Everyone is; should healthcare? Outsourcing: Issues in strategic planning, organizational culture, and organizational ethics

Expenditures for personal health services in the United States have doubled over the last decade. They continue to outpace the growth rate of the gross national product. Costs for medical care have steadily increased at an annual rate well above the rate of inflation and have gradually outstripped payers' ability to meet their premiums. This limitation of resources justifies the ongoing healthcare reform strategies to maximize utilization and minimize costs. The majority of the cost-containment effort has focused on hospitals, as they account for about 40 percent of total health expenditures. Although good patient outcomes have long been identified as healthcare's central concern, continuing cost pressures from both regulatory reforms and the restructuring of healthcare financing have recently made improving fiscal performance an essential goal for healthcare organizations. ^ The search for financial performance, quality improvement, and fiscal accountability has led to outsourcing, which is the hiring of a third party to perform a task previously and traditionally done in-house. The incomparable nature and overwhelming dissimilarities between health and other commodities raise numerous administrative, organizational, policy and ethical issues for administrators who contemplate outsourcing. This evaluation of the outsourcing phenomenon, how it has developed and is currently practiced in healthcare, will explore the reasons that healthcare organizations gravitate toward outsourcing as a strategic management tool to cut costs in an environment of continuing escalating spending. ^ This dissertation has four major findings. First, it suggests that U.S. hospitals in FY2000 spent an estimated $61 billion in outsourcing. Second, it finds that the proportion of healthcare outsourcing highly correlates with several types of hospital controlling authorities and specialties. Third, it argues that healthcare outsourcing has implications in strategic organizational issues, professionalism, and organizational ethics that warrant further public policy discussions before expanding its limited use beyond hospital “hotel functions” and back office business processes. Finally, it devises an outsourcing suitability scale that organizations can utilize to ensure the most strategic option for outsourcing and concludes with some public policy implications and recommendations for its limited use. ^

Confidence: dependencies and their critical role in fostering user acceptance in pervasive applications

Pervasive computing offers new scenarios where users are surrounded by invisible and proactive technology making smart spaces. Although the utility and power of solutions developed using this computer paradigm are proved, there are unresolved problems that hinder their acceptance and inclusion in our private life. Users have problems understanding the operations of a pervasive computing solution, and therefore they should trust that the solution works properly and according to their expectations. Nevertheless, the concept of trust is already framed in a specific use within the ecosystem of applications that can populate a smart space. To take this concept of trust to the whole space, we propose to study and define the concept of confidence. In contrast to the concept of trust, confidence has deeper psychological implications.

Research in speech communication.

Advances in digital speech processing are now supporting application and deployment of a variety of speech technologies for human/machine communication. In fact, new businesses are rapidly forming about these technologies. But these capabilities are of little use unless society can afford them. Happily, explosive advances in microelectronics over the past two decades have assured affordable access to this sophistication as well as to the underlying computing technology. The research challenges in speech processing remain in the traditionally identified areas of recognition, synthesis, and coding. These three areas have typically been addressed individually, often with significant isolation among the efforts. But they are all facets of the same fundamental issue--how to represent and quantify the information in the speech signal. This implies deeper understanding of the physics of speech production, the constraints that the conventions of language impose, and the mechanism for information processing in the auditory system. In ongoing research, therefore, we seek more accurate models of speech generation, better computational formulations of language, and realistic perceptual guides for speech processing--along with ways to coalesce the fundamental issues of recognition, synthesis, and coding. Successful solution will yield the long-sought dictation machine, high-quality synthesis from text, and the ultimate in low bit-rate transmission of speech. It will also open the door to language-translating telephony, where the synthetic foreign translation can be in the voice of the originating talker.

The Virtual Interactive Relationship Between BIM Project Teams: Effective Communication to aid Collaboration in the Design Process

Building Information Modelling (BIM) provides a shared source of information about a built asset, which creates a collaborative virtual environment for project teams. Literature suggests that to collaborate efficiently, the relationship between the project team is based on sympathy, obligation, trust and rapport. Communication increases in importance when working collaboratively but effective communication can only be achieved when the stakeholders are willing to act, react, listen and share information. Case study research and interviews with Architecture, Engineering and Construction (AEC) industry experts suggest that synchronous face-to-face communication is project teams’ preferred method, allowing teams to socialise and build rapport, accelerating the creation of trust between the stakeholders. However, virtual unified communication platforms are a close second-preferred option for communication between the teams. Effective methods for virtual communication in professional practice, such as virtual collaboration environments (CVE), that build trust and achieve similar spontaneous responses as face-to-face communication, are necessary to face the global challenges and can be achieved with the right people, processes and technology. This research paper investigates current industry methods for virtual communication within BIM projects and explores the suitability of avatar interaction in a collaborative virtual environment as an alternative to face-to-face communication to enhance collaboration between design teams’ professional practice on a project. Hence, this paper presents comparisons between the effectiveness of these communication methods within construction design teams with results of further experiments conducted to test recommendations for more efficient methods for virtual communication to add value in the workplace between design teams.

