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Employees currently face an increasingly demanding environment in terms of intrapreneurial behaviour due to the key role it plays in the survival of companies and the elimination of threats in the organisational environment. This paper investigates the antecedents of intrapreneurial behaviour in the service sector in southern Spain, analysing the relationships between it and authentic leadership, as well as the mediating role of practiced creativity, autonomy and meaningful work. This study uses a quantitative approach through the distribution of a questionnaire. A total of 333 employees completed the research questionnaire. The results show that although authentic leadership has a significant negative direct effect on intrapreneurial behaviour, it positively and significantly promotes it through practiced creativity and meaningful work. In contrast to the previous two mediations, the mediation of autonomy was not significant. This research provides empirical findings that can contribute to a better understanding of intrapreneurial behaviour by highlighting the importance of balanced, authentic leadership and offering guidance to organisations in designing a work climate that enhances organisational effectiveness. [ABSTRACT FROM AUTHOR]

The article focuses on the importance of maintaining focus on the purpose of a system to avoid failure, particularly in the context of redesigning health systems. Topics include the interconnectedness and interdependence of systems, the necessity for alignment across all levels of an organization to achieve desired outcomes, and the failure of redesign efforts due to a lack of consideration for the overall context and purpose.

Background: Due to the aging population, the need for home care services is increasing in most Western countries, including Norway. However, the highly physical nature of this job could contribute to make recruiting and retaining qualified home care workers (HCWs) challenging. This issue may be overcome by adopting the Goldilocks Work principles, aiming at promoting workers' physical health by determining a "just right" balance between work demands and recovery periods while maintaining productivity. The aim of this study was to 1) gather suggestions from home care employees on suitable organizational (re)design concepts for promoting HCWs' physical health and 2) have researchers and managers define actionable behavioral aims for the HCWs for each proposed (re)design concept and evaluate them in the context of the Goldilocks Work principles. Methods: HCWs, safety representatives, and operation coordinators (n = 14) from three Norwegian home care units participated in digital workshops led by a researcher. They suggested, ranked, and discussed redesign concepts aimed at promoting HCWs' health. The redesign concepts were subsequently operationalized and evaluated by three researchers and three home care managers. Results: Workshop participants suggested five redesign concepts, namely "operation coordinators should distribute work lists with different occupational physical activity demands more evenly between HCWs", "operation coordinators should distribute transportation modes more evenly between HCWs", "Managers should facilitate correct use of ergonomic aids and techniques", "HCWs should use the stairs instead of the elevator", and "HCWs should participate in home-based exercise training with clients". Only the first two redesign concepts were considered to be aligned with the Goldilocks Work principles. A corresponding behavioral aim for a "just right" workload was defined: reduce inter-individual differences in occupational physical activity throughout a work week. Conclusions: Operation coordinators could have a key role in health-promoting organizational work redesign based on the Goldilocks Work principles in home care. By reducing the inter-individual differences in occupational physical activity throughout a work week, HCWs' health may be improved, thus reducing absenteeism and increasing the sustainability of home care services. The two suggested redesign concepts should be considered areas for evaluation and adoption in practice by researchers and home care services in similar settings. [ABSTRACT FROM AUTHOR]

An enhanced understanding of the innovative use of artificial intelligence (AI) is essential for organizations to improve work design and daily business operations. This study's purpose is to offer insights into how AI can transform organizations' work practices through diving deeply into its innovative use in the context of a primary AI tool, a chatbot, and examining the antecedents of innovative use by conceptualizing employee trust as a multidimensional construct and exploring employees' perceived benefits. In particular, we have conceptualized employee trust in chatbots as a second‐order construct, including three first‐order variables: trust in functionality, trust in reliability, and trust in data protection. We collected data from 202 employees. The results supported our conceptualization of trust in chatbots and showed that three dimensions of first‐order trust beliefs have relatively the same level of importance. Further, both knowledge support and work–life balance enhance trust in chatbots, which in turn leads to innovative use of chatbots. Our study contributes to the existing literature by introducing the new conceptualization of trust in chatbots and examining its antecedents and outcomes. The results can provide important practical insights regarding how to support innovative use of chatbots as the new way we organize work. [ABSTRACT FROM AUTHOR]

