The positive moderating effect of absorptive capacity on R&D investment: the case of Argentina's ict firms.

The model analyzes the positive moderating role of absorptive capacity (ACAP) in the innovative outcomes of the firms. It focuses on ACAP as a moderating variable of the innovative efforts that firms develop or have the chance of incorporating from outside and not just as an antecedent of the innovation results. The empirical evidence collected comes from a study conducted on 189 SMEs working in IT services in Argentina and the results prove the main hypothesis of how ACAP is a positive moderating factor of the innovative effort of firms, even in the case of the connections created by their the participation in international networks not having a high correlation. Some suggestions for policymaker managers and future lines of research are provided.

Implementation of a formulary management process.

PURPOSE: The application of lean methodology in an initiative to redesign the formulary maintenance process at an academic medical center is described. SUMMARY: Maintaining a hospital formulary requires clear communication and coordination among multiple members of the pharmacy department. Using principles of lean methodology, pharmacy department personnel within a multihospital health system launched a multifaceted initiative to optimize formulary management systemwide. The ongoing initiative began with creation of a formulary maintenance redesign committee consisting of pharmacy department personnel with expertise in informatics, automation, purchasing, drug information, and clinical pharmacy services. The committee met regularly and used lean methodology to design a standardized process for management of formulary additions and deletions and changes to medications' formulary status. Through value stream analysis, opportunities for process and performance improvement were identified; staff suggestions on process streamlining were gathered during a series of departmental kaizen events. A standardized template for development and dissemination of monographs associated with formulary additions and status changes was created. In addition, a shared Web-based checklist was developed to facilitate information sharing and timely initiation and completion of tasks involved in formulary status changes, and a permanent formulary maintenance committee was established to monitor and refine the formulary management process. CONCLUSION: A clearly defined, standardized process within the pharmacy department was developed for tracking necessary steps in enacting formulary changes to encourage safe and efficient workflow.

Full impact of laboratory information system requires direct use by clinical staff: cluster randomized controlled trial.

OBJECTIVE: To evaluate the time to communicate laboratory results to health centers (HCs) between the e-Chasqui web-based information system and the pre-existing paper-based system. METHODS: Cluster randomized controlled trial in 78 HCs in Peru. In the intervention group, 12 HCs had web access to results via e-Chasqui (point-of-care HCs) and forwarded results to 17 peripheral HCs. In the control group, 22 point-of-care HCs received paper results directly and forwarded them to 27 peripheral HCs. Baseline data were collected for 15 months. Post-randomization data were collected for at least 2 years. Comparisons were made between intervention and control groups, stratified by point-of-care versus peripheral HCs. RESULTS: For point-of-care HCs, the intervention group took less time to receive drug susceptibility tests (DSTs) (median 9 vs 16 days, p<0.001) and culture results (4 vs 8 days, p<0.001) and had a lower proportion of 'late' DSTs taking >60 days to arrive (p<0.001) than the control. For peripheral HCs, the intervention group had similar communication times for DST (median 22 vs 19 days, p=0.30) and culture (10 vs 9 days, p=0.10) results, as well as proportion of 'late' DSTs (p=0.57) compared with the control. CONCLUSIONS: Only point-of-care HCs with direct access to the e-Chasqui information system had reduced communication times and fewer results with delays of >2 months. Peripheral HCs had no benefits from the system. This suggests that health establishments should have point-of-care access to reap the benefits of electronic laboratory reporting.

[Inter-municipal health consortia: the case of Paraná State, Brazil]. / Consórcios Intermunicipais de Saúde: o caso do Paraná, Brasil.

Inter-municipal health consortia emerged in Brazil's Unified National Health System (SUS) policy in the late 1980s. Municipal health administrators adhered to this strategy with the aim of upgrading health services supplied to the population. This research analyzes the profile of such consortia in Paraná State, focusing on specialized medical care. Data were obtained from reports by the State Health Council and questionnaires sent to all 20 existing municipal health consortia. Governmental Decree no. 1,101 and data published in 2000 on the profile of the health system in Paraná were used as references. Of the 399 municipalities in Paraná State, 81.5% have joined municipal consortia. Specialists are allocated by municipalities (4.4%), the State government (13.6%), or Federal Government (12.8%); another 69.2% are hired by the consortia themselves. The supply of consultations with specialists is either insufficient or inadequately distributed, and there are flaws in the referral and counter-referral system. Municipal health consortia serve as viable instrument for expanding and increasing the capacity of municipalities to supply specialized care, although there is a need for well-defined criteria, planning, and improving of the referral and counter-referral system.

Infection control in a Brazilian regional multihospital system.

