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Boundaryless Hospital - Rethink and Redefine Health Care Management
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Boundaryless Hospital - Rethink and Redefine Health Care Management
von: Horst Albach, Heribert Meffert, Andreas Pinkwart, Ralf Reichwald, Wilfried von Eiff
Springer-Verlag, 2016
ISBN: 9783662490129
357 Seiten, Download: 6079 KB
 
Format:  PDF
geeignet für: Apple iPad, Android Tablet PC's Online-Lesen PC, MAC, Laptop

Typ: B (paralleler Zugriff)

 

 
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Inhaltsverzeichnis

  Preface 6  
  Contents 10  
  Part I: Challenges and Opportunities of Health Care Management in the Twenty-First Century 12  
     Network Management: Strategic Option for the Boundaryless Hospital 13  
        1 Initial Situation 14  
        2 The Boundaryless Hospital and the Value Chain in Health Care 15  
        3 Networks in Medicine and the Health Business: Rational Network Design 17  
        4 Restrictions of an Effective Network Design 19  
        5 Types of Networks and Their Purposes 19  
        6 Factors Constraining Network Design 21  
        7 Forms of Organization 21  
           7.1 King-Pin and Resident Principle 21  
           7.2 C+C Model 22  
        8 Selected Examples of Network Cooperation 22  
           8.1 The Portal Clinic as an Element of a Referral Physicians Network 22  
           8.2 Integrated Cross-Sectoral Supply Models as a Strategic Option 23  
              8.2.1 Contracts of Integrated Care 23  
              8.2.2 The Integrated Care Net: Supply with Managed Care Character 23  
           8.3 Networks in Emergency Care 24  
           8.4 Medical Clusters 26  
           8.5 The Campus Concept 27  
        9 Conclusion 28  
        References 29  
     Cancer Care: New Value Chains Challenge German Hospital Structures-A Comprehensive Cancer Center Perspective 31  
        1 Introduction: Challenges and Opportunities 32  
           1.1 Barriers in the German Health Care System 32  
           1.2 Cancer Genomics Changes Medical Practice 32  
           1.3 Economic Trends in Ambulatory Oncology 34  
        2 Potential Solutions 36  
           2.1 Cross-Sectional Organization Design in Oncology 36  
           2.2 The Future Lies in Networking 38  
           2.3 Clinical Trial Management: The Backbone of Innovation 39  
           2.4 Standardized Care and Interdisciplinarity 41  
        3 Practical Experience 42  
           3.1 Comprehensive Cancer Centers as Hubs of Regional Care Networks 42  
           3.2 Palliative Medicine and Psychosocial Care 43  
           3.3 Psycho-Oncology 44  
           3.4 Oncological Training Therapy 44  
           3.5 Cancer Registries 44  
        4 Summary and Outlook 46  
        References 47  
     Health Care Under Market Conditions: An Ethical Analysis 51  
        1 Introduction 52  
           1.1 Problems 52  
           1.2 Background 53  
           1.3 Contribution, Method, and Limits of Ethical Analysis 54  
        2 An Examination of the (Collective) Ethical Foundation of Providing Sufficient Resources for Health Care on the Three Levels ... 55  
           2.1 The Macro or Resource-Raising Level 55  
              2.1.1 Responsibility 55  
              2.1.2 Solidarity 56  
           2.2 The Meso or Resource-Distributing Level 57  
           2.3 The Micro or Resource-Allocating Level 57  
           2.4 Tensions on All Three Levels 58  
           2.5 Social System or Market? 59  
           2.6 On the Logic of the Difference Between Raising Resources and Profit 59  
        3 An Analysis of the (Individual) Ethical Basis of Securing Medical Ethos Under the Condition of Economic Efficiency 60  
           3.1 Protection of Life, the Patient´s Benefit, and Respect for Autonomy-Based Self-Determination 60  
           3.2 The Problems of DRGs 61  
        4 An Inquiry into the Logic of the Relation Between Prioritization and Rationing from an Ethical Point of View 61  
           4.1 Levels and Addressees of Prioritizations 62  
