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Financial subsidies and tax incentives play essential roles in the innovation efficiency of enterprises. This paper selects Chinese listed NEV enterprises from 2010 to 2022 as a research sample and investigates various impacts under various circumstances. We find that both financial subsidies and tax incentives can promote the innovation efficiency of NEV enterprises. Compared to financial subsidies, tax incentives are more effective; the interaction between financial subsidies and tax incentives has a weaker impact on the innovation efficiency of NEV enterprises. Both financial subsidies and tax incentives have more potent innovation effects on enterprises with higher financing constraints. In addition, financial subsidies and tax incentives have a stronger innovation efficiency effect on private enterprises than state-owned enterprises. Further research shows that marketization and market distortion affect the innovation efficiency of NEV enterprises. This study provides a new perspective for understanding the effects of financial subsidies, tax incentives, and innovation efficiency of NEV enterprises, and the conclusions and suggestions are relevant references for the government to improve the quality of policy-making., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Binhua Qian. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

The aim of this paper is to analize the influence of professionalization over firm's performance and the effect of two mediating variables, risk-taking and technological innovation. A total of 310 Spanish SMEs were surveyed, and the study was conducted using partial least squares path modelling (PLS-SEM) technique. The findings showed that firm's performance is influenced by professionalization, risk-taking and technological innovation. These effects are not only direct and positive, but there are also important indirect effects that reinforce the positive effects of professionalization on firm's performance. This research contributes to the literature on professionalization considering mediating effects of risk-taking and technological innovation in the relationship between professionalization and firm's performance. The results provide interesting implications for theory and practice, indicating how companies can orient their strategies with the aim of gaining competitive advantage in order to increase their performance., Competing Interests: The authors have declared that no competing interests exist.

While most researchers interested in the concept of dynamic capabilities focus their attention on analyzing how companies transform their resources to compete in their environment, the process of developing dynamic capabilities is treated as a marginal issue. Although the literature suggests various approaches to developing dynamic capabilities, they are formulated in general terms, and doubts can be raised about the links between actions. There is also a lack of empirical research indicating the links between activities in the process of developing dynamic capabilities and their influence on the effectiveness of an organization. The aim of the study is to formulate a proposal for a model of the process of developing dynamic capabilities aimed at increasing the economic effectiveness of a company and to determine the links between the activities in the model. The theoretical contribution of the paper consists in presenting a model of the process of developing dynamic capabilities aimed at increasing the economic effectiveness of the company. The results presented in the paper refer to an empirical examination of the model of developing dynamic capabilities, covering five activities: searching for opportunities; knowledge management and learning; coordination; configuration and reconfiguration; and organizational adaptation. The study also includes an examination of the possible impact the components of the dynamic capabilities building process have on a company's performance. The study uses the survey method and data was obtained from top managers. The conclusion, based on data from 471 Polish companies, was made using structural equation modelling. The results of the empirical research suggest that the individual activities in the process of developing dynamic capabilities are interconnected, and through mutual interactions and couplings, they positively affect the economic effectiveness of an enterprise. The results indicate that searching for opportunities is the precursor, and the main factor influencing the other activities in the process, which suggests that managers should focus on improving activities in this area., Competing Interests: The authors have declared that no competing interests exist.

The glass cliff suggests that women are more likely to access leadership positions when organizations are facing a crisis. Although this phenomenon is well established, it is still largely unknown how variations in types of crises influence the strength of the think crisis-think female association, and whether female leaders and leaders with communal gendered traits are both affected by this association. We hypothesized that selection of stereotypically feminine traits (communal leaders) is specific to a relational crisis because of a fit between leader traits and traits required by the situation. We further expected that the selection of women also extends to other crisis situations because other factors such as their signaling change potential may play a role. We investigated the associations that participants made with candidates who varied across gendered traits and gender and between two crisis situations involving problems with either stereotypically feminine (e.g., an internal disharmony) or masculine (e.g., a financial problem) components, and a no crisis situation control. Results from three experimental studies (Ns = 319, 384, 385) supported our hypotheses by showing that communal leaders were most strongly associated with a relational crisis and least with a financial crisis, with the no crisis context situated in-between. This pattern was explained by higher relevance ratings for communal leadership behavior in the relational crisis versus financial crisis context, with the no crisis context situated in-between. In contrast, female leaders were most strongly associated with the relational crisis and least with the no crisis context, with the financial crisis situated in-between. Specific explanatory mechanisms related to the female-crisis association are explored and discussed. Our findings suggest that implicit motivations for valuing feminine/communal leadership and atypical leaders in crisis situations need further research., Competing Interests: The authors have declared that no competing interests exist.

