International Journal of Healthcare Technology and Management (10 papers in press)
A scenario-based approach for master surgery scheduling under uncertainty
by S.A. MirHassani, F. Hooshmand, A. Akhavien
Abstract: Operating room planning is an important task for the hospital management authorities to improve the quality of health care under limited medical and financial resources. The aim of this study is to develop an optimal cyclic allocation table in which operating room blocks are allocated to surgeons. The emphasis is on minimising the expected bed shortage in the intensive care unit and wards, where the number of patients operated by each surgeon, the length of stay for each patient and the number of available beds in hospitalisation units are uncertain. Therefore, a scenario-based, two-stage, stochastic model on a large scenario space is proposed. Then, the sample average approximation method is employed to solve the problem for a number of randomly sampled scenarios. Numerical experiments demonstrate that the solutions obtained by this method converge to a real optimum with a moderate sample size in a reasonable time. Moreover, even for small sample sizes, the solution quality is better than other methods, such as expected value approach.
Keywords: master surgery schedule; bed shortage in hospitalisation units; scenario-based stochastic problem; scenario generation; sample average approximation.
The attitude of Greek society to public private partnerships in the public health sector
by Georgios Chatzipoulidis, George Aretoulis, Glykeria Kalfakakou
Abstract: The National Health Service (NHS) of Greece was founded in 1983 and today appears out of date. The need for reengineering the NHS is undeniable. Public Private Partnerships (PPPs) are examined as a possible funding tool, along with the critical success factors for such an implementation. The research focus was on the social reaction of Greek society towards implementation of PPPs in the public health sector. This was considered extremely important, because previous attempts to implement PPPs in various construction projects were met with intense opposition from the citizens, and as a result, the projects were not realised. A structured questionnaire survey took place. There were 500 recorded responses. The sample selection aimed to cover representative regions of Greece. The effort to collect the available data was enormous. Usually elderly participants and people who were not aware of the PPPs completely refused to participate in the survey. Descriptive statistics and correlation analysis focusing on place of residence, age, and gender, were implemented, using SPSS. Both approaches appear to lead to the same conclusions. Respondents indicated that a positive social reaction was found towards the involvement of the private sector in providing specific support services during the contract. On the other hand, there is a great reluctance, or complete refusal, to involve the private sector in any service related to the direct provision of curative care to the patients in public hospitals.
Keywords: public private partnerships; Greek National Health Service; health infrastructure; critical success factors; public acceptance.
Multi-level determinants of tele-healthcare innovations: an Italian case study.
by Sabina De Rosis, Sara Barsanti
Abstract: The objective of this research paper is to identify and describe factors influencing the implementation and scaling-up of tele-healthcare innovations. The project design was a case study, exploring tele-healthcare solutions in primary care or continuity of care in the region of Tuscany (Italy). A multi-level and multi-stakeholder sample of 32 informants was in-depth interviewed about topics based on a previous literature analysis. Crucial determinant factors in the management of tele-healthcare services were identified in relation to technological, individual, organisational and contextual aspects. A restructuration of healthcare organisations towards participative dynamics of teamwork, as well as collaborative culture, was indicated as a potential solution. A collaborative interrelationship within and among healthcare organisations, and with other stakeholders, may contribute to tele-healthcare integration into the practice, which is also strongly influenced by leadership and strategic vision, which implies the understanding that tele-healthcare is change.
Keywords: tele-healthcare; determinants; stakeholders’ perspective; re-organisation; tele-medicine; scaling-up; deployment; change management; innovation management; health technology.
A healthy lifestyle app for older adults with diabetes and hypertension: a usability assessment
by Jenna Smith-Turchyn, Janelle Gravesande, Gina Agarwal, Dee Mangin, Dena Javadi, Jessica Peter, Fiona Parascandalo, Lisa Dolovich, Julie Richardson
Abstract: Risk factor modification interventions using mobile health technology have been shown to be effective in managing non-communicable lifestyle-related conditions. The objective of this study was to explore how older adults with type 2 diabetes and hypertension use an online app developed to help manage these conditions. Usability testing was conducted on the TAPESTRY-CM Healthy Lifestyle app, an online self-management application. This included an online session, using a cognitive interviewing approach, and semi-structured interviews at various times. Qualitative content analysis was performed as sessions were completed using coding and category formation. All participants commented positively on the app content. Suggestions for improvement were given with regard to app content and layout. This study provides strong support for initial use of this app. Results will be used to improve the app prior to conducting larger scale effectiveness trials or using it in clinical practice.
Keywords: usability assessment; older adults; healthcare technology; self-management; non-communicable lifestyle-related conditions; type 2 diabetes; hypertension; healthy lifestyle app; cognitive interviewing; qualitative content analysis.
Ontology driven meta-modelling of clinical documents
by Shreya Banerjee, Anirban Sarkar
Abstract: In recent days, distinct healthcare information systems use and exchange electronic clinical documents frequently. This creates the necessity of specifying uniform semantic interpretation of clinical documents and their contents. Further, modern technology, such as connected home monitoring devices, should incorporate contextual awareness into clinical documents. Besides this, todays healthcare domain is driven by emergence of new roles, which are played by stakeholders related to that domain. Thus, effective semantic representations of clinical documents include not only the shared conceptualisation of clinical contents, but also evolving contexts and roles of stakeholders. Existing standards for representation of clinical documents fail to absorb these criteria. Thus, healthcare information systems require achieving common interpretation of clinical documents so that (1) those can be exchanged among healthcare information systems meaningfully, and (2) a personalised document view in a specific context can be achieved effectively. To address these issues, in this paper, an ontology driven meta-model for clinical documents is proposed. The proposed meta-model is represented in mathematical logic, which may facilitate reasoning on clinical knowledge. The novelty of the proposed work is to represent uniform formal conceptualisation of clinical documents. This proposed conceptualisation may fulfil a customised document view based on the demands of stakeholders in a specific context that may change with time. Consequently, the proposed work helps in meaningful exchange of clinical documents between healthcare information systems, and hence provides efficient representations of clinical decision system specifications. Further, the proposed conceptualisation is implemented in an ontology editorial tool Prot
Keywords: clinical document; ontology driven; semantic interoperability; uniform interpretation; meta-modelling; middle level ontology.