           4.2 Is Compatibility of Medical Ethos and Economic Conditions Possible? 63  
        5 Summary 64  
        References 65  
  Part II: Seizing the Opportunities Across Countries and Subdisciplines 67  
     Pathways Towards Health Care Systems with a Chronic-Care Focus: Beyond the Four Walls 68  
        1 Introduction 69  
        2 Current Provision of Health Care in Hospitals 72  
           2.1 Hospital Discharges and Size of Hospitals 73  
           2.2 Average Length of Stay 74  
        3 Chronic Care Models and the Role of Hospitals 77  
        4 International Experiences with Chronic Care and the Evolution of Hospitals 81  
        5 Conclusion 84  
        References 86  
     The Importance of Time in Developing a Boundaryless Hospital: An Example from Northern Portugal 90  
        1 Introduction 91  
           1.1 The Role of Time in Implementing and Developing a New Organization 93  
           1.2 The Definition of Local Health Units 94  
        2 The ULS Matosinhos 96  
        3 Methods 97  
        4 Results: ULSM Integration and Openness Process 98  
           4.1 ULSM Main Health Outcomes Since 1999 101  
           4.2 Local Health Plan Development 102  
           4.3 Quality Policy Strategy 103  
           4.4 Reduction in Hospital Admissions Sensitive to Primary Care 103  
           4.5 Integration Between Primary and Secondary Care 104  
        5 Discussion: The Importance of Time in the Evolution of ULSM 105  
        6 Conclusion 108  
        References 108  
     Networked Care: IT-Assisted Tools (Wearable Sensors) for Patients at Risk 111  
        1 Networked Care: The Cardiovascular Patient at Risk 113  
           1.1 Feasibility (Monitoring, Transmitting, and Interpreting Physiological Data) 113  
           1.2 User-Network Interfaces (Patients, Medical Professionals) 115  
        2 Perspectives of Networked Care 116  
           2.1 Personalized Risk Management 116  
           2.2 Self-Empowerment 117  
        3 Networked Care Adapted to Needs: Toolbox and Showcase 119  
           3.1 Toolbox 119  
           3.2 Showcase and Roadmap: Networked Care for Regional Development 124  
        References 125  
     Carving Out a Place for New Health Care Occupations: An Ethnographic Study into Job Crafting 127  
        1 Introduction 128  
        2 Carving Out a Place Through Processes of Job Crafting 129  
           2.1 On Carving Out a Place 129  
           2.2 On Processes of Job Crafting 131  
        3 Research Design and Empirical Setting 133  
           3.1 Background 133  
           3.2 Case Studies 133  
           3.3 Research Design and Data Collection 134  
           3.4 Data Analysis 136  
        4 Results 136  
           4.1 Crafting a Job Through Changing Tasks and Relations 136  
              4.1.1 Tasks 137  
              4.1.2 Relations 138  
           4.2 Crafting a Job Through Attaching Meaning and Deriving an Identity 142  
        5 Conclusions 144  
        6 Discussion 146  
        References 147  
     Personalized Medicine Challenges the Health Care System 150  
        1 Introduction 150  
        2 Definition/Terminology 151  
        3 Oncology on Focus 151  
        4 Companion Diagnostics 152  
        5 Targeting Drugs 152  
        6 Four Clinical Examples 153  
           6.1 Colo-Rectal Cancer 153  
           6.2 Non-small Cell Lung Cancer 154  
           6.3 Malignant Melanoma 155  
           6.4 Breast Cancer 156  
        7 How and Why Personalized Medicine Challenges the Health Care System 157  
        8 What Is Necessary to Implement Personalized Tumor Medicine? 158  
           8.1 How to Overcome Clinical Boundaries 158  
           8.2 How to Overcome Regional Boundaries 159  
           8.3 How to Overcome Institutional/Social/Political Boundaries 159  
        9 Summary 161  
        References 161  
  Part III: Meeting the Challenges 163  
     Measuring Performance in Hospitals: The Development of an Operational Dashboard to Coordinate and Optimize Patient, Material a... 164  