Importance: This study assesses the role of telehealth in the delivery of care at the start of the COVID-19 pandemic., Objectives: To document patterns and costs of ambulatory care in the US before and during the initial stage of the pandemic and to assess how patient, practitioner, community, and COVID-19-related factors are associated with telehealth adoption., Design, Setting, and Participants: This is a cohort study of working-age persons continuously enrolled in private health plans from March 2019 through June 2020. The comparison periods were March to June in 2019 and 2020. Claims data files were provided by Blue Health Intelligence, an independent licensee of the Blue Cross and Blue Shield Association. Data analysis was performed from June to October 2020., Main Outcomes and Measures: Ambulatory encounters (in-person and telehealth) and allowed charges, stratified by characteristics derived from enrollment files, practitioner claims, and community characteristics linked to the enrollee's zip code., Results: A total of 36 568 010 individuals (mean [SD] age, 35.71 [18.77] years; 18 466 557 female individuals [50.5%]) were included in the analysis. In-person contacts decreased by 37% (from 1.63 to 1.02 contacts per enrollee) from 2019 to 2020. During 2020, telehealth visits (0.32 visit per person) accounted for 23.6% of all interactions compared with 0.3% of contacts in 2019. When these virtual contacts were added, the overall COVID-19 era patient and practitioner visit rate was 18% lower than that in 2019 (1.34 vs 1.64 visits per person). Behavioral health encounters were far more likely than medical contacts to take place virtually (46.1% vs 22.1%). COVID-19 prevalence in an area was associated with higher use of telehealth; patients from areas within the top quintile of COVID-19 prevalence during the week of their encounter were 1.34 times more likely to have a telehealth visit compared with those in the lowest quintile (the reference category). Persons living in areas with limited social resources were less likely to use telehealth (most vs least socially advantaged neighborhoods, 27.4% vs 19.9% usage rates). Per enrollee medical care costs decreased by 15% between 2019 and 2020 (from $358.32 to $306.04 per person per month). During 2020, those with 1 or more COVID-19-related service (1 470 721 members) had more than 3 times the medical costs ($1701 vs $544 per member per month) than those without COVID-19-related services. Persons with 1 or more telehealth visits in 2020 had considerably higher costs than persons having only in-person ambulatory contacts ($2214.10 vs $1337.78 for the COVID-19-related subgroup and $735.87 vs $456.41 for the non-COVID-19 subgroup)., Conclusions and Relevance: This study of a large cohort of patients enrolled in US health plans documented patterns of care at the onset of COVID-19. The findings are relevant to policy makers, payers, and practitioners as they manage the use of telehealth during the pandemic and afterward.

The COVID-19 outbreak has affected cancer research and cancer care. European cancer charities need to reconsider strategies for safeguarding income and supporting cancer researchers, in times when sustaining cancer research funding is more crucial than ever., (© 2020 The Authors. Published by FEBS Press and John Wiley & Sons Ltd.)

COVID-19 has resulted in broad impacts on the economy and aspects of daily life including our collective mental health and well-being. The Australian health care system already faces limitations in its ability to treat people with mental health diagnoses. Australia has responded to the COVID-19 outbreak by, among other initiatives, providing reimbursement for telehealth services. However, it is unclear if these measures will be enough to manage the psychological distress, depression, anxiety and post-traumatic distress shown to accompany infectious disease outbreaks and economic shocks. Decision making has focused on the physical health ramifications of COVID-19, the avoidance of over-burdening the health care system and saving lives. We propose an alternative framework for decision making that combines life years saved with impacts on quality of life. A framework that simultaneously includes mental health and broader economic impacts into a single decision-making process would facilitate transparent and accountable decision making that can improve the overall welfare of Australian society as we continue to address the considerable challenges that the COVID-19 pandemic is creating.

