Designing a management system that might facilitate workflow while improving the quality of patient outcomes was the project addressed by Alex Mu-Hsing Kuo, Elizabeth Borycki, Andre Kushniruk, and Te-Shu Kee. Their solution is to join Lean and Six Sigma, using Lean's focus on operating efficiency along with Six Sigma's emphasis on the quality of the results. To illustrate the potential operation and impact of the new system in a postanesthesia recovery unit, they present their adaptation of an actual case study presented in May 2008 (HINF551) at the University of Victoria, British Columbia, Canada. The unpredictability of the results of management decisions is addressed by Helena Hvitfeldt Forsberg, Hakan Aronsson, Christina Keller, and Staffan Lindblad. They explore the use of simulation modeling in decision making. They point to the value of simulation in allowing what amounts to a rehearsal of a perceived problem situation and of the potential effects of various possible strategies that might be employed in resolving it. The authors present 3 models of simulation modeling systems: system dynamics, discrete event simulation, and agent-based modeling.
The comparative effectiveness of a treatment protocol and a practitioner-originated order in facilitating the relief of pain in emergency department patients presenting with renal colic was studied by Peter L. Steinberg, Ajay K. Nangia, and Kevin M. Curtis. They found that patients treated for pain in accordance with the protocol experienced a 35-minute reduction in time to effective analgesia, for a decrease of 49% in comparison with control patients. While acknowledging the inherent bias in their retrospective study, the authors point out that conducting a prospective study involving deliberately withholding pain medication would have been unethical.
In a sample of 30 diverse private practices, Mary C. Ruhe, Sandy N. Bobiak, David Litaker, Caroline A. Carter, and their coauthors tested the effect of an appreciative inquiry improvement plan in improving preventive service delivery rates. In the course of the study, they identified and labeled certain enabling practice conditions that fostered intervention implementation and practice development.
A considerable body of research has been devoted to demonstrating the impact of provider groups' interpersonal relationships and internal communication on the quality of care, including the safety of patients. Jenna Howard, Eric K. Shaw, Elizabeth Clark, and Benjamin F. Crabtree used data collected during 2 separate 5-year-long intervention studies in analyzing and evaluating the efforts over time of 1 primary care practice (PCP) to improve its interpersonal relationships and internal communication.
Refusing to pay for work that produces an undesired result, such as a preventable complication, sends a powerful message. Adoption of this principle by the Centers for Medicaid & Medicare Services has generated a body of research literature that Timothy J. Hoff and Christina Soerensen find surprisingly thin. They suggest that researchers have been missing opportunities to compare the impact of the penalizing model of "pay for performance" with the impact of models designed around the concept of rewarding excellent performance. Noting that 80% of the articles they reviewed did not present any original research, they argue that the current literature tends to reflect opinion and is largely non-evidence-based.
The increasing frequency of "medical travel" from the patient's home country to another one is giving rise to measurable differences in hospital utilization between "domestic" and "foreign" patients in US hospitals. As the volume of medical travel increases, one possible consequence could be increases in national or regional average length of stay. Siriporn Patricia Satjapot, Tricia J. Johnson, and Andrew N. Garman, found that international patients in US hospitals remained hospitalized significantly longer than domestic patients with the same diagnoses and severity of illness. The difference was 21% in patients with extreme severity of illness. The authors point to the paucity of organized continuing care systems overseas as a possible explanation for the marked differences.
-Jean Gayton Carroll, PhD
Editor