OBJECTIVE: This study describes the organization of infection control committees in a Brazilian multihospital system, identifying their major problems. Our goal is to discuss the main deficiencies in infection control and to target some interventions that can improve the efficiency of these actions in Brazilian hospitals. DESIGN AND SETTING: We used a descriptive epidemiologic design. We interviewed the chairs and the nurses of the infection control committees and visited the main areas to observe infection control in a multihospital system with 3146 beds. For analysis of the results, we performed a standardization process, establishing a score for each hospital by using infection control organization as a surrogate marker for quality outcome. The mean hospital scores for infection control, existence of policies, and infrastructure at each hospital were compared by using different stratification and multivariate analysis. RESULTS: Statistically significant differences were found among surveyed hospitals by using stratification by size, funding status, and presence of teaching activities. CONCLUSIONS: Diverse patterns of infection control organization were found among surveyed hospitals. Small hospitals represented the major problem in providing effective infection control. Chiefly for these hospitals, the epidemiologic indicators and the surveillance and control system proposed by the Brazilian Ministry of Health and based on the Centers for Disease Control and Prevention model showed poor suitability.

A system that 'walks the talk'. Using improved community health status for CEO evaluation and compensation. Interview by Karen Gardner.

Crozer-Keystone Health System, with corporate headquarters in Media, PA, is relatively new. The system was formed in 1990 to integrate four hospitals--roughly 1,160 acute care beds--five long-term care facilities, skilled nursing facilities and personal care facilities. According to President and CEO John C. McMeekin, the system comprises "very aggressive" programs in senior wellness, geriatric care, women's and children's health, behavioral medicine and psychiatric substance abuse. And it also has a large managed care organization that was undertaken as part of a joint venture with members of the hospitals' medical staff. The system is still defining itself, and perhaps that's why it has been willing to venture into an area that is virtually unique among health care organizations: using community health status indicators as part of the CEO's annual evaluation and compensation. Recently, Trustee editor Karen Gardner spoke to McMeekin and board Chairman Richard W. Billings about a major community needs assessment project that the system undertook in 1991 and how it is using the results of that study.

Costs and benefits of integrated healthcare systems.

Although forming an integrated healthcare system can be extremely expensive, many hospitals and physician groups are discovering that by doing so, they can reap significant benefits, including increased market share, more secure physician income, and better physician "quality of life," a financially stronger organization, and an enhanced ability to adapt to the changing healthcare environment. In most cases, the return on the investment required to reorganize the physician, hospital, and healthcare plan relationship is likely to be substantial.

Implementation of a national nursing standards program.

At an annual nursing management conference of a multisystem hospital management firm, nursing executives expressed a need for developing nursing care standards. Because many of the hospitals were small or rural, they lacked some of the resources needed to develop such a program individually. Pooling resources so that all could benefit was an innovative and sensible approach. The authors describe the project that resulted in the development of a nation-wide standards program involving nearly 50 hospitals.

Skills for selecting valued leaders. Eastern Mercy Health System takes a nine-step approach to choosing managers.

Catholic healthcare facilities seek skilled leaders who can adapt to the organization's culture. Eastern Mercy Health System, Radnor, PA, has developed an educational course, Selecting Valued Leaders, that teaches interviewers selection skills on the basis of the organization's values and mission. The course covers four major topics. The first is building culture. Each participant examines his or her organization's history, communication styles, organizational behavior, and mission. Next, course participants discuss the competencies necessary for a leader's success. Eastern Mercy Health System has identified the following six competency clusters essential for its values-oriented leaders: empower people, steward resources, integrate values, act as advocate, support sponsor's priorities, and maintain Catholic identity. The third part of the course covers a nine-step approach for selecting values-oriented leaders. Participants discuss topics such as the search committee, job description, search strategy, and job offer. In the final section of the course, participants sharpen their selection skills. They review appropriate interview procedures and discuss open-ended questions to ask the candidate.

An innovative way to continue the ministry. A Catholic multi-institutional healthcare system achieves public juridic person status.

Members in a Catholic multi-institutional healthcare system that has been established as a public juridic person know their missions will be carried on even if they must leave the healthcare field. The establishment of a public juridic person was a goal of the Catholic Health Corporation (CHC), Omaha, since it began in 1980. The juridic person was to be named Catholic Health Care Federation (CHCF) in order to distinguish the canonical juridic person from the civil law corporation. It took many years to determine which competent authority was the most appropriate to grant CHCF public juridic status. The Congregation for Institutes of Consecrated Life and Societies of Apostolic Life (CICLSAL) was deemed the appropriate authority. CICLSAL established CHCF as a public juridic person on June 8, 1991. CHCF's member religious institutes are the same as CHC's. But CHCF is the canonical sponsor for two owned facilities and manages a third community-owned facility. The religious institutes remain the sole canonical sponsor for their own facilities; however, they jointly sponsor three facilities through CHCF. Public juridic person status is a way for CHCF to continue Christ's healing mission.