Purpose: Many health systems face challenges such as rising costs and lacking quality, both of which can be addressed by improving the integration of different health care sectors and professions. The purpose of this viewpoint is to present the German health care Innovation Fund (IF) initiated by the Federal Government to support the development and diffusion of integrated health care., Design/methodology/approach: This article describes the design and rationale of the IF in detail and provides first insights into its limitations, acceptance and implementation by relevant stakeholders., Findings: In its first period, the IF offered € 1.2 billion as start-up funding for model implementation and evaluation over a period of four years (2016-2019). This period was recently extended to a second round until 2024, offering € 200 million a year as from 2020. The IF is triggering the support of relevant insurers for the development of new integrated care models. In addition, strict evaluation requirements have led to a large number of health service research projects which assess structural and process improvements and thus enable evidence-based policy decisions., Originality/value: This article is the first of its kind to present the German IF to the international readership. The IF is a political initiative through which to foster innovations and promote integrated health care., (© Emerald Publishing Limited.)

Background: Crowdsourcing is a distributed problem-solving and production mechanism that leverages the collective intelligence of non-expert individuals and networked communities for specific goals. Social innovation (SI) initiatives aim to address health challenges in a sustainable manner, with a potential to strengthen health systems. They are developed by actors from different backgrounds and disciplines. This paper describes the application of crowdsourcing as a research method to explore SI initiatives in health., Methods: The study explored crowdsourcing as a method to identify SI initiatives implemented in Africa, Asia and Latin America. While crowdsourcing has been used in high-income country settings, there is limited knowledge on its use, benefits and challenges in low- and middle-income country (LMIC) settings. From 2014 to 2018, six crowdsourcing contests were conducted at global, regional and national levels., Results: A total of 305 eligible projects were identified; of these 38 SI initiatives in health were identified. We describe the process used to perform a crowdsourcing contest for SI, the outcome of the contests, and the challenges and opportunities when using this mechanism in LMICs., Conclusions: We demonstrate that crowdsourcing is a participatory method, that is able to identify bottom-up or grassroots SI initiatives developed by non-traditional actors.

Background: Isolated pediatric femur fractures have historically been treated at local hospitals. Pediatric referral patterns have changed in recent years, diverting patients to high volume centers. The purpose of this investigation was to assess the treatment location of isolated pediatric femur fractures and concomitant trends in length of stay and cost of treatment., Methods: A cross-sectional analysis of surgical admissions for femoral shaft fracture was performed using the 2000 to 2012 Kids' Inpatient Database. The primary outcome was hospital location and teaching status. Secondary outcomes included the length of stay and mean hospital charges. Polytrauma patients were excluded. Data were weighted within each study year to produce national estimates., Results: A total of 35,205 pediatric femoral fracture cases met the inclusion criteria. There was a significant shift in the treatment location over time. In 2000, 60.1% of fractures were treated at urban, teaching hospitals increasing to 81.8% in 2012 (P<0.001). Mean length of stay for all hospitals decreased from 2.59 to 1.91 days (P<0.001). Inflation-adjusted total charges increased during the study from $9499 in 2000 to $25,499 in 2012 per episode of treatment (P<0.001). Total charges per hospitalization were ∼$8000 greater at urban, teaching hospitals in 2012., Conclusions: Treatment of isolated pediatric femoral fractures is regionalizing to urban, teaching hospitals. Length of stay has decreased across all institutions. However, the cost of treatment is significantly greater at urban institutions relative to rural hospitals. This trend does not consider patient outcomes but the observed pattern appears to have financial implications., Level of Evidence: Level III-case series, database study.

Competing Interests: Competing interests: We have read and understood BMJ policy on declaration of interests and have no relevant interests to declare.

Changes under way in the healthcare environment have the potential to accelerate the pace at which evidence is incorporated into practice. Motivated by new payment models that hold clinicians accountable for cost and quality, healthcare organisations in the US are developing their capacity to become learning healthcare systems that are able to generate, adopt and apply evidence to support quality improvement and high-value care. The pace at which healthcare organisations will make progress will depend on whether they perceive a return on their investments, the availability of internal and external resources to help them make this transformation, and the external pressures on them to be accountable for managing the cost and quality of their patient care., Competing Interests: None declared.