It is not yet clear whether work redesigns actually affect individual-, team- or organizational-level performance. In a synthesis of this literature, we conclude there is good overall evidence, with the most promising evidence at the individual level. Specifically, our systematic review assessed whether top-down work redesign interventions affect performance and, if so, why (mechanisms) and when (boundary conditions). We identified 55 heterogeneous work redesign intervention studies, of which 39 reported a positive effect on performance, two reported a negative effect, and 14 reported mixed effects. Of five types of work redesign, the evidence that work characteristics can explain the effect of redesign interventions on performance was most promising for relational interventions, and participative and non-participative job enrichment and enlargement. Autonomous work group and system-wide interventions showed initial evidence. As to 'why' work redesigns enhance performance, we identified change in work motivation, quick response and learning as three core mechanisms. As to 'when', we showed that intervention implementation, intervention context (including alignment of organizational systems, processes and the work redesign) and person factors are key boundary conditions. We synthesize our findings into an integrative multilevel model that can be used to design, implement and evaluate work redesigns aimed at improving performance. [ABSTRACT FROM AUTHOR]

Work values, which describe what employees seek from their jobs and which parts of their jobs are important to them, have been linked to employees' response to work situations, organizational commitment, and job satisfaction. One work value that has not received adequate attention when exploring the link between work values and employees' work-related outcomes is creativity. This paper reports the results of a study that sought to fill this gap by assessing the relationships between employees' attitudes and values toward creativity, work environment, and job satisfaction in human service employees in the United States and Lithuania. The results differed for the two countries. While in the Lithuanian sample, creativity as a work value was significantly positively related to job satisfaction, this relationship was negative and non-significant in the US sample. Work environment was a significant predictor of job satisfaction in both countries. The interaction effect of creativity as work value and work environment on job satisfaction was not significant. Based on the results of the study, the authors discuss the practice implications of how to redesign jobs and make changes in work environments to create more complementarity between the two factors. [ABSTRACT FROM AUTHOR]

A significant number of quantitative studies have associated a positive or healthy work environment with job satisfaction. Nurses, patients, and organizational characteristics have been studied as contributing factors. Other studies have focused on structural or physical environmental factors such as noise, space, or lighting as influencing to satisfaction. Little research has focused on how a changed work environment initiated by an organization for improved patient care affected the nurses' perceptions of how their practice had changed. The purpose of this qualitative study was to determine nurses' perceptions of a changed work environment on their practice, specifically patient care. Twelve nurses participated in the semistructured interviews. Interviews were transcribed verbatim and content analysis was used to identify categories of phrases and the resulting major themes. Most importantly, and the significant overall theme of patient- and family-centered improved care described their perceptions of this change. Other themes included camaraderie, nurse-patient relationships, being valued by the organization, and efficiency for decreasing stress. The results illuminate and extend some of the findings from prior quantitative studies on professional practice environments. A major contribution of this research is the perception of the nurses, often overlooked in quantitative studies. Significant was the nurses' view that the changed environment improved patient- and family-centered care although, as in other study findings, there was a view that peer camaraderie decreased. [ABSTRACT FROM AUTHOR]

Careful and appropriate designing of the parts of a job has an impact on the job holder. Literature supports that it determines the effectiveness of job performance, job satisfaction, work commitment and involvement through motivation towards work. The current study aimed to find out the work motivation of teachers teaching in the schools of Jalandhar region of Punjab by calculating motivating potential score (MPS). It is calculated on the data collected from 200 teachers through job diagnostic survey which covers five dimensions of job characteristics model. MPS is calculated using a standardized formula and thereafter the weighted average score of five dimensions and each item within these dimensions is also calculated. Results show very low motivation on all the five dimensions of motivation model i.e. Job Characteristics Model. Results call for a strong need to relook and redesign the job of school teachers. In addition, the paper also deliberated the significance of results with respect to overall management and administration of the schools. [ABSTRACT FROM AUTHOR]