Across the dividing range - bridging the divides: Pharmacy opportunities across the hospital/community and inter-professional divides in rural and remote Australia

Rural and remote areas of Australia offer many opportunities for innovation in healthcare services. Some true healthcare 'network' models based around rural pharmacy can be established and evaluated. The lines between community and hospital pharmacy are often blurred and communication between health professionals enhanced. The blurring divide between hospital and community pharmacy in rural and remote areas has provided significant advances in practice. Projects have been set up to investigate the feasibility of community pharmacists integrating care for patients. These projects take advantage of the dual roles and the enhanced interaction between pharmacists and other health professionals in the bush. Opportunities for provision of clinical services beyond the traditional supply role have been taken in a number of remote communities

Innovation management using logical framework in hospital-based healthcare units

Innovation is part and parcel of any service in today's environment, so as to remain competitive. Quality improvement in healthcare services is a complex, multi-dimensional task. This study proposes innovation management in healthcare services using a logical framework. A problem tree and an objective tree are developed to identify and mitigate issues and concerns. A logical framework is formulated to develop a plan for implementation and monitoring strategies, potentially creating an environment for continuous quality improvement in a specific unit. We recommend logical framework as a valuable model for innovation management in healthcare services. Copyright © 2006 Inderscience Enterprises Ltd.

Managing healthcare technology in quality management framework

Healthcare services available these days deploy high technology to satisfy both internal and external customers by continuously improving various quality parameters. Quality improvement in healthcare services is a complex and multidimensional task. Although various quality management tools are routinely deployed for identifying quality issues in healthcare delivery, there is absence of an integrated approach, which can identify and analyse issues, provide solutions to resolve those issues and develop a project management framework to implement and evaluate those solutions. This study introduces an integrated and uniform quality management framework for healthcare services. This study uses the Logical Framework Analysis (LFA) to improve the performance of healthcare services. LFA has three major steps - problem identification, solution derivation and formation of a planning matrix for implementation and evaluation. LFA has been applied in a case study environment to three acute healthcare services (Operating Room (OR) utilisation, Accident and Emergency (A&E) and intensive care) in order to demonstrate its effectiveness. Copyright © 2007 Inderscience Enterprises Ltd.

Information and communication technology (ICT) and human development

Using panel data for 41 developed and developing countries over the period 1998-2004, this paper examines the links between ICT diffusion and human development. We conducted a panel regression analysis of the investments in healthcare, education and information and communication technology (ICT) against human development index (HDI). The results show that these variables can be used to predict HDI scores. In agreement with findings of previous research, it is clear from our analysis that the central focus on ICT as a solution for development will not bring the results that the promoters of ICT as an ‘engine of growth’ are expecting. It is unwise to disaggregate the issues of education and healthcare infrastructure from ICT infrastructure development. ICT policies should be integrated with other national policies in order to find a holistic and structural solution to development.

Analyze impact of context information on rate adaptation algorithm in vehicular communication

Nowadays, road safety and traffic congestion are major concerns worldwide. This is why research on vehicular communication is very vital. In static scenarios vehicles behave typically like in an office network where nodes transmit without moving and with no defined position. This paper analyses the impact of context information on existing popular rate adaptation algorithms. Our simulation was done in MATLAB by observing the impact of context information on these algorithms. Simulation was performed for both static and mobile cases.Our simulations are based on IEEE 802.11p wireless standard. For static scenarios vehicles do not move and without defined positions, while for the mobile case, vehicles are mobile with uniformly selected speed and randomized positions. Network performance are analysed using context information. Our results show that in mobility when context information is used, the system performance can be improved for all three rate adaptation algorithms. That can be explained by that with range checking, when many vehicles are out of communication range, less vehicles contend for network resources, thereby increasing the network performances. © 2013 IEEE.

Integration issues in the healthcare supply chain

The efficacy, quality, responsiveness, and value of healthcare services provided is increasingly attracting the attention and the questioning of governments, payers, patients, and healthcare providers. Investments on integration technologies and integration of supply chain processes, has been considered as a way towards removing inefficiencies in the sector. This chapter aims to initially provide an in depth analysis of the healthcare supply chain and to present core entities, processes, and flows. Moreover, the chapter explores the concept of integration in the context of the healthcare sector, and indentifies the integration drivers, as well as challenges.

