Continuity in health care: lessons from supply chain management

In health care, multidisciplinary collaboration is both indispensable and complicated. We discuss organizational problems that occur in situations where multiple health care providers are required to cooperate for patients with complex needs. Four problem categories, labelled as communication, patient safety, waiting times and integration are distinguished. Then we develop a supply chain perspective on these problems in the sense of discussing remedies according to supply chain management (SCM) literature. This perspective implies a business focus on inter-organizational conditions and requirements necessary for delivering health care and cure across organizational borders. We conclude by presenting some strategic and policy recommendations.     

Promise and problems with supply chain management approaches to health care purchasing

BACKGROUND: Double-digit health care inflation, coupled with widespread reports of poor care quality and deadly medical errors, has caused private sector employers to reevaluate their health benefits purchasing strategies, with a focus on supply chain management approaches. In other industries, this strategy has proven to be an effective method for simultaneously reducing costs and increasing quality. PURPOSE: This article describes four current applications of supply chain management network methodologies to health care systems and identifies potential ways to improve purchasers' return on investment. In particular, information exchanges, purchase decision, and payment agreement components of integrated supply chains are described. APPROACH: First, visual depictions of the health care supply chain are developed from a purchaser's perspective. Next, five nationwide programs designed to realign incentives and rewards across the health care supply chain are described. FINDINGS: Although several nationwide efforts are gaining traction in the marketplace, at this time, no cost reduction and quality improvement program initiative appears to systematically align the entire health care supply chain from providers to purchasers, raising doubt about the ability of supply chain management network techniques to significantly impact the health care marketplace in the short run. PRACTICE IMPLICATIONS: Current individual efforts to coordinate the health care supply chain do not act on all of the actors necessary to improve outcomes, promote safety, and control costs. Nevertheless, there are indications that several of the individual efforts are coming together. If national efforts touching on all critical elements can coordinate with purchasers, then the health care supply chain's performance may improve significantly.     

Improving management of vaccine supply chains: A multi-methods evaluation of vSTEP in Zambia

BackgroundEquipping supply chain professionals at all levels of the health care systems with essential leadership and management skills is essential to achieving global immunization targets. Numerous and diverse professional development initiatives have been established to support vaccine supply chain managers in Gavi-eligible countries. However, COVID-19 catalyzed rapid innovation in approaches to support leadership development in times of rapid change, and systematic evaluation of these approaches can inform future workforce development strategies to ensure resilient health systems. Therefore, we sought to evaluate outcomes and short-term impact of the fully virtual Strategic Training Executive Program 2.0 (vSTEP 2.0) program in Zambia on participant engagement, skill development, and application of new skills to improve supply chain performance.MethodsWe used a multi-method design to describe the outcomes and short-term impact of vSTEP 2.0 at three levels: (1) delegate response to the training experience (including participation, completion, and satisfaction); (2) delegate change in leadership skill (including achievement of learning objectives and change in competencies); and (3) application of new skills to impact supply chain performance.ResultsThe program achieved high levels of engagement and an 83% graduation rate despite the length and rigor of the program. High satisfaction was evidenced by positive feedback from delegates on the quality and relevance of the program, especially in the context of COVID response (100% would "definitely" recommend). Delegates demonstrated significant growth in all domains of leadership competencies and applied their learnings to address a complex challenge in supply chain performance in their home organization.DiscussionThese findings demonstrate a strong appetite for leadership development support among vaccine supply chain professionals, especially in times of rapid change such as during the COVID response. These results also demonstrate the feasibility and impact of a fully virtual model for leadership development, with implications well beyond the COVID-19 pandemic.     

医疗服务供应链系统结构及协同管理研究

从供应链管理的视野系统分析医疗服务供应链的各功能环节。以医疗服务供应链的流程为基础,强调医疗服务提供商之间的有效协同,构建医疗服务供应链系统体系结构,提出医疗服务供应链协同管理措施及评价体系,以提高医疗服务水平、降低医疗成本和促进医疗服务体系的完善,为进一步分析研究医疗服务提供了新的框架,并指导医疗服务实践。     

Managing the quality of health care

This article reviews quality of health care initiatives beginning with the quality assessment/quality assurance movement of the 1970s. Conceptually, modern quality of care management is rooted in the intellectual work of Avedis Donabedian who defined quality of care as a combination of structure, process, and outcome. Donabedian's model is presented and some limitations are pointed out. In the late 1980s and 1990s. the health care industry adopted total quality management (TQM). More recently, the pursuit of health care quality has led to substantial performance measurement initiatives such as ORYX by the Joint Commission on Accreditation of Healthcare Organizations and MEDIS by the National Commission of Quality Assurance. The importance of CONQUEST, a freely available performance measurement database developed at the Harvard School of Public Health, is noted and discussed. The article concludes with a list of challenges facing public and private parties interests in health care quality improvement.     

