This article analyses what a sample of women experiencing menopause say they would like in terms of a quality menopause health service. Thirty-nine women who defined themselves as currently or... Show More

This article analyses what a sample of women experiencing menopause say they would like in terms of a quality menopause health service. Thirty-nine women who defined themselves as currently or recently menopausal were interviewed in depth, and data were analysed using a qualitative strategy known as thematic networks analysis. In terms of the structure of a menopause service, the dominant picture emerging was that women wanted an integrative menopause service where General Practitioners would act as a gateway to both biomedical treatments and complementary and alternative medicine. In addition, participants recommended that practitioners be knowledgeable about the wider (psychosocial) issues associated with menopause, and well versed in a range of therapies. In terms of process issues, participants wanted a service where their experiences were listened to and taken seriously. Given the tension between biomedicine and complementary and alternative medicine over the status of knowledge and diverse approaches to what counts as evidence about whether or not a therapy works, at least some aspects of what participants want from a menopause service may be very difficult to realise.

This paper applies two concepts, ‘knowledge structuring’ and ‘knowledge domination,’ to a real life work situation. The purpose is to explore, analyze and discuss what happens when management... Show More

This paper applies two concepts, ‘knowledge structuring’ and ‘knowledge domination,’ to a real life work situation. The purpose is to explore, analyze and discuss what happens when management interferes into the activities of a knowledge worker in a specific organizational setting by computerizing a key document. Exercising knowledge is delicate and complex. This study makes visible how some parts of performing anesthesia become structured and re-structured when the anesthesia patient record is transformed into a knowledge management system at the same time as someone or something influences how that structuring takes place.

Along the health care supply chain, cost and quality measures are vital in the decision-making process for treatment and care delivery. This study applies statistical significance to a hypothesis... Show More

Along the health care supply chain, cost and quality measures are vital in the decision-making process for treatment and care delivery. This study applies statistical significance to a hypothesis about cost effectiveness of patients’ total charges by health insurance providers for different heart conditions. A retrospective, observational analysis of data is collected from an urban hospital in the Southeastern United States. Using the Agency for Healthcare Research and Quality (AHRQ) database, diagnoses are selected for further analysis based on their prevalence in the general population. The numbers of procedures as well as the patient’s length of stay in the hospital are significantly higher among the Medicare population. However, results indicate that although Medicaid and Medicare have significantly higher ordinary average total charges than the private counterparts, the difference is negligible when comparing means adjusted to remove covariate influence. One implication is that if private insurers were to insure the same types of high risk patients as Medicare and Medicaid the average total charges of a visit would be comparable between providers. These results also suggest that to enhance cost saving measures in government funded insurance programs, the clinical pathways need to be adapted to reduce length of stay and number of procedures per visit.

The World Health Organization identified inadequate Health Information Systems as a challenge in Nigeria. Many developed countries have either implemented or are in the process of implementing an... Show More

The World Health Organization identified inadequate Health Information Systems as a challenge in Nigeria. Many developed countries have either implemented or are in the process of implementing an Integrated Electronic Health Record (EHR) system because of its potential benefits. Pilot projects in many developing countries like Kenya, Malawi, Peru, and Haiti are demonstrating the viability of EHR in resource constrained areas. This study shows that the health system in Nigeria is pluralistic and complex with Federal, State and Local Governments, Health Related Agencies, Non-Governmental Organizations, private healthcare providers, patients, and researchers as the major stakeholders. The drivers for adoption of a nationwide EHR include the need to report data; improve patient safety, improve work place efficiency; comply with government reforms aimed at reducing the cost and increasing access to health services. Corruption, poor coordination among stakeholders, and lack of constant supply of electricity are some of the barriers to a successful implementation of a nationwide EHR. Factors considered critical to a successful implementation of a nationwide EHR include enforceable legislation, a trained and motivated workforce, and significant and sustainable funding.