Background: Although organizational context can affect the implementation of quality initiatives, we know less about the influence of contextual conditions on quality outcomes. We examined organizational features of primary care clinics that achieved greatest performance improvements after implementing Lean redesigns. Methods: We used operational data and baseline (ie, pre-Lean implementation) surveys of 1333 physicians and staff in 43 primary care clinics located across a large ambulatory care system. Segmented regression with interrupted time series analysis was used to identify clinics with highest improvements in workflow efficiency, physician productivity, and patient satisfaction following Lean redesign. We conducted independent-samples t tests to identify contextual features of clinics that showed greatest improvements in performance outcomes. Results: Clinics with highest increases in efficiency had most prior experience with quality improvement, compared with all other clinics. Efficiency gains were also found in clinics reporting highest levels of burnout and work stress prior to redesign. Highest improvements in physician productivity were associated with a history of change, staff participation, and leadership support for redesigns. Greatest improvements in patient satisfaction occurred in least stressful environments with highest levels of teamwork, staff engagement/efficacy, and leadership support. Conclusions: Our findings encourage careful evaluation of clinic characteristics and capacity to effectively implement redesigns. Such evaluations may help leaders select interventions most appropriate for certain clinics, while identifying others that may need extra support with implementing change. [ABSTRACT FROM AUTHOR]

The article presents an integrative review of healthcare system studies to explore facilitators of and barriers to design thinking. It discusses the four barriers to design thinking including limitations in existing literature, extensive time to implementation, social pressure influence, and poor concept definition. It notes that design thinking, when successfully implemented, can improve patient outcomes, clinical practice, and care quality.

In this article the author discusses research he conducted that examined the beliefs held by managers who work in different parts of the same organization. The author notes that the existence of similar beliefs could be the result of managerial practices designed to promote consensus and conformity while differing beliefs could be the result of different work roles. The author notes that previous research has shown the later to be true. In carrying out his research the author discusses how he has chosen to divide parts of an organization, noting that he utilizes Mintzberg's five basic parts which are the operating core, technostructure, middle line, support staff and strategic apex. This research focuses on the beliefs held by managers in the middle line and the technostructure.

This paper explores the sequential structure of work processes in a task unit whose work involves high numbers of exceptions, low analyzability of search, frequent interruptions, and extensive deliberation and that cannot be characterized as routine under any traditional definition. Yet a detailed analysis of the sequential pattern of action in a sample of 168 service interactions reveals that most interactions follow a repetitive, functionally similar pattern. This apparent contradiction presents a challenge to our theoretical understanding of routines: How can apparently nonroutine work display such a high degree of regularity? To answer this question, we propose a new definition of organizational routines as a set of functionally similar patterns and illustrate a new methodology for studying the sequential structure of work processes using rule-based grammatical models. This approach to organizational routines juxtaposes the structural features of the organization against the reflective agency of organizational members. Members enact specific performances from among a constrained, but potentially large set of possibilities that can be described by a grammar, giving rise to the regular patterns of action we label routines. [ABSTRACT FROM AUTHOR]

This paper proposes a multiple-contingencies theory that simultaneously examines the effects of task and dependence on unit design and efficiency. The theory explores and predicts the conditions under which work-unit designs fail to fit their contexts. Findings from studies of one contingency factor (e.g., uncertainty or dependence) have shown that poor performance by units is related to a lack of fit with theoretically prescribed patterns of design, but because such studies do not do justice to the complexities of design, it is difficult to predict misfit. The multiple-contingency approach proposed here specifically focuses on issues such as misfit, conflicting contingencies, and equifinality. The model is tested, using data from 529 work units in 60 employment-security offices. A key finding is that units facing conflicting contingencies are more prone to design misfit and lower performance. [ABSTRACT FROM AUTHOR]

This investigation of environmental complexity is based on a unique conceptual view of organizational environments which distinguishes among broad factors facing many organizations, conditions unique to a system, and interorganizational characteristics. Environmental complexity is viewed as the interaction between environmental risk, dependency, and interorganizational relationships. Research questions concerning complexity in the task environment are investigated in 26 small, rigidly structured social service organizations in a populous mid-western state. Results show that neither complexity nor risk is associated with organizational effectiveness. Both task environment dependency and interorganizational interaction alone and in combination are positively and significantly correlated with effectiveness. Some of the results may be unique to the sample, but a separation of internal and external conditions alters typical interpretations of external impacts. A more careful differentiation among internal, external, and linkage variables is recommended. [ABSTRACT FROM AUTHOR]