The information imperative of outcomes management

Health care providers are being asked to collect, analyze, and evaluate the results of medical processes or procedures to improve the outcome of health care services. The linkage of process to outcome is not a new science, but it has assumed greater importance in today's health care economic climate. Medical effectiveness and outcomes management studies, once within the purview of health services investigators, are moving to the individual provider setting. This evolution has tremendous impact on health information management professionals. As the guardians of the data that are indispensable for medical effectiveness and outcomes management investigations, health information management professionals play a key role in caregivers' attempts to correlate process and outcome performance measures. The article discusses the historical origins of outcomes management, the prominence of outcomes management in health care reform activities, and the responsibilities of health information management professionals in these strategic initiatives.     

Current pulse: can a production system reduce medical errors in health care?

One of the reasons for rising health care costs is medical errors, a majority of which result from faulty systems and processes. Health care in the past has used process-based initiatives such as Total Quality Management, Continuous Quality Improvement, and Six Sigma to reduce errors. These initiatives to redesign health care, reduce errors, and improve overall efficiency and customer satisfaction have had moderate success. Current trend is to apply the successful Toyota Production System (TPS) to health care since its organizing principles have led to tremendous improvement in productivity and quality for Toyota and other businesses that have adapted them. This article presents insights on the effectiveness of TPS principles in health care and the challenges that lie ahead in successfully integrating this approach with other quality initiatives.     

Developing a Global Health Diplomacy Supply Chain—A Viable Option for the United States to Curb Extremism

This study examines the idea of developing a global health diplomacy supply chain as an important foreign policy approach with the aim of improving the lives of vulnerable populations and serving the best interests of the United States. The study was based on the review of academic literature, news events, and military communiqués, and historical writings were studied to determine the feasibility of the idea and the extent of costs and benefits of such an endeavor. An integrated strategic business model, supported by a medical care delivery process, was developed to create a framework for a feasible global health diplomacy supply chain. The findings indicate that extremism can be contained by creating and efficiently executing an effective supply chain to get medical care units to those that need them. The limitations are the potential exit strategies required, the tactical abilities, and diplomatic techniques needed in order to create positive diplomatic change in aid distribution. Managers must consider how supply chains will affect other organizations giving aid and the potential public response. Moreover, determining the level of care necessary to achieve the greatest positive health diplomacy continues to require vigilant scrutiny over the potential cost/benefit analysis. The analysis is valuable to policymakers considering the impacts of health diplomacy by utilizing supply chain management.     

我国基层卫生综合改革政策梳理与分析

推进基层卫生综合改革的关键是建立和巩固基层运行新机制,主要包括公益性的管理体制、长效性的补偿机制、竞争性的用人机制、激励性的分配机制和规范性的药品供应机制。文章通过梳理相关文件,分析了我国基层卫生综合改革的政策演变和政策特点。同时,展现了有关政策本身和政策落实方面的地方文件中提出的创新举措。     

The moderate success of quality of care improvement efforts: three observations on the situation.

Why is the health care system still unable to achieve a breakthrough in its quality performance? This commentary offers three observations on the problem of the moderate success of quality of care improvement efforts. We based our discussion on theoretical models from management theory and research. We conclude that health care organizations invest efforts in quality improvement initiatives; however, there is a potential in improving the fit between these efforts and the specific problems these organizations face.     

Straight talk--new approaches in healthcare. Want better relationships with payors? Focus on medical management

When it comes to managing medical care for their enrollees, payors are moving towards a broader focus for medical management that includes both costs and quality. In the twelfth installment of Straight Talk, we look at how health plans, such as CIGNA, are developing incentives to reward high-quality, low-cost providers of medical care and transitioning their utilization management operations to a new model. To ensure quality, they are beginning to compare providers' performance to national standards for medical outcomes. Through these initiatives, known as "medical management," payors hope to improve not only medical care but also their relationships with providers.     

Pathways, networks and choice in health care

PURPOSE: The purpose of the paper is to present an alternative to the supply chain model of health care delivery that currently informs most thinking about the design of care processes. DESIGN/METHODOLOGY/APPROACH: The paper draws on arguments from systems theories and public administration, to generate an analysis of the nature of health care processes. It sets out a model of services characterised by treatment and care needs that vary over time, that are inherently uncertain, involve frequent assessment and re-assessment, and provide patients and service providers with choices about treatment and care. Evidence from an evaluation of intermediate care is used to illustrate the analysis. FINDINGS: The analysis suggests that both the supply chain and a more network-like model of health care processes can help us to understand health care processes. The two are complementary. RESEARCH LIMITATIONS/IMPLICATIONS: Largely conceptual in nature. The empirical evidence is taken from one study. The ideas are presented to stimulate thinking rather than to prove an argument. PRACTICAL IMPLICATIONS: The conceptualisation of care processes as network-like has implications for the way in which we think about the design and performance of health care systems. ORIGINALITY/VALUE: There have been few publications that seek to use both systems and network approaches to understand health care processes.     

Emotional Labor and Performance in the Field of Child Life: Initial Model Exploration and Implications for Practice

The need to suppress emotion and sustain outward expressions in pediatric health care facilities can be overwhelming for employees, leading to low job performance and high turnover. This is particularly true within the field of child life. Notwithstanding, retention and performance of health care professionals have emerged as national agenda items, and hospital administrators are routinely asked to increase performance, reduce turnover, and increase patient-care quality. Although human health care professionals are asked to support these initiatives, few evidence-based models are available to guide intervention. This correlational study (N?=?241) examined links among organizational-level climate variables, turnover-related attitudes, and emotional labor in the field of child life. Hypotheses were tested through correlational and hierarchical regression analytic procedures. Contributions to practice and recommendations for future research are discussed.     