Electronic health records (EHRs) are increasingly moving towards cloud-based web environments. While cloud-based EHRs claim substantial benefits at reduced cost, little cost-benefit research exists for dental schools. The aim of this study was to examine the cost-benefits of a cloud-based EHR compared to an on-premise client-server EHR in the University of Michigan School of Dentistry (U-M Dent). Data were collected in 2016 from the U-M Dent cost-benefit comparison of tangible and intangible factors associated with implementing a new EHR, using the Total Cost of Ownership (TCO) framework from EDUCAUSE. The TCO framework assessed three factors: foundational (overarching aspects: three items), qualitative (intangibles: 56 items), and quantitative (actual costs). Stakeholders performed factor grading, and relative assessment scores were derived for each item as well as the overall factor. The cloud-based EHR solution received higher foundational and qualitative factor summary scores. The overall cost of an on-premise solution over a two-year period was approximately $2,000,000 higher than a cloud-based solution. Cloud solutions did not carry any hidden costs, while such costs accounted for 8% (~$540,000) of the overall costs of the on-premise solution. Across the two-year period, both one-time and ongoing costs were higher for the on-premise solution than the cloud-based solution (by 40.5% and 20.5%, respectively). This study found that a cloud-based EHR system in the U-M Dent offered significant cost savings and unique benefits that were not available with the on-premise EHR solution. Based on cost, the U-M Dent has made a case for cloud-based EHR systems.

Maintaining a competitive edge is increasingly imperative for surgical research teams. To publish as efficiently and effectively as possible, research teams should apply business strategies and theories in everyday practice. Drawing from concrete examples in both the corporate and nonprofit worlds, and by reflecting on the practices of the Michigan Comprehensive Hand Center for Innovation Research, this article identifies important business theories that can be applied to plastic surgery research. These theories can potentially be applied in practice and include (1) development of a realistic vision and strategies, (2) effective execution of these strategies, and (3) reflective evaluation for continual improvement.

Introduction: Adoption of Medicaid Section 1115 waiver is one of the many ways of innovating healthcare delivery system. The Delivery System Reform Incentive Payment (DSRIP) pool, one of the two funding pools of the waiver has four categories viz. infrastructure development, program innovation and redesign, quality improvement reporting and lastly, bringing about population health improvement., Background: A metric of the fourth category, preventable hospitalization (PH) rate was analyzed in the context of eight conditions for two time periods, pre-reporting years (2010-2012) and post-reporting years (2013-2015) for two hospital cohorts, DSRIP participating and non-participating hospitals. The study explains how DSRIP impacted Preventable Hospitalization (PH) rates of eight conditions for both hospital cohorts within two time periods., Methods: Eight PH rates were regressed as the dependent variable with time, intervention and post-DSRIP Intervention as independent variables. PH rates of eight conditions were then consolidated into one rate for regressing with the above independent variables to evaluate overall impact of DSRIP. An interrupted time series regression was performed after accounting for auto-correlation, stationarity and seasonality in the dataset., Results: In the individual regression model, PH rates showed statistically significant coefficients for seven out of eight conditions in DSRIP participating hospitals. In the combined regression model, the coefficient of the PH rate showed a statistically significant decrease with negative p-values for regression coefficients in DSRIP participating hospitals compared to positive/increased p-values for regression coefficients in DSRIP non-participating hospitals., Conclusion and Implications: Several macro- and micro-level factors may have likely contributed DSRIP hospitals outperforming DSRIP non-participating hospitals. Healthcare organization/provider collaboration, support from healthcare professionals, DSRIP's design, state reimbursement and coordination in care delivery methods may have led to likely success of DSRIP., Level of Evidence: IV, a retrospective cohort study based on longitudinal data., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Faced with scarce resources and a demand for health care that exceeds supply, health policy makers at all levels of government need to adopt some form of rationing when deciding which health services should be funded in the public health system. With a relatively small investment, programs such as Queensland Health's New Technology Funding Evaluation Program (NTFEP) fosters innovation by providing funding and pilot studies for new and innovative healthcare technologies. The NTFEP assists policy makers to make informed decisions regarding investments in new safe and effective technologies based on available evidence gathered from real-world settings relevant to Queensland patients and clinicians. In addition, the NTFEP allows appropriate patient access, especially in rural and remote locations, to potentially beneficial technologies and acts a gatekeeper, protecting them from technologies that may be detrimental or harmful.

