Physicians in leadership: the association between medical director involvement and staff-to-patient ratios

In a hospital environment that demands a careful balance between commercial and clinical interests, the extent to which physicians are involved in hospital leadership varies greatly. This paper assesses the influence of the extent of this involvement on staff-to-patient ratios. Using data gathered from 604 hospitals across Germany, this study evidences the positive relationship between a full-time medical director (MD) or heavily involved part-time MD and a higher staff-to-patient ratio. The data allows us to control for a range of confounding variables, such as size, rural/urban location, ownership structure, and case-mix. The results contribute to the sparse body of empirical research on the effect of clinical leadership on organizational outcomes.

Stakeholder challenges in purchasing medical devices for patient safety.

OBJECTIVE: This study identifies the stakeholders who have a role in medical device purchasing within the wider system of health-care delivery and reports on their particular challenges to promote patient safety during purchasing decisions. METHODS: Data was collected through observational work, participatory workshops, and semi-structured qualitative interviews, which were analyzed and coded. The study takes a systems-based and engineering design approach to the study. Five hospitals took part in this study, and the participants included maintenance, training, clinical end-users, finance, and risk departments. RESULTS: The main stakeholders for purchasing were identified to be staff from clinical engineering (Maintenance), device users (Clinical), device trainers (Training), and clinical governance for analyzing incidents involving devices (Risk). These stakeholders display varied characteristics in terms of interpretation of their own roles, competencies for selecting devices, awareness and use of resources for purchasing devices, and attitudes toward the purchasing process. The role of "clinical engineering" is seen by these stakeholders to be critical in mediating between training, technical, and financial stakeholders but not always recognized in practice. CONCLUSIONS: The findings show that many device purchasing decisions are tackled in isolation, which is not optimal for decisions requiring knowledge that is currently distributed among different people within different departments. The challenges expressed relate to the wider system of care and equipment management, calling for a more systemic view of purchasing for medical devices.

Geometric perspectives on MDO and MDO architectures

Two main perspectives have been developed within the Multidisciplinary Design Optimization (MDO) literature for classifying and comparing MDO architectures: a numerical point of view and a formulation/data flow point of view. Although significant work has been done here, these perspectives have not provided much in the way of a priori information or predictive power about architecture performance. In this report, we outline a new perspective, called the geometric perspective, which we believe will be able to provide such predictive power. Using tools from differential geometry, we take several prominent architectures and describe mathematically how each constructs the space through which it moves. We then consider how the architecture moves through the space which it has constructed. Taken together, these investigations show how each architecture relates to the original feasible design manifold, how the architectures relate to each other, and how each architecture deals with the design coupling inherent to the original system. This in turn lays the groundwork for further theoretical comparisons between and analyses of MDO architectures and their behaviour using tools and techniques derived from differential geometry. © 2012 by the American Institute of Aeronautics and Astronautics, Inc. All rights reserved.

Soft robotics: Challenges and perspectives

There has been an increasing interest in the use of unconventional materials and morphologies in robotic systems because the underlying mechanical properties (such as body shapes, elasticity, viscosity, softness, density and stickiness) are crucial research topics for our in-depth understanding of embodied intelligence. The detailed investigations of physical system-environment interactions are particularly important for systematic development of technologies and theories of emergent adaptive behaviors. Based on the presentations and discussion in the Future Emerging Technology (fet11) conference, this article introduces the recent technological development in the field of soft robotics, and speculates about the implications and challenges in the robotics and embodied intelligence research. © Selection and peer-review under responsibility of FET11 conference organizers and published by Elsevier B.V.

AI in locomotion: Challenges and perspectives of underactuated robots

This article discusses the issues of adaptive autonomous navigation as a challenge of artificial intelligence. We argue that, in order to enhance the dexterity and adaptivity in robot navigation, we need to take into account the decentralized mechanisms which exploit physical system-environment interactions. In this paper, by introducing a few underactuated locomotion systems, we explain (1) how mechanical body structures are related to motor control in locomotion behavior, (2) how a simple computational control process can generate complex locomotion behavior, and (3) how a motor control architecture can exploit the body dynamics through a learning process. Based on the case studies, we discuss the challenges and perspectives toward a new framework of adaptive robot control. © Springer-Verlag Berlin Heidelberg 2007.