        1 Introduction 165  
        2 Process Thinking in Hospitals 165  
        3 Performance Measurement 168  
        4 KPIs in Health Care 169  
        5 Developing a Dashboard 172  
           5.1 Framework 173  
              5.1.1 Demand Side 173  
              5.1.2 Supply Side 176  
        6 Illustrative Case Study 177  
           6.1 Selection of KPIs 177  
           6.2 Practical Issues in the Selection Process of KPIs 178  
        7 Practical Implications 180  
        References 182  
     The Boundaryless Hospital Through Risk Management Approach: A Case Study of the AandE Unit of a Tertiary-Care Hospital in Malta 187  
        1 Introduction 188  
        2 AandE in a Boundaryless Hospital 189  
        3 Why Focus on Risk Management? 189  
        4 Risk Management in the Health Care Setting 190  
        5 Risks in the Accident and Emergency Department 191  
        6 Case Study 193  
           6.1 Setting 193  
           6.2 Method 193  
           6.3 Results 195  
              6.3.1 Focus Group 195  
              6.3.2 Time-Motion Analysis 197  
        7 Discussion 198  
        8 Conclusion 200  
        References 200  
     Leveraging the Value for Health Care Providers Using Clinical Workflow Analytics 204  
        1 Introduction 204  
        2 Processes and Process Quality 205  
           2.1 Process Quality 205  
           2.2 Process Quality Improvement and Optimization 206  
        3 Healthcare Environment 206  
           3.1 Challenges in Health Care 206  
           3.2 ``Value´´ in Health Care 207  
        4 Clinical IT Systems 207  
        5 Workflow Analytics in Health Care 209  
        6 Conclusion 210  
        References 211  
     Role and Function of the Emergency Department in a Boundaryless Hospital: Optimizing the Process Flow 213  
        1 Context: The Boundaryless Hospital and the Role of Emergency Departments 214  
           1.1 The Value Chain in Health Care 214  
           1.2 Purpose of the Emergency Department 214  
           1.3 Process Optimization 216  
        2 POCT as an Investment Object 217  
        3 Empirical Study in the Emergency Department of a Maximum Provider Hospital 220  
           3.1 Aim of the Study, Setting and Methodology 220  
           3.2 Fictitious Example: Emergency Department 222  
           3.3 Results 223  
           3.4 Findings 225  
        4 The Control Study 226  
        5 Organizational and Technological Keys to Success in the ED 228  
           5.1 Process Integration and Networking 228  
           5.2 Admission/Short Stay Patients´ Ward and Chest Pain Unit 228  
           5.3 POCT Technologies in the ED 229  
        6 Conclusion 233  
        References 235  
     Stakeholder Involvement Transcends Boundaries in University Hospitals 237  
        1 Mission and Challenges of University Hospitals 238  
        2 Reputation-Related Factors 239  
        3 Relevance, Importance and Influential Power of University Hospitals´ Stakeholder Groups 239  
        4 Stakeholders´ Importance 240  
        5 Determinants of Reputation 241  
           5.1 The Value of Patient Satisfaction 242  
           5.2 Patient Questionnaires 243  
        6 Interaction with Patients 244  
        7 From Employee Satisfaction to Employee Engagement 244  
        8 Referrers´ Relations 245  
           8.1 Referrer Questionnaires 246  
           8.2 Conclusions for a Targeted Referrer Involvement 247  
        9 Outlook 248  
        10 Implications for Governance 248  
        References 249  
     The Hospital Situation for Diseases Requiring Sophisticated Examinations Using Epilepsy as an Example 251  
        1 Introduction 252  
        2 Epilepsy: Causes and Methods of Confirmation 252  
           2.1 Genetically Determined Epilepsies 252  
           2.2 Metabolically Determined Epilepsies 253  
           2.3 Immunologically Determined Epilepsies 253  
           2.4 Structurally Determined Epilepsies 253  
        3 Highly Specialized Methods in Epilepsy 254  