Funded in part by taxpayer dollars, Dell Medical School has a mandate to improve community health. It's also identifying novel ways to reward value.

The implementation of innovations is considered necessary in healthcare, both for improving patient outcomes and services and to reduce costs. Two problems can occur during the implementation process: innovations that have not been properly evaluated in terms of patient outcomes or cost-effectiveness can sometimes spread quickly, whereas innovations that have shown to lead to significant improvements in a research study setting may struggle to find their way into clinical practice. Problems may also arise when organizational innovations are implemented that are not evidence-based: an example would be the implementation of a new ICT system that affects the patient's environment negatively upon introduction. In this article, the problems surrounding innovation implementation in medical care are described in general and in more concrete terms, we describe how Dutch radiotherapy centres perform in this area. Based on the findings, a systematic plan is described that can help to innovate more effectively and efficiently to the benefit of clinical practice in all disciplines.

Background: The Government of Turkey has initiated a series of major health reforms in 2003 with an objective of increasing access to health care services and improving efficiency of public and private hospitals. This study attempts to understand the technical efficiency of public and private hospitals in Turkey to better guide hospital reform., Methods: We use data from 1079 public and private hospitals and translog stochastic production frontier was adopted to estimate technical inefficiency of hospitals., Results: Results indicate that there is no statistically significant difference in the degree of inefficiency of hospitals by geographic location or its level of economic development. Efficiency scores vary significantly across hospital types with Ministry of Health (MoH) General Hospitals being the most efficient followed by MoH teaching hospitals. Better performance of MoH hospitals may be due to successful implementation of 2003 health reforms in Turkey, which intended to improve resource utilization within and across MoH hospitals. Among MoH hospital types, integrated county hospitals were the least efficient. Since the hospital outcome measure did not include the value of medical training, efficiency scores of university hospitals became relatively low. Wide variability of efficiency scores of private general hospitals implies the existence of both highly efficient and inefficient hospitals in the private sector., Conclusions: Efficiency differences of various hospital types can be leveraged to guide future reforms by emphasizing the strengths of general hospitals and improving the referral system from county hospitals to general hospitals. Encouraging resource sharing across hospitals, as being done by the 2011 reforms, should further improve hospital efficiency. Promoting private hospitals may not necessarily be efficiency enhancing due to high variability of private hospitals in terms of efficiency scores. Similarly, implementation of common productivity standards and quality control measures are likely to improve hospital technical efficiency scores further.

The Patient-Centered Medical Home (PCMH) is a widely-implemented model for improving primary care, emphasizing care coordination, information technology, and process improvements. However, its treatment as an undifferentiated intervention in policy evaluation obscures meaningful variation in implementation. This heterogeneity leads to contracting inefficiencies between insurers and practices and may account for mixed evidence on its success. Using a novel dataset we group practices into meaningful implementation clusters and then link these clusters with detailed patient claims data. We find implementation choice affects performance, suggesting that generally-unobserved features of primary care reorganization influence patient outcomes. Reporting these features may be valuable to insurers and their members., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Public and private higher education funding models are shifting from traditional funding of schools and departments to a model in which schools increasingly rely on revenue other than tuition to fulfill and supplement activities related to their core missions. In this paper we discuss what nursing deans need to know about non tuition funding in this contemporary paradigm. We focus on how the Duke University School of Nursing created a Business Development Initiative (BDI) that provides additional revenue to help meets the financial needs of its' programs while nurturing the entrepreneurial spirit of faculty and staff. This BDI holds promise as a model that can be adapted by other schools seeking to support education, research and professional development initiatives without relying solely on tuition, tax dollars, endowments and/or grants., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Climate change presents a complex set of challenges for natural resource managers across North America. Despite recognition that climate change poses serious threats to species, ecosystems, and human communities, implementation of adaptation measures is not yet happening on a broad scale. Among different regions, a range of climate change trajectories, varying political contexts, and diverse social and ecological systems generate a myriad of factors that can affect progress on climate change adaptation implementation. In order to understand the general versus site-specific nature of barriers and opportunities influencing implementation, we surveyed and interviewed practitioners, decision-makers, and scientists involved in natural resource management in four different North American regions, northern Ontario (Canada), the Adirondack State Park (US), Arctic Alaska (US), and the Transboundary Rocky Mountains (US and Canada). Common barriers among regions related to a lack of political support and financial resources, as well as challenges related to translating complex and interacting effects of climate change into management actions. Opportunities shared among regions related to collaboration, funding, and the presence of strong leadership. These commonalities indicate the importance of cross-site learning about ways to leverage opportunities and address adaptation barriers; however, regional variations also suggest that adaptation efforts will need to be tailored to fit specific ecological, political, social and economic contexts. Comparative findings on the similarities and differences in barriers and opportunities, as well as rankings of barriers and opportunities by region, offers important contextual insights into how to further refine efforts to advance adaptation actions in those regions.

