scholarly journals The Outsourcing Debate: Theories and Findings

2005 ◽  
Vol 11 (2) ◽  
pp. 37-52 ◽  
Author(s):  
Stewart R. Clegg ◽  
Steve Burdon ◽  
Natalia Nikolova

ABSTRACTThis paper addresses the issue of services outsourcing by looking at both theoretical and empirical arguments. Previous debates have often concentrated on the motives for adopting the practice rather than the outcomes. These various themes can be discussed under the twin concepts of the cost and efficiency argument and the fashion and isomorphism approach. Our research provides strong evidence to support the cost efficiency argument. On average, significant cost advantages were sought and delivered, as well as improvements in service levels and systems. Many organisations in the current environment in Australia look at outsourcing not only as a method of increasing efficiency but also as gaining competitive advantage through harnessing the superior specialist skills and experience of the outsourcing provider who takes someone's back office function and transforms them into their front office. A 10% net cost saving was considered necessary by an organisation before embarking on an organisational change that was disruptive and in some cases involved downside risks. Even if other efficiency gains such as service levels or systems improvements were required, so were 10%+ cost savings. A number of the organisations thought their skills in managing outsourcing had improved considerably such that they were in a position to move from a client/server relationship to a partnership model (i.e. an alliance).

Author(s):  
Stewart R. Clegg ◽  
Steve Burdon ◽  
Natalia Nikolova

ABSTRACTThis paper addresses the issue of services outsourcing by looking at both theoretical and empirical arguments. Previous debates have often concentrated on the motives for adopting the practice rather than the outcomes. These various themes can be discussed under the twin concepts of the cost and efficiency argument and the fashion and isomorphism approach. Our research provides strong evidence to support the cost efficiency argument. On average, significant cost advantages were sought and delivered, as well as improvements in service levels and systems. Many organisations in the current environment in Australia look at outsourcing not only as a method of increasing efficiency but also as gaining competitive advantage through harnessing the superior specialist skills and experience of the outsourcing provider who takes someone's back office function and transforms them into their front office. A 10% net cost saving was considered necessary by an organisation before embarking on an organisational change that was disruptive and in some cases involved downside risks. Even if other efficiency gains such as service levels or systems improvements were required, so were 10%+ cost savings. A number of the organisations thought their skills in managing outsourcing had improved considerably such that they were in a position to move from a client/server relationship to a partnership model (i.e. an alliance).


2015 ◽  
Vol 4 (6) ◽  
pp. 82 ◽  
Author(s):  
Julie M. Mhlaba ◽  
Emily W. Stockert ◽  
Martin Coronel ◽  
Alexander J. Langerman

Objective: Operating rooms (OR) generate a large portion of hospital revenue and waste. Consequently, improving efficiency and reducing waste is a high priority. Our objective was to quantify waste associated with opened but unused instruments from trays and to compare this with the cost of individually wrapping instruments.Methods: Data was collected from June to November of 2013 in a 550-bed hospital in the United States. We recorded the instrument usage of two commonly-used trays for ten cases each. The time to decontaminate and reassemble instrument trays and peel packs was measured, and the cost to reprocess one instrument was calculated.Results: Average utilization was 14% for the Plastic Soft Tissue Tray and 29% for the Major Laparotomy Tray. Of 98 instruments in the Plastics tray (n = 10), 0% was used in all cases observed and 59% were used in no observed cases. Of 110 instruments in the Major Tray (n = 10), 0% was used in all cases observed and 25% were used in no observed cases. Average cost to reprocess one instrument was $0.34-$0.47 in a tray and $0.81-$0.84 in a peel pack, or individually-wrapped instrument.Conclusions: We estimate that the cost of peel packing an instrument is roughly two times the cost of tray packing. Therefore, it becomes more cost effective from a processing standpoint to package an instrument in a peel pack when there is less than a 42%-56% probability of use depending on instrument type. This study demonstrates an opportunity for reorganization of instrument delivery that could result in a significant cost-savings and waste reduction.


Author(s):  
Benjamin R. Hubbard ◽  
Joshua M. Pearce

This study provides designs for a low-cost, easily replicable open source lab-grade digital scale that can be used as a precision balance. The design is such that it can be manufactured for use in most labs throughout the world with open source RepRap-class material extrusion-based 3-D printers for the mechanical components and readily available open source electronics including the Arduino Nano. Several versions of the design were fabricated and tested for precision and accuracy for a range of load cells. The results showed the open source scale was found to be repeatable within 0.1g with multiple load cells, with even better precision (0.01g) depending on load cell range and style. The scale tracks linearly with proprietary lab-grade scales, meeting the performance specified in the load cell data sheets, indicating that it is accurate across the range of the load cell installed. The smallest loadcell tested(100g) offers precision on the order of a commercial digital mass balance. The scale can be produced at significant cost savings compared to scales of comparable range and precision when serial capability is present. The cost savings increase significantly as the range of the scale increases and are particularly well-suited for resource-constrained medical and scientific facilities.


