The application of hospitality elements in hospitals.

In the last decade, many hospital designs have taken inspiration from hotels, spurred by factors such as increased patient and family expectations and regulatory or financial incentives. Increasingly, research evidence suggests the value of enhancing the physical environment to foster healing and drive consumer decisions and perceptions of service quality. Although interest is increasing in the broader applicability of numerous hospitality concepts to the healthcare field, the focus of this article is design innovations, and the services that such innovations support, from the hospitality industry. To identify physical hotel design elements and associated operational features that have been used in the healthcare arena, a series of interviews with hospital and hotel design experts were conducted. Current examples and suggestions for future hospitality elements were also sought from the experts, academic journals, and news articles. Hospitality elements applied in existing hospitals that are addressed in this article include hotel-like rooms and decor; actual hotels incorporated into medical centers; hotel-quality food, room service, and dining facilities for families; welcoming lobbies and common spaces; hospitality-oriented customer service training; enhanced service offerings, including concierges; spas or therapy centers; hotel-style signage and way-finding tools; and entertainment features. Selected elements that have potential for future incorporation include executive lounges and/or communal lobbies with complimentary wireless Internet and refreshments, centralized controls for patients, and flexible furniture. Although the findings from this study underscore the need for more hospitality-like environments in hospitals, the investment decisions made by healthcare executives must be balanced with cost-effectiveness and the assurance that clinical excellence remains the top priority.

An overview of Afghan National Army critical care capabilities.

BACKGROUND: The North Atlantic Treaty Organization created the International Security Assistance Force to help support the growth in capacity and capability of Afghan National Army (ANA). OBJECTIVE: This article describes the current critical care capabilities of the ANA, which was supported by embedded medical mentors to help build up Afghanistan's medical infrastructure after the fall of the Taliban. DESIGN: We reviewed the experiences of deployed medical mentors in ANA hospitals to report the progress and limitations of the North Atlantic Treaty Organization medical mentoring mission. RESULTS: From October 2008 through November 2009, the continued development of ANA Intensive Care Unit capabilities has decreased mortality from 26.3% to 5.1% despite an increase in admissions from 19 to 78 per month. CONCLUSIONS: Significant progress was made in the critical care capabilities of the ANA critical care physicians. The medical mentoring mission is an effective weapon in building the health care capacity of the ANA medical system.

A hospital-based patient and family education center: if you build it, will they come?

Librarians located in a 560-bed, inner city academic medical center with 25,000 + admissions per year planned and opened a Patient and Family Education Center (PFEC) in the lobby of a new patient care pavilion. A review of use in the first 19 months revealed that expected needs were being met while a variety of unexpected needs were identified. Ongoing use continues to be monitored by a detailed log of patron visits maintained by library staff. This article describes the evolution of the Patient and Family Education Center, outreach to the hospital community, and plans for the future.

A nutrition support service web application to manage patients receiving parenteral nutrition.

Parenteral nutrition (PN) is a complex therapy that requires expertise and experience to avoid errors in prescribing and management. Because of care coordination issues, one medical center has developed and implemented a Web-based application to manage PN patients. PN orders have already been programmed into the physician order entry system, but the nutrition support service (NSS) consult and daily PN management have been performed using paper forms. The Web system is developed for ease of use by clinicians and accessibility at any computer within the medical center. The database consists of 12 tables interrelated by the patient medical record number, admission number, or location. The NSS consult is the main table used to navigate to the other tables. Update of the laboratory and PN formula table must be done through the consult table. The system is compliant with the Health Insurance Portability and Accountability Act guidelines, and has been developed so that the forms that are required to be placed in the patient's permanent record can be printed. Demographic information and laboratory data are automatically populated via a link to the medical center's medication management system. At present, there are 1393 patients in the database and 21,000 pages are viewed each month during daily PN management by clinicians. Data can be easily retrieved for management reports. Data elements can be exported directly from the database to worksheets. This function has been used for projects designed to improve the efficiency of this PN system.