Background: The NHS Five Year Forward View identifies a range of approaches for addressing the NHS's challenges. The Transition movement helps communities to reframe and rebuild their world by working on issues such as climate change, food, community relationships and localizing the economy., Methods: This paper describes Transition using five short example projects and, informed by these, identifies mechanisms by which Transition could potentially help reduce pressure on the NHS., Results: Transition is characterized by people self-organizing to address local challenges with benefits arising from both the outcomes and the process of the projects. Transition may be able to help the NHS reframe change, prevent disease, improve staff well-being and increase local economic resilience., Discussion: The evidence base for the relationship between Transition and health is growing but is not yet well developed. This reflects the complexity of establishing an evidence base for wider determinants of health. There is substantial potential learning for those in the NHS about change outside formal institutional structures., Conclusions: Transition provides new ways of thinking and acting to develop greater 'community intelligence', which could help the NHS in the face of increasing pressures., (© The Author 2016. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com)

Background: Unnecessary care contributes to high costs and places patients at risk of harm. While most providers support reducing low-value care, changing established practice patterns is difficult and requires active engagement in sustained behavioral, organizational, and cultural change. Here we describe an action-planning framework to engage providers in reducing overused services., Methods: The framework is informed by a comprehensive review of social science theory and literature, published reports of successful and unsuccessful efforts to reduce low-value care, and interviews with innovators of value-based care initiatives in twenty-three health care organizations across the United States. A multi-stakeholder advisory committee provided feedback on the framework and guidance on optimizing it for use in practice., Results: The framework describes four conditions necessary for change: prioritize addressing low-value care; build a culture of trust, innovation and improvement; establish shared language and purpose; and commit resources to measurements. These conditions foster productive sense-making conversations between providers, between providers and patients, and among members of the health care team about the potential for harm from overuse and reflection on current frequency of use. Through these conversations providers, patients and team members think together as a group, learn how to coordinate individual behaviors, and jointly develop possibilities for coordinated action around specific areas of overuse., Conclusions: Organizational efforts to engage providers in value-based care focused on creating conditions for productive sense-making conversations that lead to change., Implications: Organizations can use this framework to enhance and strengthen provider engagement efforts to do less of what potentially harms and more of what truly helps patients., (Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.)

Competing Interests: Competing interests: We have read and understood BMJ policy on declaration of interests and declare: AJ and MG are honorary research fellows at the Value Based Healthcare Programme at the University of Oxford, CS holds research grants from the NIHR and is on the board of the NIHR Health Services and Delivery Research Programme. JW is a doctoral research fellow supported by the NIHR. The views expressed in this publication are those of the authors and not necessarily those of the NHS, the National Institute for Health Research, Health Education England, or the Department of Health. Provenance and peer review: Not commissioned; externally peer reviewed.

In a 2015 global study of low-cost or frugal innovations, we identified five leading innovations that scaled successfully in their original contexts and that may provide insights for scaling such innovations in the United States. We describe common themes among these diverse innovations, critical factors for their translation to the United States to improve the efficiency and quality of health care, and lessons for the implementation and scaling of other innovations. We highlight promising trends in the United States that support adapting these innovations, including growing interest in moving care out of health care facilities and into community and home settings; the growth of alternative payment models and incentives to experiment with new approaches to population health and care delivery; and the increasing use of diverse health professionals, such as community health workers and advanced practice providers. Our findings should inspire policy makers and health care professionals and inform them about the potential for globally sourced frugal innovations to benefit US health care.