This paper aims to develop a reliable and valid CRM (Customer relationship management) Index specifically catering to Indian hospitals. Standard method of scale development was followed by case... Show More

This paper aims to develop a reliable and valid CRM (Customer relationship management) Index specifically catering to Indian hospitals. Standard method of scale development was followed by case based method for development of CRM Index. The proposed scale shows CRM in Indian hospitals as a multidimensional construct comprising of factors namely tangibles, service quality, trust, availability and accessibility which is validated through the structural model. The proposed Index will help in identifying issues that contribute to CRM in Indian hospitals and formulate strategies accordingly, resulting in efficient (cost) and effective (outcomes) practices. A fair amount of literature on Indian hospitals dealt with identifying factors explaining the constructs of quality, value or satisfaction. There is paucity of research pertaining to industry specific CRM Index development and validation and the authors attempt to bridge this gap in the existing literature.

The Greek Ministry of Health has decided to reform hospital services, due to high cost and low services offered and a part of health care expenditures is wasted. The Minister of Health, Mr. Andreas... Show More

The Greek Ministry of Health has decided to reform hospital services, due to high cost and low services offered and a part of health care expenditures is wasted. The Minister of Health, Mr. Andreas Loverdos has enacted a law for the Greek health care system which include 3 major health reforms: the co-management of hospital units, taking either the type of ‘shared Manager’ or ‘shared Board of Directors,’ the transformation of some general hospitals/health centers or specialized hospitals that present low effective/efficiency rates into either primary health care units or day clinics for specific health care problems, and the merging of similar departments/clinics and/or laboratories either in a hospital or among two or more hospitals that are in the neighborhood. From these reforms, it is estimated that more than 150 million Euro will be saved from these reforms during the 4-year period 2012-2015.

Mobile devices and applications are becoming popular in today’s society. The number of applications available to both the patient and the healthcare provider is changing the way healthcare is being... Show More

Mobile devices and applications are becoming popular in today’s society. The number of applications available to both the patient and the healthcare provider is changing the way healthcare is being delivered and consumed. The integration of mobile devices into every-day lives is driving the changes in healthcare. While all areas of medicine are being impacted, changes are mostly of chronic care, long term care and any place that causes a need for constant data, monitoring or training. The acceptance of mobile devices by healthcare consumers within wide range of age and socioeconomic circumstances is reason to look at mobile technology as the future of healthcare. While increased use of mobile applications are welcomed by most providers and consumers alike, there is a need to systematize the study of its use. The authors provide a framework for considering mobile applications in healthcare, based on their risk-profile. They accomplish this by first identifying and classifying the mobile healthcare applications.

This study discusses the best practices of a hospital in a semi-urban area in India and how the hospital management system has gained extended use through the usage of bio metrics device. Using the... Show More

This study discusses the best practices of a hospital in a semi-urban area in India and how the hospital management system has gained extended use through the usage of bio metrics device. Using the information system, all the stakeholders have benefitted and the monetary benefits have justified IT investment. Integration of information systems with patient care activities has reduced the patient care cost, making it a sustainable investment, making this a benefit to all hospitals.

Information technology has the potential to transform working procedure in the health care sector. Clinicians have used Health Information Management and Technology (HIM&T) for more than two decades... Show More

Information technology has the potential to transform working procedure in the health care sector. Clinicians have used Health Information Management and Technology (HIM&T) for more than two decades to assist in achieving better healthcare delivery outcomes. Medical knowledge is too complex for humans to master in a single mind, and to remember everything about each patient. Medical data consist of many kinds of data from different sources, requiring the development of many medical decision support systems. Creating and indexing records for hospitals and health systems present difficult challenges, because the medical records contain sensitive information. Increased computerization and other policy factors have contributed to privacy risks. Transforming from paper-based to Electronic Medical Records (EMR) allows healthcare providers to share information across their care ecosystem. Access to this digital lifeline, connecting the EMR to the digital web platforma, is critical to saving lives, preventing medical errors and improving efficiency of healthcare delivery. Choosing the international classification systems for patients, ICD, DRGs, grouped patients according to the resources consumption required for treatment and other clinical characteristics. Information Technology provides solutions to this problem. A vital element of healthcare delivery is to ensure that the patient is always at the centre of everything clinicians do.

