Identifying competitive strategies to improve the performance of hospitals in a competitive environment.

BACKGROUND: This study is based on competitive dynamics theory, and discusses competitive actions (including their implementation requirements, strategic orientation, and action complexity) that influence hospitals' performance, while also meeting the requirements of Taiwan's "global budget" insurance payment policy. METHODS: In order to investigate the possible actions of hospitals, the study was conducted in two stages. The first stage investigated the actions of hospitals from March 1 to May 31, 2009. Semi-structured questionnaires were used, which included in-depth interviews with senior supervisors of 10 medium- and large-scale hospitals in central Taiwan. This stage collected data related to the types of actions adopted by the hospitals in previous years. The second stage was based on the data collected from the first stage and on developed questionnaires, which were distributed from June 29 to November 1, 2009. The questionnaires were given to 20 superintendents, deputy superintendents, and supervisors responsible for the management of a hospital, and focused on medical centers and regional hospitals in central Taiwan in order to determine the types and number of competitive actions. RESULTS: First, the strategic orientation of an action has a significantly positive influence on subjective performance. Second, action complexity has a significantly positive influence on the subjective and the objective performance of a hospital. Third, the implementation requirements of actions do not have a significantly positive impact on the subjective or the objective performance of a hospital. CONCLUSION: Managers facing a competitive healthcare environment should adopt competitive strategies to improve the performance of the hospital.

Developing collective customer knowledge and service climate: The interaction between service-oriented high-performance work systems and service leadership.

This study theorized and examined the influence of the interaction between Service-Oriented high-performance work systems (HPWSs) and service leadership on collective customer knowledge and service climate. Using a sample of 569 employees and 142 managers in footwear retail stores, we found that Service-Oriented HPWSs and service leadership reduced the influences of one another on collective customer knowledge and service climate, such that the positive influence of service leadership on collective customer knowledge and service climate was stronger when Service-Oriented HPWSs were lower than when they were higher or the positive influence of Service-Oriented HPWSs on collective customer knowledge and service climate was stronger when service leadership was lower than when it was higher. We further proposed and found that collective customer knowledge and service climate were positively related to objective financial outcomes through service performance. Implications for the literature and managerial practices are discussed.

Effect of auricular acupressure on peri- and early postmenopausal women with anxiety: a double-blinded, randomized, and controlled pilot study.

We tested effects of auricular acupressure on peri- and early postmenopausal women with anxiety (PPWA). Fifty PPWA were randomly assigned to the auricular acupressure group (AG) or the sham group (SG). After 3 meals and before sleep every day for 4 weeks, the AG received auricular acupressure on the bilateral ear shenmen and subcortex points for 3 min per point on alternating ears. The SG received sham auricular acupressure. The Alprazolam was reduced from 0.5 mg/day at baseline to 0.3 mg/day 4 weeks after auricular acupressure (4 W) in the AG (P < .05) whereas maintained at 0.5 mg/day in the SG (P > .05). The Zolpidem was reduced from 3.0 mg/day at baseline to 1.5 mg/day at 4 W (P < .05) whereas was reduced from 2.4 mg/day to 1.9 mg/day at 4 W in the SG (P > .05), thus, significant tapering medication, suggesting auricular acupressure is helpful to PPWA.

Cost-effectiveness of clinical pathway in coronary artery bypass surgery.

Few studies have been devoted to the exploration of the effect of clinical pathways on coronary artery diseases treated with coronary artery bypass (CAB) surgery. This study was aimed to investigate the cost and effectiveness of the clinical pathway on CAB surgery in a medical center. With a retrospective dataset in 2003-2007, 212 CAB surgery patients were included. Data of the costs and postoperative complication occurrence and length of stays were the focus and patient demographics, surgical risk indicator EuroSCORE, surgical conditions were collected. It revealed that there was differentiation across specified cost items in beating heart CAB surgery patients, but not for heart arrest CAB surgery patients with and without clinical pathways enrolled. In addition, there was no difference in postoperative complication occurrence in CAB surgery patients enrolled into clinical pathways. However, robotic beating heart CAB surgery patients enrolled clinical pathways were shown to have less postoperative ordinary ward stay than those not enrolled clinical pathways. CAB surgery patients' age and surgical risks were related to their postoperative lengths of stay to some extent.