Never before in the healthcare industry has there been such intense emphasis and open debate on the issue of quality. The steady rise in the cost of healthcare coupled with the need for quality have combined to put the healthcare industry at the top of the national agenda. Quality, costs, and service are not just socially provocative ideas. They are critical criteria for decision-making by patients, physicians, and many key constituents of healthcare organizations. The pursuit of improved performance has driven a host of executives and managers in search of techniques for structuring, rehabilitating, redesigning, and reengineering the organizations they serve. Unfortunately, the narrow-mindedness with which programs are implemented and the discontinuity in their application weaken the promise of success. The process of quality improvement can become an undisciplined search for illusions rather than reality. For many years, healthcare managers have embraced the narrow definition of performance solely in the context of financial success. Forward-thinking executives now realize that the road to financial success begins with success in quality and service. Quality and service are no longer separate issues – they are the same. Neither one by itself will bring about lasting success. The ultimate measure of performance is in an organization’s ability to create value for its customers, and true performance must be measured in the context of the customers’ total experience. This book is about how to manage performance in the context of value to the customer or patient. It brings together the many pieces of the performance improvement puzzle – quality, technology, costs, productivity, and customer service. The author also covers process improvement tools including Lean and Six Sigma, and how to create a culture of continuous improvement as well as how to improve the patient experience and productivity improvement strategies. The book is filled with examples, illustrations, and tools for improving key aspects of a healthcare organization’s performance.

The United States has the highest per capita spending on health care of any industrialized nation but continually lags behind other nations in health care outcomes including life expectancy and infant mortality. National health expenditures are projected to exceed $2.5 trillion in 2009. Given healthcare's direct impact on the economy, there is a critical need to control health care spending. According to The Health Imperative: Lowering Costs and Improving Outcomes, the costs of health care have strained the federal budget, and negatively affected state governments, the private sector and individuals. Healthcare expenditures have restricted the ability of state and local governments to fund other priorities and have contributed to slowing growth in wages and jobs in the private sector. Moreover, the number of uninsured has risen from 45.7 million in 2007 to 46.3 million in 2008. The Health Imperative: Lowering Costs and Improving Outcomes identifies a number of factors driving expenditure growth including scientific uncertainty, perverse economic and practice incentives, system fragmentation, lack of patient involvement, and under-investment in population health. Experts discussed key levers for catalyzing transformation of the delivery system. A few included streamlined health insurance regulation, administrative simplification and clarification and quality and consistency in treatment. The book is an excellent guide for policymakers at all levels of government, as well as private sector healthcare workers.

This volume analyzes group purchasing organizations (GPOs) and pharmacy benefit managers (PBMs) in order to better understand the significant roles that these entities play in the healthcare supply chain. It examines who they contract with, on what terms, and who they represent and answer to while charting their historical development. The analysis reveals that the current roles of both players have historical roots that explain why they behave the way they do. Finally, the book reviews the evidence base on the performance results of these two players. This work fills a void in our understanding about two important and controversial players in the healthcare value chain. Both organizations are cloaked in secrecy — partly by virtue of the private sector contracts they negotiate, partly by virtue of the lack of academic attention. Both play potentially important roles in controlling healthcare costs, albeit using contracting strategies and reimbursement mechanisms that arouse suspicion among stakeholders. This timely text explicates how these organizations arose and evolved to shed more light on how they really operate.

The U.S. health care system is in crisis. At stake are the quality of care for millions of Americans and the financial well-being of individuals and employers squeezed by skyrocketing premiums—not to mention the stability of state and federal government budgets. In Redefining Health Care, internationally renowned strategy expert Michael Porter and innovation expert Elizabeth Teisberg reveal the underlying—and largely overlooked—causes of the problem, and provide a powerful prescription for change. The authors argue that competition currently takes place at the wrong level—among health plans, networks, and hospitals—rather than where it matters most, in the diagnosis, treatment, and prevention of specific health conditions. Participants in the system accumulate bargaining power and shift costs in a zero-sum competition, rather than creating value for patients. Based on an exhaustive study of the U.S. health care system, Redefining Health Care lays out a breakthrough framework for redefining the way competition in health care delivery takes place—and unleashing stunning improvements in quality and efficiency. With specific recommendations for hospitals, doctors, health plans, employers, and policy makers, this book shows how to move health care toward positive-sum competition that delivers lasting benefits for all.