Towards a model of emergency department congestion
by Malcolm Brady, Vikas Kumar, P.J. Byrne, Gerry Conyngham, Paul Liston, Peadar Gilligan
Abstract: The purpose of this paper is to examine the flow of patients through the emergency department of a large suburban acute general hospital and the factors that influence overcrowding and congestion. The paper broadly draws on the input-process-output systems paradigm as a basis for examining emergency department patient throughput. A dataset of all attendances at the emergency department of a large suburban acute general hospital during the course of a full calendar year was examined using statistical tools. The analysis found that the major influencers of length of stay were patient-related factors such as age, severity of ailment (triage category), and whether or not the patient was admitted into the main hospital. Patients admitted into the hospital had significantly longer length of stay in emergency than those who were not admitted. The main influencers of patient arrivals were temporal factors such as time of day and day of arrival. These influencing factors are formed into a tentative model of emergency department congestion.
Keywords: emergency department; age; length of stay; throughput; congestion; patient admission; hospital.
Personal healthcare records research: past, present and new dimensions
by Konstantinos Koumaditis, Tajammal Hussain
Abstract: When designed and managed properly, Personal Health Records (PHRs) are valuable tools that can reform healthcare systems. Yet while the PHR literature covers multidiscipline cases on design requirements, implementations, and early positive results, it also echoes concerns related to the undelivered potential and challenges tied to PHRs. Consequently, a vast body of literature exists with unclear themes and blurred lines between perception, realisation, and outcome. This paper exposes dominant research themes in PHR research and aids the understanding of this developing field. Our bibliographic analysis of 524 papers published from 2000 to 2015 revealed a core set of 61 publications. Interesting identified themes include the operation of PHRs with emphasis on innovation, prototypes, and governance, as well as the impact of PHRs on specific medical conditions, healthcare processes, and sociotechnical issues. Design issues were also exposed focusing on user requirements, design elements and technologies, and lessons learned through empirical cases.
Keywords: personal healthcare records; medical systems; healthcare technology; lessons learned; bibliometric analysis; multidimensional scaling.
Management of techno-psychological factors influencing the patient-physician electronic relationship
by Jamil Razmak, Charles Bélanger
Abstract: Focusing on the patient-physician electronic relationship, this empirical study was conducted to explore certain personal traits and psychological factors that can influence behavioural attitude toward adopting a patient portal. Statistical tests were used to compare the answers of physicians and patients and to test patients dispositions toward technology. The results revealed significant differences among physicians and patients with respect to the purpose of website referrals. With the exception of the education level, the findings indicated that age, sex, and ethnicity did not significantly influence participants attitudes. The three psychological factors used in the regression model turned out to be significant predictors of participants behavioural attitude toward adopting the patient portal. Based on these results, e-health applications require a long-term investment in technology generation to develop a new education system that supports these online platforms; this strategy, along with adequate support from healthcare providers, will produce the most effective results.
Keywords: website referrals; computer self-efficacy; computer anxiety; e-health literacy; patient portal.
SERVQUAL impact on overall satisfaction and brand loyalty: an empirical study in Delhi NCR hospitals
by Bhawna Singh, Rushina Singhi
Abstract: This paper analyses the impact of SERVQUAL on overall satisfaction and brand loyalty in the healthcare industry. SERVQUAL is a standard instrument consisting of five dimensions, namely reliability, empathy, responsiveness, tangibility and assurance, for measuring functional service quality. The study has been initiated by conducting a survey of various hospitals of Delhi NCR. A conceptual model is designed and confirmatory test of the model is done by using the confirmatory factor analysis technique. Structural Equation Modelling (SEM) using AMOS 4.0 is used to analyse the causal relationship between SERVQUAL, overall satisfaction and brand loyalty. The outcome shows that SERVQUAL has a positive effect on overall satisfaction, and overall satisfaction also has a positive effect on brand loyalty.
Keywords: service quality; overall satisfaction; brand loyalty; SERVQUAL.
A paradigm shift to enhance patient safety in health care, a resilience engineering approach: scoping review of available evidence
by Riccardo Patriarca, Giulio Di Gravio, Francesco Costantino, Massimo Tronci, Federico Bilotta
Abstract: This review analyses the contributions about resilience engineering as an emerging topic in healthcare literature. Owing to the cross-disciplinarity of the theme, this review takes into account PubMed and Scopus database through March 2017, as well as other not-indexed papers from the Resilience Engineering Association (REA) symposia and other books in the field. After removing duplicates and screening full-texts, we analysed 63 studies that were categorised into four groups that describe the current research state of resilience engineering in health care. This scoping review demonstrates the relevance of resilience in complex healthcare activities, exploring the potential benefits to engineer it. The theoretical background and the preliminary applications confirm the potential of this paradigm shift for safety management to cope with current and future healthcare system needs.
Keywords: patient safety; healthcare management; healthcare engineering; safety management; risk management; resilience engineering; resilience; resilient IT; complexity management; complexity; safety culture; new view of safety; socio-technical system.