The theoretical and empirical research literature on task design and path-goal theory of leadership is reviewed. It is suggested that task design and individual variables interact to form a construct called individual-task congruence. A model is then developed which depicts leader behavior as a moderating variable between individual-task congruence and satisfaction and performance. [ABSTRACT FROM AUTHOR]

There is no clear understanding of how jobs influence the level of employee motivation. A conceptual model is needed to guide research and provide greater insight into motivational implications of changes in the nature of jobs. Seven conceptual models of the motivational properties of tasks are reviewed. Each model is examined in terms of its scope and specificity. Suggestions are offered for future research. [ABSTRACT FROM AUTHOR]

Differences in motivational properties between job enlargement and job enrichment are investigated. Differences in employees' motivation and ability should be reflected in determining an appropriate type of job design. Expectancy/instrumentality theory of motivation provides a basis for explaining employees' responses to various job designs. [ABSTRACT FROM AUTHOR]

The post-Hulin and Blood task design literature is reviewed, and several observations are made Individual differences (especially growth need strength) and organization variables moderate, affective responses (especially satisfaction with work) are most predictable, objective measures are needed; dimensionality is variable; optimal combinatory models are not widely accepted and methodological problems are widespread. [ABSTRACT FROM AUTHOR]

Researchers are devoting much time to proving or disproving the validity of the two-factor theory of work motivation (the foundation of job enrichment). Though the research findings are not conclusive, professors and practitioners have been receptive to job enrichment. This article analyzes whether this enthusiastic acceptance is justified. [ABSTRACT FROM AUTHOR]

Employee work attachment has been found to predict many important work attitudes and behaviours. In this article, we hypothesize that job crafting will be positively associated with work attachment as indicated by psychological ownership of the job and affective organizational commitment. Moreover, drawing on theories and research on work meaning and work identity, we propose that the positive association between job crafting and work attachment will be stronger when employees experience tough times at work (i.e., low‐quality leader‐member dynamics that result from being rated as a poor performer, or experiencing job insecurity). We test our hypotheses in two studies: the first using cross‐sectional survey data from a sample of 295 employees matched with archival performance evaluation data and the second using data collected from two, time‐lagged surveys from a sample of 194 employees and their supervisors. Results from these two studies supported the main effect of job crafting on work attachment. Moreover, the analyses of moderators showed that job crafting was strongly related to work attachment for low performers or insecure job‐holders (i.e., those who experience tough times). The present research provides insights into how to build work attachment by highlighting the proactive role of employees and advances job crafting theory by identifying moderators of job crafting effects. Practitioner points: Employee job crafting is positively related to work attachment (e.g., feelings of job ownership and organizational commitment). Organizations should provide employees with more opportunities to job craft so that employees would get more attached to their work and may thus achieve more positive work outcomes. Low performers and insecure job‐holders develop greater work attachment through job crafting (e.g., seeking more job resources and challenges) than high performers and secure job‐holders. [ABSTRACT FROM AUTHOR]

Operational failures persist, in part because employees work around them without engaging in actions to prevent recurrence. To break this cycle, we investigate the impact of work design factors on responses to operational failures. We use hospital nurses as subjects in a laboratory experiment, where, unknown to them, two medication administration supplies are missing. We observe their real-time responses to the two failures and whether they contribute an improvement idea. We randomly assign half of the participants to an experiment location far away from a satellite pharmacy where the missing supplies can be obtained ("difficult condition"), and the other half are located near the satellite pharmacy ("easy condition"). Both conditions contain risky, against-policy supplies that can be used to complete the work tasks, giving participants a choice between policycompliant workarounds and risky, against-policy workarounds. In the first study, we find that participants in the difficult condition are more likely to contribute improvement ideas but are less likely to use policy-compliant workarounds. A second experiment with a 2×2 design shows that participants in the difficult condition who have high access to the process owner are more likely to use policy-compliant workarounds than when they have low access. Our results suggest that hospitals can increase communication about operational failures by deliberately making it difficult to work around them while simultaneously providing a high level of access to process owners. Otherwise, nurses encountering operational failures are likely to resort to against-policy workarounds, a behavior observed in practice. [ABSTRACT FROM AUTHOR]

