Speed and quality in coronary artery bypass graft (CABG) surgery: is there a connection?

In this paper we study the connection between coronary artery bypass graft (CABG) operation time and quality. Our quality metric was the improvement in health related quality of life (HRQoL) survey score in a sample of 432 patients admitted to Kuopio University Hospital. Patients were interviewed with a structured questionnaire a day before the procedure and the follow-up questionnaires were mailed 6 and 12 months after the surgery. However, the HRQoL metric used did not have high retest reliability. Subsequently, we did not find any connection between CAGB operation times and HRQoL. Likewise, we did not find the speed of the surgeon to have any connection to HRQoL improvement.

Stakeholder approach for evaluating organizational change projects.

PURPOSE: This paper aims to create a model for evaluating organizational change initiatives from a stakeholder resistance viewpoint. DESIGN/METHODOLOGY/APPROACH: The paper presents a model to evaluate change projects and their expected benefits. Factors affecting the challenge to implement change were defined based on stakeholder theory literature. The authors test the model's practical validity for screening change initiatives to improve operating room productivity. FINDINGS: Change initiatives can be evaluated using six factors: the effect of the planned intervention on stakeholders' actions and position; stakeholders' capability to influence the project's implementation; motivation to participate; capability to change; change complexity; and management capability. RESEARCH LIMITATIONS/IMPLICATIONS: The presented model's generalizability should be explored by filtering presented factors through a larger number of historical cases operating in different healthcare contexts. The link between stakeholders, the change challenge and the outcomes of change projects needs to be empirically tested. PRACTICAL IMPLICATIONS: The proposed model can be used to prioritize change projects, manage stakeholder resistance and establish a better organizational and professional competence for managing healthcare organization change projects. ORIGINALITY/VALUE: New insights into existing stakeholder-related understanding of change project successes are provided.

The impact of patient-physician web messaging on healthcare service provision.

BACKGROUND: Information technology can support the delivery of healthcare. Patients are eager to make use of such tools as web messaging, yet its deployment has been limited to date. A fear still pervades that the cost associated with a possible increase to physician workloads may outweigh any suggested benefits. GOAL: This paper aims to review the body of research completed in the area of patient-physician web messaging. The findings of this review will then be assessed and synthesised, with the intention of creating an overview of both the benefits and costs of patient-physician online messaging. Areas of particular importance to future research may then be identified. RESULTS: Demand and support for online communication tools amongst patients is strong, and can increase quality of care due to increased patient-physician communication. Although there would seem to be great potential to increase process efficiency, there would not seem to be sufficient evidence as of yet to suggest that this is the case. CONCLUSION: Further quantitative research in particular is required to assess the impact of online communication, with special regard to the effect on overall patient demand and on healthcare process efficiency.

Cardiac surgery productivity and throughput improvements.

PURPOSE: The high variability in cardiac surgery length--is one of the main challenges for staff managing productivity. This study aims to evaluate the impact of six interventions on open-heart surgery operating theatre productivity. DESIGN/METHODOLOGY/APPROACH: A discrete operating theatre event simulation model with empirical operation time input data from 2603 patients is used to evaluate the effect that these process interventions have on the surgery output and overtime work. A linear regression model was used to get operation time forecasts for surgery scheduling while it also could be used to explain operation time. FINDINGS: A forecasting model based on the linear regression of variables available before the surgery explains 46 per cent operating time variance. The main factors influencing operation length were type of operation, redoing the operation and the head surgeon. Reduction of changeover time between surgeries by inducing anaesthesia outside an operating theatre and by reducing slack time at the end of day after a second surgery have the strongest effects on surgery output and productivity. A more accurate operation time forecast did not have any effect on output, although improved operation time forecast did decrease overtime work. RESEARCH LIMITATIONS/IMPLICATIONS: A reduction in the operation time itself is not studied in this article. However, the forecasting model can also be applied to discover which factors are most significant in explaining variation in the length of open-heart surgery. PRACTICAL IMPLICATIONS: The challenge in scheduling two open-heart surgeries in one day can be partly resolved by increasing the length of the day, decreasing the time between two surgeries or by improving patient scheduling procedures so that two short surgeries can be paired. ORIGINALITY/VALUE: A linear regression model is created in the paper to increase the accuracy of operation time forecasting and to identify factors that have the most influence on operation time. A simulation model is used to analyse the impact of improved surgical length forecasting and five selected process interventions on productivity in cardiac surgery.

Time-based management of patient processes.

PURPOSE: The purpose of this paper is to present a conceptual framework that would enable the effective application of time based competition (TBC) and work in process (WIP) concepts in the design and management of effective and efficient patient processes. DESIGN/METHODOLOGY/APPROACH: This paper discusses the applicability of time-based competition and work-in-progress concepts to the design and management of healthcare service production processes. A conceptual framework is derived from the analysis of both existing research and empirical case studies. FINDINGS: The paper finds that a patient episode is analogous to a customer order-to-delivery chain in industry. The effective application of TBC and WIP can be achieved by focusing on through put time of a patient episode by reducing the non-value adding time components and by minimizing time categories that are main cost drivers for all stakeholders involved in the patient episode. RESEARCH LIMITATIONS/IMPLICATIONS: The paper shows that an application of TBC in managing patient processes can be limited if there is no consensus about optimal care episode in the medical community. PRACTICAL IMPLICATIONS: In the paper it is shown that managing patient processes based on time and cost analysis enables one to allocate the optimal amount of resources, which would allow a healthcare system to minimize the total cost of specific episodes of illness. Analysing the total cost of patient episodes can provide useful information in the allocation of limited resources among multiple patient processes. ORIGINALITY/VALUE: This paper introduces a framework for health care managers and researchers to analyze the effect of reducing through put time to the total cost of patient episodes.

Time-based analysis of total cost of patient episodes: a case study of hip replacement.

PURPOSE: Healthcare in the public and private sectors is facing increasing pressure to become more cost-effective. Time-based competition and work-in-progress have been used successfully to measure and improve the efficiency of industrial manufacturing. Seeks to address this issue. DESIGN/METHODOLOGY/APPROACH: Presents a framework for time based management of the total cost of a patient episode and apply it to the six sigma DMAIC-process development approach. The framework is used to analyse hip replacement patient episodes in Päijät-Häme Hospital District in Finland, which has a catchment area of 210,000 inhabitants and performs an average of 230 hip replacements per year. FINDINGS: The work-in-progress concept is applicable to healthcare--notably that the DMAIC-process development approach can be used to analyse the total cost of patient episodes. Concludes that a framework, which combines the patient-in-process and the DMAIC development approach, can be used not only to analyse the total cost of patient episode but also to improve patient process efficiency. ORIGINALITY/VALUE: Presents a framework that combines patient-in-process and DMAIC-process development approaches, which can be used to analyse the total cost of a patient episode in order to improve patient process efficiency.