India, with its billion inhabitants, requires better emergency services to meet the growing demand for faster critical care facilitation. The scientific advances in the field of information and... Show More

India, with its billion inhabitants, requires better emergency services to meet the growing demand for faster critical care facilitation. The scientific advances in the field of information and communication technology have contributed to the implementation of various e-health initiatives by various state governments within the country to improve the quality, access, and delivery of emergency care. “108 Emergency Response Service” is an e-health project established by the government of Tamilnadu state in India to render emergency services to the people. A qualitative study of the effectiveness of Information and Communication technologies in this Emergency Response Service (108 Emergency Service) in Coimbatore district of Tamilnadu state (http://www.coimbatore.tn.nic) was done and recommendations to increase the effectiveness were provided. The results reveal that the efficiency and effectiveness of 108 ERS could be greatly enhanced by providing better telecommunication facilities in rural areas and by deploying Global Positioning System (GPS) and Geographic Information System (GIS) and Automatic Vehicle Location (AVL) technologies to reduce the response time of the emergency vehicles.

One prevailing problem in outpatient clinics with appointment systems in Singapore is that patients have to wait a long time for an available slot once they make requests. Such a long wait may... Show More

One prevailing problem in outpatient clinics with appointment systems in Singapore is that patients have to wait a long time for an available slot once they make requests. Such a long wait may negatively impact on the access to healthcare facilities, patient safety and satisfaction, etc. In recent years, such a problem is becoming worse due to the aging society and growing population. Besides the pressure of increasing demand, healthcare service providers in outpatient clinics are facing other challenges such as the complexity of patient request types, e.g., urgent or normal requests, requests for new or follow-up visit, etc. How to allocate the limited slots to meet the requirements of different requests is one of the performance measurements in outpatient clinics. In this paper, discrete event simulation is applied to study different slot allocation strategies and their impacts on waiting time. The dynamics between new visits and follow-up visits are analyzed as well.

This article describes a model of health-care services that ensure the high quality of health-care service and effective brand creation for a hospital. The problems described here that are connected... Show More

This article describes a model of health-care services that ensure the high quality of health-care service and effective brand creation for a hospital. The problems described here that are connected to improving the quality of health care in Poland indicates that high quality of health care builds a positive and strong image of a health-care unit on the medical market. The contents of this article involve basic definitions of quality in health care and also the way the quality is understood and perceived from patient’s and hospital’s point of view. The article also describes a health care quality model, to which health care units should aspire in order to create a positive picture of said units, simultaneously improving and maintaining high quality of health care services. The article investigates the quality factors of health care services, which influence the healthcare units’ brand, its functioning on the market and patient-perceived quality of services. The described management model, which ensures efficient brand-building of healthcare units through services’ quality, takes into account changes in healthcare system and does so in order to ensure the improvement in healthcare units’ functioning.

Financial crisis is particularly acute in Greece. Public Private Partnerships (PPPs), under these conditions, appear as a “reasonable” strategic decision. A PPP’s project implementation requires a... Show More

Financial crisis is particularly acute in Greece. Public Private Partnerships (PPPs), under these conditions, appear as a “reasonable” strategic decision. A PPP’s project implementation requires a high level of preparation, especially in the sensitive area of the National Health System (NHS). The implementation of PPPs projects in Health Sector, has recently initiated in Greece, while the relevant legal framework has been already voted since 2005. Many people express reservations about the extent and the content of this implementation. The aim of the current survey was to measure the satisfaction of health professionals in the public sector from the existing infrastructures and the assessment of their attitude to the prospect of PPP’s application to upgrade health infrastructure and health services. Results focus on the response of the hospital executive personnel towards PPP’s implementation. The research found a generally positive response to PPPs, while at the same time this approach is being characterized as a last resort. The positive reaction was identified in the involvement of the private sector, in providing support services during the contract, according to the current legislative framework. On the other hand, there is a significant opposition towards any prospect of transferring to the private investor, services related to medical and nursing care.