Background: Nursing interruptions are a costly and dangerous variable in acute care hospitals. Malfunctioning technology equipment interrupts nursing care and prevents full utilization of computer safety systems to prevent patient care errors., Aims: This paper identifies an innovative approach to nursing interruptions related to computer and computer cart malfunctions. The impact on human resources is defined and outcome measures were proposed. A multifaceted proposal, based on a literature review, aimed at reducing nursing interruptions is presented. This proposal is expected to increase patient safety, as well as patient and nurse satisfaction., Setting: Acute care hospitals utilizing electronic medical records and bar-coded medication administration technology., Participants: Nurses, information technology staff, nursing informatics staff, and all leadership teams affected by technology problems and their proposed solutions., Methods: Literature from multiple fields was reviewed to evaluate research related to computer/computer cart failures, and the approaches used to resolve these issues., Results: Outcome measured strategic goals related to patient safety, and nurse and patient satisfaction. Specific help desk metrics will demonstrate the effect of interventions., Conclusions: This paper addresses a gap in the literature and proposes practical and innovative solutions. A comprehensive computer and computer cart repair program is essential for patient safety, financial stewardship, and utilization of resources., (© 2015 Wiley Periodicals, Inc.)

Nursing homes have been challenged in their attempts to achieve deep, organizational change (i.e., culture change) aimed at providing quality of care and quality of life for nursing home residents through person-centered care. To attain deep change, 2 well-defined components must be in place: a shared understanding of (a) the what, or content goals, and (b) the how, or process of change. However, there are few examples of this at a macro or micro level in long-term care. In an effort to enact true culture change in nursing homes statewide, the Kansas Department for Aging and Disability Services implemented the Promoting Excellent Alternatives in Kansas Nursing Homes program. This program is a Medicaid, pay-for-performance program that formalizes the content and process of achieving culture change through person-centered care principles. This article aims to detail the content (what) and process (how) of a model macro-level program of culture change throughout the State of Kansas. Applications to the micro level (individual homes) are presented, and implications for psychologists' roles in facilitating culture change are discussed. (PsycINFO Database Record, ((c) 2017 APA, all rights reserved).)

As healthcare continues to consume more and more of provincial government spending, there is a continuing pressure to improve efficiency and cut overall costs. In this increasingly constrained healthcare system, value for money is a growing focus of discussions around accountability and system sustainability; healthcare leaders are required to find ways of measuring, enforcing, and reporting on that value. In 2014, our organization began implementing an innovative system of structured incentives, linking distribution of Ministry of Health and Long-Term Care academic physician funding to quality and performance goals. Through a carefully planned process of benchmarking, stakeholder consultation, model improvement, and change management, we were able to move to a new value for money allocation model. The new model drives accountability by linking distribution of government payments to quality and performance outcomes. Initial results include increased stakeholder satisfaction as well as broader physician engagement in corporate and academic quality improvement initiatives.

For new technology and innovation such as precision medicine to become part of the solution for the fiscal sustainability of Canadian Medicare, decision-makers need to change how services are priced rather than trying to restrain emerging technologies like precision medicine for short-term cost savings. If provincial public payers shift their thinking to be public purchasers, value considerations would direct reform of the reimbursement system to have prices that adjust with technologically driven productivity gains. This strategic shift in thinking is necessary if Canadians are to benefit from the promised benefits of innovations like precision medicine.

Nurse residency programs are widely implemented to enhance integration of new graduate nurses entering the workforce. This article presents a retrospective analysis of 10 years of residency data from an internally developed residency program that used the Casey-Fink Graduate Nurse Experience Survey. Outcomes of this program were similar to those from studies using commercially available products, suggesting that an internally developed residency curricula may be equally beneficial to the development of new graduate nurses.

Seven healthcare innovations could save the NHS £18.5 billion and the social care sector £6.3 billion in 15 years, according to the International Longevity Centre UK (ILC-UK).

Competing Interests: POTENTIAL CONFLICT OF INTEREST: The author has indicated he has no potential conflicts of interest to disclose.