           3.1 Electroencephalogram Recordings 254  
           3.2 Magnetic Resonance Imaging 254  
        4 Virtual Cooperation in Epilepsy Treatment 254  
           4.1 Expert Review of Data 255  
           4.2 Optimized Patient Transferral to Specialized Centers 255  
        5 Research Aspects 255  
        6 Obstacles and New Ways 256  
        References 256  
     Identifying the Adoption Process for Electronic Health Services: A Qualitative Study 258  
        1 Introduction 259  
        2 Definition and Classification of e-Health Services 260  
        3 Fundamentals of the Innovation-Decision Process 262  
           3.1 Theoretical Background 262  
           3.2 Literature Review on the Adoption Process in the Context of Technology-Based Services, Health Services and Technology-Base... 263  
        4 Study Description and Main Findings 265  
           4.1 Research Design 265  
           4.2 Study Population 266  
           4.3 Data Analysis 267  
           4.4 Findings from the Patient Interviews 268  
        5 Implications for Theory and Practice, Conclusions 271  
        References 274  
     Infection Prevention Networks and the Role of the Boundaryless Hospital 277  
        1 Introduction 278  
        2 Historical Background 278  
        3 Antibiotic Stewardship in Hospitals 280  
        4 Role of the Staff 283  
        5 The Search-and-Destroy Policy in the Netherlands 284  
        6 Boundaries Affecting Infection Prevention and the Role of the Hospital 285  
        7 Infection Prevention Networks 288  
        8 Conclusion 289  
        References 289  
  Part IV: The Boundaryless Hospital from the Patients´ Perspective 292  
     From Community Analysis to Prototype: Creating an Online Matchmaker for Inflammatory Bowel Disease Patients 293  
        1 Introduction 294  
        2 About Inflammatory Bowel Disease 296  
        3 Analyzing the IBD Patient Community Network (2010-2011) 297  
        4 Tracing the Whipworm: A Dynamic Communication Analysis 302  
        5 Creating a Collaborative Online Patient Network (2012: Ongoing) 307  
        6 Summary and Outlook 312  
        References 313  
     Patients´ Complaints and Managers´ Responses as a Process of Institutional Interaction 319  
        1 Introduction 320  
        2 The Active Citizen in Health Care 320  
        3 Research Subject 322  
        4 Data and Methods 322  
        5 Analysis of Objection Documents 324  
           5.1 Subject of Objections 325  
           5.2 Subject of Responses 326  
           5.3 The Tension Caused by the Objection Process 327  
        6 Analysis of Questionnaires 328  
           6.1 Objection 328  
           6.2 Objection Functionality 330  
           6.3 Objection Effects 331  
           6.4 Developing the Objection Process 332  
           6.5 Information, Care and Compensation 333  
        7 Conclusions 333  
        References 335  
     Innovations by and for Patients, and Their Place in the Future Health Care System 339  
        1 Introduction 339  
        2 Health Care for and by Patients, a Literature Review 340  
           2.1 Patient-Centered Health 340  
           2.2 Patients as Consumers and Developers of Health Care Products and Services 342  
        3 The Critical Factors for Progression of Patient Innovation Activity: Multiple Case Study 343  
           3.1 Collaboration 345  
              3.1.1 Access to the Community of Patients 345  
              3.1.2 Complementary Skills 346  
              3.1.3 Expertise from Medical Professionals 346  
           3.2 The Perception of the Solution´s Value, and the Incentives for Sharing 347  
        4 Should Health Care Embrace Patient Innovation, and How? 349  
           4.1 The Collaborative Force of Patients 349  
           4.2 The Integrative Role of Health Care Professionals 350  
           4.3 Infrastructures for Sharing Solutions and Health-Related Data 351  
        5 Conclusion 352  
        References 352  
  About the Editors 356  


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