We propose and meta-analytically test a theoretical model of individual and job-based predictors of change-oriented behaviors. Meta-analytic tests (106 effect sizes, N = 28,402) demonstrate that employee's proactive personality is a stronger predictor of change-oriented behavior than the five-factor model (FFM) personality traits of openness and extraversion. Also, enriched job characteristics (autonomy, complexity, and task significance) are more important in predicting change-oriented behavior, than un-enriched job characteristics (routinization and formalization). Finally, we establish work engagement as a mediator that provides an explanation for how and why proactive personality and enriched job characteristics predict change-oriented behavior. We provide both theoretical and empirical integration of the literature with practical implications for managing change-oriented behaviors, which are increasingly recognized as important to both organizational effectiveness and employee career management. [ABSTRACT FROM AUTHOR]

With the implementation of the PACS in the hospital, there is an increasing demand from the clinicians for immediate access and display of radiological images. Recently, our hospital has installed the first wireless local area network (WLAN)-based direct digital radiography (DDR) portable radiography system. The DDR portable radiography system allows wireless retrieval of modality worklist and wireless transmission of portable X-ray image on the console to the Picture Archiving and Communication System (PACS), via WLAN connection of wireless fidelity (Wi-Fi). The aim of this study was to analyze the workflow and performance between the WLAN-based DDR portable radiography system and the old practice using conventional portable X-ray machine with computed radiography (CR) system. A total of 190 portable chest X-ray examinations were evaluated and timed, using the conventional portable X-ray machine with CR from March to April of 2012 and using the new DDR portable radiography system on December of 2012 ( n = 97 for old system and n = 93 for DDR portable system). The time interval of image becoming available to the PACS using the WLAN-based DDR portable radiography system was significantly shorter than that of the old practice using the conventional portable X-ray machine with CR (6.8 ± 2.6 min for DDR portable system; 23 ± 10.2 min for old system; p < 0.0001), with the efficiency improved by 70 %. The implementation of the WLAN-based DDR portable radiography system can enhance the workflow of portable radiography by reduction of procedural steps. [ABSTRACT FROM AUTHOR]

The boarding of patients is a root cause of overcrowding in a majority of emergency departments (EDs) nationwide. It reduces capacity to treat ED patients, decreases bed utilization, and compromises quality, safety, and the patient experience. Because of its systemic nature, it can only be effectively addressed through attention and commitment by all stakeholders. Once emergency departments have addressed throughput challenges they can solve on their own, they are ready to focus on proactive communication and teamwork with inpatient leaders to identify and transfer potential admissions more efficiently. No-delay nurse reports are an important tool to reduce time from admit orders to arrival on patient units. An effective hospital-wide flow committee also removes barriers for admitting patients quickly from the emergency department and addresses a revised January 1, 2014, Joint Commission standard that requires goal setting and measurement to mitigate and better manage the boarding of patients. This article discusses who should attend, the scope of the committee charter, how to use a hospital-wide throughput dashboard to measure results, and includes a sample agenda. It is recommended that the committee also assess and evaluate the effectiveness of the surge plan at least every three years to ensure that it meets goals identified by the committee. This article also shares best practices associated with two key tactics to support an effective hospital-wide throughput committee: inpatient bed huddles to expedite inpatient admissions and inpatient leader rounding, where the inpatient leader rounds on boarded ED patients to ensure safety and quality while also establishing ownership for the transition. [ABSTRACT FROM AUTHOR]

As healthcare providers cope with pricing pressures and increased accountability for performance, they should be rededicating themselves to improving the value they deliver to their patients: better outcomes and lower costs. Time-driven activity-based costing offers the potential for clinicians to redesign their care processes toward that end. This costing approach, however, is new to healthcare and has not yet been systematically implemented and evaluated. This article describes early time-driven activity-based costing work at several leading healthcare organizations in the United States and Europe. It identifies the opportunities they found to improve value for patients and demonstrates how this costing method can serve as the foundation for new bundled payment reimbursement approaches. [ABSTRACT FROM AUTHOR]

