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.

Rationing of nursing care, a deviation from holistic nursing: A systematic review.

BACKGROUND: Rationing of care in nursing is nurses' inability to complete all care activities for patients because of scarcity in time and resource. Literature suggests that rationing of care is closely related to patient safety and quality of care. The phenomena have been defined and studied from varied perspectives and contexts. A systematic review of studies related to the concept was aimed at identifying and synthesizing the finding. METHODS: The review followed Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines, and literature searches were conducted in MEDLINE, CINAHL, PsycInfo, Web of Science and EMBASE databases. Fifty-seven quantitative studies were included in the review. FINDINGS: The review observed that nursing activities addressing the emotional, educational, mobility and hygiene needs of the patients were commonly rationed. Antecedents of rationing included resource inadequacy and organizational work environment. Rationing influenced patient satisfaction, mortality and a number of adverse events and was associated with decreased job satisfaction, increased intention to leave and high turnover among nurses. DISCUSSIONS: This review concludes that rationing in nursing is ubiquitous, embedded in the work environment and poses a threat to the professional health and philosophical base of nursing in addition to having serious implications on patients' safety. Strategies to reframe and reconsider organizational traits, and open discussion with other healthcare stakeholders can reduce rationing of nursing care. The review suggests future researchers adopt different methodological layout to study rationing.

Older people's views of prioritization in health care. The applicability of an interview study.

AIM: Older people's views of prioritization in health care. The applicability of an interview study. Old age has been stated as a criterion for prioritization in health care, although older people are seldom asked for their opinions. The aim of this pilot study was to investigate the applicability of a questionnaire as a base for an interview study to explore older people's experiences and views of prioritization in health care. DESIGN: Descriptive, with a qualitative and quantitative approach. Fifty-four persons, 32 women and 22 men (aged 60-93 years), were asked to participate in a structured, tape-recorded interview covering their experience and views of the priorities applied in health care. RESULTS: The questions in the interview manual appeared to be applicable for collecting data concerning views of prioritization, but the analysis revealed that certain questions, particularly on economic matters, were missing. The procedure, a personal structured interview had advantages, for example, in capturing the respondents' reflections on the questions. The respondents emphasized the equal value of all human beings and that age is not a basis for prioritization within health care. The respondents also showed an unwillingness to precede anyone in rank. IMPLICATIONS: The questions used proved to be adequate but to be really complete further questions need to be added. This pilot study indicates that older people's views on priorities in health care differ from those expressed by the younger population. The study therefore needs to be replicated in a larger sample to be fully able to understand older people's views of prioritization, which will require exploring gender and age differences as well as other aspects that may explain variations.

Waiting for scheduled services in Canada: development of priority-setting scoring systems.

RATIONALE, AIMS AND OBJECTIVES: An Achilles' heel of Canadian Medicare is long waits for elective services. The Western Canada Waiting List (WCWL) project is a collaboration of 19 partner organizations committed to addressing this issue and influencing the way waiting lists are structured and managed. The focus of the WCWL project has been to develop and refine practical tools for prioritizing patients on scheduled waiting lists. METHODS: Scoring tools for priority setting were developed through extensive clinical input and highly iterative exchange by clinical panels constituted in five clinical areas: cataract surgery; general surgery procedures; hip and knee replacement; magnetic resonance imaging (MRI) scanning, and children's mental health. Several stages of empirical work were conducted to formulate and refine criteria and to assess and improve their reliability and validity. To assess the acceptability and usability of the priority-setting tools and to identify issues pertaining to implementation, key personnel in the seven regional health authorities (RHAs) participated in structured interviews. Public opinion focus groups were conducted in the seven western cities. RESULTS: Point-count scoring systems were constructed in each of the clinical areas. Participating clinicians confirmed that the tools offered face validity and that the scoring systems appeared practical for implementation and use in clinical settings. Reliability was strongest for the general surgery and hip and knee criteria, and weakest for the diagnostic MRI criteria. Public opinion focus groups endorsed wholeheartedly the application of point-count priority measures. Regional health authorities were generally supportive, though cautiously optimistic towards implementation. CONCLUSIONS: While the WCWL project has not 'solved' the problem of waiting lists and times, having a standardized, reliable means of assigning priority for services is an important step towards improved management in Canada and elsewhere.

