overlooked boundary condition and offers a theoretical explanation of why the most relevant observed causal relationships may occur. The results provide a deeper understanding of the ERP success causal mechanisms and informative managerial suggestions to steer ERP initiatives towards long-haul success.

Case Study: Using Electronic Medication Administration Record to Enhance Medication Safety and Improve Efficiency in Long-Term Care Facilities.

The electronic medication administration record (eMAR) has been used in hospitals and acute care facilities in Canada for over a decade. Unfortunately, the Canadian continuing care sector has been slow to adopt eMAR usage. Medication delivery in long-term care has traditionally been through paper-based orders and manual documentation in the paper medication administration record. The effectiveness of this manual system as it relates to medication incidents, patient safety and nursing efficiency is not well understood because most of the information is based on anecdotal evidence. Peer-reviewed scientific literature supports the premise that the eMAR, compared to the MAR, is more efficient, significantly reduces medication incidents, promotes patient safety and improves workflow efficiency. In April 2016, the Brenda Strafford Foundation committed to implementing the eMAR at each of our three long-term care facilities to improve medication delivery, reducing and eliminating medication incidents and evaluating the benefits of the electronic system. Under the direction of the clinical team, including nurses, physicians, pharmacists, and the software provider/vendor, an electronic system was developed and new processes for medication delivery were instituted within eight months of starting the project. Since the past year, the evaluation of the eMAR at the Brenda Strafford Foundation demonstrated a reduction in medication delivery time allowing for more time for direct care and a decrease in medication incidents, which directly affects resident health and safety. Nursing and the healthcare aides trained in medication management were surveyed and indicated that the eMAR provides a holistic view of the resident and provides important information readily available to improve the quality of resident care.

Predicting Length of Stay and the Need for Postacute Care After Acute Myocardial Infarction to Improve Healthcare Efficiency.

Background To improve value in the care of patients with acute myocardial infarction (MI), payment models increasingly hold providers accountable for costs. As such, providers need tools to predict length of stay (LOS) during hospitalization and the likelihood of needing postacute care facilities after discharge for acute MI patients. We developed models to estimate risk for prolonged LOS and postacute care for acute MI patients at time of hospital admission to facilitate coordinated care planning. Methods and Results We identified patients in the National Cardiovascular Data Registry ACTION registry (Acute Coronary Treatment and Intervention Outcomes Network) who were discharged alive after hospitalization for acute MI between July 1, 2008 and March 31, 2017. Within a 70% random sample (Training cohort) we developed hierarchical, proportional odds models to predict LOS and hierarchical logistic regression models to predict discharge to postacute care. Models were validated in the remaining 30%. Of 633 737 patients in the Training cohort, 16.8% had a prolonged LOS (≥7 days) and 7.8% were discharged to a postacute facility (extended care, a transitional care unit, or rehabilitation). Model discrimination was moderate in the validation dataset for predicting LOS (C statistic=0.640) and strong for predicting discharge to postacute care (C statistic=0.827). For both models, discrimination was similar in ST-segment-elevation MI and non-ST-segment-elevation MI subgroups and calibration was excellent. Conclusions These models developed in a national registry can be used at the time of initial hospitalization to predict LOS and discharge to postacute facilities. Prospective testing of these models is needed to establish how they can improve care coordination and lower costs.

A four-stage DEA-based efficiency evaluation of public hospitals in China after the implementation of new medical reforms.

This study applied the non-parametric four-stage data envelopment analysis method (Four-Stage DEA) to measure the relative efficiencies of Chinese public hospitals from 2010 to 2016, and to determine how efficiencies were affected by eight factors. A sample of public hospitals (n = 84) was selected from Chongqing, China, including general hospitals and traditional Chinese medicine hospitals graded level 2 or above. The Four-Stage-DEA method was chosen since it enables the control of the impact of environment factors on efficiency evaluation results. Data on the number of staff, government financial subsidies, the number of beds and fixed assets were used as input whereas the number of out-patients and emergency department patients and visits, the number of discharged patients, medical and health service income and hospital bed utilization rate were chosen as study outputs. As relevant environmental variables, we selected GDP per capita, permanent population, population density, number of hospitals and number of available sickbeds in local medical institutions. The relative efficiencies (i.e. technical, pure technical, scale) of sample hospitals were also calculated to analyze the change between the first stage and fourth stage every year. The study found that Four-Stage-DEA can effectively filter the impact of environmental factors on evaluation results, which sets it apart from other models commonly used in existing studies.