1986 ◽  
Vol 1 (20) ◽  
pp. 153
Author(s):  
K.J. MacIntosh ◽  
W.F. Baird

At the 19th ICE Conference in Houston in 1984 an alternative concept for the design of rubble mound breakwaters was introduced. This concept has the objective of providing a least cost structure by optimizing the use of locally available materials and utilizing simple construction procedures. Contractors' bids demonstrated that significant cost savings could be achieved, when compared to the cost of traditional designs. Considerable prototype experience has now been obtained with this concept of breakwaters. Breakwaters have been built using the concept in Canada, the United States, and Iceland since 1984 and have been subjected to storms and ice action. Prototype observations have supported the performance predicted during the design process. In this paper surveys of a breakwater taken after construction and after storm action are presented. In addition to wave action, this breakwater has also been subjected to extensive ice action. The response of the breakwater has been monitored and observed and is discussed.


The purpose of this research is to evaluate the design of a coffee maker by using Boothroyd Dewhurst Method which this method is one of the Design for Assembly (DFA) methods. DFA method will help to simplify the assembly designs of the product that will leads to significant cost savings and less tine to produce a product. Main objective of DFA is to estimate the difficulty of assembly, eliminate unnecessary parts and assembly tooling and design products that are less costly to manufacture. The study will focus on analyzing the current design of coffee maker, reducing the number of parts, comparing the design efficiency and the cost between the current and improved design. The product is evaluated by using Manual Handling Table and Manual Insertion Table. The results of current design are used to make improvement to the coffee maker. Then, new design is made by eliminating or combining the old design so that total cost and time for assemble the coffe maker is reduced. Lastly, comparison is made between new and old design.


BMC Medicine ◽  
2020 ◽  
Vol 18 (1) ◽  
Author(s):  
Anne B. Wichmann ◽  
◽  
Eddy M. M. Adang ◽  
Kris C. P. Vissers ◽  
Katarzyna Szczerbińska ◽  
...  

Abstract Background The number of residents in long-term care facilities (LTCFs) in need of palliative care is growing in the Western world. Therefore, it is foreseen that significantly higher percentages of budgets will be spent on palliative care. However, cost-effectiveness analyses of palliative care interventions in these settings are lacking. Therefore, the objective of this paper was to assess the cost-effectiveness of the ‘PACE Steps to Success’ intervention. PACE (Palliative Care for Older People) is a 1-year palliative care programme aiming at integrating general palliative care into day-to-day routines in LTCFs, throughout seven EU countries. Methods A cluster RCT was conducted. LTCFs were randomly assigned to intervention or usual care. LTCFs reported deaths of residents, about whom questionnaires were filled in retrospectively about resource use and quality of the last month of life. A health care perspective was adopted. Direct medical costs, QALYs based on the EQ-5D-5L and costs per quality increase measured with the QOD-LTC were outcome measures. Results Although outcomes on the EQ-5D-5L remained the same, a significant increase on the QOD-LTC (3.19 points, p value 0.00) and significant cost-savings were achieved in the intervention group (€983.28, p value 0.020). The cost reduction mainly resulted from decreased hospitalization-related costs (€919.51, p value 0.018). Conclusions Costs decreased and QoL was retained due to the PACE Steps to Success intervention. Significant cost savings and improvement in quality of end of life (care) as measured with the QOD-LTC were achieved. A clinically relevant difference of almost 3 nights shorter hospitalizations in favour of the intervention group was found. This indicates that timely palliative care in the LTCF setting can prevent lengthy hospitalizations while retaining QoL. In line with earlier findings, we conclude that integrating general palliative care into daily routine in LTCFs can be cost-effective. Trial registration ISRCTN14741671.


2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e19362-e19362
Author(s):  
Jennifer Webster ◽  
Robert E. Smith ◽  
Danielle Wieland ◽  
John Verniero ◽  
Jeffrey A. Scott