Aerodigestive Programs Enhance Outcomes in Pediatric Patients.

The early efforts of pediatric airway surgeons, gastroenterologists, and pulmonologists to optimize surgical outcomes involved evaluating multiple organ systems for diseases negatively affecting surgery. This resulted in coordinated clinics with multiple services, ancillary testing, and endoscopic procedures, known as aerodigestive programs. These programs have nationally increased the value of care, with multidisciplinary experts delivering organized and efficient care to children with complex needs. This article describes the origin and value of aerodigestive programs within the modern health care landscape, serving as a primer for providers and administrators investigating how to facilitate aerodigestive or similar programs.

Legal issues affecting ancillaries and orthopedic practice.

The federal and state governments have imposed significant regulations on health care generally and on ancillary services in particular. This article focuses on how state and federal laws shape the ability of an orthopedic physician to offer ancillary services, whether as an individual, through a group practice, or as part of a joint venture. It focuses on how the Stark law, the Medicare anti-kickback statute, state anti-kickback, fee-splitting provisions, certificate of need laws, and various Medicare billing and supervision requirements impact the provision of ancillary services. It also briefly discusses how physicians should prepare for and respond to government investigations.

Outsourcing and its implications for hospital organizations in Turkey.

To thrive in this era of global competition, all organizations must explore new managerial approaches to get an edge in the marketplace. One increasingly appealing approach is outsourcing. Hospitals are particularly fertile environments for outsourcing, given their role as providers of a broad and complex array of services, many of which may be bought from other institutions. The purpose of this study is to determine the types of services that hospitals in Turkey buy from other organizations. The study sample included 14 university hospitals, 20 Ministry of Health Hospitals, 15 Social Insurance Organization Hospitals and 31 private hospitals in Istanbul, Ankara, Izmir, Antalya, and Eskisehir, which are the biggest cities in Turkey. The following services were found to be outsourced: hospital management information systems (83.8%), cleaning services (81.3%), maintenance services (72.5%), leased medical devices (75.0%), food services (60.0%), patient direction services (63.8%), magnetic imaging services (60.0%), other imaging services (48.8%), laboratory services (42.5%), security services (38.8%), laundry services (36.3%), patient transportation services (33.8%), accounting services (26.3%), ambulance services (22.5%), patient satisfaction measurement services (13.8%), consultancy services (12.5%), and financial and investment services (9.5%). Private hospitals bought more services than public facilities did. The sampled hospitals chose to outsource services in order to decrease costs (78.8%), increase the quality of services rendered (65.5%), increase flexibility and share risk (36.6%), and increase profits (11.2%). The results of this study suggest that outsourcing, when applied judiciously through cost and risk analysis, is a cost-effective approach that can be used by most hospitals.

The transfer of a health insurance/managed care business.

The owners of a health insurance/managed care business may want to sell that business for a variety of reasons. Health care provider systems may want to exit that business due to operating losses, difficulty in complying with regulations, the inherent conflict in operating that business as part of a provider system, or the desire to focus on being a health care provider. Health insurers/HMOs may want to sell all or a portion of their business due to operating losses, difficulty in servicing a particular market, or a desire to focus on other markets. No matter what reason prompts a seller to undertake a sale, a sale of health insurance/managed care business can be a complicated transaction involving a multitude of issues. This article will focus first on the ways in which such a sale may be structured. The article will then discuss some transactional issues that may arise in the negotiations for the sale of a health insurance/managed care business. The article will then focus on some particular legal issues that arise in each sale-e.g., antitrust, HIPAA, regulatory approvals, and charitable issues. Finally, this article will provide an overview of tax structuring considerations.

Women in Rural America Are Losing Hospital-Based Obstetric Services.

Isolated counties with low populations are most affected.

Nonclinical outcomes of hospital-based palliative care.