Disease Management and Its Implications for Outpatient Physician Practice

While disease management may be viewed with skepticism, suspicion, or outright hostility, there are several reasons why this approach to care may warrant physician support. The care of patients with chronic illness in usual primary care practice is beset by significant quality gaps, and significant improvement due to other initiatives such as the electronic health record, pay for performance, or consumer-directed healthcare insurance has yet to be consistently demonstrated. In contrast, an emerging body of peer-reviewed literature is demonstrating that disease management does lead to improvements in clinical quality.Disease management is also an intervention that is closely linked to primary care and, thanks to its willingness to assume many of the tasks of patient engagement, can offload and improve practice efficiency. If successful, it can lead to greater reimbursement from pay for performance, and future iterations of disease management may also reimburse physicians for work effort and quality achievements that support its programs. The electronic health record may introduce new challenges, such as a greater reliance on remote messaging, that can also be addressed by this approach to care. It is also possible that future versions of consumer-directed plans will accommodate disease management approaches in an attempt to protect the healthcare consumer with chronic disease from high out-of-pocket expenses. Last but not least, as disease management and the chronic care model evolve, physicians and the sponsors and suppliers of disease management services may find approaches to care that adopt the best elements of each.     

Performance management in small practices

Performance management, variably referred to as corporate, business, or enterprise performance management, has traditionally been viewed as a strategy to achieve an optimum mix of solvency, quality, safety, and patient satisfaction in large healthcare organizations. Now, however, with the readily available data from government and nonprofit organizations promoting quality health care and affordable business intelligence tools, small practices can adopt management strategies, tools, and techniques once limited to corporate executives. With a modest investment in self-assessment and affordable analysis tools, a small practice can benefit from a scaled-down version of the performance management initiatives in place at the leading health-care organizations.     

The livestock vaccine supply chain: Why it matters and how it can help eradicate peste des petits Ruminants,based on findings in Karamoja,Uganda

Understanding factors that hinder vaccination, including logistical and social constraints, is critical to finding the most effective approach for the global eradication of peste des petits ruminants (PPR). Vaccination projects should analyze the supply chain and take it into consideration when planning and creating a vaccination strategy. Adequate supply chain management of the PPR vaccine could lead to reduced cost, increased availability, and the construction of a data platform for other livestock vaccines. Integrating the supply chain of PPR vaccine with other veterinary or health commodities could reduce cost, as well as increase uptake. The use of a thermostable vaccine could potentially have a positive impact on the eradication of PPR in remote areas, such as the Karamoja subregion in Uganda, as it did with rinderpest across Sub Saharan Africa. In terms of vaccine delivery, the use of community animal health workers (CAHWs) could be beneficial in certain areas, such as the Karamoja subregion of Uganda, by alleviating supply chain constraints in the last-mile delivery, as well as increasing coverage and uptake. A gendered approach to livestock vaccines should also be considered, as decision-making power regarding livestock vaccination is gendered in many various contexts. The PPR eradication strategy—as well as other livestock vaccination programs—would be more effective and efficient if the supply chain management were considered as a key component in the process and efforts tailored, accordingly.     

实施医疗质量审评加大监督管理力度

吉林不管不顾要对吉林省医疗机构医疗质量进行监督审评。认为实施医疗质量审评,加大监督管理力度应从以下几方面入手：（１）学好文件,抓好落实;（２）预防为主,强化规范;（３）监督评审,依据标准。     

Health care transformation and the case for a community-wide health information management environment

The transformation of the health care delivery system in local, metropolitan, and regional markets is progressing rapidly. This transformation is fueled by competition, the shift of financial risk to the provider continuum, employer demands for cost containment, and the breadth and depth of state and federal government reform initiatives. However, information systems do not yet exist to support these transformations. We propose establishing a new community-level information management environment and new measures of health care system performance.     

Improving performance using indicators. Recent experiences in the United States, the United Kingdom, and Australia.

This article describes recent national performance improvement initiatives in the United States, United Kingdom, and Australia. This comparison is of particular interest because each of these three countries faces similar challenges in delivering health care and improving health. Each has elevated a focus on safety and quality improvement to a national level. Marked differences in the organization and financing of health care across these three countries provide a unique opportunity to compare and contrast approaches. Drawing on the experience of the authors in each of the three countries and publicly available data sources about specific national initiatives, we describe the national context for improvement and outline recent performance improvement initiatives and emerging issues and challenges. Similarities and differences in the current evolution of national performance initiatives are described and conclusions are drawn about challenges that all three countries face, particularly in terms of developing meaningful sets of national indicators of health system performance. The challenges for future work include the importance of information infrastructure, the paucity of accurate and accessible clinical data, the need for effective performance measurement processes at a local level to capture useful data, and the tensions of balancing accountability and improvement agendas for measurement.