Patient experiences of serious adverse drug reactions and their attitudes to medicines:a qualitative study of survivors of Stevens-Johnson syndrome and toxic epidermal necrolysis in the UK

Background: Adverse drug reactions (ADRs) cause significant morbidity and mortality and account for around 6.5% of hospital admissions. Patient experiences of serious ADRs and their long-term impact on patients' lives, including their influence on current attitudes towards medicines, have not been previously explored. Objective: The aim of the study was to explore the experiences, beliefs, and attitudes of survivors of serious ADRs, using drug-induced Stevens-Johnson syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) as a paradigm. Methods: A retrospective, qualitative study was undertaken using detailed semi-structured interviews. Fourteen adult survivors of SJS and TEN, admitted to two teaching hospitals in the UK, one the location of a tertiary burns centre, were interviewed. Interview transcripts were independently analysed by three different researchers and themes emerging from the text identified. Results: All 14 patients were aware that their condition was drug induced, and all but one knew the specific drug(s) implicated. Several expressed surprise at the perceived lack of awareness of the ADR amongst healthcare professionals, and described how the ADR was mistaken for another condition. Survivors believed that causes of the ADR included (i) being given too high a dose of the drug; (ii) medical staff ignoring existing allergies; and (iii) failure to monitor blood tests. Only two believed that the reaction was unavoidable. Those who believed that the condition could have been avoided had less trust in healthcare professionals. The ADR had a persisting impact on their current lives physically and psychologically. Many now avoided medicines altogether and were fearful of becoming ill enough to need them. © 2011 Adis Data Information BV. All rights reserved. Conclusions: Life-threatening ADRs continued to affect patients’ lives long after the event. Patients’ beliefs regarding the cause of the ADR differed, and may have influenced their trust in healthcare professionals and medicines. We propose that clear communication during the acute phase of a serious ADR may therefore be important.

DC power line communication based on power/signal dual modulation in phase shift full bridge converters

For intelligent DC distributed power systems, data communication plays a vital role in system control and device monitoring. To achieve communication in a cost effective way, power/signal dual modulation (PSDM), a method that integrates data transmission with power conversion, can be utilized. In this paper, an improved PSDM method using phase shift full bridge (PSFB) converter is proposed. This method introduces a phase control based freedom in the conventional PSFB control loop to realize communication using the same power conversion circuit. In this way, decoupled data modulation and power conversion are realized without extra wiring and coupling units, and thus the system structure is simplified. More importantly, the signal intensity can be regulated by the proposed perturbation depth, and so this method can adapt to different operating conditions. Application of the proposed method to a DC distributed power system composed of several PSFB converters is discussed. A 2kW prototype system with an embedded 5kbps communication link has been implemented, and the effectiveness of the method is verified by experimental results.

A lean kultúra értelmezése és mérése egy egészségügyi szolgáltatónál (The interpretation and measurement of the lean culture – in case of a healthcare service provider)

A lean menedzsment egészségügyi szolgáltatásokra való alkalmazásával elérhető eredmények egyre inkább nyilvánvalóvá válnak. Ennek köszönhetően a szektorban dinamikus növekedés tapasztalható ezen a téren. A kutatások azonban arra hívják fel a figyelmet, hogy a lean menedzsment alkalmazásával elért eredmények csak akkor lesznek fenntarthatóak, ha az eszközök alkalmazását a kultúra átalakulása is követi. A kultúra változásának követéséhez annak folyamatos értékelésére van szükség. A szervezeti kultúra lean-specifikus méréséhez azonban – a szerzők tudomása szerint – még nincs kidolgozott eszköz. Ezért cikkükben a kapcsolódó szakirodalom áttekintése után kidolgoztak egy lean kultúra kérdőívet, majd bemutatják a kérdőív tesztelését és annak eredményeit. Összegzésként elmondható, hogy az itt bemutatott kérdőív az első tesztelés alapján további fejlesztésre szorul. / === / The results that can be obtained by applying lean management in healthcare services become more and more clear. This generates a dynamic increase of lean applications in healthcare. However, researches are warning that the res ults obtained by lean applications can only be sustained, if next to the use of the lean tools cultural change will also take place. In order to track changes in culture its constant evaluation is necessary. According to the authors’ knowledge today does not exist any lean-specific culture evaluation tool. In this paper they elaborate a lean culture questionnaire based on the review of relevant literature. Than they describe its test and the results of the test. The authors conclude that the questionnaire as introduced here needs further improvement.