Estrés de rol y satisfacción laboral: examinando el papel mediador del engagement en el trabajo / Role stress and job satisfaction: examining the mediating role of work engagement

El objetivo de este estudio es examinar las relaciones entre estrés de rol, engagement y satisfacción laboral de acuerdo con el modelo demandas-recursos laborales. El modelo propuesto plantea que el engagement media la relación entre ambigüedad, conflicto y sobrecarga de rol, por un lado y satisfacción en el trabajo, por el otro. Para verificar el modelo, se obtuvieron datos de una muestra de 586 trabajadores del sur de España (Medad = 37.11, 50% mujeres). El ajuste del modelo y de la mediación se realizaron mediante un modelo de ecuaciones estructurales (path analysis). Los resultados mostraron que el conflicto de rol y la ambigüedad de rol junto con el engagement fueron predictores significativos de la satisfacción laboral. No obstante, el engagement no medió la relación entre el estrés de rol y la satisfacción laboral. El estrés de rol como demanda obstaculizadora explicaría el mayor impacto directo sobre la satisfacción que a través del engagement. Se proponen implicaciones prácticas y futuras investigaciones (AU)

The aim of this study is to examine the relationship between role stress, work engagement, and job satisfaction according to the Job Demands-Resources Model. The proposed model hypothesizes that work engagement mediates the relationship between role ambiguity, role conflict, and role overload on one hand, and job satisfaction on the other. To test the model, data was collected from 586 workers from southern Spain (Mage = 37.11, 50% women). Model fit and mediation test were examined using structural equation modeling (path analysis). Results showed that role conflict, role ambiguity, and work engagement were significant predictors of job satisfaction. However, work engagement did not mediate the relationship between role stress and job satisfaction. Role stress as a hindrance job demand would explain the most direct impact on job satisfaction than through work engagement. Implications for practice and future research are considered (AU)

Implementation of indicators through balanced scorecards in a nutritional therapy company.

INTRODUCTION: The Balanced Scorecard (BSC) is a tool that helps in strategic management under the four following perspectives: the financial one, the client s, the internal processes of the company's, the growth and learning processes. In order to measure the performance of the entities, the BSC uses as a basis financial and non-financial indicators. OBJECTIVES: To implement the BSC in a nutrional therapy company. METHODS AND MATERIALS: This research deals with a case study that took place in a nutrional therapy company from January to November 2010. For analysis of the learning and growth perspective all 45 of the company's collaborators were considered and for client analysis 124 home-care clients were considered. The study sample consisted of 39 collaborators and 44 clients participating in the research. Material was elaborated for collection of data and verification of perspective tendencies through analysis of the main processes of the company, questionnaires of client's satisfaction, questionnaires of collaborator s satisfaction and spread sheets for the verification of net renvenue and percentage of disallowances. The data was launched in the spread sheet of the Excel Application Program. RESULTS AND DISCUSSIONS: The indicators were chosen conforming to the strategic objectives and organizational profiles. Learning perspectives and personal growth: efficacy in capacitaion 94%, participation 77%, fidelity/retention 93%, satisfaction 75%, organizational environment 88%, well being 100%, process perspective: microbiological analysis 100%, internal auditing 100%, productivity 100%, nutritional evaluation 81%, nutritional support 100%, indication for domicile hospital care 94%, home-care visits 98%, client perspective: company perception 97%, prioritizating 94%, retention 59%, insatisfaction 24%, logistics 94%, customers ervice (SAC) 88%, motivation: trust, financial perspectives, disallowances 5% and positive company net revenue. CONCLUSION: The implementation of indicators under the four perspectives of the Balanced Scorecard were favourable in the organizational performance, in helping the decision making process.