Drawing on the work of the Roundtable on Evidence-Based Medicine, the 2007 IOM Annual Meeting assessed some of the rapidly occurring changes in health care related to new diagnostic and treatment tools, emerging genetic insights, the developments in information technology, and healthcare costs, and discussed the need for a stronger focus on evidence to ensure that the promise of scientific discovery and technological innovation is efficiently captured to provide the right care for the right patient at the right time. As new discoveries continue to expand the universe of medical interventions, treatments, and methods of care, the need for a more systematic approach to evidence development and application becomes increasingly critical. Without better information about the effectiveness of different treatment options, the resulting uncertainty can lead to the delivery of services that may be unnecessary, unproven, or even harmful. Improving the evidence-base for medicine holds great potential to increase the quality and efficiency of medical care. The Annual Meeting, held on October 8, 2007, brought together many of the nation's leading authorities on various aspects of the issues - both challenges and opportunities - to present their perspectives and engage in discussion with the IOM membership.

In light of the dynamic nature of the healthcare industry sector, the analysis supporting business valuation engagements for healthcare enterprises, assets, and services must address the expected economic conditions and events resulting from the four pillars of the healthcare industry: reimbursement, regulation, competition, and technology. This title presents specific attributes of each of these enterprises, assets, and services and how research needs and valuation processes differentiate depending on the subject of the appraisal, the environment the property interest exists, and the nature of the practices.

Digital Transformation in Healthcare in Post-Covid19 Times discusses recent advances in patient care and offers critical comparative insights into their application across multiple domains in healthcare. By showcasing key problems, best practices and emerging challenges, the book offers a state-of-art review of opportunities and prospects in the process of delivering smart sustainable healthcare services. Topics discussed include healthcare challenges in the post-COVID-19 era, enabling technologies for digital transformation, value driven approaches to the delivery of patient centric top-quality health services, and analytics and enhanced decision making. In addition, the book updates knowledge on best practices for training towards digital transformation and sustainable health. This is a valuable resource for healthcare professionals, medical doctors, researchers, graduate students and members of the biomedical field who are interested in learning more about the use of emerging technologies in healthcare. Holistically discusses the new landscape of digital transformation and sustainability in health Presents a case study driven approach based on real-world scenarios to help readers apply the knowledge gained into practice Promotes sound research on the impact of emerging technologies in health and life specialties and their relevant role during the COVID-19 pandemic

A wide-ranging discussion of factors that impede the cumulation of knowledge in the social sciences, including problems of transparency, replication, and reliability. Rather than focusing on individual studies or methods, this book examines how collective institutions and practices have (often unintended) impacts on the production of knowledge.

This book presents a hands on approach to the digital health innovation and entrepreneurship roadmap for digital health entrepreneurs and medical professionals who are dissatisfied with the existing literature on or are contemplating getting involved in digital health entrepreneurship. Topics covered include regulatory affairs featuring detailed guidance on the legal environment, protecting digital health intellectual property in software, hardware and business processes, financing a digital health start up, cybersecurity best practice, and digital health business model testing for desirability, feasibility, and viability. Digital Health Entrepreneurship is directed to clinicians and other digital health entrepreneurs and stresses an interdisciplinary approach to product development, deployment, dissemination and implementation. It therefore provides an ideal resource for medical professionals across a broad range of disciplines seeking a greater understanding of digital health innovation and entrepreneurship.

Most of the current literature on healthcare operations management is focused on importing principles and methods from manufacturing. The evidence of success is scattered and nowhere near what has been achieved in other industries. This book develops the idea that the logic of production, and production systems in healthcare is significantly different. A line of thing that acknowledges the ingenious characteristics of health service production is developed. This book builds on a managerial segmentation of healthcare based on fundamental demand-supply constellations. Demand can be classified with the variables urgency, severity, and randomness. Supply is constrained by medical technology (accuracy of diagnostics, efficacy of therapies), patient health behavior (co-creation of health), and resource availability. Out of this emerge seven demand-supply-based operational types (DSO): prevention, emergencies, one-visit, electives, cure, care, and projects. Each of these have distinct managerial characteristics, such as time-perspective, level of co-creation, value proposition, revenue structure, productivity and other key performance indicators (KPI). The DSOs can be envisioned as platforms upon which clinical modules are attached. For example, any Emergency Department (ED) must be managed to deal with prioritization, time-windows, agitated patients, the necessity to save and stabilize, and variability in demand. Specific clinical assets and skill-sets are required for, say, massive trauma, strokes, cardiac events, or poisoning. While representing different specialties of clinical medicine they, when applied in the emergency – context, must conform to the demand-supply-based operating logic. A basic assumption in this book is that the perceived complexity of healthcare arises from the conflicting demands of the DSO and the clinical realms. The seven DSOs can neatly be juxtaposed on the much-used Business Model Canvas (BMC), which postulates the business model elements as value proposition; customer segments, channels and relations; key activities, resources and partners; the cost structure; and the revenue model.