The objective of this study was to explore and identify physical design correlates of safety and efficiency in emergency department (ED) operations. This study adopted an exploratory, multi-measure approach to (1) examine the interactions between ED operations and physical design at 4 sites and (2) identify domains of physical design decision-making that potentially influence efficiency and safety. Multidisciplinary gaming and semistructured interviews were conducted with stakeholders at each site. Study data suggest that 16 domains of physical design decisions influence safety, efficiency, or both. These include (1) entrance and patient waiting, (2) traffic management, (3) subwaiting or internal waiting areas, (4) triage, (5) examination/treatment area configuration, (6) examination/treatment area centralization versus decentralization, (7) examination/treatment room standardization, (8) adequate space, (9) nurse work space, (10) physician work space, (11) adjacencies and access, (12) equipment room, (13) psych room, (14) staff de-stressing room, (15) hallway width, and (16) results waiting area. Safety and efficiency from a physical environment perspective in ED design are mutually reinforcing concepts--enhancing efficiency bears positive implications for safety. Furthermore, safety and security emerged as correlated concepts, with security issues bearing implications for safety, thereby suggesting important associations between safety, security, and efficiency. [ABSTRACT FROM AUTHOR]

Background Bed capacity management is a critical issue facing hospital administrators, and inefficient discharges impact patient flow throughout the hospital. National recommendations include a focus on providing care that is timely and efficient, but a lack of standardised discharge criteria at our institution contributed to unpredictable discharge timing and lengthy delays. Our objective was to increase the percentage of Hospital Medicine patients discharged within 2 h of meeting criteria from 42% to 80%. Methods A multidisciplinary team collaborated to develop medically appropriate discharge criteria for 11 common inpatient diagnoses. Discharge criteria were embedded into electronic medical record (EMR) order sets at admission and could be modified throughout a patient's stay. Nurses placed an EMR time-stamp to signal when patients met all discharge goals. Strategies to improve discharge timeliness emphasised completion of discharge tasks prior to meeting criteria. Interventions focused on buy-in from key team members, pharmacy process redesign, subspecialty consult timeliness and feedback to frontline staff. A P statistical process control chart assessed the impact of interventions over time. Length of stay (LOS) and readmission rates before and after implementation of process measures were compared using the Wilcoxon rank-sum test. Results The percentage of patients discharged within 2 h significantlyConclusions Through standardising discharge goals and implementation of high-reliability interventions, we reduced LOS without increasing readmission rates. improved from 42% to 80% within 18 months. Patients studied had a decrease in median overall LOS (from 1.56 to 1.44 days; p=0.01), without an increase in readmission rates (4.60% to 4.21%; p=0.24). The 12-month rolling average census for the study units increased from 36.4 to 42.9, representing an 18% increase in occupancy. [ABSTRACT FROM AUTHOR]

A medical/surgical unit at the University of Michigan Health System implemented a pod nursing model of care to improve efficiency and patient and staff satisfaction. One centralized station was replaced with 4 satellites and supplies were relocated next to patient rooms. Patients were assigned to 2 nurses who worked as partners. Three patient (satisfaction, call lights, and falls) and nurse (satisfaction and overtime) outcomes improved after implementation. Efforts should be focused on addressing patient acuity imbalances across assignments and strengthening communication among the healthcare team. Studies are needed to test the model in larger and more diverse settings. [ABSTRACT FROM AUTHOR]

Most solutions proposed for the looming shortage of primary care physicians entail strategies that fall into one of three categories: train more, lose fewer, or find someone else. A fourth strategy deserves more attention: waste less. This article examines the remarkable inefficiency and waste in primary care today and highlights practices that have addressed these problems. For example, delegating certainadministrative tasks such as managing task lists in the electronic health record can give physicians more time to see additional patients. Flow managers who guide physicians from task to task throughout the clinical day have been shown to improve physicians' efficiency and capacity. Even something as simple as placing a printer in every exam room can save each physician twenty minutes per day. Modest but systemwide improvements could yield dramatic gains in physician capacity while potentially reducing physician burnout and its implications for the quality of care. If widely adopted, small efforts to empower nonphysicians, reengineer workflows, exploit technology, and update policies to eliminate wasted effort could yield the capacity for millions of additional patient visits per year in the United States. [ABSTRACT FROM AUTHOR]