Introducción: La Balanced Scorecard (BSC) es una herramienta que ayuda en la gestión estratégica, bajo las siguientes cuatro perspectivas: la financiera, la del cliente, los procesos internos de la empresa, y los procesos de crecimiento y aprendizaje. Con el fin de medir el rendimiento de las entidades, la BSC emplea como plataforma indicadores financieros y no financieros. Objetivos: Implantar la BSC en una empresa de terapias nutricionales. Material y métodos: Esta investigación comprende el estudio de un caso que tuvo lugar en una empresa de terapia nutricional, entre enero y noviembre de 2010. Para el análisis de la perspectiva de aprendizaje y crecimiento, se consideraron los 45 colaboradores de la compañía y para el análisis de los clientes, 124 clientes de atención domiciliaria. La muestra del estudio consistió de 39 colaboradores y 44 clientes que participaron en la investigación. Se elaboró material para la recogida de los datos y verificación de las tendencias de las perspectivas mediante el análisis de los principales procesos de la compañía, encuestas de satisfacción del colaborador y hojas de cálculo para la verificación del beneficio neto y el porcentaje de anulaciones. Los datos se introdujeron en una hoja de cálculo de la aplicación informática Excel. Resultados y discusión: Se escogieron los indicadores en función de los objetivos estratégicos y los perfiles organizativos. Perspectivas de aprendizaje y crecimiento personal: eficacia en la capacitación 94%, participación 77%, fidelidad/ retención 93%, satisfacción 75%, ambiente organizativo 88%, bienestar 100%, perspectiva del proceso: análisis microbiológico 100%, auditoría interna 100%, productividad 100%, evaluación nutricional 81%, soporte nutricional 100%, indicación de atención domiciliaria 94%, visitas s domicilio 98%, perspectiva del cliente: percepción de la compañía 97%, priorización 94%, retención 59%, insatisfacción 24%, logística 94%, servicio al cliente (SAC) 88%, motivación: confianza, perspectivas financieras, anulaciones 5% y beneficio neto para la compañía. Conclusión: La implantación de indicadores incluidos en las cuatro perspectivas del Balanced Scorecard fue favorable para el rendimiento organizativo y en ayudar en el proceso de toma de decisiones.

Integrated care in patients with schizophrenia: results of trials published between 2011 and 2013 focusing on effectiveness and efficiency.

PURPOSE OF REVIEW: Overview on integrated care trials focusing on effectiveness and efficiency published from 2011 to 2013. RECENT FINDINGS: Eight randomized controlled trials (RCTs) and 21 non-RCT studies were published from 2011 to 2013. Studies differed in several methodological aspects such as study population, psychotherapeutic approaches used, outcome parameters, follow-up times, fidelities, and implementation of the integrated care model and the nation-specific healthcare context with different control conditions. This makes it difficult to draw firm conclusions. Most studies demonstrated relevant improvements regarding symptoms (P=0.001) and functioning (P=0.01), quality of life (P=0.01), adherence (P<.05) and patient's satisfaction (P=0.01), and reduction of caregiver's stress (P<0.05). Mean total costs were favoring or at least equalizing costs but with positive effects found on subjective health favoring integrated care models. SUMMARY: There is an increasing interest in the effectiveness and efficiency of integrated care models in patients with mental disorders, specifically in those with severe and persistent mental illness. To increase generalizability, future trials should exactly describe rationales and content of integrated care model and control conditions.

Efficiency, effectiveness, equity (E3). Evaluating hospital performance in three dimensions.

There are well-established frameworks for comparing the performance of health systems cross-nationally on multiple dimensions. A sub-set of such comprehensive schema is taken up by criteria specifically applied to health service delivery, including hospital performance. We focus on evaluating hospital performance, using the New Zealand public hospital sector over the period 2001-2009 as a pragmatic and illustrative case study for cross-national application. We apply a broad three-dimensional matrix--efficiency, effectiveness, equity--each based on two measures, and we undertake ranking comparisons of 35 hospitals. On the efficiency dimension--relative stay, day surgery--we find coefficients of variation of 10.8% and 8.5% respectively in the pooled data, and a slight trend towards a narrowing of inter-hospital variation over time. The correlation between these indicators is low (.20). For effectiveness--post-admission mortality, unplanned readmission--the coefficient of variation is generally higher (24.1% and 12.2%), and the trend is flat. The correlation is again low (.21). The equity dimension is assessed by quantifying the degree of ethnic and socio-economic variation for each hospital. The coefficient of variation is much higher--40.7-66.5% for ethnicity, 55.8-84.4% for socio-economic position--the trend over time is mixed, and the correlation is moderate (.41). On averaging the rank of hospitals across all measures it is evident that there is limited consistency across the three constituent dimensions. While it is possible to assess hospital performance across three dimensions using an illustrative set of standard measures derived from routine data, there appears to be little consistency in hospital rankings on these New Zealand data for the period 2001-2009. However, the methodology of using rankings derived from readily available data--possibly allied with multiple or composite indicator models--has potential for the cross-national comparison of hospital profiles, and assessments in three dimensions provide a more holistic and rounded account of performance.

[Efficiency of inspections of the corpse before cremation performed in the area of the Halle University Medical Centre]. / Effizienz der Krematoriumsleichenschau im Bereich des Universitätsklinikums Halle.