Equidad y distribución geográfica de recursos financieros en los sistemas de salud / Equity and geographic distribution of financial resources in health systems

This study focuses on equity in health and specifically the geographic distribution of financial resources. The author reviews the main contemporary theories of social justice and discusses the concept of equity in general and specifically in the health field. Based on the discussion of selected international experiences (United Kingdom, Spain, and Italy), the Resource Allocation Working Party (RAWP) formula used in the United Kingdom is identified as the most adequate distributive methodology, sizing the relative needs based on the population's demographic and epidemiological profiles. Finally, the results are presented from a simulation performed for the Brazilian case, showing that a more equitable geographic distribution of financial resources would require a redistribution favoring the States of the North and Northeast. The article concludes by highlighting that a comparison of actual fund outlays by the Ministry of Health in 1994 and the results of the simulation with the RAWP methodology for the Brazilian case show that the principles written into Brazilian legislation were absent from the geographic distribution of financial resources.

[Equity and geographic distribution of financial resources in health systems]. / Equidad y distribución geográfica de recursos financieros en los sistemas de salud.

This study focuses on equity in health and specifically the geographic distribution of financial resources. The author reviews the main contemporary theories of social justice and discusses the concept of equity in general and specifically in the health field. Based on the discussion of selected international experiences (United Kingdom, Spain, and Italy), the Resource Allocation Working Party (RAWP) formula used in the United Kingdom is identified as the most adequate distributive methodology, sizing the relative needs based on the population's demographic and epidemiological profiles. Finally, the results are presented from a simulation performed for the Brazilian case, showing that a more equitable geographic distribution of financial resources would require a redistribution favoring the States of the North and Northeast. The article concludes by highlighting that a comparison of actual fund outlays by the Ministry of Health in 1994 and the results of the simulation with the RAWP methodology for the Brazilian case show that the principles written into Brazilian legislation were absent from the geographic distribution of financial resources.

Los sistemas de información en el INSALUD / Information systems in the Spanish public health system

Las organizaciones sanitarias se basan en la gestión del conocimiento, por lo que la información constituye un valor clave, tanto por la cantidad que genera el acceso a otras fuentes de conocimiento como por su necesidad para la toma de decisiones. Esto lleva a diseñar una serie de sistemas de información interrelacionados, apoyados en el desarrollo de tecnologías de la información y de la comunicación, y adecuados para atender las necesidades de los distintos componentes de la organización, tanto de los profesionales sanitarios como de los distintos niveles de dirección y gestión o de la población atendida. Este desarrollo, en el Insalud, se basa en la puesta en marcha de una serie de proyectos que abarcan la identificación de la población atendida (a través de la tarjeta sanitaria individual), herramientas precisas para la asistencia sanitaria y su gestión (renovación tecnológica de hospitales, informatización de centros de salud), gestión de prestaciones, presupuestos, etc., así como la habilitación de las infraestructuras necesarias como la red corporativa de comunicaciones, telemedicina, acceso a Internet y otros servicios como correo electrónico. Todos estos proyectos, funcionantes y consolidados, están diseñados para dar respuesta a las necesidades actuales y, a la vez con una visión de futuro, ya que permiten su evolución y redimensionamiento según las nuevas necesidades (AU)

Rationing, randomizing, and researching in health care provision.

In this paper the need for valid evidence of the cost-effectiveness of treatments that have not been properly evaluated, yet are already available, albeit in short supply, are examined. Such treatments cannot be withdrawn, pending proper evaluation, nor can they be made more widely available until they have been shown to be cost-effective. As a solution to this impasse the argument put forward recently by Toroyan et al is discussed. They say that randomised controlled trials of such resources could be done but only if resources are randomly allocated independently of a research context. Relevant outcome data could then be collected for research, given this opportunity. (There are already a few investigators who have turned limited resources, mostly health service provision, to their advantage in this way.) We agree. We disagree with Toroyan et al on a number of points. First, they claim that no ethical issue relating to equipoise arises. We disagree and this disagreement depends on our showing that equipoise should be maintained in a relationship that they do not consider. Secondly, they say that consent to data collection is always needed. Again we disagree. Thirdly, they claim that the previous two issues are the only possible ethical issues that could arise. We argue, instead, that there is a further conflict of interests that has ethical import.