Today all OECD (Organization for Economic Cooperation and Development) countries are faced with the challenge of escalating healthcare costs. Most are agreed that e-health appears to offer a... Show More

Today all OECD (Organization for Economic Cooperation and Development) countries are faced with the challenge of escalating healthcare costs. Most are agreed that e-health appears to offer a solution and thus we are witnessing the design, development and implementation of various e-health solutions. This is also true in Germany where the current focus is on the new e-health card concept. It is anticipated that the introduction of this e-health card will totally change the current healthcare system within Germany, primarily because it offers several new functions. Some of these functions are mandatory, while other functions are optional. Such an initiative however, brings with it several advantages and disadvantages. A particularly sensitive aspect here concerns data protection and data security. To address this consideration, the development of a new telematics infrastructure is critical and in some respects the backbone for the e-health card. Thus, the following provides an assessment of the telematics infrastructure behind the German e-health card.

One in three Americans will be diabetic by 2050, and the rate of diabetes is disproportionately high among Native Americans, especially among Native elders age 55 and older. Early identification and... Show More

One in three Americans will be diabetic by 2050, and the rate of diabetes is disproportionately high among Native Americans, especially among Native elders age 55 and older. Early identification and prevention strategies have been regarded as the cornerstone of preventative medicine. The objective of the authors’ research was to identify factors related to diabetes and their interactions specifically among Native elders and develop a simple prediction model which can be used by healthcare professionals while interacting with Native elders in remote or rural areas. Data from a survey of 18,078 Native American elders was used in their study. After eliminating outliers using Pearson’s residuals and Cook’s distance, the area under the receiver operating characteristic curve was 0.7812 for men and 0.7230 for women. The results from the authors’ analysis provide additional perspective on how diabetes affects Native elders thus helping healthcare providers and policy makers when dealing with these community members.

This paper investigates whether Knowledge Management (KM) tools and techniques would be useful to General Practitioners within the new UK Commissioning Consortia when they adopt the role of General... Show More

This paper investigates whether Knowledge Management (KM) tools and techniques would be useful to General Practitioners within the new UK Commissioning Consortia when they adopt the role of General Practitioners commissioners from the current Primary Care Trusts. Empirical data based on questionnaires were sent to a small sample group made up of General Practitioners, Primary Care Staff and Academics in addition to data collected from a set of one to one interviews with some of the sample group. The authors’ findings show that stakeholders (n=30) are not accustomed to using KM as a way to maximize existing knowledge of commissioning of services within the Primary Care Trust but it does show that they are not too far away from possibly realizing that some type of KM strategy would probably work for them. General Practitioners are already using some of the knowledge management tools under different guises. A lot of resources will be saved if General Practitioners can capture as much of the knowledge already available within the Primary Care Trust by incorporating KM tools and techniques.

System dynamics models can facilitate the understanding of complex and dynamic biomedical systems such as in HIV/AIDS. Untangling the dynamics among various population stocks (e.g., susceptible... Show More

System dynamics models can facilitate the understanding of complex and dynamic biomedical systems such as in HIV/AIDS. Untangling the dynamics among various population stocks (e.g., susceptible population, infected population, HIV population, AIDS population) can be used to investigate the effective points of interventions in the HIV/AIDS cycle. With that in mind, the authors have developed a system dynamics model that can be used to examine various policy decisions for the prevention and the treatment of HIV/AIDS. The specific objectives of their study was to examine the growing number of AIDS-related deaths in Canada. They used the authors’ dynamic simulation model to evaluate the impact of various HIV/AIDS policy intervention scenarios centred on the reduction of the number of AIDS deaths in Canada. Their analysis suggests that more lives will be saved if effective preventive and treatment programs are implemented simultaneously. A simultaneous implementation of these programs will also result in a much smaller HIV-infected and AIDS populations.