From 1993 to 2007, the Institute of Forensic Medicine in Halle conducted 882 post-mortems before cremation. These records were now used for a systematic analysis of these cases to assess the efficiency of so-called second inspections of the corpse carried out in the area covered by the Halle University Hospital. In the period under review, considerable fluctuations were found from year to year, but these are mainly attributable to changes in the Saxony-Anhalt burial law introduced in 2002. Our 882 post-mortems were based on 84,677 corpse inspections before cremation; thus, an autopsy was performed in about 1% of all cases. Males were significantly overrepresented, younger age groups were dominant and there was a relatively high percentage where the first inspection of the corpse could not determine the manner of death or had to declare death by an unnatural cause. With regard to the manner and cause of death, the results of the first inspection and the post-mortem differed significantly. In 17.6% of our 882 cases, only the post-mortem revealed that death had been due to an unnatural cause. Despite the presence of sometimes strong clues to an unnatural cause, 156 of these cases were classified as natural deaths (56.4%) or the manner of death was stated as undetermined (43.6%). For more than two thirds of these 156 cases we were able to inspect the records kept by the Departments of Public Prosecution. 105 of these at first overlooked cases of unnatural deaths turned out to be deaths by accident. The other cases included 11 suicides, and 36 deaths related to medical treatment. In the remaining four cases, the autopsy results strongly suggested homicide, but only in one of these four cases subsequent police investigations were able to identify the perpetrator. This outcome demonstrates that the rule of inspecting the corpse a second time before cremation is clearly indispensable, even in its currently rather limited form.

Benchmarking environmental and operational parameters through eco-efficiency criteria for dairy farms.

Life Cycle Assessment (LCA) is often used for the environmental evaluation of agri-food systems due to its holistic perspective. In particular, the assessment of milk production at farm level requires the evaluation of multiple dairy farms to guarantee the representativeness of the study when a regional perspective is adopted. This article shows the joint implementation of LCA and Data Envelopment Analysis (DEA) in order to avoid the formulation of an average farm, therefore preventing standard deviations associated with the use of average inventory data while attaining the characterization and benchmarking of the operational and environmental performance of dairy farms. Within this framework, 72 farms located in Galicia (NW Spain) were subject to an LCA+DEA study which led to identify those farms with an efficient operation. Furthermore, target input consumption levels were benchmarked for each inefficient farm, and the corresponding target environmental impacts were calculated so that eco-efficiency criteria were verified. Thus, average reductions of up to 38% were found for input consumption levels, leading to impact reductions above 20% for every environmental impact category. Finally, the economic savings arising from efficient farming practices were also estimated. Economic savings of up to 0.13€ per liter of raw milk were calculated, which means extra profits of up to 40% of the final raw milk price.

Relationship between quality improvement processes and clinical performance.

OBJECTIVES: To examine the association between performance on clinical process measures and intermediate outcomes and the use of chronic care management processes (CMPs), electronic medical record (EMR) capabilities, and participation in external quality improvement (QI) initiatives. STUDY DESIGN: Cross-sectional analysis of linked 2006 clinical performance scores from the Integrated Healthcare Association's pay-for-performance program and survey data from the 2nd National Study of Physician Organizations among 108 California physician organizations (POs). METHODS: Controlling for differences in PO size, organization type (medical group or independent practice association), and Medicaid revenue, we used ordinary least squares regression analysis to examine the association between the use of CMPs, EMR capabilities, and external QI initiatives and performance on the following 3 clinical composite measures: diabetes management, processes of care, and intermediate outcomes (diabetes and cardiovascular). RESULTS: Greater use of CMPs was significantly associated with clinical performance: among POs using more than 5 CMPs, we observed a 3.2-point higher diabetes management score on a performance scale with scores ranging from 0 to 100 (P <.001), while for each 1.0-point increase on the CMP index, we observed a 1.0-point gain in intermediate outcomes (P <.001). Participation in external QI initiatives was positively associated with improved delivery of clinical processes of care: a 1.0-point increase on the QI index translated into a 1.4-point gain in processes-of-care performance (P = .02). No relationship was observed between EMR capabilities and performance. CONCLUSION: Greater investments in CMPs and QI interventions may help POs raise clinical performance and achieve success under performance-based accountability schemes.

Electronic health records. A systematic review on quality requirements.

