[Application of artificial intelligence systems in the emergency room : Do the communication patterns give indications for possible starting points? An observational study]. / Anwendung von Systemen der künstlichen Intelligenz im Schockraum : Geben die Kommunikationsmuster Hinweise auf mögliche Ansatzpunkte? Eine Beobachtungsstudie.

BACKGROUND: High expectations are currently attached to the application of artificial intelligence (AI) in the resuscitation room treatment of trauma patients with respect to the development of decision support systems. No data are available regarding possible starting points for AI-controlled interventions in resuscitation room treatment. OBJECTIVE: Do information request behavior and quality of communication indicate possible starting points for AI applications in the emergency room? MATERIAL AND METHODS: A 2­stage qualitative observational study: 1. Development of an observation sheet based on expert interviews that depicts the following six relevant topics: situational factors (course of accident, environment), vital parameters, treatment-specific Information (treatment carried out). trauma-specific factors (injury patterns), medication, special features of the patient (anamnesis, etc.) 2. Observational study Which topics were inquired about during emergency room treatment? Was the exchange of information complete? RESULTS: There were 40 consecutive observations in the emergency room. A total of 130 questions: 57/130 inquiries about medication/treatment-specific Information and vital parameters, 19/28 of which were inquiries about medication. Questions about injury-related parameters 31/130 with 18/31 regarding injury patterns, course of accident (8/31) and type of accident (5/31). Questions about medical or demographic background 42/130. Within this group, pre-existing illnesses (14/42) and demographic background (10/42) were the most frequently asked questions. Incomplete exchange of information was found in all six subject areas. CONCLUSION: Questioning behavior and incomplete communication indicate a cognitive overload. Assistance systems that prevent cognitive overload can maintain decision-making abilities and communication skills. Which AI methods can be used requires further research.

Topic modeling revisited: New evidence on algorithm performance and quality metrics.

Topic modeling is a popular technique for exploring large document collections. It has proven useful for this task, but its application poses a number of challenges. First, the comparison of available algorithms is anything but simple, as researchers use many different datasets and criteria for their evaluation. A second challenge is the choice of a suitable metric for evaluating the calculated results. The metrics used so far provide a mixed picture, making it difficult to verify the accuracy of topic modeling outputs. Altogether, the choice of an appropriate algorithm and the evaluation of the results remain unresolved issues. Although many studies have reported promising performance by various topic models, prior research has not yet systematically investigated the validity of the outcomes in a comprehensive manner, that is, using more than a small number of the available algorithms and metrics. Consequently, our study has two main objectives. First, we compare all commonly used, non-application-specific topic modeling algorithms and assess their relative performance. The comparison is made against a known clustering and thus enables an unbiased evaluation of results. Our findings show a clear ranking of the algorithms in terms of accuracy. Secondly, we analyze the relationship between existing metrics and the known clustering, and thus objectively determine under what conditions these algorithms may be utilized effectively. This way, we enable readers to gain a deeper understanding of the performance of topic modeling techniques and the interplay of performance and evaluation metrics.

Giving voice to all patients: On patients at the margins and their intention and perceived ability to complain.

BACKGROUND: It is now widely established that health care organizations are well advised not only to identify and act upon the concerns of all patient groups but also to encourage and enable them to voice their concerns in the first place. That said, research has begun to reveal that patients differ substantially in their readiness to complain, with many deciding to remain silent even after experiencing severe adverse events. Little research has explored whether patients at the margins (e.g., elderly, disabled, or mentally ill patients) are more likely to remain silent. PURPOSE: We examined the extent to which patients' social (being elderly or poorly educated), physical (having a permanent impairment such as deafness, blindness, or a chronic physical condition), and mental marginality (having a mental illness or learning disability) is associated with their intention and perceived ability to complain. METHODOLOGY: We matched survey and patient record data for hospital inpatients treated in the English National Health Service in 2007. We then computed two-stage probit selection models to estimate the cross-sectional association between patients' social, physical, and mental marginality and their intention (Stage 1, N1 = 58,062) and perceived ability to complain (Stage 2, N2 = 3,765). FINDINGS: Only 6.47% of all patients intended to complain. Of these, only 10.41% indicated that hospital staff provided them with all the information they needed to complain. An additional 14.70% reported to have received at least some of the information needed for this purpose. Patients above 80 not only exhibited significantly lower intentions to complain than their mid-aged counterparts (-1.16%) but also felt considerably less well informed to file a complaint (-5.45%). Similarly, patients suffering from blindness or a severe vision impairment showed a significantly lower perceived ability to complain (-5.20%). PRACTICE IMPLICATIONS: Patients at the margins, especially elderly patients and those with a severe vision impairment, will often remain silent and require special attention, if health care organizations are to listen to-and learn from-the voices of all patients. Our results indicate the need for inclusive complaint procedures designed to fuel organizational learning. Dedicated roles such as case managers and complaint officers might help to make such feedback channels accessible to all patients.

A widening gap? Static and dynamic performance differences between specialist and general hospitals.