The NHS is challenged with making efficiency savings of £20 billion by 2015. In order to achieve a target of this magnitude, commissioners, clinicians and patients are required to work together to evaluate current service delivery and explore all options which have the potential to increase efficiency. This article describes the significant service redesign work undertaken in Rotherham by commissioners, clinicians and patients which has improved the way in which prescriptions are issued to patients requiring stoma products. The project has achieved impressive financial savings and, importantly, has improved patient experience. The project illustrates how new ways of working can significantly contribute to the £20 billion savings target, avoiding cuts in service provision while simultaneously improving the quality of service provided to patients. [ABSTRACT FROM AUTHOR]

We used the systems engineering technique of discrete event simulation modeling to assist in increasing patient access to positron emission tomographic examinations in the Department of Nuclear Medicine at Mayo Clinic, Rochester. The model was used to determine the best universal slot length to address the specific access challenges of a destination medical center such as Mayo Clinic. On the basis of the modeling, a new schedule was implemented in April 2012 and our before and after data analysis shows an increase of 2.4 scans per day. This was achieved without requiring additional resources or negatively affecting patient waiting, staff satisfaction (as evaluated by day length), or examination quality. [ABSTRACT FROM AUTHOR]

Emergency care in large urban hospitals across the country is in the midst of major redesign intended to deliver quality care through improved access, decreased wait times, and maximum efficiency. The central argument in this paper is that the conceptualization of quality including the documentary facts and figures produced to substantiate quality emergency care is socially organized within a powerful ruling discourse that inserts the interests of politics and economics into nurses' work. The Canadian Triage and Acuity Scale figures prominently in the analysis as a high-level organizer of triage work and knowledge production that underpins the way those who administer the system define, measure and evaluate emergency care processes, and then use this information for restructuring. Managerial targets and thinking not only dominate the way emergency work is understood, determined, and controlled but also subsume the actual work of health-care providers in spaces called 'wait times', where it is systematically rendered 'unknowable'. The analysis is supported with evidence from an extensive institutional ethnography that shows what nurses actually do to manage the safe passage of patients through their emergency care process starting with the work of triage nurses. [ABSTRACT FROM AUTHOR]

Lean Six Sigma is a well-proven methodology to enhance the performance of any business, including health care. The strategy focuses on cutting out waste and variation from the processes to improve the value and efficiency of work. This article walks through the journey of "green belt" training using a Lean Six Sigma approach and the implementation of a process improvement project that focused on wait time for patients to be examined in an urban academic primary care clinic without requiring added resources. Experiences of the training and the project at an urban paper-based satellite clinic have informed the planning efforts of a data and performance team, including implementing a 15-minute nurse "pre-visit" at primary care sites of an accountable care organization. [ABSTRACT FROM AUTHOR]

Background Oncology care is delivered largely in ambulatory settings by interdisciplinary teams. Treatments are often complex, extended in time, dispersed geographically and vulnerable to teamwork failures. To address this risk, we developed and piloted a team training initiative in the breast cancer programme at a comprehensive cancer centre. Methods Based on clinic observations, interviews with key staff and analyses of incident reports, we developed interventions to address four high-risk areas: (1) miscommunication of chemotherapy order changes on the day of treatment; (2) missing orders on treatment days without concurrent physician appointments; (3) poor follow-up with team members about active patient issues; and (4) conflict between providers and staff. The project team developed protocols and agreements to address team members' roles, responsibilities and behaviours. Results Using a train-the-trainer model, 92%of breast cancer staff completed training. The incidence of missing orders for unlinked visits decreased from 30% to 2% (p<0.001). Patient satisfaction scores regarding coordination of care improved from 93 to 97 (p=0.026). Providers, infusion nurses and support staff reported improvement in efficiency (75%, 86%, 90%), quality (82%, 93%, 93%) and safety (92%, 92%, 90%) of care, and more respectful behaviour (92%, 79%, 83%) and improved relationships among team members (91%, 85%, 92%). Although most clinicians reported a decrease in non-communicated changes, there was insufficient statistical power to detect a difference. Conclusions Team training improved communication, task coordination and perceptions of efficiency, quality, safety and interactions among team members as well as patient perception of care coordination. [ABSTRACT FROM AUTHOR]