OBJECTIVES: Since the first concepts for electronic health records (EHRs) in the 1990s, the content, structure, and technology of such records were frequently changed and adapted. The basic idea to support and enhance health care stayed the same over time. To reach these goals, it is crucial that EHRs themselves adhere to rigid quality requirements. The present review aims at describing the currently available, mainly non-functional, quality requirements with regard to electronic health records. METHODS: A combined approach - systematic literature analysis and expert interviews - was used. The literature analysis as well as the expert interviews included sources/experts from different domains such as standards and norms, scientific literature and guidelines, and best practice. The expert interviews were performed by using problem-centric qualitative computer-assisted telephone interviews (CATIs) or face-to-face interviews. All of the data that was obtained was analyzed using qualitative content analysis techniques. RESULTS: In total, more than 1200 requirements were identified of which 203 requirements were also mentioned during the expert interviews. The requirements are organized according to the ISO 9126 and the eEurope 2002 criteria. Categories with the highest number of requirements found include global requirements, (general) functional requirements and data security. The number of non-functional requirements found is by contrast lower. CONCLUSION: The manuscript gives comprehensive insight into the currently available, primarily non-functional, EHR requirements. To our knowledge, there are no other publications that have holistically reported on this topic. The requirements identified can be used in different ways, e.g. the conceptual design, the development of EHR systems, as a starting point for further refinement or as a basis for the development of specific sets of requirements.

Service quality in health care setting.

PURPOSE: This paper attempts to explore the concept of service quality in a health care setting. DESIGN/METHODOLOGY/APPROACH: This paper probes the definition of service quality from technical and functional aspects for a better understanding on how consumers evaluate the quality of health care. It adopts the conceptual model of service quality frequently used by the most researchers in the health care sector. The paper also discusses several service quality dimensions and service quality problems in order to provide a more holistic conception of hospital service quality. FINDINGS: The paper finds that service quality in health care is very complex as compared to other services because this sector highly involves risk. ORIGINALITY/VALUE: The paper adds a new perspective towards understanding how the concept of service quality is adopted in a health care setting.

Pathways in multidisciplinary oral health care as a tool to improve clinical performance.

PURPOSE: To investigate the optimization of multidisciplinary and interdisciplinary oral health care through the introduction of pathways. MATERIALS AND METHODS: A prospective randomized clinical trial was carried out in a tertiary referral academic institution. Ninety-one patients admitted for multidisciplinary oral health care from January 1, 2001, to March 31, 2003, were randomized to the test group (n = 50) or to the control group (n = 41). Pathways were implemented by means of the Medical Patient Management program, a computerized planning and coordination system specifically developed for a population with multidisciplinary oral rehabilitation needs. The efficiency of pathways in interdisciplinary oral health care was assessed. RESULTS: Statistically significant differences between test and control groups were found for variables regarding the process of care, such as "number of planned versus actual disciplines," "length of planned versus actual treatment," and "average length of a treatment session." For variables regarding patient satisfaction, significant differences between test and control groups were found for questions regarding patient involvement with the treatment and patient satisfaction with the outcome of multidisciplinary treatment. Regarding practitioner satisfaction, the results of the questionnaire indicate that implementation of pathways into everyday clinical practice is desired but remains difficult. CONCLUSION: The findings of this study show that the implementation of pathways in multidisciplinary oral health care improved some aspects of the process of care and increased patient satisfaction. The predictive capability of the Medical Patient Management program in managing oral health care has been demonstrated.

Using program theory to develop key performance indicators for child and adolescent mental health services.

Key Performance Indicators are used increasingly by health services, but their relevance and utility may be questionable. In this article, Program Theory is used to model the irreducible stages in the system of clinical care in Child and Adolescent Mental Health Services, define the major program operations in each of these stages, and specify the intermediate outcomes of each stage and the final outcomes sought. National and State policy standards are used, with practice experience, to identify key program operations and intermediate outcomes sought. Systematic criteria are then applied to select KPIs that are measurable, reliable, valid for our program theory, utilitarian, and relevant to clinicians, clients and managers.

Continuous improvement and TQM in health care: an emerging operational paradigm becomes a strategic imperative.

Argues that US health care is in a state of crisis. Escalating costs account for 13 per cent of GNP, making health care the third largest industry in the USA, and spending is expected to increase. Claims health-care providers need to control rising costs, improve productivity and flexibility, adopt appropriate technologies, and maintain competitive levels of quality and value. States that TQM may provide an environment that will focus on quality of patient care and continuous quality improvement at all levels of the organization including the governing body, the administrative, managerial, and clinical areas. Any new national or state health-care plan will force providers to be more efficient while maintaining quality standards. Concludes that it will be strategically imperative that health-care providers ranging from family physicians to major medical centres and suppliers ranging from laboratories to pharmaceutical firms establish methods for making rapid continuous improvement and total quality management the cornerstone of the strategic planning process.