Evidence-based outcomes are commonly used in making decisions about clinical care. For healthcare executives, evidence-based outcomes also can be useful in making decisions about hospital services. Finkler and Ward (2003) suggest a model whereby cost measurement, cost control, and value assessment can be used as nonclinical, evidence-based outcome measures to provide decision support and to guide management decisions. The Finkler and Ward framework is used to understand the financial implications of establishing an inpatient palliative care unit (PCU). A longitudinal study was conducted to examine the nonclinical outcomes associated with opening and operating an inpatient PCU at a large academic medical center during the first four years of the unit's operation. First, the cost of providing inpatient palliative care was measured. Results indicated that the cost per day to care for patients hospitalized in the last 20 days leading up to their death was significantly less on the PCU than on intensive care units and non-PCUs. Average daily total charges exceeded reimbursement on the ICU and non-PCUs, but the cost on the PCU for the same population was equal to or below the average daily total charges. Second, ways to control costs when operating an inpatient PCU were identified and measured. Evidence from one organization suggests that costs can effectively be controlled by admitting patients directly to the PCU and by appropriate use of hospital resources, including staff, ancillary services, and pharmaceuticals. Third, the study assessed the value to the institution of operating an inpatient PCU. Results indicated that the inpatient PCU yielded a cost savings of nearly 1 million dollars by the third year of operations. This study highlights the nonclinical outcomes of one institution's inpatient PCU and provides guidelines for healthcare executives and managers to use in making decisions about adopting such programs.

Reading the tea leaves. Making sense of new legal guidance on ancillary services.

Medical groups continue to explore ancillary service development to address patient care and generate revenue. However, the regulatory environment surrounding ancillary service arrangements changed as the Department of Health and Human Services Office of Inspector General rejected a "turn-key" pathology laboratory service arrangement in Advisory Opinion 04-17 (AO-04-17). This article considers how this and other recent guidance affects what medical groups can and cannot do regarding ancillary services.

Entering the well-guarded fortress: alternative practitioners in hospital settings.

There is a growing evidence that alternative health care practitioners and physicians are working together in collaborative patterns. The paper examines these collaborative patterns in hospital settings in Israel. On the theoretical level, the specific issues relate to theories concerning relationships between dominant institutional structures which enjoy the benefits of epistemological legitimacy as well as extensive, supportive social structures and groups of non-conformists who seek to attain many of the same goals by utilizing different methods based on other epistemologies. In the most general sense, the issues involved concern processes of accommodation and social change. Data were collected by means of semi-structured, qualitative interviews in four general hospitals in Jerusalem during 2000. Nineteen persons were interviewed including 10 alternative practitioners working in a variety of fields and nine biomedical practitioners who worked with them (six physicians and three nurses). Interviews focused on background and training, reasons for entry into the hospital, length of practice, status in the hospital system, mode of remuneration, content of work, modes of interaction with others in the hospital and problems encountered. The findings suggest a dual process of simultaneous acceptance and marginalization of alternative practitioners. While small numbers of alternative practitioners were found to be practicing in a wide variety of hospital departments and in a broad spectrum of specialties, they were in no way accepted as regular staff members and their marginality was made clear by a variety of visible structural, symbolic and geographical cues. There is a division of labour expressed by focusing on the biomedical practitioners on the diagnosis and treatment of specific disease entities, while the alternative practitioners work in the illness context, concentrating of feelings and affective states involving the alleviation of pain, suffering and efforts to improve the quality of life.

Consolidating ancillary testing in multihospital systems.

This article introduces a new initiative that allows medical centers to establish uniformity and quality management of laboratory diagnostic testing performed in on-site and outreach locations for hospitalized inpatients and ambulatory care patients. This article also reviews the requirements of the Clinical Laboratory Improvement Amendments of 1988 (CLIA '88) and how they affect ancillary testing sites.

The development of a massage service for cancer patients.

