Reengineering rehabilitative healthcare delivery in the Nineties and beyond: a systems approach to medical technology, quality and cost management
by Elias G. Carayannis, Jeffrey Alexander, Rajiv Mallick, Richard Radecki
International Journal of Healthcare Technology and Management (IJHTM), Vol. 1, No. 1/2, 1999

Abstract: The quality of rehabilitative healthcare delivery in the nineties and beyond hinges as much on improving management at the health provider level as on managing the systems and technologies the health providers rely on. Moreover, with a shifting burden of care from an acute care setting to other settings such as long term and rehabilitative care, there will be increasing pressure to attain cost containment and quality improvements in the rehabilitative setting. As a result, the need for more effective patient outcome measures increases substantially. A systems approach to managing the technological, economic, medical and organisational dimensions of health care entails examining the issues from a multi-dimensional, integrative perspective. This perspective should combine the resource-based view [1-3] with the transaction cost economics view [4,5] as well as with the knowledge-based, organisational routines view [6-10] in dealing with medical technology, defined by the Office of Technology Assessment as ''the drugs, devices, medical, and surgical procedures used in medical care and the organisational and supportive systems within which such care is provided'' [11]. Specifically, this approach addresses directly the challenge of improving the management of clinical and informational technologies in rehabilitative care by: (a) focusing on quality, cost, and timeliness of delivery measures, and (b) enhancing the quality, cost, and timeliness measures themselves within a continuous improvement context. A conceptual framework for profiling the anatomy of such a perspective was empirically validated by an on-site ethnographic study at two rehabilitative healthcare centres, a profit-making, private unit in Schenectady, New York and a non profit -making, state-chartered one in Albuquerque, New Mexico. Lessons learned from related ICU studies were compared and contrasted with our field research findings to drive our conclusions.

Online publication date: Mon, 30-Jun-2003

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