e19362 Background: Pegfilgrastim is a key supportive care agent in oncology patients, providing significant febrile neutropenia prophylaxis for patients on chemotherapy. However, pegfilgrastim also accounts for 5.3% of the total cost of cancer care for all patients in the Oncology Care Model (OCM). Fluctuations in the cost or quantity of pegfilgrastim can have significant impact on a practice’s performance under OCM. One such cost fluctuation is the introduction of biosimilars to the marketplace. This study seeks to understand how CMS reimbursement for pegfilgrastim has been impacted by the introduction of two pegfilgrastim biosimilars into the market. Methods: We tracked average CMS reimbursement for pegfilgrastim (Neulasta, Udenyca and Fulphila) from 7/1/2016 through 6/30/2019. We compared the average reimbursement and the average change in reimbursement before and after the introduction of biosimilars. Results: Prior to the introduction of biosimilars, the Medicare Part B reimbursement (80% of ASP +6%) of pegfilgrastim increased at a steady rate of $292 per year through the first 30 months of the OCM program, resulting in an average reimbursement of $3636 per administration in Q3 2018. However, since the introduction of biosimilars, average pegfilgrastim reimbursement has held steady, averaging $3543 for the time period from 7/1/2018 through 6/30/2019. The change in reimbursement has decreased from $292/year to -$93/year. Conclusions: In 2018, 88,847 Medicare patients received pegfilgrastim, resulting in $1.39 billion in Medicare reimbursement. Assuming that the patterns we’ve detected in our OCM data sample can be applied to the general Medicare population, we have estimated that the introduction of biosimilars resulted in a $4.8 million in savings (1.39%) compared with what the total reimbursement would have been without biosimilars in the market in Q4 2018. This bending of the cost curve is projected to result in savings of $79.1M (5.7%) in 2019 and $157.9M (11.5%) in 2020. Importantly, most of this cost containment is not due to patients utilizing biosimilars. 90.6% of patients in Q2 2019 are still receiving branded pegfilgrastim. However, the introduction of biosimilars has caused even the branded agent to stabilize and possibly even drop net acquisition cost prices. Introduction of biosimilars has created enough pressure on the market to result in significant cost savings, increasing the overall value proposition of pegfilgrastim. This results in significant cost saving to CMS, and also makes it easier for practices participating in OCM to have successful financial outcomes.


2019 ◽  
Vol 51 (3) ◽  
pp. 320-324
Author(s):  
Sumedha Kulkarni ◽  
Dina Piraino ◽  
Rachel Strauss ◽  
Eva Proctor ◽  
Suzanne Waldman ◽  
...  

Abstract Background Preanalytical errors account for most laboratory errors. Although the frequencies of preanalytical errors are well characterized in the literature, little is known regarding the costs of these errors to the laboratory. Objective To analyze costs associated with preanalytical errors associated with the international normalized ratio (INR) test. Methods We performed a retrospective analysis of INR requests associated with preanalytical error codes from January 2009 through September 2013. Preanalytical error types were those related to order entry (no specimen collected) and those unrelated to order entry (insufficient specimen quantity or specimen-integrity concerns). We calculated the cost of analysis of a specimen and the cost of investigating errors. Results During the study period, there were 557,411 INR requests, 13.1% of which were associated with a preanalytical error code. The total annual cost of INR testing was USD $379,222.50. Investigation and reporting of preanalytical errors not related to order entry represented 10.5% of our annual INR testing budget (USD $39,939.00). Conclusions Minimizing preanalytical errors has the potential to result in significant cost savings.


Author(s):  
Andrew Greasley ◽  
Chris M. Smith

Purpose This study is based at a police force’s communications centre which undertakes a vital role in receiving and processing emergency and non-emergency telephone calls from the public and other agencies. The purpose of this paper is to evaluate a method for addressing the conflict between the need to reduce cost and the requirement to meet national standards in terms of a timely response to customer calls. Design/methodology/approach In a two-stage methodology an activity-based costing (ABC) approach is used as a framework to show how costs are generated by the three “drivers” of cost which relate to the design efficiency of the process, the demand on the process and the cost of resources used to undertake the process. The study then provides an analysis from a resource driver perspective using discrete-event simulation to model workforce staffing scenarios. Findings Cost savings within the police communications centre are identified from an analysis of the three drivers of cost. Further analysis from a resource driver viewpoint using a simulation study of an alternative workforce schedule predicted an overall reduction in staffing cost of 9.4 per cent. Originality/value The study outlines an innovative method that identifies where cost can be reduced using ABC and then provides an assessment of strategies that aim to reduce cost whilst maintaining service levels in a police operation using simulation.


Info ◽  
2016 ◽  
Vol 18 (5) ◽  
pp. 45-55 ◽  
Author(s):  
Nan Zhang ◽  
Heikki Hämmäinen ◽  
Hannu Flinck

Purpose This paper models the cost efficiency of service function chaining (SFC) in software-defined LTE networks and compares it with traditional LTE networks. Design/methodology/approach Both the capital expenditure (CAPEX) and operational expenditure (OPEX) of the SFC are quantified using an average Finnish mobile network in 2015 as a reference. The modeling inputs are gathered through semi-structured interviews with Finnish mobile network operators (MNO) and network infrastructure vendors operating in the Finnish market. Findings The modeling shows that software-defined networking (SDN) can reduce SFC-related CAPEX and OPEX significantly for an average Finnish MNO in 2015. The analysis on different types of MNOs implies that a MNO without deep packet inspection sees the biggest cost savings compared to other MNO types. Practical implications Service function investments typically amount to 5-20 per cent of the overall MNO network investments, and savings in SFC may impact highly on the cost structure of a MNO. In addition, SFC acts as both a business interface, which connects the local MNOs with global internet service providers, and as a technical interface, where the 3GPP and IETF standards meet. Thus, the cost efficient operation of SFC may bring competitive advantages to the MNO. Originality/value The results show solid basis of network-related cost savings in SFC and contributes to MNOs making cost conscious investment decisions. In addition, the results act as a baseline scenario for further studies that combine SDN with virtualization to re-optimize network service functions.


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