Redressing dis-advantage: promoting vertical equity within South Africa.

This paper represents the first attempt to apply vertical equity principles to the South African health sector. A vertical equity approach, which recognises that different groups have different starting points and therefore require differential treatment, appears to offer an appropriate basis for considering how best to redress the vast inequities which exist in post-Apartheid South Africa. Vertical equity principles are applied in critically analysing two areas of recent policy action which are particularly relevant to health sector equity in South Africa, namely public-private sector cross-subsidies and the allocation of government resources between provinces. Despite a strong political commitment to redressing historical inequities, recent government policy actions in these two areas appear to fall short of desirable goals when viewed through a vertical equity lens. In particular, policies since the first democratic elections in 1994 have done little to reduce the extent of government subsidies to the private health sector, which serves a minority of the population. In addition, recent proposals for a Social Health Insurance will allow minimal cross-subsidies between high- and low-income earners and would not adequately redress the currently inequitable public-private cross-subsidies. With respect to the allocation of government resources between provinces, a vertical equity approach would suggest that the most historically dis-advantaged provinces have an even greater claim on government resources than reflected in the current formula, as developed by the Department of Finance. This paper also considers the potential benefits of engaging with societal views in determining what constitutes dis-advantage in the South African context, in order to identify those who should receive priority in resource allocation decisions. It concludes with a review of a number of practical steps that can be taken to draw vertical equity principles into policy action.

The effectiveness of resource allocation methods used by RWCA Title II Consortia in Virginia.

The authors sought to determine the following: (1) How rigorous are the current resource allocation methods used by Virginia's five regional Ryan White CARE (Comprehensive AIDS Resources Emergency) Act Title II consortia? (2) How useful are existing databases in allocating resources? (3) Is it feasible to introduce a standardized performance measurement approach for state-level assessment of consortia effectiveness? The authors reviewed proposals and progress reports from each of the consortia to the Virginia public health agency; they then visited each of the consortia to solicit information to refine the study questions and to review the consortia's databases. The authors reviewed the literature on existing models used to allocate resources, and surveyed members of the Virginia consortia about how they used various resource allocation tools, how effective these tools were, and how ready the consortia were to be evaluated regarding resource allocation. The authors found no uniform process for the allocation of Title II funds in Virginia. Consortia members who felt connected and involved with their consortium were significantly more knowledgeable about its operations and more likely to consider it effective. A consortium's use of a continuous quality improvement (CQI) approach to allocating resources was strongly associated with its members' perception that the consortium was effective. Statewide performance and/or outcome measures cannot be set without some standardized expectations for performance. To do this, some expectations for basic resource allocation procedures must be established. Three of Virginia's five consortia will make use of this study's instrumentation in their next resource allocation processes, and, if their experiences are useful, a statewide process may be established. If a statewide process is established, regional consortia must continue to be able to determine local needs and to respond with locally appropriate service planning.

Creating a table of authorization to empower staff.

Empowering frontline managers to make and accept accountability for decisions poses a significant challenge, especially for integrated delivery systems (IDSs) where multiple organizational layers and complex management structures can create confusion about roles and responsibilities. Without a clear set of guidelines for independent action, attempts to achieve staff empowerment are likely to fail. To achieve its empowerment goals, Overlook Hospital in Summit, New Jersey, a part of the Atlantic Health System, a New Jersey-based IDS, developed the "Table of Authorization for the Commitment or Expenditure of the System's Physical or Financial Resources." This management tool clarifies the degree to which frontline managers may make decisions and initiate actions without the need for senior management or board approval. The table provides an effective means of promoting a uniform basis for decision making across the system and encourages improved customer service vital in competitive markets.