Driven by evidence of continuing gaps in health care quality and efficiency and inspired by the emergence of new value-based payment models, both large and small health care organizations are developing and deploying a wide range of care delivery innovations. But how can decision makers in these organizations determine if the innovations really improve service delivery, patient experience, clinical outcomes, or costs? Organization leaders need appropriate, timely evidence to inform their decision making. In this article we describe a range of approaches to evaluating innovations and pose key questions about the validity of the results. We highlight a specific type of evaluation approach-the stepped wedge design-because it can balance the need for internal and external validity with the ability to generate timely results. We elaborate on three key steps in the innovation assessment phase (identifying the target population, describing baseline performance, and documenting the components of the innovation) that are useful for both organizations that will generate new evidence and those using evidence generated by others. We conclude with a discussion of payer approaches for supporting health care organizations in their efforts to develop new evidence on innovations., (Project HOPE—The People-to-People Health Foundation, Inc.)

The need for innovations in care delivery is recognized by providers, payers, and patients alike. Hospitals, physicians, and other clinicians are experimenting with new models of care designed to better meet patients' needs, reduce administrative burdens, and lower costs. The Affordable Care Act placed the Medicare and Medicaid programs at the center of a national effort to experiment with delivery and payment models designed to improve care and contain costs. These public-sector efforts have often aligned with private initiatives, such as the use of reference pricing-in which an insurer will only pay for a service at the price available from the lowest-cost provider. Employers in the public and private sectors have adopted value-based insurance design, in which copayments and deductibles are calibrated to the clinical benefit obtained from different services. Patients have the most to gain-or lose-from delivery innovations. Better, more efficient care should translate into better health and lower costs, but payment models designed to encourage innovation may have the unintended effect of limiting access to care., (Project HOPE—The People-to-People Health Foundation, Inc.)

Using delivery system innovations to advance health care reform continues to be of widespread interest. However, it is difficult to generalize about the success of specific types of innovations, since they have been examined in only a few studies. To gain a broader perspective, we analyzed the results of forty-three ambulatory care programs funded by the first round of the Center for Medicare and Medicaid Innovation's Health Care Innovations Awards. The innovations' impacts on total cost of care were estimated by independent evaluators using multivariable difference-in-differences models. Through the first two years, most of the innovations did not show a significant effect on total cost of care. Using meta-regression, we assessed the effects on costs of five common components of these innovations. Innovations that used health information technology or community health workers achieved the greatest cost savings. Savings were also relatively large in programs that targeted clinically fragile patients-clinically complex populations at risk for disease progression. While the magnitude of these effects was often substantial, none achieved conventional levels of significance in our analyses. Meta-analyses of a larger number of delivery system innovations are needed to more clearly establish their potential for patient care cost savings., (Project HOPE—The People-to-People Health Foundation, Inc.)

With health services continuing to feel the strain, collaboration will give nurses, doctors and other care staff 'the best chance of success', according to England's chief nursing officer Jane Cummings.

Background: Due to scarce resources in health care, staff deployment has to meet the demands. To optimise skill-grade-mix, a Swiss University Hospital initiated a project based on principles of Lean Management. The project team accompanied each participating nursing department and scientifically evaluated the results of the project. Aim: The aim of this qualitative sub-study was to identify critical success factors of this project. Method: In four focus groups, participants discussed their experience of the project. Recruitment was performed from departments assessing the impact of the project retrospectively either positive or critical. In addition, the degree of direct involvement in the project served as a distinguishing criterion. Results: While the degree of direct involvement in the project was not decisive, conflicting opinions and experiences appeared in the groups with more positive or critical project evaluation. Transparency, context and attitude proved critical for the project’s success. Conclusions: Project managers should ensure transparency of the project’s progress and matching of the project structure with local conditions in order to support participants in their critical or positive attitude towards the project.

This commentary highights the key arguments and contributions of institutional thoery, transaction cost economics (TCE) theory, high reliability theory, and organizational learning theory to understanding the development and evolution of Accountable Care Organizations (ACOs). Institutional theory and TCE theory primarily emphasize the external influences shaping ACOs while high reliability theory and organizational learning theory underscore the internal fctors influencing ACO perfromance. A framework based on Implementation Science is proposed to conside the multiple perspectives on ACOs and, in particular, their abiity to innovate to achieve desired cost, quality, and population health goals., (© The Author(s) 2016.)