Many factors combine to drive the growth in health spending worldwide, but the introduction of new technologies, drugs, and therapies is probably the most important. However, in contrast to other industries, innovations in health care have not tended to reduce the need for labor. In fact, labor still accounts for the largest proportion of expenditures in many health systems. But labor-saving technologies, workforce innovations, and patient self-care approaches are now emerging and altering health care's labor structure. For example, in Mexico more than one million households pay $5 per month to access a health advice hotline before setting foot in a physician's office. In India assembly line-style eye surgery has dramatically reduced cost without sacrificing quality. Policy makers should focus on such labor-saving innovations; reform reimbursement systems to encourage them; tackle professionals' resistance; and remove regulatory barriers. Bold experiments to redesign health services around patient self-care approaches are also warranted. [ABSTRACT FROM AUTHOR]

The article presents a case study which investigated the adoption of Lean by a cardiology department in a hospital in Sweden. The study focused on the rationale and evolution of the Lean adoption and examined how Lean affected the daily work of employees. It was found that previous improvement efforts may facilitate the introduction of Lean but may be less important when predicting whether Lean will be sustained over time.

A team of RAND Corporation researchers projected in 2005 that rapid adoption of health information technology (IT) could save the United States more than $81 billion annually. Seven years later the empirical data on the technology's impact on health care efficiency and safety are mixed, and annual health care expenditures in the United States have grown by $800 billion. In our view, the disappointing performance of health IT to date can be largely attributed to several factors: sluggish adoption of health IT systems, coupled with the choice of systems that are neither interoperable nor easy to use; and the failure of health care providers and institutions to reengineer care processes to reap the full benefits of health IT. We believe that the original promise of health IT can be met if the systems are redesigned to address these flaws by creating more-standardized systems that are easier to use, are truly interoperable, and afford patients more access to and control over their health data. Providers must do their part by reengineering care processes to take full advantage of efficiencies offered by health IT, in the context of redesigned payment models that favor value over volume. [ABSTRACT FROM AUTHOR]

The article discusses a study examining the impact of decentralization of support spaces on reduction of the time wasted by registered nurses (RNs) in walking, using a simulation-based experimental method. Results showed that the total walking time can be reduced up to 67.9 percent, depending on the decentralization level used. It suggests that appropriate levels of decentralization may contribute to care quality and efficacy, although extreme levels may reduce the opportunities for several activities in areas of peer support, socialization and mentoring that contribute to care quality.

As payment reform in health care gathers momentum, employers, as major payers, endorse the effort to move away from volume-driven payment to incentivizing and rewarding the delivery of better health care at lower cost. In this commentary we discuss large employers' perspectives on three particular challenges that payment reform alone, as important as it is, may not be sufficient to address: high health care prices, inefficient and complex systems, and an outdated work environment ill designed to meet the pressing goals of better health care at lower cost. We believe that policies that support health care organizations in redesigning work processes will be essential to reducing prices and simplifying interactions in care delivery. We also believe that health care organizations will need to redesign their compensation systems to align their employees' pay with improvements in performance. To that end, we describe the major transformation that IBM underwent in the 1990s to position itself to compete in a radically changed computer marketplace. We also offer several policy recommendations to support health care organizations in making the necessary changes. [ABSTRACT FROM AUTHOR]

The article discusses the key aspects of a project undertaken by Staten Island University Hospital (SIUH) to reduce the cost of nursing care by decreasing supply waste. The process followed by the hospital began with the creation of a multidisciplinary team to develop goals, brainstorm and determine the project direction. The goals developed by the team are included. Several supply utilization ideas as put forth by staff members are described. Some of the other ways to go green and avoid wastage and some examples of savings that were brought about are included. The key role that nurse administrators and educators can play in this initiative is highlighted.

The article focuses on a study which explored the relationship between an evidence-based framework for high-performance work practices (HPWPs) use and three process improvement strategies. These strategies are hardwiring excellence, lean/six sigma and Baldrige. Results of the study showed that there are important gaps in these strategies in relation to incorporating HPWPs. It notes that organizations' existing management systems influence the efficacy of these strategies.