Making tough resource decisions. A process for considering both values and costs.

Effective resource management involves prospective decision making, including setting priorities. This enables healthcare facilities to provide services that are consistent with institutional commitments and, under some circumstances, to limit or deny services that are inconsistent with those commitments. The challenge is to apply explicit moral analysis to resource allocation efforts to ensure that facilities are treating patients consistently and fairly. Not only are allocation decisions unavoidable, they also can promote holistic, socially responsible medical practice. But current mechanisms, which are largely hidden from view and informal, can negatively affect important relationships with constituents. The just allocation of our precious healthcare resources rests on values that can either conflict with or complement one another. The core values in resource management include respect for persons, professional integrity, due process, informed consent, stewardship, and the common good. An interdisciplinary team of providers should oversee an ongoing review of resource management mechanisms. The group should meet regularly to look at how the mechanism works, what its goals are, what unit of care it evaluates, and what measurements are used to reach the goals. The measures might include severity of illness, effectiveness, cost, and social factors. Examining questions related to each of these areas can help the group determine whether an existing or proposed resource management mechanism is morally defensible.

Health for All and British health policy: a comment on the quest for "healthy public policy".

Explains that Health for All is an international extra-governmental movement that seeks to pursue equity in access to health-related resources by broadening the scope of health policy. Notes that its major principles include social participation in state decision making, inter-sectoral collaboration in policy formulation and the improvement of conditions for the disadvantaged. Points out that its local initiatives often encompass health-service professionals and practitioners as well as the voluntary sector, social services and other local authority departments, and that the effect of this local activity on political understandings of health at a national level gives some indication of the extent to which this local time and effort have been justified. In this respect, notes two limits to the impact of the Health for All movement on the political debates about health in Britain. Suggests that these centre on a largely indifferent but powerful national government and an emphasis within the movement initiatives at the level of a politically marginalized local state.

A comparison of principle-based and case-based approaches to ethical analysis.

Illness is not just something that persons have or get--it is something that they experience. They live this experience fully with their entire being--emotionally, psychologically, spiritually, and physiologically. Any method of ethical analysis must take care to not simplify the process of dealing with morally troubling cases. The multidimensional nature of human life is so complex that the decisions made in these situations are seldom if ever strictly medical decisions--they are also social, emotional, religious, and moral ones. Ethical dilemmas present in today's health care settings compel members of HECs to engage in and contribute toward meaningful dialogue in ethics that is collaborative, multidisciplinary, and mutually respectful. The inevitability of change in the way in which the health needs of people are going to be handled in the future demands this proactive approach. Individuals who accept this responsibility must equip themselves for ethical analysis that deals effectively with the inevitably complex questions that will arise.

Which patients should receive lung transplants?

Lung transplantation is a therapeutic option for selected patients with end-stage respiratory failure from a variety of pulmonary vascular and parenchymal lung diseases. Early problems due to ischaemic dehiscence of the bronchial anastomosis were avoided with heart-lung transplantation where the coronary bronchial collateral circulation remains intact. With the increase in number of cardiac transplantation, the number of heart-lung blocks available for heart-lung transplantation are declining significantly. Improved techniques now make double lung, bilateral single lung and single lung transplantations suitable alternatives to heart-lung transplantations for many patients, with good anastomotic healing and encouraging results. Patients should only be accepted onto the transplant waiting list if they have deteriorating chronic respiratory failure with a severely impaired quality of life. All patients require a detailed pre-transplant medical and psychosocial assessment. While the absolute contraindications to transplantation include pre-existing malignant disease, active aspergillus or mycobacterial infection, infection with HIV or hepatitis B and noncompliance with treatment, new haemostatic techniques have made it possible to treat many patients who have had previous thoracic surgery. Advances in immunosuppressive agents and post-operative medical care have led to improved survival and quality of life. However, obliterative bronchiolitis remains a serious problem. Demand will always be in excess of available human organs. It is hoped that the development of successful xenografting will enable more patients to benefit from lung transplantation.