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