This paper develops and tests a dynamic model of hospital focus. It does so by tracing the performance trajectories of specialist and general hospitals to identify whether a performance gap exists and whether it widens or shrinks over time. Our longitudinal analyses of all hospital organizations within the English National Health Service (NHS) reveal not only a notable performance gap between specialist and general hospitals in particular with regards to patient satisfaction that widens over time, but also the emergence of a gap especially with regards to hospital staff job satisfaction. These findings reflect the considerable potential of specialization as a means to enhance hospital effectiveness. However, they also alert health policy makers to the threat of a widening performance gap between specialist and general hospitals with potential negative repercussions at the patient and health system level.

Shaping innovation in health care: A content analysis of innovation policies in the English NHS, 1948-2015.

Governments around the world seek to design policies that enhance the innovative capacity of public service. Hence, identifying the underlying meanings attributed to innovation concepts in public policies is critical, as these very understandings inform not only the policy discourses, but also the overall institutional landscape regulating innovation activities. This paper examines such fundamental definitional aspects in the specific context of the National Health Service in England. For this purpose, it traces the evolution of the innovation concept in policy discourse based on the analysis of 21 key policy documents published or commissioned by the English Department of Health between 1948 and 2015. Systematic analysis of these texts reveals that policymakers' conception of healthcare innovation broadened considerably over time. English health innovation policy initially focused on basic biomedical research. Subsequently, it entered a transitional period, zeroing in on science- and technology-based innovation. Finally, this focus gradually shifted to a broader conception of innovation translating into health, economic, and service design benefits.

Fighting MRSA Infections in Hospital Care: How Organizational Factors Matter.

OBJECTIVE: To identify factors associated with methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infections at the level of the hospital organization. DATA SOURCES: Data from all 173 acute trusts in the English National Health Service (NHS). STUDY DESIGN: A longitudinal study based on trust-level panel data for the 5-year period from April 2004 to March 2009. Fixed effects negative binominal and system generalized method of moment models were used to examine the effect of (i) patient mix characteristics, (ii) resource endowments, and (iii) infection control practices on yearly MRSA counts. DATA COLLECTION: Archival and staff survey data from multiple sources, including Public Health England, the English Department of Health, and the Healthcare Commission, were merged to form a balanced panel dataset. PRINCIPAL FINDINGS: MRSA infections decrease with increases in general cleaning (-3.52 MRSA incidents per 1 standard deviation increase; 95 percent confidence interval: -6.61 to -0.44), infection control training (-3.29; -5.22 to -1.36), hand hygiene (-2.72; -4.76 to -0.68), and error reporting climate (-2.06; -4.09 to -0.04). CONCLUSIONS: Intensified general cleaning, improved hand hygiene, additional infection control training, and a climate conducive to error reporting emerged as the factors most closely associated with trust-level reductions in MRSA infections over time.

The relationship between employees' perceptions of human resource systems and organizational performance: examining mediating mechanisms and temporal dynamics.

Given the limited understanding of temporal issues in extant theorizing about the link between human resource management (HRM) and performance, in this study we aim to shed light on how, when, and why HR interventions affect organizational performance. On the basis of longitudinal, multi-informant and multisource data from public hospital services in England, we provide new insights into the complex interplay between employees' perceptions of HR systems, job satisfaction, and performance outcomes over time. The dynamic panel data analyses provide support for changes in employees' experience of an HR system being related to subsequent changes in customer satisfaction, as mediated by changes in job satisfaction, albeit these effects decrease over time. Moreover, our longitudinal analyses highlight the importance of feedback effects in the HRM-performance chain, which otherwise appears to evolve in a cyclical manner.

Hospital innovativeness and organizational performance: evidence from English public acute care.

BACKGROUND: Hospitals around the world dedicate increasing attention and resources to innovation. However, surprisingly little is known about the nature of hospital innovativeness and its relationship with organizational performance. Given both the specific characteristics of the hospital sector and the rather mixed evidence from other industries, a positive innovation-performance link should not be taken for granted but requires empirical examination. PURPOSES: The purposes of this study were to introduce a perspective of hospitals as vital generators of innovation, to unpack the concept of innovativeness, to propose a measurement model for hospital innovativeness, and to empirically investigate the innovativeness-performance relationship. METHODOLOGY: We conducted a large-scale empirical study among the entire population of public hospital organizations that are part of the English National Health Service (n = 173) and analyzed the data using exploratory factor and regression analyses. FINDINGS: Our analyses suggest a significant positive relationship between science- and practice-based innovativeness and clinical performance but provide less unambiguous support for the existence of such a relationship between innovativeness and administrative performance. In particular, we find that higher levels of innovativeness are rather associated with superior quality of care than with measurable bottom-line financial benefits. PRACTICE IMPLICATIONS: Hospitals investing in innovation-generating activities might find their efforts well rewarded in terms of tangible clinical performance improvements. However, to achieve measurable financial benefits, numerous hospitals have yet to discover and capture the commercial value of some of their innovations-a challenging task that requires a holistic innovation management and an effective network of complementary partners.