Factors Impacting Grandparent and Grand Child Communication Across Sex- Related Topics in Kenya

Background: Although many studies have investigated sexual communication between parents and children in Kenya, none have focused singularly on grandparent and grandchild communication when grandparents are primary caregivers. Further, few studies have asked about specific topics related to sex, instead asking generally about “sex related topics” or focusing on HIV/AIDS. This research aims to investigate communication on ten specific sex- related topics between grandparents who are primary caregivers and their grandchildren. The primary research aim was to identify facilitators and barriers to grandparent-grandchild communication associated with frequency of communication. A secondary exploratory question was whether frequency of communication and youth satisfaction with communication were associated with youth’s desire for more communication in the future. Methods: The study was conducted in urban and peri-urban central Kenya. A convenience sample of 193 grandparents and 166 twelve to fifteen year old grandchildren were identified by community health workers. A cross sectional survey assessed nine potential barriers or facilitators to communication (e.g., frequency of communication, perceived grandparent knowledge, grandparent sense of responsibility to communication on a given topic) on ten specified sex- related topics (e.g., peer pressure on sex topics, romantic relationships, condoms). Bivariate and multivariable analyses identified significant associations between communication variables and the outcomes of interest. Results: Bivariate regression showed that higher grandchild age, grandchild gender, higher perceived grandparent knowledge, higher perceived grandparent comfort, higher grandparent-reported sense of responsibility, higher grandparent-reported belief that child should be aware of a given topic before initiating in sex, and higher youth’s own comfort during communication, were significantly associated with higher levels of communication frequency. In the multivariable model, higher grandchild age, gender, higher comfort during communication, and higher perceived grandparent knowledge remained significantly associated with higher levels communication frequency. For the secondary research question, higher communication frequency and higher levels of youth satisfaction were both significantly associated with higher levels of youth desire for more communication in bivariate regression, and higher levels of youth’s satisfaction with communication remained significantly associated with higher levels of youth’s desire for more in the adjusted analysis. Conclusions: This study found that several potential barriers and facilitators of communication are associated with both frequency of and youth’s desire for more communication. The association between grandchild age, gender and perceived grandparent knowledge and frequency of communication is similar to findings from other studies that have examined sex-related communication between parent primary caregivers and children. This finding has important implications for understanding grandparent and grandchild communication, and communication on specific topics in a population from Kenya. The positive association between youth satisfaction of and desire for more communication has important education policy and intervention implications, suggesting that if youth are satisfied with the communication with their caregivers, they may want to learn more.

Using Coding to Improve Localization and Backscatter Communication Performance in Low-Power Sensor Networks

Backscatter communication is an emerging wireless technology that recently has gained an increase in attention from both academic and industry circles. The key innovation of the technology is the ability of ultra-low power devices to utilize nearby existing radio signals to communicate. As there is no need to generate their own energetic radio signal, the devices can benefit from a simple design, are very inexpensive and are extremely energy efficient compared with traditional wireless communication. These benefits have made backscatter communication a desirable candidate for distributed wireless sensor network applications with energy constraints.

The backscatter channel presents a unique set of challenges. Unlike a conventional one-way communication (in which the information source is also the energy source), the backscatter channel experiences strong self-interference and spread Doppler clutter that mask the information-bearing (modulated) signal scattered from the device. Both of these sources of interference arise from the scattering of the transmitted signal off of objects, both stationary and moving, in the environment. Additionally, the measurement of the location of the backscatter device is negatively affected by both the clutter and the modulation of the signal return.

This work proposes a channel coding framework for the backscatter channel consisting of a bi-static transmitter/receiver pair and a quasi-cooperative transponder. It proposes to use run-length limited coding to mitigate the background self-interference and spread-Doppler clutter with only a small decrease in communication rate. The proposed method applies to both binary phase-shift keying (BPSK) and quadrature-amplitude modulation (QAM) scheme and provides an increase in rate by up to a factor of two compared with previous methods.

Additionally, this work analyzes the use of frequency modulation and bi-phase waveform coding for the transmitted (interrogating) waveform for high precision range estimation of the transponder location. Compared to previous methods, optimal lower range sidelobes are achieved. Moreover, since both the transmitted (interrogating) waveform coding and transponder communication coding result in instantaneous phase modulation of the signal, cross-interference between localization and communication tasks exists. Phase discriminating algorithm is proposed to make it possible to separate the waveform coding from the communication coding, upon reception, and achieve localization with increased signal energy by up to 3 dB compared with previous reported results.

The joint communication-localization framework also enables a low-complexity receiver design because the same radio is used both for localization and communication.

Simulations comparing the performance of different codes corroborate the theoretical results and offer possible trade-off between information rate and clutter mitigation as well as a trade-off between choice of waveform-channel coding pairs. Experimental results from a brass-board microwave system in an indoor environment are also presented and discussed.