Despite major technological advances in the treatment of cancer, many patients are dissatisfied with conventional biomedical interventions. This is largely because they fail to resolve long term intractable problems such as chronic pain or stress. More emphasis is now being placed on quality of life. This shift in attitude has opened the door for complementary therapies as adjuvants to traditional models of cancer care. Changes within the NHS have facilitated this transition, by the creation of the 'internal market' and the development of central funding to individual clinical directorates. To exploit these opportunities, complementary, therapists must develop new skills and be prepared to adopt NHS standards of assessment to evaluate the efficacy of their work. Standards are a component of 'Quality assurance'. They are observable, achievable and measurable, and contribute towards an acceptable evaluation process. Standards are used by health care purchasers to assess which therapies should be made available to patients within the NHS. This paper describes the development of a massage service that has been integrated into the Hammersmith Oncology Department. The massage standard is seen to be fundamental and essential to the continued development and evaluation of the project.

Ancillary services in the health care industry: is Six Sigma reasonable?

Within the naval medical center construct, the disparate disciplines encompassed within ancillary services lend themselves to formal quality analysis and process improvement. This analysis uses the Six Sigma approach. Error rates were investigated and calculated for various processes within ancillary services at Naval Medical Center, San Diego. These were translated into the common metric of defects per million opportunities (DPMO). DPMO rates vary between 21.5 and 420,000. These correspond to Sigma values from 1.7 to approaching 6. Rates vary with biological complexity of the system and the degree of automation available. Some ancillary services translate well into a Six Sigma schema. Systems with high potential patient risk if performed poorly and those amenable to second checking and computer oversight may be candidates for such optimization. This should be undertaken in a local environment conducive to individual error reporting, and in a corporate environment with the will and funding to support the transition.

Organisational governance structures in allied health services: a decade of change.

A ten year review of developments in the organisation and management of allied health services in Australian acute care public hospitals reveals a steady transformation away from a medically managed universal model towards more complex and contested models of governance. This article revisits early observations about the reorganisation of allied health services and presents more recent research findings to guide managerial decision-making about restructuring the diverse disciplines that constitute allied health. A new organisational model "integrated decentralization" is presented as an approach to managing allied health services which accommodates multiple stakeholder demands in the context of New Public Management (NPM) related reforms. The focus on the institutional level is complemented by examining developments in the profile and activity of allied health at the regional, state and national levels to present a more comprehensive picture of change over the decade of the 1990s.

Carving an identity for allied health.

This paper outlines the development, growth and performance of the Division of Allied Health at Lottie Stewart Hospital, Sydney. It discusses the choice of a suitable organisational model, the findings from three evaluations conducted and a summary of the significant outcomes of the Division. An early version of this paper was presented at the 4th National Allied Health Conference in March 2001.

Transforming Allied Health.

In 1995, the Division of Allied Health at the Women's and Children's Hospital Adelaide (WCH) began a process of critical review of its service delivery models and organisational structure in order better to meet the vision and values of the WCH and the needs of consumers. This paper describes the change management process. Barriers to and facilitators of change are highlighted. The outcomes of the change process are described, including the new multidisciplinary team and program-based organisational structure and culture.

Designing teams that work.

This paper describes the development of clinical improvement teams in a multi-disciplinary acute health care setting. The process included an information-gathering phase that enabled a match of team structure and leadership to staff skills and experience. It was found that an environment that supported collaborative practice and shared decision-making was critical to staff support of the teams and the outcomes achieved.

Service-level agreements at the Huddersfield NHS Trust.

Service-level agreements (SLAs) have been claimed to be an excellent vehicle for organisational improvement where there is a substantial degree of departmental autonomy. Such a situation is likely to exist in NHS trust hospitals because of the differentiated nature of the work performed by each department, with varying degrees of specialisation and professionalism, access to patients, use of technology and differing cost bases but also an interdependence of the direct services to the support services. It is proposed that SLAs can be used to promote improved integration between departments, quality assurance and provide a framework for cost transfer charging. The article describes and analyses SLAs from an overview of the idea to the particular implementation to date at the Huddersfield NHS Trust. SLAs have been negotiated between the Directorate of Clinical Support and its customers, and these are supported by computerised measurement and reporting tools.